CONCEPT MAP TEMPLATE
Schizophrenia
Objective:
Subjective:
Nsg. Dx: Disturbed Thought Process
Nsg. Dx: Ineffective Coping
Nursing Action:
Nursing Action:
Outcome:
Outcome:
Nsg. Dx: Disturbed Sensory Perception
r/t
Nursing Action:
Outcome:
Case study 1 - Schizophrenia
Caroline, age 22, was diagnosed with schizophrenia at age 19. She led a relatively normal life
during school age and high school years. She left her parents at age 17 to attend a college
somewhat distant to her home. She apparently had no problems during her first year, but when
she returned for Thanksgiving break during her second year, her parents noticed her distancing
herself from others. She spent a lot of time alone, was irritable, and had begun chain smoking
and drinking alcohol. She failed two courses that fall and was placed on probation. When she
went back to school in the spring, her former roommate refused to stay with her, saying, “She
acts so crazy sometimes. She talks out of her head, and I’m afraid of her.” In late February,
Caroline’s parents got a call from the dean of students who related that the campus police had to
be called to Caroline’s room to quiet her. She had been “yelling and screaming” and no one
could understand what it had all been about. She had apparently really frightened the other
students in the dormitory. These bizarre behaviors continued and during spring break in March,
Caroline’s parents moved her back home and made an appointment with a psychiatrist for an
evaluation. During the assessment, Caroline’s thought processes were loose, vague, and often
circumstantial. She exhibited behaviors that suggested auditory hallucinations (stopping
midsentence and “cocking” her head to the side as if listening), although when questioned about
whether or not she heard voices, she denied it. Paranoid delusional thinking was evident. She
made statements such as, “There is no one I can trust at that college. Every student in that dorm
has been told to keep an eye on me. They all know I am too smart to be there, so they will do
what they can to make me fail. If I pass, then everyone else fails.” She also expressed somatic
delusions, “I’m pregnant, you know. It will be a virgin birth. That’s another reason the college
kids are out to get me. They are so jealous! I am the chosen one.” Since that time, she has been
on several antipsychotic medications (chlorpromazine, clozapine, and risperidone), each with
only minimal success, and which she would eventually quit taking altogether. She currently lives
at home with her parents who are beside themselves with concern and frustration. The
psychiatrist has admitted Caroline to the hospital at this time to evaluate her behavior and to
begin her on a trial of fluphenazine decanoate which will eventually be administered only every
3 weeks by IM injection in an effort to encourage increased medication compliance on
Caroline’s part. Design a nursing care plan for Caroline during this hospital admission.
Case study 2 - MDD
Valerie, age 25, is admitted to the psychiatric unit by her psychiatrist after stating that she no
longer wanted to live. She has a long history of psychiatric problems, beginning at age 15, when
she swallowed a handful of aspirin and acetaminophen. Valerie’s mother has a history of
depression and her father is very authoritarian. He ruled Valerie and her sister with an iron hand
and rarely showed affection or gave positive feedback. In college Valerie met Bob, with whom
she immediately fell in love. He was very affectionate, and she felt she received some nurturing
from him that she had not received from her parents. In the semester before graduation, Bob told
her he was leaving to go to graduate school in another state and that he was not ready to get
married at this time. Valerie became hysterical and went into a deep depression. After a few
weeks she met Jack, with whom she immediately began a sexual relationship and became
pregnant. Jack agreed to marry Valerie, and so they began a short, but extremely stormy,
relationship. Six months after the birth of their baby boy, they began divorce proceedings, with a
great deal of negative negotiations regarding custody and child support. The child is 4 years old
now, and Valerie has had several “serious” relationships since her divorce, having just broken off
from the most recent one this week. Ralph told her that she is just “too intense, draining him of
all his energy.” She said he told her that she expects too much from their relationship—more
than he has to give. She admits that she got serious really fast, but that she really believes she
loves him. She says to the admitting nurse, “What’s the matter with me? Why can’t I have
normal relationships like other people? If it weren’t for my little boy, I wouldn’t even be here
now.” Design a plan of care for Valerie’s hospital stay.
Case study 3 - Bipolar
Noreen, age 32, had always been described as “moody.” Depending upon what was happening in
her life at the time, she could be very sad and depressed, or very lighthearted and happy. During
her “down” times she would feel tired, experience loss of appetite, and sleep a lot. During her
“happy” times, she would party a lot, be very outgoing, and have a remarkable amount of energy.
Noreen did well in college and graduated at age 26 with an MBA. Since that time, she has been
employed in the administration department of a large corporation, in which she has had several
promotions. Two weeks ago, management was to make the announcement of who would be
fulfilling the position of vice president of corporate affairs. Noreen and a male colleague, Ted,
were vying for the position. It was a choice position that Noreen desperately wanted. She became
very depressed when the announcement was made that Ted had been chosen. She stayed at
home, in bed, and slept a lot for several days. On about the 4th day, she got up, feeling
exhilarated, and decided to go shopping. She spent more than $1,000 on clothing. She then
decided to have a party for several hundred people, ordering it catered, and planning all the
details. Tonight was the party. Noreen wore a new, very expensive dress, drank a lot of
champagne, was very jovial and seductive, and bragged to everyone who would listen that she
would soon be getting a new job, and that the people at her old organization would be sorry they
had failed to promote her. She left the party with a man she hardly knew. At 3:00 a.m., she was
picked up by the police, under the grandstand at the local baseball stadium wearing only her
underclothes, high-heeled shoes, and carrying a half-filled bottle of champagne. She was alone
and speaking very loudly and rapidly. The police brought her to the emergency department of the
local hospital where she was admitted to the psychiatric unit with a diagnosis of manic episode.
Design an initial care plan for Noreen.
Purchase answer to see full
attachment