solved

Question
Answered step-by-step
Asked by anikolli

I need help answering these questions please. Please see questions below along the scenario for a mental health class in nursing. Please provide 2 peer reviewed references.

 

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

Scenario Analysis Questions*
PCC/S       What should be the nurse’s priority when caring for Sandra Littlefield? What action should be initiated to maintain personal safety? If the nurse did not recognize the importance of personal safety, what could be the consequence?
PCC/S       Discuss the importance of therapeutic communication and setting limits for Sandra Littlefield.
T&C/S      What members of the healthcare team should be involved in Sandra Littlefield’s case?

Concluding Questions
Describe how you would apply the knowledge and skills that you obtained in Sandra Littlefield’s case to an actual patient care situation.

 

 

Patient Introduction

Location: The medical area of a jail

Time: 10:00

Report from the intake coordinator to the RN:

Situation: The patient, Sandra Littlefield, is a 36-year-old female who has been in the Blooming County Jail for the past week on prostitution charges. She has a history of back pain and has been given acetaminophen and ibuprofen for pain, but she has put in a request to see the nurse for the third time this week complaining of unrelieved pain.

Background: Sandra has a diagnosis of borderline personality disorder. She has been compliant during this incarceration but has a history of aggressive behavior during past incarcerations. She has a history of sex abuse and has been hospitalized for suicide attempts in the past, as well as for drug and alcohol problems. She does, as mentioned, also have a history of back pain with frequent emergency room visits. During her prior two visits to the nurse, she was given acetaminophen and ibuprofen for pain, but she is now demanding “something stronger” for the pain.

Assessment: Sandra was examined by Dr. Smiley 3 days ago. She was alert and oriented, and her vital signs were as follows: heart rate, 84 beats/min; respiratory rate, 16 breaths/min; blood pressure, 132/80 mmHg; blood oxygen saturation, 98%; and temperature, 37°C (98.6°F). A physical examination of her back revealed no evidence of physical problems, and an MRI of her back was also negative. She receives ibuprofen 600 mg every 8 hours and was given both ibuprofen 600 mg and as-needed acetaminophen 1000 mg at 08:00.

Recommendation: Please complete a mental status examination to see whether her problems are escalating. The physician has asked that we avoid focusing too much on the physical complaints and instead try to help her with coping strategies, so please also do that.

 

 

