Unfolding clinical reasoning case study Schizophrenia Clinical Reasoning Case Study (answered)

Unfolding clinical reasoning case study Schizophrenia Clinical Reasoning Case Study (answered) Schizophrenia Clinical Reasoning Case Study (answered) Case Study Scenario: Jeremy Brown is a 30-year-old Caucasian male who was brought to the emergency department (ED) by the police after being involved in an altercation at work. Jeremy was at work today, and he threw a large piece of metal at a coworker and began yelling, “Stop following me, I know what you have been up to!” Key Components 1. Develop Critical Thinking By applying and using knowledge most important to practice 2. Develop Clinical Reasoning By recognizing relevant clinical data to identify the nursing priority 3. Develop Clinical Judgment Outcome when student interprets, notices, and responds appropriately Kendall Harrison Schizophrenia Case Study Carrington College Mental Health Clinical July 10, 2020UNFOLDING Clinical Reasoning Case Study History of Present Problem: Jeremy Brown is a 30-year-old Caucasian male who was brought to the emergency department (ED) by the police after being involved in an altercation at work. Jeremy was at work today, and he threw a large piece of metal at a coworker and began yelling, “Stop following me, I know what you have been up to!” Because Jeremy was very agitated and upset, and the police were called. Since arriving in the ED, he has been agitated, displaying rapid pressured speech and repeating the phrases he hears the police and others in the ED said. Jeremy reported that he recently stopped taking his risperidone and citalopram because he believed his coworkers have been breaking into his house and poisoning his medications. Jeremy’s manager reports that he was diagnosed with schizophrenia five years ago. Personal/Social History: Jeremy graduated from college with a 4.0 GPA and was in his first year at law school when he experienced the first episode of acute mental illness and was diagnosed with schizophrenia. He had to drop out of law school at age 24 and never finished. Jeremy lives at home with his mother and father and recently broke up with his girlfriend. Jeremy likes his job at the foundry but feels he is a disappointment because both of his sisters are lawyers, as is his father. Jeremy has no close friends and only a few acquaintances. Jeremy’s mental health had been stable up until the last three months. He has been feeling more paranoid the past three months and experienced a dramatic increase in symptoms when he stopped taking all of his medications one month ago. What data from the histories are RELEVANT and have clinical significance to the nurse? RELEVANT Data from Present Clinical Significance:Problem: o Patient threw a large metal object at coworker o yelled “stop following me, I know what you’ve been up to.” o Signs of rapid pressured speech and repeating phrases o Stopped taking medication because he believes coworkers are trying to poison him o High emotion which means patient should be monitored to make certain that further escalation is avoided. o Paranoia is a positive symptom of schizophrenia (Halter, 2014, pg. 197) o Pressured speech as well as echolalia are both symptoms of someone presenting with a severe and mental illness such as schizophrenia (Professor Reynolds, 2020). o Patient is experiencing paranoia and persecutory delusions which are symptoms of an exacerbated schizophrenic episode related to lack of taking medication. RELEVANT Data from Social History: Clinical Significance: o Recently ended relationship with girlfriend o diagnosed with schizophrenia 5 years ago o Feels he has disappointed his family because he wasn’t able to complete college o Has no close friends and only a few o Changes in relationship can trigger an increase in symptoms or relapse in patients with schizophrenia. o Patient is experiencing acute phase of schizophrenia and Diagnosis of schizophrenia explains patient’s behavior and symptoms. o Feelings of disappointment may lead to depression and anxiety, which have the ability to increase schizophrenic symptoms o All persons require socialization, someone with schizophrenia or other mental illnesses are at risk foracquaintances o Patient states that he has been feeling more paranoid the last three months and notices a dramatic increase in symptoms since stopping medication last month isolation related to their symptoms o Needs a med reconciliation. Possibly needs larger dose of medication. If untreated symptoms can resurface. Lifelong disease requires continual meds. Family should get educated on recognizing symptoms of early decompensation. Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment: T: 97.8 F/36.6 C (oral) Provoking/Palliative : Denies pain P: 100 (regular) Quality: R: 22 (regular) Region/Radiation: BP: 130/84 Severity: O2 sat: 98% room air Timing:What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance: o P (100) o RR (22) o BP (130/86) o Pulse and respirations are in the high end of the normal and blood pressure is also elevated. May be caused by recent agitation and stress, will need to continue to monitor vitals signs. Current Assessment: GENERAL APPEARANCE: Calm, body relaxed, no grimacing, appears to be resting comfortably RESP: Breath sounds clear with equal aeration bilaterally ant/post, nonlabored respiratory effort CARDIAC: Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal to palpation at radial/pedal/post-tibial landmarks, brisk cap refill NEURO: Alert & oriented to person, place, time, and situation (x4) GI: Abdomen flat, soft/nontender, bowel sounds audible per auscultation in all four quadrants GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact, skin turgor elastic, no tenting present Mental Status Examination: APPEARANCE: Diaphoretic, uncombed shoulder-length, somewhat greasy hair; cloths are stained and torn. Cooperative with the admission process. MOTOR BEHAVIOR: No abnormal muscle movements SPEECH: Rapid and pressured. Client often repeats words and phrases he hears others in the emergency room say. The client says, “He was brought to the emergency room” over and over again when he is not distracted or engaged in conversation. MOOD: Reports feeling very upset AFFECT: Becomes agitated/anxious when talking about his co-workers and his meds; guarded andsuspicious, mood and affect are congruent. THOUGHT PROCESS: Linear but irrational THOUGHT CONTENT: Displays paranoid delusions that coworkers are following him to hurt him and are poisoning his medication. PERCEPTION: Denies auditory or visual hallucinations, or feelings of depersonalization (feeling detached from self or environment) INSIGHT: Poor-believes he was brought in to the emergency room for protection from his coworkers JUDGMENT: Poor-stopped meds and is acting aggressively towards co-workers COGNITION: Alert and oriented times 4 (person, place, time and purpose), is easily distracted INTERACTIONS: Is in good control when talking with nursing staff, his boss, and police. SUICIDAL/HOMICIDA L: Denies any suicidal thoughts or thoughts of self-harm. Stated he wants to “punish” his co-workers. What assessment data are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Assessment Data: Clinical Significance: o Calm and relaxed o Mood is upset o Affect and effect are misaligned o Changes in mood and behavior are symptomatic of psychosisRELEVANT Mental Status Exam Data: Clinical Significance: o A/O x 4 o Poor hygiene and appearance o Pressured speech o Paranoia o Poor insight and judgement o States wanting to “punish” his coworkers o Patient is aware of self, time, place, and events. This helps to rule out any secondary issues that may be contributing to presenting problem (Halter, 2018). o Diminished self-care signals that patient is less able to care for basic needs which are a clinical manifestation of negative symptoms for schizophrenia (Halter, 2018). o Commonly seen in the acute episode of schizophrenia o Another symptom seen during a schizophrenic episode. This can make relationship building more difficult (Halter, 2018). o Patient has ineffective executive functioning contributing to inappropriate behaviors, must be monitored closely (Halter, 2018). o Needs further evaluation, utilizing a Lethality Assessment (Mental Status Exam Interview and Report, 2019). Lab Results: Basic Metabolic Panel (BMP:) Current: High/Low/WNL? Most Recent: Sodium (135–145 mEq/L) 130 WNL 135 Potassium (3.5–5.0 mEq/L) 3.5 WNL 3.8 Glucose (70–110 mg/dL) 160 HIGH 128 Creatinine (0.6–1.2 mg/dL) 1.1 WNL 1.0 What lab results are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable: o Sodium o May indicate malnourishment, fluid and o Worseningo Glucose o Potassium o Creatinine electrolyte imbalance and/or polydipsia (Potter, Perry, & Hall, 2017) o Can indicate a comorbid development of Diabetes, may be a result from lack of medication, or from sympathetic nervous system activation during aggression (Potter, Perry, & Hall, 2017) o WNL but declining. Heart contractility is good. Monitor I&O (Potter, Perry, & Hall, 2017) o WNL but high, monitor kidney function o Worsening o Worsening o Stable Complete Blood Count (CBC:) Current: High/Low/WNL? Most Recent: WBC (4.5–11.0 mm 3) 6.5 WNL 8.2 Neutrophil % (42–72) 60 WNL 68 Hgb (12–16 g/dL) 12.5 WNL 12.8 Platelets (150-450 x103/µl) 250 WNL 289 What lab results are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Lab(s): Clinical Significance: TREND: Improve/Worsening/Stable: o WBC o Patients levels are within normal limits but trending downward in possible relation to poor nutrition or from medication changes (Potter, o Worseningo Neutrophil o Hbg o Platelets Perry, & Hall, 2017) o Used to evaluate infection and agranulocytosis which is a side effect of some antipsychotic medications. WNL but will need to be monitored (Potter, Perry, & Hall, 2017) o Used to evaluate anemia, bleeding, or if elevated, polycythemia. Currently WNL but should be monitored (Potter, Perry, & Hall, 2017) o Test done to evaluate for either decreased clotting or increased