Nursing Case Studies: Pleural Effusion, Schizophrenia, Depression

This document presents three nursing case studies focusing on Pleural Effusion and Restrictive Lung Disease, Schizophrenia, and a Depressed Patient with Suicidal Thoughts. The first case study explores the diagnosis, symptoms, and treatment of pleural effusion, including the interpretation of vital signs, differentiation between transudate and exudate, causes, pathophysiology, and nursing interventions such as thoracentesis, medication administration, and chest tube management. The second case study examines schizophrenia, covering positive and negative symptoms, delusional thinking, diagnostic screening, initial interventions, medication, and psychosocial treatments. The third case study focuses on a depressed patient with suicidal thoughts, addressing risk factors, psychiatric disorders associated with suicide, assessment questions, common signs of depression, immediate interventions, and treatment options including pharmacological and psychotherapeutic approaches. Each case study includes detailed questions and answers, providing a comprehensive analysis of the patient's condition and the appropriate nursing care.

Running head: NURSING CASE STUDIES 1
Nursing Case Studies
Name
Institutional Affiliation

NURSING CASE STUDIES 2
Nursing Case Studies
Case Study Pleural Effusion and Restrictive Lung Disease
1. Given his diagnosis, are A.B.'s admission VS expected? Explain.
Presence of shallow breath results in low oxygen availability. In order to maintain an appropriate
level of Oxygen, there needs to be more breaths per minute. Another symptom of Pleural
Effusion is Fever. The vital signs of A.B are thus expected during his admission.
2. What is pleural effusion?
By definition, pleural effusion is a condition in the lungs where there is abnormal amount of
water present. The patient, A.B had made complaints about short breath, dry cough, weakness
and chest pains.
3. What is the difference between transudate and exudate?
When blood vessels or lymph vessels are blocked or inflamed or there is lung injury, the fluid
accumulation resulting from these factors is referred to as Exudative pleural effusion. Transudate
pleural effusion on the other hand results from fluid leakage into chest pleural space.
4. List three common causes of pleural effusion.
 Leakage from other organs
 Cancer.
 Infections
5. Review the pathophysiology and consequences of pleural effusion and
pulmonary infiltrates.
Pleural effusion is the abnormal fluid collection in lungs and the consequence is that this fluid
causes a decrease in lung expansion and hence short breaths. Pulmonary infiltrates is a

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hypersensitivity reaction due to the infiltration by eosinophil and mononuclear cells and
inflammation of the lungs. The consequence is prolonged illness with symptoms such as weight
loss, cough, night sweats among others.
6.How does the underlying pathophysiology give rise to A.B.'s presenting signs and
symptoms?
The pleural effusion underlying pathophysiology results in patient A.B symptoms. This is
because the pleural cavity fluid occupies the cavity and results in decreased lung expansion.
Dyspenea, dullness/ flatness, and weak breath sounds are some common symptoms.
7.How do you differentiate between cardiac and pleural pain?
Cardiac chest pains result from lack of blood and Oxygen flowing to the heart tissues. Pleuritic
chest pains on the other hand arise from inflamed and irritated pleura membrane.
8.How does A.B.'s increased metabolic rate affect his nutritional needs?
Metabolism refers to the transformation of food to energy for normal body functioning. Patient
A.B requires intake of balanced food that will cater to boost his nutritional requirement as there
is demand for more energy in his body.
9. What is a thoracentesis?
By definition, thoracentesis is a procedure that involves the removal of the extra fluid present
between the thoracic wall and lungs the lining.
10.The order for the cefuroxime (Ceftin) reads to infuse 1 g in 100 mL 0.9% NaCl over 30
minutes. You have IV tubing that supplies 20 gtt/mL. At how many gtt per minute will you
regulate the infusion?
Volume (mL) /Time (min) X Drop factor (gtt/mL) = IV flow (gtt/mL)

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Therefore: 100mL / 30min X 20gtt/mL = 66.6 gtt/mL
11.What maneuvers would promote the clearance of pulmonary secretions?
Chest physiotherapy consists of external mechanical maneuvers, such as chest percussion,
postural drainage, vibration, to augment mobilization and clearance of airway secretions,
diaphragmatic breathing with pursed-lips, coughing and controlled coughing. The maneuvers are
such as clearance of air path, diaphragmatic breathing, postural drainage, coughing, chest
percussion and controlled coughing.
12.The pleural C&S results indicate a large amount of Klebsiella organism growth that is
not sensitive to cefuroxime (Ceftin). What action will you take next?
The most appropriate action would be to prescribe a higher IV rate and thus I would regulate the
infusion to around 80 gtt/mL
13.Because fluid continues to collect in the pleural space, the physician decides to insert a
pleural chest tube under nonemergent conditions. What is your responsibility as A.B.'s
nurse?
Key role would be to ensure than my Patient A.B medication is well administered, the drawing
of blood sample and taking vital sign as well as interacting with the patient’s family for more
information that would be useful.
14.Evaluate each of the following statements about chest tube drainage systems. Enter “T”
for true or “F” for false. Discuss why the false statements are incorrect.
1. True
2. True
3. True
4. True

