We had our first Psychiatric rotation for the year and I could use some assistance
to make sure I am not barking up the wrong tree.
My patient is a paranoid schizophrenic with delusions. He has been hospitalized
6 times in 20 years, 5 of which are from non compliance with medication. He stopped taking
one unnamed medication because he stated it made his liver and pancreas leak.
He stopped taking thorazine because he claims it made his brain hemorrhage and
although he tried to fix it by taking vitamin k, it still kept bleeding and if he didn't
stop the thorazine his whole body would hemorrhage. He is now hospitalized and
being given 4mg Risperdal PO am and 37.5 mg Risperdal via IM injection q two weeks.
I am concerned that he is "working" toward another medical problem, and noncompliance
because his statement to me about the Risperdal was; because it was yellow, he would
need to start taking vitamin B12. No explanation for that one yet.
We need to do a physiological or safety and security for our #1 diagnosis and
a Psychosocial for our secondary.
Does the following nursing diagnosis fall into safety and security?
"Noncompliance with therapeutic medication regime r/t delusions that each medication
is hurting his body AEB statement that that Thorazine made his brain hemorrhage."
Or do I need to go with the standard "Disturbed sensory perception....etc.
I just ask, because all the assessment data on my patient tells me that his problems
are about non compliance. I know that he has Disturbed sensory perception, which
the care plan would include administering anti-psychotic medications, but unless
we can figure out a way to make him comply with taking medications it is a mute point.
My goal/outcome would be ?: Client will be compliant with taking medications AEB:
?1) Returns for Bi-weekly IM injections of Risperdal
?2) Maintains therapeutic levels of Risperdal (time frame?)
?3) Has no episodes of delusions or hallucinations (time frame?)
?4) Does not return to re-hospitalization (time frame?)
What interventions would I use to ensure his compliance?
?1) Assess medications for side effects that patient feels are intolerable(rationale)
?2) Assess medications for effectiveness(rationale)
?3) Enlist Mothers assistance with medication compliance(rationale)
?4) Provide verbal and written information on medications action and possible side effects(rationale)
?5) Monitor for therapeutic levels of risperdal bi weekly (rationale)
Any feedback would be appreciated!