Saul Kahneman is a 42-year-old, single white male with adiagnosis of schizophrenia. His current symptoms include auditoryhallucinations, disorganized speech, and diminished emotionalexpression. His father, David, brings Saul to the inpatientpsychiatric unit for treatment. David reports that Saul stoppedtaking his Seroquel 400 mg BID for psychosis and his melatonin 6 mgfor sleep a week ago. He also reports that Saul has been respondingto internal stimuli, talking to himself, not sleeping, and believesthe government has bugged their home. This is the third psychiatricadmission for Saul in two years.
When you, the psychiatric nurse practitioner, talk to Saul, hereports, “The medication isn’t working anymore.â€
- Vital signs: BP 148/72, HR 88, R 18, pulse ox 98%
- HT: 6’ 1â€
- WT: 230 pounds
- Appearance: Unkempt, poor hygiene, dressed in several layers ofclothing (current season is late spring, average temperatureoutside is 70 degrees)
- Blood work: A1C 6.2, total cholesterol 188 mg/dl, HDL 22 mg/dl,LDL 176 mg/dl
- Triglycerides: 148 mg
- All other lab results are within normal limits.
Questions
You know you will change Saul’s antipsychotic medication.
- Based on the information in the case study—vital signs, HT/WT,and appearance, as well as the lab results—what recommendationsrelative to medications would you make? Name the type of typical oratypical antipsychotic you would prescribe and identify the dosingand administration.
- Decide whether you would add any other medication, and if so,identify the medication, dose, and time of administration. Providecurrent literature (EBP, research article, and/or textbookreference) to support your decision.
- Based on the medications you would prescribe, what educationwould you provide to Saul?
- Identify any laboratory testing you would order and explainyour rationale.
- Would you refer Saul to any other providers? If so, to whomwould you refer him? Provide your rationale for any referrals.
