Patient Introduction Location: Patient room on a mental health unit Time: 20:00 Report from the char

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Asked by ProfHeatMonkey101

Patient Introduction

Location: Patient room on a mental health unit

Time: 20:00

Report from the charge nurse:

Situation: Li Na Chen is a 40-year-old Chinese female who presented to the emergency room (ER) accompanied by her husband, Mr. Jack Chen. Mr. Chen reported that upon his return home today, he found his wife crying on the bathroom floor surrounded by several empty pill bottles. He reported that his wife told him “she can’t live like this” and “she simply cannot function this way anymore.” She has been admitted from the ER with major depression and suicide attempt.  . 

Background: Li Na was diagnosed with depression 3 years ago, and she has had two suicide attempts with drug overdose over the past 3 years, requiring hospitalization both times. Her last attempt was 1 year ago. She sees a psychiatric nurse practitioner with prescriptive authority. Her treatment plan includes pharmacologic antidepressant therapy and biweekly counseling sessions. Her usual dose of sertraline was 100 mg, but 2 weeks ago, the nurse practitioner recommended tapering her sertraline and beginning a trial of venlafaxine. Since then, the nurse practitioner has been on vacation, and Li Na is scheduled for a follow-up upon her return from vacation. During the past 2 weeks, Li Na has made three visits to the community clinic with varying complaints of low back pain and headaches with increasing difficulty sleeping through the night. She has been prescribed extra-strength ibuprofen (600 mg) 4 times a day and as-needed extra-strength acetaminophen (500 mg). These are the drugs she overdosed on in her suicide attempt. Her husband also reports that she has lost 10 lb in the past month due to lack of appetite.

Assessment: The pill bottles for her recently prescribed acetaminophen and ibuprofen accompanying her appear empty. Mrs. Chen claims to have been using the medications as prescribed by the community clinic. Her husband reports that she may have taken approximately 6000 mg of acetaminophen and 4800 mg of ibuprofen. Acetylcysteine 7000 mg in 200 mL of 5% dextrose in water was given in the ER, and she underwent a gastric lavage; many recognizable pills were identified in the contents. Her vital signs are being monitored; the results of her last set of vital signs, which were taken in the ER, are as follows: temperature, 37°C (98.6°F); heart rate, 100 beats/min; respiratory rate, 20 breaths/min; and blood pressure, 110/70 mmHg. Blood for laboratory tests was obtained in the ER. The results are available in the chart. The acetaminophen level was 80 mcg/mL, and the ibuprofen level was 150 mcg/mL. They also assessed her depression in the ER using the Hamilton Depression Scale. The result is in her chart.

Recommendation: Admit the patient to the mental health unit with suicide precautions and safety checks. They have not searched her personal belongings for dangerous items in the ER, so please also do that. Please also take vital signs, complete a mental health assessment and call me with a report when you’re done.

