Reference no: EM133844572
Question
Drake is a 48 year old male. He is being transported to the local emergency department (ED) by the police. The nurse receives in report that the man's neighbors reported he was standing in the middle of the street, yelling out, waving his hands, and acting "crazy". When the police arrived, he would not speak to them and attempted to hit them with a baseball bat. He was yelling, "Where is Jesus? I need to see Jesus!! All of you devil worshippers need to leave me alone!!"
Drakes parents, Meghan and Jack tell the nurse he was first diagnosed with schizophrenia when he was 27 years old. Drake first psychotic break was while he was in college. He didn't complete college due to his illness. He has lived with them since leaving college. They talk about some 'signs' before that too, but they just thought that he was a little eccentric. Drake is not employed. He tried to get a job several times, but never kept one. Drake has not been connected with Social Security disability benefits. He goes to the local mental health unit (MHU) for Haldol D depot injections q8weeks. He is allergic to peanuts and seafood. He has attempted to kill himself on three separate occasions and has been violent toward his parents multiple times. Meghan and Jack don't want him back in their home. They are both in their 70s. They are afraid for their lives and safety at this point. Jack states that Drake does not see any physician regularly and often misses his appointments at MHU.
Other medications and additional history
Cogentin 1mg PO QHS
Seroquel (quetiapine) 200mg PO BID
Desyrel (trazadone) 100mg PO QHS
History of HTN, uncontrolled DM with high blood glucose levels, and elevated cholesterol, all untreated.
Lab Results- Negative tox screen, Reactive RPR, CBC wnl, Blood glucose 385, HIV negative
1. What additional information is needed?
2. What are Positive (things that are normally not there) and Negative signs of schizophrenia?
a. What things are in the case study that are signs you typically will see?
3. What document does the hospital need to keep the patient against his will?
a. What is the maximum time the ED can hold the patient against his will?
b. What actions that a patient displays allows the hospital to hold the patient against his will?
The patient becomes very angry and agitated when he is told that he is being transferred to the psychiatric hospital. He becomes very loud and begins threatening the ED staff.
The physician orders Haldol 10mg IM at 4:30pm.
You have Haldol 2mg/ml available.
4. How many ml will the nurse administer?
5. Where will the nurse administer the injection?
The nurse is now the RN receiving the patient from the local ED. The patient is thrashing about on the stretcher. The unit is short-staffed, so the nurse decides to receive the patient with the assistance of one other staff member. Upon transferring him to the bed on the unit, he grabs the nurse's neck and attempts to choke the nurse. A staff member grabs the restraints and calls a code over the intercom. Physician is notified.
Physician orders four point restraints. Patient is restrained. Physician orders Haldol 10mg IM stat.
Patient becomes calm after being in four point restraints for two hours. Restraints are released by the nurse.
6. What is the proper technique for doing this?
7. What safety concerns should the nurse have?
8. What are safety concerns?
Lab calls with lab values of:
Blood glucose 412
Total cholesterol 200 HDL/HDL-C=35 LDL= 130 Triglycerides= 150 Total cholesterol/HDL ratio= 4.2 à metabolic syndrome
9. What should the nurse do?
The physician orders a social worker consult for placement options for the patient. The nurse notifies the social worker using SBAR format. Pick up the phone and notify the social worker. The patient is on the unit and appears very agitated hitting on the walls, yelling out. The Medication Administration Record (MAR) has Haldol 5mg IM ordered q2h PRN agitation. One hour later, the patient continues to be agitated.
10. What report would you give using SBAR?
11. What is the nurse's next action?
12. What do you suspect?
13. What is the treatment?
14. Is there anything else we missed while talking to the physician?
Patient's vital signs are stable. He is alert, and oriented to person only. Physician now orders Clozaril (clozapine) 12.5 mg PO 2xdaily and Geodon (ziprasidone) 10mg IM PRN q2h not to exceed 40mg/day. A few days have passed.
Lab notifies you of patient's
WBC value of 3.2
15. What is the nurse's next action?
16. What medication should the nurse recommend starting?
17. As it is getting time for the patient to be discharged, how can the nurse include the patient in the decision-making processes? How can the nurse empower the patient?
18. The doctor starts the patient on Risperdal consta, the patient reports his mouth feels as if he is chewing something. The nurse assess his mouth for food or gum nothing is observed. What further assessment can the nurse do?
19. What are possible nursing diagnoses that would be app.