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Mental Health Facility for Patient with Schizophrenia Assessment Answer

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Length: 1500 words

Please note: Students are required to comply with word and time limits. You are not expected to achieve exactly the required length, and a 10% leeway on either side is acceptable. The marker will not mark beyond the 10%. Only your work to that point will be marked against the assessment criteria.

This assessment relates to:

Learning Outcomes 1, 2, 4, 5


Read the case studies below, choose only one of the following case studies to discuss, and answer all 4 of the questions listed below. You do not need an introduction or conclusion and headings are advised. You must use academic writing and reference your work using APA referencing. Your ISBAR may be presented in table format. Please do not use bullet points, instead use well-structured paragraphs.

Case Study 1 (Remote Clinic)

As the RN you arrive at the remote clinic at Wilcannia for your fortnightly visit, the population here is mainly Indigenous Australians and there is a high percentage of children in this community. It is normally quite a busy day.

The next patient you see is Ashanti, a 3 year old indigenous girl. Ashanti presents in the arms of her Mother with her Grandmother present. When asked about Ashanti’s chief complaint, her mother explains she has ‘had the runs for a few days and whatever I give her just goes straight through’. Ashanti is lethargic and unable to walk. On examination you observe Ashanti to have cracked lips, a dry tongue,

sunken eyes and looks very unwell. You ask when she last passed urine and you are told ‘it has not been for a day or so’.

You take her observations and record the following



Ashanti is fully immunised and has no medical history she weighs 13kg.

On further questioning Ashanti's Mother tells you she has had about 2 cups of juice today you work this out to equate to approximately 400mls. You also ask about her urine output, Ashanti Mother is unsure about this as she just states that it is just her bowels that are working, as far as she knows she has not passed urine.


  1. Discuss your assessments on this patient, identify signs of deterioration and clearly state if the patient requires a clinical review or rapid response as per Between the Flags (BTF). Justify your decision with data from the case and relevant support.
  2. Document a succinct and accurate ISBAR handover in verbal script format (eg. Hello, my name is...)
  3. Considering the assessment findings, prioritise and discuss the immediate nursing management of the patient
  4. Succinctly discuss the ongoing management of this case and integrate the relevant members of the interdisciplinary team

Case Study 2 (Mental health facility)

Alex is a 23 year who was admitted to the acute ward at the mental health facility, he has been admitted to the locked ward due to his his acute psychosis. Alex was recently diagnosed with a drug induced schizophrenia caused by the use of marijuana. Alex has been in the ward for the past two weeks, over the past couple of days it has been discussed amongst staff the large amount of food and water Alex consumes (5 litres plus a day and extra meals), they have put this down to his psychosis.

The following day Alex’s behaviour deteriorates and he has become aggressive and unable to walk in a straight line, the staff are confused and wondering if one of his visitors has given him something. The staff take routine bloods and decide to do a drug screen as well. They have also noted the number of times a day he has been going to the toilet (this has been frequent at least hourly if not more regularly). They conduct a full set of vital observations and document the following;

(However Alex is disorientated to time and place)


  1. Discuss your assessments on this patient, identify signs of deterioration and clearly state if the patient requires a clinical review or rapid response as per Between the Flags (BTF). Justify your decision with data from the case and relevant support.
  2. Document a succinct and accurate ISBAR handover in verbal script format (eg. Hello, my name is...)
  3. Considering the assessment findings, prioritise and discuss the immediate nursing management of the patient
  4. Succinctly discuss the ongoing management of this case and integrate the relevant members of the interdisciplinary team



1. Discussing the assessment of the mentioned patient by identifying the signs that lead to deterioration

Drugs and alcohol are used as self-medication by the people who are suffering from mental health issues. This paper will discuss the patient named Alex, who is 23 years old who was admitted to the hospital because of acute psychosis. This is more dangerous than behavioural dysfunction that affects the patient and others. The patient had schizophrenia due to the intake of marijuana for a prolonged period. From the case study, it is evident that Alex has been consuming a tremendous amount of water and food as reported by the staff. With each passing day, the behaviour of the patient gets deteriorated, and that results in aggression. According to the report, the mental health facility staff assumes that something was given to Alex by his visitors (Bergin et al., 2018). From the description given in the case study, it is clear that psychotic illness is not one dimensional and can be multifactorial. Alex has been taking an increased amount of marijuana that is linked to psychosis. The report of the patient cites evidence that the patient was exposed to a heavy dose of cannabis that triggered the risk factors, especially schizophrenia. The identified signs of deterioration of Alex as per the report includes;