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5. FALSE. Due to suction, the chamber is not always open.
6. FALSE. When the tube is stripped, it can cause damage to the wound.
7. FALSE. With no leakages, the system can remain clamped till a new system is introduced.
8. FALSE. It is not practically true, however theoretically it sounds true. A Heimlich valve can
be used to decrease the risk of backfilling.
9. True.
10. True.
15.How will you appropriately maintain A.B.'s chest tube system?
This will be through patient observation, drainage system observation, management of pain and
suction.
16.What type of discharge instructions do you need to give to A.B.?
The instruction would be as follows: A.B, in case you experience the following, immediately
come back to our emergency department. Any symptoms such as dizziness, progressive breath
shortness, fainting, chest pains, persistent cough or any other abnormal feeling.

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CASE STUDY 129 Schizophrenia
1.Explain what a “negative” symptom of schizophrenia is, and identify at least three
negative symptoms of schizophrenia that R.B. might be experiencing.
Negative sign in paranoid Schizophrenia has been referred to by researchers as when a patient
shows sign of a disease that is not responsive to antipsychotic treatment as would positive sign.
The negative signs make the patient more cognitively and physically disabled. Signs observed in
R.B is such as anorexia, weight loss and water phobic.
2.Explain what a “positive” symptom of schizophrenia is, and identify at least two positive
symptoms of schizophrenia that R.B. might be experiencing.
Positive sign in paranoid Schizophrenia has been referred to by researchers as when a patient
shows sign such as delusion and paranoia. It is responsive to antipsychotic treatment and does
not disable the patient.
3.Give the definition of each of the following types of delusional thinking:
 Thought broadcasting –this is when a person thinks anyone can listen to what they are
thinking.
 Thought insertion- It is a feeling that one’s thoughts are not their own, but inserted into
their mind.
 Grandeur-It is the belief that one is a very powerful or an important person in the society.
 Ideas of reference- It is the perception that events are related to one’s self yet they are
not.
 Persecution-Belief that others are out to harm them.
 Somatic delusions-Believing that one’s body is changing in an unusual way.

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4.What symptoms indicate that R.B. has paranoid schizophrenia?
The most open signs that indicate R.B has paranoid Schizophrenia is that he shows persecution.
He believes that there are people out there who after him. He also shows anorexia behaviour. He
experiences hallucinations, has isolated himself and shows poor hygienic standards.
5.Why is it important to know R.B.'s history before he is diagnosed with schizophrenia?
The history of J.B’s family line is very important. It will help in identifying if the patients has or
had a first degree relative with Schizophrenia. This would greatly increase the chance of J.B also
getting diagnosed with such. It would also serve to know whether the patient has renal disease,
delirium or neurological conditions.
6.What diagnostic screening is important in evaluating R.B.?
It would be important to know the history of J.B’s family to see whether there is any family
linked condition. It would also be important to check whether the patient has had depression
before.
7.What are the most important initial interventions in treating R.B.?
The initial interventions would be to ensure that the patient is safe. That would be achieved by
ensuring he does not hurt himself or others.
There would need for questions such as whether the patient intends to commit suicide, need for
check on substance use and also check for any signs of hallucinations. The patient may also be
delusional and so it is important the patient get assured that he is safe. The next stage would be to
assess his nutritional and hydration status, medical history. Last it would be in order to see that
R.B mental status is assessed the present happenings and how he manages them.

