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Evolving Plan of Care

 

Part 1: Mental Health 

 

Step one: Read all parts
Step two: Complete answer  questions labelled under “EPC Part 1: 
Responses should be based on readings, lectures, PPT’s, and class discussion
Be specific in your answers – let your profession know you understand by clearly explaining when required

 

 

EPC Part 1: Scenarion

 

Anthony is a single, African American twenty-four-year-old female telemarketer who presents to the emergency department with complaints of ‘feeling sad and off’ for the past eight months. She states that she doesn’t like to hang out with her family or friends, or do any activities that she used to enjoy. She says everything feels ‘so pointless’ with her life. She felt like this maybe a year or two ago but did not seek care. She also mentions a headache for the past day or so. 

 

During the nursing assessment, Anthony states she has little to no energy. She never feels well rested after waking up and likes to drink a few glasses of wine to help her go to sleep. When asking about Tammy’s activities at home, she states that most of her time goes by when she is sitting in her pajamas and crying. She only feels comfortable in her pajamas because her other clothes are too loose. 

It is noted that her skin and oral cavity both seem dry. 

 

At work,Anthony  states her mind wanders, and has a hard time meeting her quota of calls to make for the day. She has taken multiple sick days because she just “didn’t want to go to work”. 

 

In the last week, Anthony states she took off another day from work. She was feeling ‘unenergized’ and just didn’t get up from the couch. At one point she felt a bit dizzy when she stood up. Yesterday she called her mom crying because she was thinking of suicide, she verbalized she will “never be happy”. Tammy states she was so scared, and her mom didn’t know what to do, so she dropped off Anthony to the ED. 

 

 

 

EPC Part 1: Vital Signs

0200:

BP: 166/78

            HR: 109 bpm

            RR: 20 breaths per min

            Pulse Oximetry: 95% SpO2 RA

            Temperature: 36.9 degrees Celsius 

            Pain: 5/10 headache

 

EPC Part 1: Doctors Orders

 

Order Frequency Status
Start a peripheral IV line Once Active
IV NS @ 100 ml/hr STAT Active
Lorazepam 5mg  BID, PRN Active
Sertraline 50 mg  Daily Active
Vital Signs Q2H Active
Lab work: electrolytes, BS, CR  Q6h x2, then Q12H Active
Lab work: Liver Function Panel  Q12 Active 
Admit to Mental Health Unit Once Active
1:1 observation Ongoing Active

 

 

EPC Part 1: Lab Results

Lab Test Values Abnormal Flag Reference Range  
Glucose, Serum  4.7mmol/L Low 5-8 mmol/L  
Creatinine, Serum  99 umol/L High 53-97umol/L  
BUN  22mg/Dl Norma limit 8-25 mg/dl  
Sodium, Serum  132mEq/L Low 135-145 mEq/L  
Potassium, Serum  3.2mEq/L Low 3.5-5.0 mEq/L  
Chloride, Serum  98mEq/L Normal Range 98-107 mEq/L  
Calcium, Serum  9.1mg/dL Normal Range 8.6-10.2 mg/dL  
Albumin, Serum  3.0g/dL Low 3.2-5.2 g/dL  
Alkaline Phosphatase 88IU/L Normal limit 39-117 IU/L  
ALT (SGPT)  27IU/L Normal Limit 4-40 IU/L  
AST (SGOT)  38IU/L High 4-37 IU/L  

 

 

You are Anthony  nurse and have returned from your break @ 0230. Your co-worker informs you Dr. joe has just completed his admission note. Your co-worker has not had a chance to read over the note or the orders that have been placed. You will now take over Anthony’s care. 

 

EPC Part 2:

 

After reading Anthony chart, identify three areas of nursing focus and a rationale for each. In other words, what should you focus on for the remainder of your shift?

 

 

From what you have read so far in the patient’s chart, identify 2 safety precautions that should be in place.

 

     

 

Has Amy been prescribed an antidepressant? If so, which one? What class of antidepressant is considered first line? What is the action?

 

 

Identify 2 key health teaching points should be provided to a patient beginning an antidepressant? Be specific to the medication. 

 

 

When communicating with Anthony, list four therapeutic communication techniques you will use and an example of each?

 

 

6. List four assessment findings consistent with DSM V criteria for depression. For each, 

   what are possible interventions , specific intervention, and indicate how you would know if the intervention was 

    effective. 

 

 

 

 

7. The nurse considers ‘trauma informed care’. How will the nurse use this concept when 

    meeting with Tammy? 

 

 

 

8. The physician asks the nurses opinion on whetherAnthony should be placed on a Form 1. 

    Do you respond with yes, or no? What is your reasoning? 

 

 

 

 

SCIENCE
HEALTH SCIENCE
NURSING
PNH 401