7) David Carter Pt. 2.,WELL EXPLAINED WITH VERIFIED ANSWERS GRADED A.

Documentation Assignments 1. Document findings associated with your screening of Mr. Carter using the AIMS scale. • The patient had no abnormal facial expression • No smacking, puckering, or pouting of the lips and perioral area • No jaw biting or clenching • No abnormal tongue movements • No tremors or abnormal extremity movements • No abnormal neck, hip, or shoulder movements 2. Document Mr. Carter’s performance of activities of daily living and his intake and output for the day. Mr. Carter’s thoughts are more organized and coherent and he denies any hallucinations at the moment. His paranoia has lessened significantly and he is eating hospital food and taking his medicaitons consistently. 3. Document all laboratory tests ordered for Mr. Carter and their results. • Hgb – 15.5 • HCT – 43 • WBC – 7 • Platelets – 185 • Na+ - 140 • K+ - 3.9 • Cl- - 102 • HCO - - 24 • BUN 18 • Creatinine – 0.7 • Glucose – 92 • Urine Drug Screen - Negative 4. Identify and document key nursing diagnoses for Mr. Carter. • Readiness for enhanced health management • Readiness for enhanced self-care • Readiness for enhanced knowledge: Medication • Readiness for enhanced coping • Readiness for enhanced resilience 5. Referring to your feedback log, document all nursing care provided and Mr. Carter’s response to this care. I checked that the scene was safe, washed my hands, and identified the patient. I asked, “is it ok for your mother to be here, while we talk?” Mr. Carter responded, “I feel bad that I scared my mom.” I asked, “what seemed to lead up to your conflict with your mom?” This employed the therapeutic technique of placing event in time or sequence. I asked, “Can you tell me a little bit more about what’s going on with you today?” David responded, “I’m worried tha the voices will come back.” I asked, “if the voices do come back, how might you handle it?” I used the therapeutic technique of formulating a plan of action. I then asked, “do you have the energy to do the normal activities necessary to get through the day?” David said, “it’s important that I take care of myself, shower, and wear clean clothes.” “Do you have any concerns about taking care of yourself?” I queried, using the therapeutic technique of exploring. “Tell me about any changes you have had in your sleep over the past few weeks?” I continued. “I am sleeping okay. They make me get up for meetings so I don’t stay in bed as long.” “Have you had any changes in your appetite over the past month?” “I’m going to be very careful about what I eat,” David explained. I used the therapeutic technique of seeking information by asking, “what do you mean by careful?” I then stated, “I would like to ask you a series of questions about how you are feeling to help me better undersand 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?” “Yes, you may,” David affirmed. Upon asking the necessary questions, I submitted the Mental Status Examination form. I then educated about the psychiatric diagnosis, new medicaitons, side effects, AIMS, extrapyramidal symptoms, and partial discharge before calling the social worker. 6. Document patient education regarding Mr. Carter’s new medications, sertraline and fluphenazine. I explained to Mr. Carter, “your healthcare provider has prescribed two medications for the treatment of schizophrenia and depressive symptoms. You will take fluphenazine 10 mg by mouth at bedtime for the treatment of schizophrenia. You are also prescribed sertraline 150 mg by mouth every day.” “Why do I have to take the medication at night?” David asked. “You will take the medication at night because it may cause you to feel drowsy. You should take the medication when you are not likely to be driving or operating machinery, so taking it at bedtime reduces those risks. It’s important that you follow up with your community mental health center for medication management. You may be switched to fluphenazine decanoate, which you woul take by injection every few weeks as ordered by your provider.” 7. Document your handoff report in the SBAR format to communicate the care plan for Mr. Carter to the nurse on the next shift. Mr. Carter is anticipated to discharge tomorrow. In the meantime, we will continue to monitor his mental health status and keep him stable. He is to reach out to the community health center upon discharge to talk about the possibility of receiving fluphenazine decanoate injections every few weeks. He is alert and oriented to person and place, but he is unaware of the exact date. He scored well on his AIMS examination. He has been educated about his psychiatric diagnosis, new medications, side effects, AIMS, extrapyramidal symptoms, and partial discharge and verbalizes understanding. Call the provider with any questions or concerns you may have. Opening Questions How did the simulated experience of David Carter’s case make you feel? I was glad to see that Mr. Carter was feeling well and adhering to his treatment plan. Talk about what went well in the scenario. All of my responses to Mr. Carter were therapeutic in their nature and he verbalized understanding to all of the education material with which he was presented. Reflecting on David Carter’s case, were there any actions you would do differently? If so, what were these actions and why? I was actually pleased with how this scenario went. My documentation of the Mental Status Examination is showing improvement! Scenario Analysis Questions* PCC What needs to be stressed during discharge teaching related to his new medication regimen (sertraline and fluphenazine)? The importance of contacting his physician right away if he exhibits any signs or symptoms of any extrapyramidal symptoms. PCC/I Identify community resources in your area that are available to David Carter and his family. One should be for David Carter, one for his mother, and one for the family. Mr. Carter might benefit form NIH involvement, and his mother and family might benefit from connection with NAMI. PCC/S What other discharge teaching is recommended for David Carter and his family? I would educate them on the above organizations and the potential benefits of involvement for both of them. Concluding Questions How would you apply the skills and knowledge gained in David Carter’s case to an actual patient situation in different acute care units (emergency room, intensive care unit, obstetrics unit, etc.)? My knowledge of sertraline and fluphenazine has expanded significantly and I hope to be able to be more comfortable with those drugs when I encounter them in the field.