This is a case study about Thomas

This is a case study about Thomas Sykes. Please review the case study and answer the questions. Chart 1 SBAR Report Time: 11:00 AM Person providing report: Susan Henretty, DNP, CRNP, PPCNP-BC Situation: Thomas Sykes is a 17-year-old male. I saw him for the first time this morning for extreme weight gain, skipping school, and depression. Background: Thomas is a new patient with a history of 60 pound weight gain within the past year, social isolation, and minimal personal hygiene. His nephew is a patient of mine, and his sister asked me to evaluate his overall health status with a focused evaluation of his mental state. During his physical exam, I noted concerning behaviors, including minimal eye contact, soft speaking voice, dirty appearance, and lack of energy. I asked the family to stay so that we can further assess his mental state and complete the Columbia-Suicide Severity Rating Scale. Assessment: Thomas looks depressed, overweight, and dirty. His physical exam was remarkable for obesity and prehypertension. We need to complete a more thorough mental health exam and determine if he is a threat to himself or others. Recommendation: Please complete a focused physical assessment, the Columbia-Suicide Severity Rating Scale, and notify me with the results. Progress Note: Thomas was seen today for the first time. He was disheveled and smelled of body odor. He made minimal eye contact and spoke very softly. He was alert and oriented x 4. His physical assessment was within normal limits, with the exception of obesity (BMI of 33.5) and prehypertension. Immunizations are up-to-date. Blood work sent for CBC, BMP, Lipid Panel, and PT/PTT. I have requested completion of the Columbia-Suicide Severity Rating Scale. Review Chart 1 and answer the Questions 1) What assessment items in SBAR and in the progress note, indicate depression? Find at least 5 things. 2) Do you think Thomas has major depression or persistent depressive disorder? Support your answer. (Give rationale). 3) Would any of the following diagnosis be a possibility for Thomas? Specifically, which ones? Give a rationale. Disturbed thought processes Chronic low self-esteem Imbalanced nutrition Constipation Disturbed sleep pattern Ineffective coping Spiritual distress Disabled family coping Chart 2 SBAR Time: 9:00 AM Person providing report: Home care coordinator Situation: 17-year-old male recently discharged from inpatient psychiatric facility for suicidal ideation, depression, and obesity. Now for home care evaluation of weight loss and depression. Background: Thomas Sykes is a 17-year-old male who lives in an inner-city apartment with his sister Keisha and Keisha’s 3-year-old son, Torrey. Thomas’ father is not involved in his life. His mother passed away about 10 years ago from complications associated with uncontrolled diabetes and obesity. Following his mother’s death, Thomas moved in with Keisha and she became his legal guardian. About a year ago, Keisha, Thomas, and Torrey moved for Keisha’s new job in the local battery plant. Her shifts rotate between days and evenings, requiring Thomas to care for Torrey when Keisha has to work the evening shift. Thomas has been overweight for most of his life, but over the past year he has gained 60 pounds and weighed 240 pounds on admission for inpatient treatment. With a height of 5 feet, 11 inches, Thomas is obese, with a BMI of 33.5. Last year, Thomas was in his junior year of high school and had been planning to graduate with his classmates, so the move was hard for Thomas. He did not make friends at his new school and spent most of his time alone playing video games or watching television with Torrey. He began skipping school up to three times a week and did not want to leave the apartment. Following an appointment with a pediatric nurse practitioner, Thomas was admitted to the inpatient psychiatric unit for evaluation for his suicidal ideation. He has undergone group therapy, individual therapy, and is on escitalopram. Upon discharge, he stated that counseling was helping and he was feeling less depressed. Before discharge, Thomas met with the nutritionist to establish an eating plan to help him get to a healthier weight. He is working on this healthy eating weight-loss plan and keeping a food log. Assessment: Obesity and depression Recommendation: During your visit, obtain current weight, review food journal, and evaluate how he is doing with his diet. Repeat the Columbia-Suicide Severity Rating Scale and compare it to the last one that was administered. Medications: escitalopram 10 mg by mouth every day acetaminophen 650 mg by mouth every 8 hours as needed for pain Assess medication compliance Assess food log and provide healthy eating suggestions as needed Assess exercise routine and suggestions for improvements where appropriate. Notify PNP with weight gain > 2 pounds, noncompliance with medication, or any additional concerns. Review Chart 2 and answer the questions Thomas is being discharged. 4) Read the SBAR and the discharge orders on chart 3. Do you recommend anything be added? 5) What kind of medication teaching does Thomas need at this point? 6) What other teaching does Thomas need? Name 2 things that could be taught that would benefit him.

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