risk for clotting. Currently WNL but will need to be monitored (Potter, Perry, & Hall, 2017) o Worsening o Worsening o Worsening Clinical Reasoning Begins 1. What is the primary problem that your patient is most likely presenting? Acute exacerbation of schizophrenia (Professor Reynolds, 2020) 2. What is the underlying cause/pathophysiology of this primary problem? Cause of schizophrenia is not known. However, research suggests that it is brought on by a combination of genetic, brain chemical, and environmental factors. Stressors such as viral infections, prenatal malnutrition, birth defects, brain injury, traumatic situations, and severe poverty are believed to be contributing factors (Halter, 2018).Collaborative Care: Medical Management Care Provider Orders: Rationale: Expected Outcome: o Admit to the inpatient mental health unit on a voluntary status o Patient needs to be stabilized in a safe environment, and is also at risk for harming his coworkers. Removing the environment that is causing agitation will allow the patient to heal in a therapeutic milieu (Professor Reynolds, 2020) o Patient had recent positive experience with this drug, and must reinstate his previous drug routine. This is a 2nd generation atypical antipsychotic drug that is used to treat irritability associated with schizophrenia but actions are unknown (Skidmore-Roth, 2019). o Patient had recent positive reaction with this SSRI antidepressant. It is used to treat depression by inhibiting CNS neuron uptake of serotonin but not norepinephrine (Skidmore-Roth, 2019) o Benzodiazepine that potentiates the actions of GABA to reduce acute anxiety and irritability (Skidmore-Roth, 2019). This is ordered PRN to help stabilize patient’s mood. o PRN for severe agitation in order to stabilize the patient. Give if the patient becomes severely violent and aggressive (Skidmoreo Patients mood will be stabilized and will be in an environment where he is no longer a risk to others or himself o Risperidone 2mg PO BID o Patient will have a decrease psychosis, agitation, and paranoia o Citalopram 20mg PO at HS o Lorazepam 1mg PO every 6 hours PRN for anxiety or agitation o Therapeutic effects can take up to 4-6 weeks so getting the patient restarted on this immediately to decrease patient’s depression o Haloperidol 5mg IM every 4 hours PRN for severe agitation o Patients anxiety and aggression will be decreased o Patients agitation will be decreasedRoth, 2019). PRIORITY Setting: Which Orders Do You Implement First and Why? Care Provider Orders: Order of Priority: Rationale: • Lorazepam 1mg • Citalopram 20mg • Haloperidol 5mg • Risperidone 2mg • Admit to inpatient mental health unit 1.Admit to inpatient mental health unit 2.Risperidone 2mg 3.Citalopram 20mg 4.Lorazepam 1mg 5.Haloperidol 5mg 1. To provide safe environment and begin treatment in therapeutic milieu (Professor Reynolds, 2020). 2. Lowers schizophrenic symptoms, takes a while to start working so start ASAP (Professor Reynolds, 2020). 3. Control patients depression associated with schizophrenia, takes a while to work, start ASAP (Professor Reynolds, 2020). 4. PRN for anxiety (Professor Reynolds, 2020). 5. For situations of violence or aggression (Professor Reynolds, 2020). Collaborative Care: Nursing 3. What nursing priority (ies) will guide your plan of care? (if more than one-list in order of PRIORITY) o Safety (Professor Reynolds, 2020). o Suicide/aggravation assessment (Professor Reynolds, 2020). o Restart antipsychotic medication and encourage strict adherence (Professor Reynolds, 2020). o Encourage recovery strategies and implement resources available in the therapeutic milieu (Professor Reynolds, 2020).4. What interventions will you initiate based on this priority? Nursing Interventions: Rationale: Expected Outcome: 1. Build a trusting nurse/patient relationship (Halter, 2018). 1. Providing a trusting and therapeutic relationship with the patient, will help the patient feel safer and allow them to be more open about their needs and concerns (Halter, 2018). 1. Patient trusts the nurse and feels comfortable confiding in the nurse, and a is willing to discuss issues, fears, hopes, and things that will help in the patient’s overall wellbeing 2. Patient will demonstrate a clam affect and will not verbalize that he wants to hurt his coworkers 2. Provide safe environment. Perform an ongoing violence assessment (Halter, 2018). 2. Patient needs to be continuously assessed and monitored to make sure that no side effects have occurred with medications, and that he is no longer a danger to others or himself. Patient is at increased risk for harm (Professor Reynolds, 2020). 3. Suicide assessment/Lethality assessment, and ongoing Mental Status Exam (Professor Reynolds, 2020). 4. Monitor for therapeutic effects and side effects, ensuring medication is 3. Patient will be monitored for signs of suicidal ideation, continuous thoughts of harm to others, and a continous mental status. These are needed to assess patient’s intention and plan (Professor Reynolds, 2020). 