NAME: Cañete, Princess Laira V.

BSN 3-YB-18

ACTIVITY 1 MIDTERM

1. Clients who fail to take medications regularly are often admitted to the hospital
repeatedly, and this can become quite expensive. How do you reconcile the client’s rights
(to refuse treatment or medications) with the need to curtail avoidable health care costs?
2. What is the quality of life for the client with schizophrenia who has a minimal response
to antipsychotic medications and therefore poor treatment outcomes?
3. Clients who take depot injections of antipsychotic medications are sometimes court-
ordered to comply with this treatment when they are in the community. Does this violate
the client’s right to self-determination or autonomy? When should clients have the ability
to refuse such medications?

ACTIVITY 2 MIDTERM

John Jones, age 33, has been admitted to the hospital for the third time with a diagnosis of
paranoid schizophrenia. John had been taking haloperidol (Haldol) but stopped taking it weeks
ago, telling his case manager it was “the poison that is making me sick.” Yesterday, John was
brought to the hospital after neighbors called the police because he had been up all night yelling
loudly in his apartment. Neighbors reported him saying, “I can’t do it! They don’t deserve to
die!” and similar statements. John appears guarded and suspicious and has little to say to anyone.
His hair is matted, he has a strong body odor, and he is dressed in several layers of heavy
clothing even though the weather is warm. So far, John has been refusing any offers of food or
fluids. When the nurse approached John with a dose of haloperidol, he said, “Do you want me to
die?”

1. What additional assessment data does the nurse need to plan care for John?
 The nurse should assess the amount of sleep during the past few days.
 Assess for positive symptoms that the client is manifesting.
 Assess the client medical history, aside from the medication, the nurse can assess
if the client had been hospitalized previously.
 Assess support system. Determine whether the family is well informed about the
disease.
 Assess the reason why the client is no longer complying to medication.
2. Identify the three priorities, nursing diagnoses, and expected outcomes for John’s care
with your rationales for the choices.
PRIORITIES NURSING Dx EXPECTED RATIONALE
OUTCOMES
1. Risk for 1. Risk for 1. The client will 1. It would be a
imbalanced imbalanced start to major issue if
nutrition nutrition verbalize what we do not
2. Risk for related to food that he stimulate the
insufficient psychological likely to eat patient’s
fluid volume disorder as 2. The client will appetite then
3. Disturbed manifested by take at least 3 the client will
thought insufficient glasses of not eat for an
processes interest in food water extended
2. Risk of 3. The client will period of time.
insufficient have 5 minutes This might
fluid volume interactions intensify his
related to that are based anxiety
psychological from reality 2. Adequate oral
disorder as fluid intake is
manifested by important and
refusal of if it is not
water intake prioritized, it
3. Disturbed will have a
thought significant
processes impact on his
related to body and
diagnosis of increase his
psychological anxiety
disorder as 3. When the
manifested by client thoughts
inappropriate are focused on
non-reality- reality -based
based thinking events, he or
she is free of
delusional
thinking.
Helps focus
attention
externally

3. Identify at least two nursing interventions for the three priorities listed in Question 2.

PRIORITIES INTERVENTION
1. Risk for imbalance nutrition  Assess the client preference for
food and why he is refusing to eat.
 Emphasize importance of food
intake to the client and assure him
 that food to be offended will not
2. Risk for insufficient fluid volume harm him.

 Identify the cause of refusal of oral

fluid

 Assess skin turgor and administer

IV fluids as ordered
3. Disturbed thought processes
 Initially do not argue with the
client’s beliefs or try to convince
the client that the delusions are false
and unreal

 Interact with client on the basis of

things in the environment. Try to
distract client from their delusions
by engaging in reality-based
activities

4. What community referrals or supports might be beneficial for John when he is

discharged?
1. Emphasize to the family the importance of social interaction to the patient.
2. Emphasize the importance of having adequate sleep to reduce the client’s
environment
3. Emphasize importance of encouraging the patient’s compliance to treatment regimen.
4. Educate and develop support networks, for the families reduces the family’s anxiety,
increase their physical and mental health.
5. Educate the family members about the disease and medications used to treat the
disease
6. Provide information on disease and treatment strategies at the family’s level of
understanding
7. Instruct the family to keep the patient from a lot of stimulus that might increase his
anxiety
8. Instruct to report any violence behaviors that the client is manifesting

ACTIVITY 3 MIDTERM

1. Is it possible for someone to make a “rational” decision to commit suicide? Under

what circumstances?

2. Are laws ethical that permit physician-assisted suicide? Why or why not?
3. A person with bipolar disorder frequently discontinues taking medication when out of the
hospital, becomes manic, and engages in risky behavior such as speeding, drinking and driving,
and incurring large debts. How do you reconcile the client’s right to refuse medication with
public or personal safety? Who should make such a decision? How could it be enforced?