Feedback Log

  0:00 Patient
  0:00 You checked scene safety. It was correct to check scene safety in order to maintain your own safety.
  0:06 You introduced yourself.
  0:37 You washed your hands.
  0:43 You identified the patient.
  1:06 You asked the patient: Is it OK for your husband to be here, while we talk? It was correct to let the patient give her consent for letting her husband be a part of the interview.
  1:24 The patient said: Jack has always been there for me, and I have let him down.\nYou answered: You have let him down? \nYou used the therapeutic technique of restating.
  1:25 You asked if the patient had any known allergies.
  1:34 You performed medication reconciliation.
  1:52 You made a safety check of the surroundings and the patient’s belongings.
  2:36 You made another safety check of the surroundings and the patient’s belongings.
  3:16 You assessed the respiration.
  3:30 You checked the pulse oximetry.
  3:47 You checked the radial pulse.
  3:59 You measured the blood pressure.
  4:14 You measured the temperature.
  4:34 You asked the patient: Can you tell me a little bit more about what’s going on with you today? It was appropriate to ask the patient what was going on with her to get an understanding of this.
  4:50 The patient said: I don’t think I can do this again.\nYou answered: Tell me more about this. \nYou used the therapeutic technique of offering general leads.
  4:54 You asked the patient: Over the past year, when did you feel your best? It was appropriate to ask the patient about when she felt her best.
  5:17 The patient said: I do better, then it all crumbles down.\nYou answered: Was it similar to the last time you were admitted to the hospital? \nYou used the therapeutic technique of encouraging comparison.
  5:24 You asked the patient: Have you had any changes in your appetite over the past month? The patient said: I am not hungry.
  5:35 You asked the patient: Do you have energy to do the normal activities necessary to get through the day?
  5:51 The patient said: I can’t do this anymore.\nYou answered: You can’t do this anymore? \nYou used the therapeutic technique of restating.
  6:00 You asked the patient: Do you have energy to do the activities that give you enjoyment?
  6:16 The patient said: I’m too tired to answer your questions.\nYou answered: Tell me more about your energy level at home. \nYou used the therapeutic technique of exploring.
  6:25 You educated about the psychiatric diagnosis.
  6:58 You asked the patient: I would like to ask you a series of questions about how you are feeling to help me better understand how together we can start to plan your care. These are questions I ask all of the patients I see. May I ask you these questions?
  7:23 The patient said: Can you finish these questions later?\nYou answered: I realize this must be tiring for you; however, I need to finish your assessment now. \nYou used the therapeutic technique of giving information.
  7:48 You removed potentially dangerous objects.
  15:45 You submitted the Mental Status Examination form. Some of your assessment answers were incorrect.\n\nRegarding the indicator “1. Appearance. Appropriately dressed for age and weather?”: You should have indicated “Yes.”\n\nRegarding the indicator “1. Appearance. Posture”: You should have indicated “Slumped.”\n\nRegarding the indicator “2. Psychomotor behavior. Abnormal movements or gestures”: You should have indicated “No.”\n\nRegarding the indicator “8. Thought process. Indicate thought process”: You should have indicated “Goal directed.”\n\nRegarding the indicator “10. Level of interest. Anhedonia”: You should have indicated “Yes.”\n\n
    You should have asked about any changes in sleep.
  17:30 You asked the patient: How would you describe your mood?
  17:48 The patient said: I don’t have the energy for this.\nYou answered: Does your lack of energy contribute to your low mood? \nYou used the therapeutic technique of exploring.
  17:59 You asked the patient: Do you have any thoughts or wishes to harm anybody else? The patient said: No.
  18:41 You asked the patient: Do you have any thoughts or wishes to harm anybody else? The patient said: No.
  18:51 You asked the patient: Do you have any thoughts or wishes to harm or kill yourself?
  19:06 The patient said: I cannot even do one thing right.\nYou answered: One thing right? \nYou used the therapeutic technique of restating.
  19:16 You asked the patient: Do you think it would be better if you were not alive?
  19:32 The patient said: I don’t want help; I just want to get away from this pain.\nYou answered: I realize the last few weeks must have been difficult for you. \nYou used the therapeutic technique of accepting.
  19:52 You asked the patient: Do you have any thoughts or wishes to harm anybody else? The patient said: No.
  20:29 You asked the patient: Are you frightened of anything?
  20:39 The patient said: No one will care about me anymore.\nYou answered: Who do you care about? \nYou used the therapeutic technique of exploring.
  20:49 You asked the patient: Do you ever see or hear things that other people do not? The patient said: No, I do not.
  21:12 You observed the appearance.
  21:34 You assessed the attention.
  21:42 You observed the motor activity.
  21:48 You assessed the speech.
  21:54 You assessed the thought processes.
  22:40 You supported the patient about feeling hopeless.
  22:48 You supported the patient about help from the health care team.
  22:58 You supported the patient’s husband.
  23:22 You called the charge nurse. This is reasonable at this point.
    The focus of this scenario is on patient safety following a suicide attempt and the necessary therapeutic communication skills required for ongoing assessment and support. Although it is important to acknowledge the potential physiologic complications that can arise with overdosing of acetaminophen and ibuprofen, this scenario addresses the mental health issues.lt;/p>lt;p>Atypical antidepressants may be prescribed for patients who have an inadequate response to selective serotonin reuptake inhibitors or experience side effects. In this case, the patient’s medications have recently been adjusted to include a serotonin norepinephrine reuptake inhibitor antidepressant, venlafaxine. This drug blocks the reuptake of serotonin, norepinephrine, and dopamine (weakly). Side effects of venlafaxine include an increase in blood pressure and pulse, nausea and vomiting, headache, dizziness, drowsiness, dry mouth, and sweating. This drug also can impact liver function tests (specifically AST and ALT) as well as kidney tests (specifically creatinine). Because this patient also has taken an overdose of acetaminophen and ibuprofen, these tests will be important to monitor.lt;/p>
    You got 91%

1- After reading the case please write a Soap Notes for the patient

2-Write an SBAR

3- write  Care Plan (write at least 2 care plan) Assessment, Diagnosis, Outcome/Planning, Intervention and Evaluation.

4- write 2 patient educations 

5 write a chief complaint 

6- record vital signs 

SCIENCE
HEALTH SCIENCE
NURSING
NUR 3262L

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