4. Therapeutic effects of medications will decrease psychosis symptoms, if patientbeing taken correctly (Professor Reynolds, 2020). 5. Keep patient in a clam and quite environment (Halter, 2018). 6. Avoid physical contact (Halter, 2018). has unwanted SE, adherence is less likely (Professor Reynolds, 2020). 5. A less stimulating and distracting environment, patient will feel relaxed and calm (Halter, 2018). 6. Avoid triggers or conflict with the patient (Halter, 2018). 3. Patient will become more mentally stable and have less psychosis symptoms 4. Patient will need the effects to the medication to feel less agitated, anxious, and scared. This will allow the patient to rest and heal. Patient will allow staff to watch patient take medications and allow staff to check patients mouth afteradministration. 5. Patient will relax and feel safe 6. To keep safety a priority, the patient or nurse will touch one another, and the patient will not touch other patients and the staff.5. What body system(s) will you assess most thoroughly based on the primary/priority concern? Neurologic system using MSE and AIMS test (Professor Reynolds, 2020). 6. What is the worst possible/most likely complication to anticipate? Self-harm or violent acts (Professor Reynolds, 2020). 7. What nursing assessments will identify this complication EARLY if it develops? MSE, a Lethality Assessment, AIMES test, safety checks while making rounds (Halter, 2018). 8. What nursing interventions will you initiate if this complication develops? o Utilize therapeutic communication and de-escalation techniques (Professor Reynolds, 2020). o Remove patient from the situation that is upsetting him and keep in a quite environment will limited stimulation (Professor Reynolds, 2020). o Administer PRN medication to control aggression and anxiety (Professor Reynolds, 2020). o Initiate one on one supervisor if needed (Professor Reynolds, 2020). 9. What psychosocial needs will this patient and family likely have that will need to be addressed? Patient will need to be able to recognize the signs and symptoms of a relapse. Utilizing a journal to keep track of daily feelings and triggers. Patient will need to learn how to engage with coworkers and friends in a positive and healthy manner. Patient and family need to utilize a group therapy session together so they can all have an understanding of what is to be expected form this illness, how to avoid relapses, and the importance of medication adherence. The family could also gather more information and training on de-escalation and therapeutic communication, so when faced with a relapse they can act in a way that is beneficial to the family and patient (Halter, 2018). 10. How can the nurse address these psychosocial needs?The nurse can provide education to both the patient and the family, and can also direct the patient and family to a social worker who can help with finding counselors or programs that will assist the family and the patient. The nurse should assess the patient’s quality of life and how certain groups may help. Make sure to encourage the patient to have hope and to encourage self expression of feelings revolving his diagnosis and how to cope with those feelings. Promote independence of the patient to discuss what things he thinks might help him with coping and informal/formal therapies (Halter, 2018). Evaluation: Six Hours Later The client has been admitted to the adult inpatient mental health unit, and you are now the nurse caring for the client. Current VS: Most Recent: Current PQRST: T: 97.4 F/36.3 C (oral) T: 97.8 F/36.6 C (oral) Provoking/Palliative : Denies pain P: 78 (regular) P: 100 (regular) Quality: R: 16 (regular) R: 22 (regular) Region/Radiation: BP: 118/70 BP: 130/84 Severity: O2 sat: 99% room air O2 sat: 98% room air Timing: Mental Status Examination: APPEARANCE: Recently showered, dressed in hospital gown and clothing MOTOR BEHAVIOR: No abnormal muscle movements SPEECH: Normal rate and rhythm MOOD/AFFECT: Flat, watchful THOUGHT PROCESS: Linear THOUGHT CONTENT: Continues to believe meds at home are poison; willing to take meds in the hospital because they are sealed. Continues to state people at work were out to harm him PERCEPTION: Denies auditory or visual hallucinations INSIGHT/JUDGMENT: Fair- Client acknowledges his diagnosis of schizophrenia and understands this is why he is in the hospital COGNITION: Alert and oriented times 4INTERACTIONS: Sitting at table with other clients but not engaging in conversation SUICIDAL/HOMICIDA L: Denies any thoughts of suicide or self-harm or thoughts to harm others.Current Assessment: GENERAL APPEARANCE: Resting comfortably appears in no acute distress RESP: Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort CARDIAC: Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal to palpation at radial/pedal/post-tibial landmarks GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact 1. What clinical data are RELEVANT that must be recognized as clinically significant? RELEVANT VS Data: Clinical Significance: • Vital signs • Normal rate and rhythm of speech • Continues to believe meds at home are poisoned and that his coworkers were out to harm him • Acknowledges diagnosis of schizophrenia • Affect is flat, sitting with others but not engaging. • Patient has improvements in insight and judgment • Vital signs are all WNL (Potter et al., 2017) • Patient has stopped experiencing pressured speech and/or echolalia. This is a positive therapeutic effect of his medication (Halter, 2018). • Patient is continuing to experience a persecutory delusion, is willing to take meds because they are sealed. May be significant because if this delusion is not resolved, patient will relapse after discharge (Halter, 2018). • Patient is aware of his disease which gives him more ability to gain control over how to manage himself and regain some control over symptoms (Halter, 2018). • Patients flat affect is consistent with his psychiatric disease. He is not engaging with others which could be a sign that he doesn’t trust them, trust seems to be a significant issue with thispatient towards others (Halter, 2018). • Realizing he needs to be in the hospital in order to gain control over his symptoms. He is willing to take his medication to decrease his psychosis (Halter, 2018). RELEVANT Assessment Data: Clinical Significance: All assessment data is within normal limits Patient does not appear to be exhibiting any physical distress or show signs of adverse reaction to medications. 2. Has the status improved or not as expected to this point? Status has improved, patient is not longer agitated or as anxious. Still believes that medications at home are poisoned by his coworkers who he believes are out to harm him and is having difficulty engaging with others, possibly indicating a non-adherence of medications after discharge (Professor Reynolds, 2020). 3. Does your nursing priority or plan of care need to be modified in any way after this evaluation assessment? Patient and family education on medication adherence and the importance of journaling feelings, triggers, and noting if daily medication was taken. Also, if patient continues to believe that only medication from a controlled environment is safe, encourage patient and family agree to long-acting IM medication that only has to be dosed 2-3 weeks which will reduce the conflict about taking medications (Professor Reynolds, 2020). It is now the end of your shift. Effective and concise handoffs are essential to excellent care and, if not done well, can adversely impact the care of this patient. You have done an excellent job to this point, now finish strong and give the following SBAR report to the nurse who will be caring for this patient: Situation:Name/age: Jeremy Brown, 30, single Caucasian male BRIEF summary of the primary problem: Brought to the ED by police after throwing large metal object at coworker who he believes has been poisoning his medication and following him. Admitted to adult inpatient mental health unit two hours ago on a voluntary basis. Background: Primary problem/diagnosis: Schizophrenia RELEVANT past medical history: Diagnosed with schizophrenia 5 years ago RELEVANT background data: Patient had been recently off medication for the past month as a result of his paranoia that started three months ago regarding believing his coworkers are following him and poisoning his medication. Once patient was brought to unit, he was restarted on his scheduled meds; Risperidone 2mg and Citalopr20mg, and given his PRN Lorazepam 1mg, has shown signs of decrease in aggravation andanxiousness. Continue to implement routine MSE, and monitor for paranoia and anxietyAssessment: Most recent vital signs: Temp: 97.4 F Pulse: 78 Respirations: 16 (Regular) BP: 118/70 O2 sat: 99% on room air Denies any pain RELEVANT body system nursing assessment data: Jeremy arrived to the ED diaphoretic, ungroomed, and agitated. He had rapid pressured speech, became agitated when talking about his medication, he repeated phrases he heard by other staff members, and stated that he wanted to “punish” his coworkers. He denies suicidal ideation. He states that he is willing to take his medications since they are from the hospital and they are sealed, but is still paranoid that his him medications are poisoned. RELEVANT lab values: CBC is WNL, glucose currently 160 which is increase from most recent data and low sodium levels all within admission to the ED TREND of any abnormal clinical data (stableincreasing/decreasing): Sodium and potassium have decreases, glucose has increased, WBC has decreased, and platelets have decreased. Jeremy can engage in conversation and answers questions appropriately, he is less agitated since receiving his scheduled and PRN medications. How have you advanced the plan of care?Jeremy was admitted into the unit, assessment was done, oriented to unit, showered and received scheduled Risperidone 2mg, Citalopram 20mg and PRN Lorazepam. 