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A Complete Solution on vSim for Nursing | Mental Health

LI NA CHEN PART 1

  1. Document the search of Mrs. Chen and her belongings on admission.
  2. Document the safety checks for Day 1.
  3. Document the findings of the mental status examination of Mrs. Chen on admission.
  4. Document the findings of the suicide assessment of Mrs. Chen.
  5. Identify and document key nursing diagnoses for Mrs. Chen.
  6. Referring to your feedback log, document all nursing care provided and Mrs. Chen’s response to this care.
  7. Document patient education regarding medications.

ANSWER

  1. Document the search of Mrs. Chen and her belongings on admission.

Mrs. Chen was explained the reason for the search of her belongings in order to maintain safety for her due to her suicide risk as well as for others. The items removed were a nail file, unwrapped tweezers, a travel sewing kit, a decorative pill box, a personal cell phone, a belt, shoelaces, and a string from her hoodie.

  1. Document the safety checks for Day 1.

The scene was checked for safety and deemed appropriate because the nurse could get out of the room if needed.

3.

Document the findings of the mental status examination of Mrs. Chen on admission.

Mrs. Chen is appropriately dressed for age and weather. She is clean and well-kept other than her hair, which is slightly disheveled. She has a slumped posture with no automatisms, such as tics, tremos, akathisia, or restlessness. Her mood is sad and depressed and her affect is congruent with her thought content. She does not have any indications of speech variations, like neologisms, aphasia, or pressured speech. Her thought content involved worries, frustrations, and hopelessness/helplessness. She denies hallucinations. Thought process is goal-directed. She acknowledges self-harm or suicide urges as well as acknowledging death wish without suicidal intent. She denies homicidal ideation. She is positive for anhedonia. Mrs. Chen is orientated X3 with long-term memory deficits but a focused attention span. Hearing sight is good.

  1. Document the findings of the suicide assessment of Mrs. Chen.

Mrs. Chen stated, “I cannot even do one thing right,” “I don‘t want help; I just want to get away from this pain,” “I don’t think I can go on,” when asked if Mrs. Chen has any thoughts or wishes to harm or kill herself.

  1. Identify and document key nursing diagnoses for Mrs. Chen.

Patient has Major Depressive Disorder related to mental condition as evidenced by loss of interest, loss of energy, excessive sleepiness, weight loss, and poor appetite

  1. Referring to your feedback log, document all nursing care provided and Mrs. Chen’s response to this care.

0:00. I checked scene safety. It was correct to check scene safety in order to maintain your own safety.

0:30. I washed your hands

0:42. I identified the patient.

0:57. I made a safety check of the surroundings and the patient’s belongings.

2:29. The patient said: I don’t think the medicines are helping. I answered: Your provider is making adjustments to your medications based upon your depressive symptoms. \

2:31. I 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.

2:47. The patient said: I don’t think I can do this again. I answered: Tell me more about this.

2:53. I 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.

3:23. The patient said: Jack has always been there for me, and I have let him down. I answered: You have let him down?

4:14. I asked the patient: Have you had any changes in your appetite over the past month? The patient said: I am not hungry.

4:34. the patient said: I need a break. I answered: I realize this must be tiring for you; however, I need to finish your assessment now.

5:13. I asked the patient: Tell me about any changes you have had in your sleep over the past few weeks? The patient said: I sleep all the time but never feel rested.

5:36. The patient said: All I want to do is go to sleep. I answered: Perhaps you and I can talk about healthy sleep habits in a few days.

6:22. I asked the patient: Do you have energy to do the normal activities necessary to get through the day?

6:37. The patient said: I can’t do this anymore. I answered: You can’t do this anymore?

6:54. The patient said: I’m too tired to answer your questions. I answered: Tell me more about your energy level at home.

6:54. I 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?

7:17. The patient said: Can you finish these questions later? I nswered: I realize this must be tiring for you; however, I need to finish your assessment now. \

8:49. The patient said: I cannot even do one thing right. I answered: One thing right? \nYou used the therapeutic technique of restating.

9:44. The patient said: I don’t think I can go on. I answered: Are you thinking about hurting yourself? \

10:13. The patient said: I’m nothing. I answered: Do you feel that you have no self-worth? \

10:42. The patient said: No one will care about me anymore. I answered: Who do you care about? \

11:27 I educated about the psychiatric diagnosis.

12:06 I assessed the respiration.

12:16. I checked the pulse oximetry.

12:32. I checked the radial pulse.

12:42. I measured the blood pressure.

12:58 . I measured the temperature.

14:47. U removed potentially dangerous objects.

18:15. I submitted the Mental Status Examination form

18:26. I called the charge nurse

  1. Document patient education regarding medications.

Patient education regarding Mrs. Li Na Chen medication, sertraline  as follows; Your health care provider has prescribed medications as follow for the treatment of  major depression. You are also prescribed 100 mg of sertraline by mouth every day. You will take the medication at night because it may make you to be drowsy. You may take the medication when you are not driving or operating machinery so taking it at night reduces the risk. It is better you follow up with the community mental healthcare center for management.

Ibuprofen (600 mg)

Patients should take ibuprofen with a full glass of water and to remain in an upright position for 15– 30 min after administration.  Patient should take medication as directed. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. It may cause drowsiness or dizziness. Advice patient to avoid driving or other activities requiring alertness until response to medication is known.

Acetaminophen (500 mg)

Patient should take medication exactly as directed and not to take more than the recommended amount. Patient should discontinue acetaminophen and notify health care professional if rash occurs.

