week 14 journal | | nursing experts help


A 68-year-old female patient with a history of asthma, COPD, arthritis, tobacco use, bipolar disorder, and schizophrenia is the subject of this case. Although the patient denied drinking but do smoke a pack of cigarettes daily. In order to undergo a reevaluation due to recent increases in delusions and paranoia, the patient was brought to the clinic by family members and Chronic obstructive pulmonary disease flare-ups. (COPD) are an important clinical issue that are linked to decreasing quality of life, lower levels of physical activity, and impaired lung function. Even a single exacerbation can have negative consequences on the mental health of the patient. (Hurst et al, 2020) 

When interrogated, patient is “concerned about her daughter being held hostage by family friend. And someone who injected in her chest. Patient stated that her friend and daughter think she is crazy and that she will make sure her daughter stays safe. She was able to maintain appropriate eye contact. 

Engaged in interview. Linear thought process. Disorganized thought content. Impaired insight and judgment into current condition because of psychotic symptoms increasing disorganization and paranoid delusional content. 

It is difficult to ascertain given her confounding delusion. Per collateral obtained by family friend, and daughter, it was unclear that patient was taking her medication as prescribed. It is believed that she has been experiencing worsening delusion and paranoia at home where she lives alone in eldercare home, but her daughter is very involved in her care and does frequent 

check on her. Medication adherence can have a tremendous impact on quality and length of life, health outcomes, and overall healthcare costs. Engaging patients and the healthcare team is essential to success in achieving medication adherence and persistence. Notable interventions include face-to-face counseling, electronic reminders, regimen simplification, adherence packaging, minimizing adverse effects, (Sabate, 2017). In the interview, Patient denied any active bodily complaints outside of left leg pain and increased fatigue which appear to be more chronic in nature. 

After evaluation agreed with the plan as documented 

Referrals to Physical therapy to manage generalized pain and to increase mobility 

Referrals to tabaco sensation group 

Initiated on olanzapine 20 mg at bedtime 

Will continue on Divalproex 125 mg and Chlorpromazine 75 mg at bedtime 

Will continue to work on management of her psychosis with psychotherapy 


 John R. Hurst, Neil Skolnik, Gerald J. Hansen, Antonio Anzueto, Gavin C. Donaldson, Mark T. Dransfield, Precil Varghese, (2020). Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life, European Journal of Internal Medicine, Vol 73,2020.Pages 1-6, ISSN 0953-6205, 


 Sabaté E. (2017). Adherence to long-term therapies: evidence for action. Geneva: World Health Organization. 2003. www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed June 10, 2017 




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