Delusion- This is a firmly held idea where Alex has false impressions and belief, which is highly characteristic in schizophrenia. The misconception of Alex involved bizarre and illogical behaviour that resulted in terminal illness (Cremonini et al., 2018).  

Disorganised activities- Alex was diagnosed with schizophrenia that resulted in trouble of maintaining and concentrating on trained thoughts. He has been reported to decline in daily activities that impaired his ability to walk and interact with others. He became aggressive with lack of impulse control and inhibition. He was reported to visit the loo very frequently.

Eating disorder- The schizophrenic patient Alex has problems with self-care, and he has been reported to eat abnormally. He has been said to consume more than 5 litres of water and extra meals every day (David & Waxman, 2018).

Identified signs of Alex

Figure 1: Identified signs of Alex

(Source: Created by author)

1.1. Statement on whether the patient requires rapid response and clinical review as per BTF with proper justification from the report

From the identified signs discussed in the previous section, it is clear that Alex's condition is deteriorating that focuses on acute psychosis linked with schizophrenia. Rigorous and detailed retrospective data from the report will help the staff to make decisions regarding rapid response and clinical review (David & Waxman, 2018).

Components of test RRSpO2BP HRBGLAVPUTemperature Pain 
Normal rate8-12 breaths/minute98%120/8060-100 Beats<100 mg/dlA370/10
Alex’s result 31 (high)96% (Low)132/68(High)140(High)30.2 (Low)A36.6 (Low)0/10 (Normal)

From the above report of Alex, it is clear that he is in the red zone and requires rapid response due to observational criteria for deterioration. Alex requires a quick response that will be capable of initiating essential clinical care(Gaddy, 2018). During the early response period, a nurse in charge needs to be called for to increase and repeat the frequency of observation. The rapid response is a clinical emergency appropriate for mandatory escalation where an A-G assessment document will be provided that can process the outcome of the health record. A-G assessment is beneficial for Alex because he has an emergency that will review abnormal observation (Kinchin et al., 2019).

2. Accurate and concise ISBAR handover

Introduction- Hello, this is Nurse 1 from the locked ward, is this Doctor 1? I'm calling for Alex, who has been admitted to an acute ward.  

Situation- I have taken him to the locked ward due to his abnormal and deteriorated condition that requires immediate observation and escalation.  

Background- Alex has been admitted to the acute ward due to psychosis, and he was also diagnosed with schizophrenia due to heavy intake of marijuana. The patient has been admitted to the mental health centre for two weeks (Kitney et al., 2018).

Assessment- From the assessment report by the staff on Alex after the airway, some of the following results have been obtained that suggested that the patient requires a rapid response. The report stated that he has a low temperature of 36.6 with an average pain level. The blood glucose level is 32, which is very low. The blood pressure measured was 132/68, which is abnormally high. The respiratory rate of Alex is 31 beats per minute, that is also unusually high. Alex has a very high heart rate that is 140 beats (Maloret & Scott, 2018). These physical conditions of Alex led to severe deterioration of his mental health that made him unable to walk and aggressive.

Recommendation- From the assessment report of Alex, it is evident that he needs a mandatory escalation with A-G documentation treatment, and the AMO should be informed immediately for clinical emergencies.

ISBAR flowchart for Alex

Figure 2: ISBAR flowchart for Alex

(Source:, 2020)

3. Discussing the priorities of immediate management on nursing for the mentioned patient

From the case study of Alex acute psychosis linked with schizophrenia have been diagnosed due to the intake of marijuana. Due to this mental condition of Alex, various disabling disorders related to psychology have been observed. Alex was marked to be delusional with behavioural, intellectual, emotional and physical disturbance (Marshall et al., 2019). According to the report prepared by the nursing management after diagnosing the patient includes;

Physical mobility that is impaired- This is observed in Alex due to his depressive mood and aggression. He was also reluctant to initiate any sort of movement. 