 

 

 

 

 

Description

vSim for Nursing | Mental Health

Patient Introduction

Location: Inpatient alcohol rehabilitation facility – treatment room

Time: 08:00

Report from charge nurse:

Situation: Mr. Davis is a 56-year-old man who voluntarily admitted himself to the alcohol rehabilitation facility yesterday afternoon. He is currently on the acute detoxification unit. Mr. Davis has been on the unit for about 16 hours.

Background: Mr. Davis is a member of the school board and the pastor of a large church. Yesterday he was removed from a school board meeting by security guards after becoming angry and directing racial and ethnic slurs at students and their family members. His wife afterward asked him to move out of their home, and this led to the admission. He has three children: a son who is 25 years old, and two daughters, aged 21 and 17 years. His daughters will not speak to him. His son accompanied him to the rehabilitation facility. Mr. Davis had an open reduction internal fixation surgery to repair a humerus fracture 2 years ago, but otherwise, he has no significant medical history and no known allergies. He reports that his alcohol intake is approximately 1 pint of vodka per day and his last drink was prior to the school board meeting. He denies using recreational drugs and tested negative for opiates and marijuana. He does not smoke.

Assessment: He is currently oriented ×3 and is embarrassed about his behavior at the school board meeting. He went to a 12-step meeting yesterday but left early, saying that he was “not like those people” and felt he wouldn’t benefit from the meeting. He was restless last night and did not sleep much. Morning laboratory tests were also drawn at 06:00, when he woke up. Their results are available in the chart, together with the laboratory results from yesterday afternoon. His behavior is appropriate, and he engages appropriately with staff, although his affect is constricted. His CIWA-Ar score was 1 on admission. At 04:00, it had increased to 7. His last set of vital signs included the following: temperature, 37.2°C (99.0°F); heart rate, 94 beats/min; respiratory rate, 20 breaths/min; blood pressure, 154/90 mmHg; and blood oxygen saturation, 98%.

Recommendation: He is due for reassessment of the CIWA score in our treatment room. He has an order for as-needed diazepam for a CIWA score of 8 or greater, so he may need that soon. He is supposed to go to group therapy today and to an Alcoholics Anonymous meeting. He is going to be evaluated by a psychiatrist later today.

 

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LI NA CHEN PART 2

  1. Document findings related to the screening of Mrs. Chen with the Hamilton Rating Scale for Depression.
  2. Document the assessment finding related to Mrs. Chen’s suicidality at discharge.
  3. Document the results of Mrs. Chen’s mental status examination at discharge.
  4. Identify and document key educational needs for Mrs. Chen and the family.
  5. Document medication reconciliation.
  6. Document patient education regarding medications and follow-up appointments.
  7. Document the aftercare plan and the emergency plan for Mrs. Chen when at home.
  8. Document and identify positive coping skills taught to Mrs. Chen.
  9. Identify strengths of Mrs. Chen and the family.

ANSWER

1 Document findings related to the screening of Mrs. Chen with the Hamilton Rating Scale for Depression.

She scored a 23 on the depression scale, which indicates mild depression

  1. Document the assessment finding related to Mrs. Chen’s suicidality at discharge.

She denies any thoughts of harming self at discharge, and is cooperative to the treatment regimen, and shows understanding of her medications and side effects

  1. Document the results of Mrs. Chen’s mental status examination at discharge.

She is oriented to person, place, and time. She denies thoughts of harming self or others. Pt feels depressed, claims losing interest in activities she once enjoyed. Pt verbalized wanting to get better

  1. Identify and document key educational needs for Mrs. Chen and the family.

-Community-based support groups

-Importance of follow-up care

-Medication

-Signs of depression relapse

-Partial hospitalization program

-Sleep interventions

  1. Document medication reconciliation.

I performed medication reconciliation. Medication reconciliation is a crucial tool for maintaining patient safety and preventing adverse drug events. Reconciling medication discrepancies and updating a patient’s medication list improves patient safety by preventing adverse drug events such as drug-drug interactions and other medication errors.

  1. Document patient education regarding medications and follow-up appointments.

Ibuprofen (600 mg)

Patients should take ibuprofen with a full glass of water and to remain in an upright position for 15– 30 min after administration.  Patient should take medication as directed. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. It may cause drowsiness or dizziness. Advice patient to avoid driving or other activities requiring alertness until response to medication is known.

Acetaminophen (500 mg)

Patient should take medication exactly as directed and not to take more than the recommended amount. Patient should discontinue acetaminophen and notify health care professional if rash occurs.

Encourage the patient and family to explore organizations that offer education and support, such as the National Alliance on Mental Illness.lt;/p>

  1. Document the aftercare plan and the emergency plan for Mrs. Chen when at home.

Partial hospitalization offers structure, education, and continuity over a longer period of time to assist patients to further develop their coping skills as they reintegrate into everyday life. A partial hospitalization program provides more intensive treatment than is usually possible outside an inpatient mental health unit, generally 5 days per week over 6 hours (e.g., 9 am to 3 pm). These programs make use of cognitive behavioral therapies to promote healthy living and help clients manage their symptoms and develop better coping skills.

  1. Document and identify positive coping skills taught to Mrs. Chen.

It is important to discuss with the patient and the family not only stress management techniques but also triggers for behaviors or feelings that could easily set off the cascade of at-risk behaviors. Successful use of positive problem-solving can reinforce coping strategies and facilitate the patient’s confidence in his or her coping skills. Encourage the patient and family to explore organizations that offer education and support, such as the National Alliance on Mental Illness.

  1. Identify strengths of Mrs. Chen and the family.

Their strength is their ability to use positive coping skills.