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8.Which class of antipsychotic medications is considered first-line therapy for
schizophrenia?
Second generation antipsychotic treatments are mostly chosen as they treat both positive and
negative signs. There is minimal side effects of extrapyramidal. An example is Zyprexa.
9.K.B. will need to be monitored closely. How will this be done?
For this to happen, he needs to be hospitalized. He needs to be monitored for agranulocytosis and
weekly WBC counts for a period of up to 6 months. He would then have monitoring on his
eating habits, hygiene both body and his laundry.
10.What types of psychosocial treatments may be used to treheat R.B.'s schizophrenia?
These would be therapies as individual, group peer and family. The family therapy would be
very helpful; as it improves life’s quality for the patient. It greatly reduces the chances of relapse
and social problem solving skills are gained. Alternative ways of conflict solving is taught.
Occupational therapies, Pyscho-educational therapies, are also explored in order to alleviate
anxiety and guilt in the patient.
11.What are the common side effects of atypical antipsychotics such as olanzapine
(Zyprexa)? (Select all that apply.)
A,BC,D,E and F
12.Is he having an illusion or a hallucination? Explain your answer.
R.B is experiencing hallucinations. This is so as he keeps seeing a bird over his bed hears it
talking to him. This is a sensory perception unlike a delusional personal that gets a false belief
even when the evidence is contrary. This would when someone sees a bed and thinks it’s a
coffin.
13.How will you respond?

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I would calmly tell R.B that I do not understand him and that I would love to understand him. It
would be important for me not to negate what he is saying and yet offer my perception. I would
not be argumentative but rather notify the physician over the behaviour in the event R.B gets
aggressive.

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CASESTUDY127 DEPRESSED PATIENT WITH SUICIDAL THOUGHTS
1. What characteristics of J.B. put him at high risk for suicide?
These characteristics include: J.B is very elderly, male, widower, recent illness and lacks of
support. All this results in one feeling and find self in isolation.
2. Which psychiatric disorders can result in suicidal ideations or gestures?
Some of these disorders include but are not limited to personality disorders such as Depression,
Schizophrenia Anxiety and Bipolar Disorder.
3. What questions would you ask J.B. to determine whether he is clinically depressed?
There are a few questions that would enable me determine whether the patient is clinically
depressed. Some would be as follows:
J.B are you sleepy? Have you experienced a change in sleep patterns? How long have you had
these feelings of sadness? J.B any change in appetite? Sir, do you have any inability to make
decisions or concentrate? J.B, has any of your family members ever been diagnosed as
depressed?
4. List five of the most common signs of depression.
 Worthlessness
 Hopelessness
 Anhedonia
 Change in Sleep pattern
 Indecisiveness
5. What immediate interventions would you carry out for J.B.?

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I would first an assessment of his safety and later contact the physician and alert him of my
findings. I would make the necessary arrangements for the transfer in order for the patient gets to
immediate mental health services. In the course of my activities, I would ensure that J.B is not
left alone. A close monitoring schedule would be in place.
6. Identify two treatments that are available for depression.
One key treatment method is Pharmacological: involves use of antianxiety or antidepressants.
The mostly likely time for patients to commit suicide is shortly after they get on medication or
when they start feeling much better. Another important treatment is psychotherapy. This
involves talks with the patient. It is very effective especially when the patient co-operates.
7. Would J.B. be a candidate for electroconvulsive therapy (ECT)? Why or why
not?
ECT would risky for the patient although it is successful when used with many patients who are
depressed and those who contemplate suicidal thoughts. It would not be safe for J.B considering
recent heart valve replacement and generally his heart problems. ECT induces seizure which
would stress the heart for a period of almost quarter an hour after start of therapy.
8. What special instructions will you give him regarding the Lexapro? (Select all
that apply.)
A,B,C,D and E
9. Why do you think that a drug in the SSRI class was chosen over a tricyclic
antidepressant or a monoamine oxidase inhibitor (MAOI)?
With consideration of J.B being non-compliant diabetic, the SSRI was best suited for the patient.
This is because MAOI’s have very strict diet restrictions and routines. With J.B showing

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decreased appetite, it would be unlikely that that a tricyclic would have been effective, as the
patient would not follow the regulations to the letter.
10. What important information needs to be conveyed to J.B.'s daughter about the first few
weeks of therapy with the SSRI?
J.B’s daughter would need to monitor his father for signs of increased suicidal thoughts or any
alarming giving away of his personal possessions. She would also ensure that the patient does
not stop his medication suddenly or mix with other medications without prior consultation with
the physician. She would also ensure that all psychiatrist appointments are kept and watch out for
and headaches or blurred vision complaints from the father.

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References
Lechner, A. J., Matuschak, G. M., & Brink, D. S. (2012). Respiratory: An integrated approach
to disease. New York: McGraw-Hill Medical.
Wenzel, A., Brown, G. K., & Beck, A. T. (2009). Cognitive therapy for suicidal patients:
Scientific and clinical applications. Washington, DC: American Psychological
Association
Weinberger, D. R., & Harrison, P. J. (2011). Schizophrenia. Chichester, West Sussex, UK:
Wiley-Blackwell.