13) What type of behavior is the patient displaying?
The patient is showing signs of anger and frustration. He also tries to brush off his problem saying that it is not as bad as it seems to be. The patient is becoming anxious and restless, these two behaviors can lead to anger, and the nurse needs to know how the patient should be handled to calm him down.
14) What are your legal and ethical nursing responsibilities in this type of situation?
Before I detain the patient, the following conditions have to be met:
The patient has a mental disorder
That it is for the best interest of the patient to be detained (health-wise, physically and emotional wise)
That it is for the best interest of those close to the patient
That more tests should be done to establish whether the patient should be given an emergency detention certificate
If I decide that the patient should be detained, I have to explain to the patient that I am using section 299 to detain them and prevent them from leaving. No force should be used to prevent the patient from leaving, and if more tests are needed, a doctor should be contacted immediately to come conduct the critical assessment.
1) Placing the patient under restraint
The patient should not be locked in seclusion and physical restraints. The reason why the patient should not be locked is that locking him will increase and worsen his fears and anxiety. It will make the patient less willing to cooperate and since he believes that people are trying to harm him, locking him up will make him think that his assumptions are right. Locking the patient also increases paranoia. Cognitive behavioral therapy should be used instead of physically restraining the patient.
2) Signs and symptoms of chronic paranoid schizophrenia
Some of the signs and symptoms of chronic paranoid schizophrenia in the patient include; paranoid delusions (the patient believes a midget with sharp pointed teeth is following him and trying to kill him. The midget is from another planet and travels in a spaceship). In addition to that, the patient is nervous and keeps looking over his right shoulder (the patient is under the impression that he is under attack) and, he also talks to himself. The patient is paranoid. More symptoms of chronic paranoid schizophrenia portrayed by the patient include lack of attention to his hygiene (he has to be reminded to bathe and change his clothes), his thinking is disorganized, hallucinations and experiencing fear.
3) Nursing diagnoses for this patient
From the symptoms the patient is displaying, he could be suffering from:
Anxiety Disorders: The patient is very unease and afraid. He believes the midget wants to kill him.
Bipolar and Related Disorders: People with bipolar disorder also experience delusions. These individuals also hallucinate from time to time.
Schizophrenia Spectrum and Other Psychotic Disorders: Patients suffering from this particular disorder experience hallucinations, delusions and are highly paranoid. They have disorganized speech and disorganized thoughts.
The patients symptoms aptly fit into the third category of schizophrenia spectrum. Under schizophrenia spectrum, there are delusional disorders, schizophreniform disorder, psychotic disorders and chronic paranoid schizophrenia among others. The reason for selecting chronic paranoid schizophrenia is that apart from experiencing hallucinations and being paranoid, the patient fails to take care of his hygiene and his behavior is catatonic. He mutters to himself constantly as well.
4) Nursing care plan and Interventions
Diagnoses Nursing Care Plans for the patient
Paranoia and fear
Anxiety and fear
Lack of self-hygiene
Interventions Nursing Care Plans for the patient
Use of medication to lower the anxiety and paranoia
Be patient with the patient and make sure he is not overwhelmed. Maintain short and consistent contacts while trying to build and maintain trust with the patient
Analyze what the patient is hallucinating. If the hallucinations put others or the patient in danger, this should be determined as well. Do not argue with the patient that what he is seeing does not exist at all. Rather tell him that even though you cannot see the midget, you do believe that he is seeing them.
Avoid joking with the patient with regards to his hallucinations since this may make the patient more afraid.
Ensure that the environment is serene and peaceful to lower the anxiety levels
The patient will start taking care of his hygiene
The patient will be able to know the causes of the hallucinations
The patients levels of fear and anxiety will reduce
The patient will accept medication and develop coping strategies
The patient will be able to express himself freely
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