Mental Health Nursing Assignment: Schizoaffective Disorder Case Study

Patient Overview & Assessment

Patient: "Maya," 28-year-old female with schizoaffective disorder, bipolar type, involuntarily admitted after command auditory hallucinations directing self-harm. Presenting symptoms include pressured speech, tangential thought process, persecutory delusions, auditory hallucinations, insomnia, and medication non-adherence for 2 weeks. Columbia-Suicide Severity Rating Scale (C-SSRS) indicates high suicide risk with recent intent but no plan.

Assessment Highlights: Vital signs stable; BMI 24.6 kg/m²; oriented x2; affect labile; insight poor; judgment impaired. Urine drug screen negative. Lithium level subtherapeutic at 0.2 mEq/L. Family reports recent stressors: job loss, eviction, limited social support. Safety assessment notes previous overdose attempt (2023) and self-injurious behaviors.

NANDA-I Nursing Diagnoses

• Risk for Self-Directed Violence related to command hallucinations and hopelessness as evidenced by suicidal ideation and history of self-harm.
• Disturbed Thought Processes related to neurochemical imbalance as evidenced by delusions, auditory hallucinations, and disorganized speech.
• Imbalanced Nutrition: Less Than Body Requirements related to decreased appetite and medication side effects as evidenced by 8-lb weight loss over two weeks.
• Interrupted Family Processes related to chronic mental illness, caregiver fatigue, and limited coping resources.

SMART Patient Outcomes (72-Hour Horizon)

• Patient will remain free from self-harm and verbalize at least two coping strategies for managing command hallucinations within 24 hours.
• Patient will report decreased hallucination intensity from 8/10 to ≤4/10 using standardized symptom scale within 72 hours.
• Patient will consume ≥75% of meals and maintain hydration over the next three days.
• Family will participate in one psychoeducation session and identify two community mental health resources before discharge planning.

Psychopharmacology Management

Psychiatric NP initiated paliperidone palmitate 234 mg IM (loading dose) with scheduled 156 mg IM booster on day 8 to promote adherence. Lithium carbonate 900 mg/day resumed with trough levels monitored q48h until therapeutic (0.6-1.2 mEq/L). PRN medications include haloperidol 5 mg IM with benztropine 1 mg IM for severe agitation, and lorazepam 1 mg PO for acute anxiety. Nurse documented patient education on tardive dyskinesia signs, lithium toxicity precautions, hydration, and consistent sodium intake.

Therapeutic Communication & Crisis Intervention

The nurse utilized trauma-informed, recovery-oriented approaches: maintained calm demeanor, validated patient experiences, avoided confrontation with delusional content, and employed motivational interviewing to explore ambivalence toward medications. Daily 1:1 sessions incorporated grounding techniques, guided breathing, and safety planning (Stanley-Brown model). The nurse conducted C-SSRS and Suicide Assessment Five-step Evaluation and Triage (SAFE-T) tools every shift, collaborating with the psychiatrist to adjust risk level and observation frequency (q15-minute checks upgraded to continuous when hallucinations intensified).

Evidence-Based Nursing Interventions

• Environmental Safety: Conducted milieu safety sweep, removed sharps/ligatures, ensured secure storage of personal belongings.
• Reality Orientation: Scheduled structured groups, reoriented patient to time/place, reinforced unit routine, and encouraged journaling of hallucination triggers.
• Nutrition Support: Collaborated with dietitian to offer high-protein snacks and monitor intake/output; administered ondansetron PRN for medication-induced nausea.
• Family Engagement: Facilitated HIPAA-compliant family meeting, provided crisis resources (NAMI, ACT team), and co-created relapse-prevention checklist.
• Discharge Planning: Coordinated with social worker to secure transitional housing, scheduled outpatient psychiatry follow-up within 3 days, and arranged peer support group referral.

Evaluation & Patient Response

By 72 hours, Maya denied suicidal intent, rated hallucination intensity at 3/10, and engaged in community meeting. She verbalized understanding of long-acting injectable benefits and agreed to ongoing therapy. Nutrition goals met with consistent meal consumption. Family identified respite care resources and committed to weekly check-ins. Discharge criteria met with safety plan, medication adherence commitment, and scheduled outpatient appointments.

Reflection & Clinical Reasoning

The nurse documented critical thinking in aligning interventions with the American Psychiatric Nurses Association (APNA) standards for psychiatric-mental health nursing. Key takeaways included proactive suicide risk mitigation, culturally sensitive communication, and interprofessional collaboration. Future recommendations emphasize digital adherence tools, ongoing CBT for psychosis, and wraparound services addressing social determinants of health.

Results & Grading Feedback

Final Grade: A (96/100)

Faculty commended the assignment's integration of DSM-5 criteria, nursing theory, and measurable outcomes. Strengths noted: detailed medication rationale, clear linkage between assessments and interventions, and emphasis on patient autonomy. Minor feedback recommended adding SBAR script for family updates and exploring community-based partial hospitalization options.

Why This Mental Health Nursing Assignment Excels

• Prioritizes patient safety with validated suicide risk tools and continuous observation protocols.
• Bridges assessment findings to targeted NANDA diagnoses and NIC-aligned interventions.
• Demonstrates mastery of psychopharmacology monitoring and patient education.
• Employs trauma-informed, recovery-focused therapeutic communication strategies.
• Incorporates interdisciplinary collaboration and evidence-based discharge planning.
• Addresses social determinants impacting relapse and medication adherence.
• Reinforces culturally competent care and family engagement best practices.