Impaired social communication- Alex was observed to be having problems related to speech and pattern. He was incapable of walking and eating correctly.  

An abnormal decrease in cardiac level- This was observed due to the hypersensitive orthostatic effects of the drug.  

After the diagnosis by the staff and nurses, there is confident nursing management that needs to be discussed and prioritised (Marshall et al., 2019).

Electroconvulsive therapy: This is used for the acute schizophrenic patient Alex. This treatment is also used because Alex did not respond to medication. This therapy is used by nursing management to reduce the cationic and depressive symptoms of schizophrenia. Commencing CPR is also useful for Alex's condition that will include activities like pushing hard the chest part to one third to get the average heartbeat .  

Maximising the functioning level: This includes the activity of nursing management to assess the ability of the patient to carry out daily tasks. Oropharyngeal insertion from the airway is one of the events of the nursing management that will normalise the respiratory rate by making a smooth passage of the air.  

Assessing the positive symptoms: Schizophrenic patients like Alex require assessing typical for delusions. It is the responsibility of the nursing management to analyse the fragments of the patient who has poorly organised body and mental ability. The nursing management's role is to focus on the therapeutic and safe environment for the patient (Schmidt et al., 2019). Thus, during the delusion time, the nurses are responsible for demonstrating the patient's belief and acting accordingly.  

Other treatments- A therapeutic relationship should be established with the patient and nurses, which emphasises on the action of the nursing management by providing care in partnership. It is the role of the nurses to establish interpersonal relationships with Alex to understand his mental condition. After following the state of his mind, it would be easier for the management to deal with empathy and authenticity. The orientation of Alex, who is a schizophrenic patient is critical and complicated, so in the identification stage, the nurses must meet all the requirements of the patient to explore the services and possibilities offered(Schmidt et al., 2019).  

4. Discussing the management body for this case and integrating the relevant member from an interdisciplinary team

It is significant to identify the right management body with skilled members from each multidisciplinary team to discuss the case of Alex. Alex is a schizophrenic patient with acute psychosis that has led to mental illness and disabilities. The development of medication based on antipsychotic treatment has been dramatic over the years. Many patients fail to obtain proper care from mental health bodies due to poorly structured management. In this segment, the structure of the multidisciplinary team will be discussed that will give Alex a meaningful recovery (Schmidt et al., 2019). Managing the medication in cases like psychosis and schizophrenia is the only way to treat the patient. This segment will illustrate how a medical care team will work to offer comprehensive treatment to Alex during the time of his deterioration to receive positive outcomes. The management body consists of a psychiatrist, clinical coordinator, psychiatric nurses, employment specialist and case manager.

Psychiatrist- He is an essential member of the team who is responsible for coordinating the other team members. He is responsible for making the decisions regarding medication and treatments of Alex. Psychiatrists will discuss all the mental health-related problems to gain the trust of the patient (Bergin et al., 2018).  

Clinical coordinator- He is responsible to screen Alex during the mental illness situation to determine the accurate diagnosis. He is also responsible for assessing the functioning related to psychology, where the patient is in requirement of targeted treatment. The clinical coordination will ask the family members of Alex to fill the questionnaire to structure the medical interview to recommend treatment procedure (Bergin et al., 2018).

Psychiatric nurses- These nurses are trained to work with patients like Alex. They will be responsible to schedule treatment for Alex regarding mental health conditions. In this context, they will work in a group to collaborate with the physician to analyse the side effects of medication given to Alex.  

Employment specialist- The role of the employment specialist in the mental health management system is to identify the ward members and coordinate with the stake leaders. They will also determine the relevant resources within the community and stake (Cremonini et al., 2018).  

Technical consultants- These are the people who will be responsible for coordinating the care and treatment for Alex by recommending him procedures like CPR, oropharyngeal insertion of airways and ventricular therapies.  

 Interdisciplinary team

Figure 3: Interdisciplinary team 

(Source: Created by author)

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