1mg and continuation of providing patient safety. Patient response: Currently sitting calmly but guarded at table with other clients, flat affect, and showing no signs of aggression. INTERPRETATION of current clinical status (stable/unstable/worsening): Condition is improving Recommendation: Suggestions to advance the plan of care: Continue to provide a safe milieu and close observation, continue assessment for suicidal ideation and aggression, encourage participating in groups and continuation of taking medications, monitor for increased agitation and paranoia, encourage milieu group therapies for self-help strategies and to help with recovery and prevent relapse, repeat/monitor blood glucose/A1C, Monitor fluid I/O and sleep. Education Priorities/Discharge Planning 1. What educational/discharge priorities will be needed to develop a teaching plan for this patient and family? • Patient will be educated on therapeutic techniques that can be used to identify acute symptoms • Patient sill be educated on resources that can be used if he is feeling depressed, wants to stop taking medications, feels like someone is out to harm him, or feels like he cannot manage his symptoms • Family members will need education material on Schizophrenia and how to identify triggers and signs of increased symptoms • Both patient and family will be given information on how to obtain counseling or support groups • Future appointments will be scheduled in order to follow up with health care providers to monitor and assess the patient’s symptoms, and assess if medications are continuing to be therapeutic.• Patients should be educated on the importance of medication adherence, the positive therapeutic effects and negative side effects of the medication • Patient cannot be discharged while still danger to self and others • Goal of therapy is the reduction of symptoms and eliminating the possibility of relapse • Family and patient both need education on self-help strategies such as outpatient support groups • Education for the family and patient on recovery of Schizophrenia, that it cannot be cured but can be managed with continuous medication use, this provides hope (Professor Reynolds, 2020) (Halter, 2018). 2. How can the nurse assess the effectiveness of patient and family teaching and discharge instructions? Implementing a contract with the patient, nurse and family that they all agree on, and they all sign. Committing to medication adherence, refraining from violent acts, and family counseling (Halter, 2018). Caring and the “Art” of Nursing 1. What is the patient likely experiencing/feeling right now in this situation? Patient is likely feeling calm and safe now that his medication has taken effect. Patient may be feeling embarrassed about his actions that led to his hospitalization. Patient should be feeling empowered to take control of his illness and understand that it is controllable (Professor Reynolds, 2020). 2. What can you do to engage yourself with this patient’s experience, and show that he/she matters to you as a person? Perhaps sitting with the patient and telling him that I just want to sit with him awhile and let him know that I am there for him, while having patience, being genuine, and caring, let him know that I care about how he feels, and care about his well-being. Making multiple rounds throughout the day to continue to reinforce that I am there for him. Promoting independence while offering support and comfort while maintaining both the patient’s and nurse’s boundaries (Professor Reynolds, 2020).Use Reflection to THINK Like a Nurse Thinking like a nurse involves reflection, it is the nurse’s ability to accurately interpret the patient’s response to an intervention at the moment as the events are unfolding to make a correct clinical judgment. 1. What did I learn from this scenario? I learned that a person with schizophrenia needs to have his basic needs met first, and that is why they are probably experiencing an exacerbation of symptoms, because they feel like they are either unsafe, hungry, tired, cold, or lonely. In fact, we all need these basic benchmarks to be happy, their illness just makes their way of expression much more amplified or perhaps violent 2. How can I use what has been learned from this scenario to improve patient care in the future? I can take use the knowledge of therapeutic communication and therapeutic relationship’s and use that to still maintain boundaries while allowing the patient to feel confident, safe and important. I can use this knowledge of how quickly someone can relapse in their illness and how these individuals require lots of patience, and genuine caring.References Halter, M. J. (2018). Varcarolis foundations of psychiatric-mental health nursing: a clinical approach. St. Louis, MO: Elsevier. Mental status exam interview and report. (Fall, 2019). [In class lecture] Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2017). Fundamentals of nursing (9th ed.). St. Louis, MO: Elsevier. Reynolds, R. (2020, June, 10). Schizophrenia [PowerPoint Slides] Skidmore-Roth, L. (2019). Mosbys 2019 nursing drug reference (32nd ed.). St. Louis, MO: Elsevier.