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.
  0:05 You introduced yourself.
  0:30 You washed your hands.
  0:38 You identified the patient.
  0:52 You asked if the patient had any known allergies.
  1:02 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.
  1:15 The patient said: I am in so much pain. You are a nurse. Don’t you know how to tell when someone is hurting?\nYou answered: You are feeling overwhelmed? \nYou used the therapeutic technique of translating to feelings.
  1:17 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.
  1:35 The patient said: There’s no reason for me to be here anymore. No one cares about me at all.\nYou answered: Are you saying you feel hopeless? \nYou used the therapeutic technique of translating to feelings.
  1:37 You asked the patient: Do you have any pain?
  1:50 The patient said: I’m finished. I’m done with you and your worthless medicine. Guard, take me back now!\nYou answered: The medicine your provider has ordered is in your best interests. \nYou used the nontherapeutic technique of reassuring.
  1:51 You asked the patient: How would you rate your pain, on a scale of 0 to 10? The patient said: It changes but is always high. Now it is 8 to 9!
  2:01 You asked the patient: On a scale of 0 to 10, how would you rate your level of distress? The patient said: I don’t know. 10?
  2:12 You asked the patient: Where is your pain located?
  2:33 The patient said: You are trying to kill me with the pain. Just let me die; I can’t live like this!\nYou answered: It seems like you are very frustrated. \nYou used the therapeutic technique of making observations.
  2:36 You asked the patient: What other pain management strategies have you used other than medications? The patient said: No. Let’s stick with the meds. It was correct to ask if the patient was using any pain management strategies other than medication.
  2:47 You asked the patient: How many meals do you eat each day? The patient said: I usually eat three meals a day.
  2:54 You asked the patient: Have you had any changes in your appetite over the past month? The patient said: My appetite has been about the same.
  3:14 You asked the patient: Have you lost or gained weight over the past month? The patient said: No, I am about the same weight.
  3:23 You asked the patient: Tell me about any changes you have had in your sleep over the past few weeks? The patient said: It isn’t easy to sleep in this place.
  3:41 You asked the patient: Do you have any trouble falling asleep? The patient said: No, not usually.
  3:49 You asked the patient: Do you nap during the day? If so, how often and for how long? The patient said: I sleep a lot because there isn’t much to do here.
  3:59 You asked the patient: Do you have nightmares or vivid dreams on a regular basis? The patient said: No, not usually.
  4:04 You asked the patient: Approximately how many hours of sleep do you get each night? The patient said: I sleep about 7 hours a night.
  4:15 You asked the patient: Do you have energy to do the normal activities necessary to get through the day?
  4:33 The patient said: You think I’m a horrible person because I’m in jail. You are no better than I am.\nYou answered: Are you feeling that no one understands how you feel? \nYou used the therapeutic technique of translating to feelings.
  4:42 You asked the patient: Do you have energy to do the activities that give you enjoyment?
  4:59 The patient said: Have you seen the security guard with the blond hair? He can take me back to my cell anytime.\nYou answered: We are here to talk about you today. \nYou used the therapeutic technique of giving information and setting limits.
  5:03 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?
  5:16 The patient said: If you can’t get me stronger medicine, why don’t you call the provider and get some?\nYou answered: You had pain medication two hours ago. It will be four more hours before I can give you another dose of acetaminophen. \nYou used the therapeutic technique of giving information.
  5:18 You asked the patient: Please tell me what today’s date is. The patient said: It is the 7th.
  5:30 You asked the patient: Have you lost interest in activities that you once enjoyed?
  5:43 The patient said: I know you have some stronger pain medicine. You gave some to another patient, and she wasn’t even in pain like me.\nYou answered: We are here together today to talk about you. \nYou used the therapeutic technique of giving information.
  5:44 You asked the patient: Can you name the last five American presidents starting with Barack Obama and going back? The patient said: Barack Obama, George W. Bush, Bill Clinton, George H. W. Bush, Ronald Reagan.
  6:01 You asked the patient: Do you have any thoughts or wishes to harm or kill yourself? The patient said: If they don’t help with my pain, I will.
  6:11 You asked the patient: Have you ever tried to harm or kill somebody else? The patient said: Yes, that police officer but he deserved it.
  6:28 You asked the patient: Can you tell me what a desired outcome of treatment would be for you?
  6:41 The patient said: I love talking to you. I wish you were here all the time. You are my favorite nurse.\nYou answered: Is there something besides your back pain you would like to talk about? \nYou used the therapeutic technique of broad openings.
  6:43 You asked the patient: How do you understand your problems? The patient said: It wasn’t my fault that I ended up in this place.
  6:50 You asked the patient: Are you frightened of anything?
  7:09 The patient said: You look so nice today. And you smell good. What perfume are you wearing?\nYou answered: Are you uncomfortable when you talk about your feelings about being here? \nYou used the therapeutic technique of making observations.
  7:16 You observed the appearance.
  7:26 You assessed the attention.
  7:28 You observed the motor activity.
  7:32 You assessed the speech.
  7:35 You assessed the thought processes.
  7:51 You auscultated the lung sounds.
  8:05 You checked the patient’s skin.
  8:23 You assessed the respiration.
  8:35 You checked the pulse oximetry.
  8:52 You checked the radial pulse.
  9:04 You measured the blood pressure.
  9:22 You measured the temperature.
  11:48 You submitted the Mental Status Examination form. Some of your assessment answers were incorrect.\n\nRegarding the indicator “2. Psychomotor behavior. Abnormal movements or gestures”: You should have indicated “No.”\n\nRegarding the indicator “3. Mood. Indicate mood”: You should have indicated “Angry.”\n\nRegarding the indicator “6. Thought content. Indications of”: You should have indicated “Worries,” “Frustrations,” and “Hopelessness or helplessness.”\n\nRegarding the indicator “9. Self-harm, suicidal, or homicidal urges. Self-harm or suicide urges”: You should have indicated “Acknowledges.”\n\nRegarding the indicator “9. Self-harm, suicidal, or homicidal urges. Death wish without suicidal intent”: You should have indicated “Acknowledges.”\n\nRegarding the indicator “10. Level of interest. Anhedonia”: You should have indicated “No.”\n\nRegarding the indicator “11. Orientation and cognitive functions. Insight.”: You should have indicated “Partial.”
  12:14 You educated about coping strategies.
  12:52 You educated about medications.
  13:26 You educated about strategies for pain management. It was correct to educate the patient about pain management strategies other than medication.
  14:11 You supported the patient about pain medication.
  14:22 You supported the patient about relaxation techniques.
  14:38 You educated about strategies for pain management.
  14:54 You called the provider.
    Patients with borderline personality disorder (BPD) usually exhibit instability in four parts of their lives: relationships, mood, self-esteem, and impulse control. This instability can manifest in multiple ways; however, there are some consistencies among patients. Common characteristics of patients with BPD include sensitivity to rejection, fear of abandonment, a tendency to see oneself as a victim, feelings of emptiness and boredom, multiple unhealthy relationships, and poor impulse control. Patients with BPD tend to see the world as black and white, all positive or all negative. Therefore, these patients often engage in “splitting”—a pattern of alternating between praising and vilifying other people (“love/hate” relationships). This can be an exhausting tug of war.lt;/p>lt;p>When working with patients with borderline personality disorder, it is important to hold to firm boundaries and not be drawn into the “splitting” behavior. The use of therapeutic communication is essential. It is also important to recognize that there are no medications that will cure this disorder. The patient may, however, be taking medication for other comorbid conditions.lt;/p>
     

 

SCIENCE
HEALTH SCIENCE
NURSING
NUR 4525L

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."