Hello I need help with the guided reflection question please, also please see the scenario below to

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Answered step-by-step
Asked by anikolli

Hello

I need help with the guided reflection question please, also please see the scenario below to answer those questions.

Please provide 2 peer reviewed references.

Opening Questions
How did the simulated experience of Li Na Chen’s case make you feel?
Talk about what went well in the scenario.
Reflecting on Li Na Chen’s case, were there any actions you would do differently? If so, what were these actions and why?

Scenario Analysis Questions*
PCC       What issues have you identified that could be barriers to a successful discharge plan for Li Na Chen? How would you address the above barriers?
S            As you prepare to contact the primary provider related to Li Na Chen’s husband’s concerns, list two concerns that you have that need to be discussed with the provider. What would be possible early indicators of relapse?

Concluding Questions
Describe how you would advocate for a patient in Li Na Chen’s situation. Identify gaps in mental health care in your community. What changes would you implement to address these gaps?

Mental health unit

Time: 10:00

Report from the charge nurse:

Situation: Li Na Chen is a 40-year-old female who was admitted through the emergency room (ER) to our unit 5 days ago accompanied by her husband, Jack. Mrs. Chen was admitted for major depression and a suicide attempt, having ingested approximately 6000 mg of acetaminophen and 4800 mg of ibuprofen, medications that had been prescribed by the community clinic for complaints of back pain and headaches. Acetylcysteine was administered, and she underwent a gastric lavage in the ER and was then admitted to our unit for suicide precautions, stabilization, and mental health assessment.

Background: Li Na was diagnosed with depression 3 years ago. She is an art historian, but she has been unable to work in recent years because of the depression. Prior to this hospitalization, her treatment plan included pharmacologic antidepressant therapy and biweekly counseling sessions. Two weeks ago, her nurse practitioner recommended tapering sertraline from 100 to 75 mg every day and adding venlafaxine 37.5 mg every day. This has now been adjusted again to 50 mg of sertraline daily and 37.5 mg of venlafaxine twice daily. Prior to the current suicide attempt, Li Na had two other attempts with drug overdoses over the past 3 years, both requiring hospitalization. Her last attempt before this admission was 1 year ago.

Assessment: Mrs. Chen has been compliant with the treatment plan on the unit, attending her individual and group therapy sessions. Her mental health team would like to discharge her to home with continued pharmacologic and weekly therapy, both group and individual. Her last Hamilton Depression Scale reading showed only slight improvement. Her husband has expressed concern about his ability to continue to manage her in their home. He is concerned about how her illness affects their two children, Connie, aged 12 years, and Jack Jr, aged 14 years, and he feels she may not be ready for discharge. He has indicated that he would like to continue to be supportive, but with her three suicide attempts, he is simply worn out and wonders whether she needs to be in a more closely supervised environment. He just arrived and is in the room with her now. Mrs. Chen is eager to return home. Last night she slept better than on previous nights, but she still wakes up during the night and has trouble falling asleep again. Her vital signs at the beginning of our shift were as follows: temperature, 36.4°C (97.5°F); heart rate, 80 beats/min; respiratory rate, 12 breaths/min; and blood pressure, 114/72 mmHg. We have been checking complete blood count, liver and kidney function tests, and acetaminophen and ibuprofen blood levels daily.

Acetaminophen and ibuprofen levels were high on admission but have decreased markedly. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin, total protein, and prothrombin time peaked on day 2 but then started falling again and are now back to or close to normal limits. Kidney function tests were also affected, but they are also on the way back to normal now. All of the results are available in the chart.

Recommendation: You will need to implement a discharge assessment for Mrs. Chen and the family, including a mental status examination of Mrs. Chen, to transition her to a partial hospitalization program before formal transition to home. You will also need to provide education for Mrs. Chen and her husband regarding available resources to assist her with self-care, stress management, and identifying signature trigger events. Please also complete a medication reconciliation and review it with Mrs. Chen and her husband. They may also benefit from education on nonpharmacologic interventions as well as a conversation on risk factors for readmission to the inpatient mental health setting.  

SCIENCE
HEALTH SCIENCE
NURSING
NUR 4525L

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