A 35years old man is brought in to Emergency room.Diagnosis :Assaulted hit on the head. (Found down)Right Temporal lobe Contusion.Left Frontal Hematoma.

Patient gets upset easily and start to yell.

Full code.weight 185lbs, Height 5feet 8inches.Alert and oriented x2.Cannot remember much.Allergy: NKDA.

Saline lock right forearm 18guage Clean/Patent/Intact.

Diet : Regular diet. Social worker/ Case manager consult.

VAX: PNA/ FLU given.

CT Scan of head done.Result pending.

Voiding well using the urinal at his bedside.

Laboratory results. K = 3.7 replaced 20meqkcl x1.WBC 8.5,magnesium 1.8,Na: 138.

CASE SCENARIO. DEPRESSION.

CODE STATUS Full code.

Height :5ft 9inches.

Weight: 125lbs.

Admitting Diagnosis: Depression.

Signs and symptoms of depression are withdrawn, regressive behavior, Obsessive thoughts, unkempt appearance, insomnia, psychomotor retardation.

Nursing Responsibilities:

Check for possible suicide, report behavioral changes, meet physical needs, structured, simple routines, use touch judiciously, encourage expression of feeling.

Treatment:

Antidepressant, group therapy, individual and family therapy.

A 65years old man recently retired salesman is brought in Psychiatric Hospital by his wife. His wife said that since her husband retired, he is restless, and roams around the house totally out of control. He complains that he has nothing to do. The patient said that without a job, I have no purpose in life. What is my reason to be living?. His wife said that he eats very little, has lost 10lbs and sleep for only three hours every night. In order to prioritize the patient’s nursing care plan ,the nurse should assess patient for Suicidal Ideation. By asking patient question to see if the patient has ever thought of hurting himself.

Questions:

Self-study Questions.

What causes depression?

Do the patient need nutrition consult?

Should his wife be afraid of her life?

Why is the patient turning his retirement inward?

Can he change his life and stop the anger?

Question:

01.When planning care for a 56years old man hospitalized with depression, the nurse include measures to increase his self-esteem. Which of the following actions should the nurse take to meet this goal?

Answer: Set simple realistic goals with him to help him experience success.

Questions:

2A.After two weeks of receiving lithium therapy a patient in the Psychological unit patient becomes depressed.

 Which of the following evaluations of the patient’s behavior by the nurse would be most accurate.

Answer: This is normal response to lithium therapy; the patient should be monitored for suicidal behavior.

2b.The nurse notes that the patient has not finished his meal. What will be the most appropriate nursing measures.

Answer: Order small frequent meals and sit with the patient while he eats in the dining room.

3.ECT: Electroconvulsive Therapy.

Stimulation for convulsions similar to grand mal seizures as treatment for depression.

Requires 6 – 12 treatment.

Preparation.

NPO 4hours, informed consent, encourage patient to avoid before starting procedure, remove jewelry, atropine 30minutes before to reduce secretions.

During Treatment: Short acting IV anesthesia and muscle relaxant, Oxygen, Suction available.

After Treatment: Confusion, and memory loss for recent events, stay with patient, reorient and check vital signs

4.A 48years old female is hospitalized with a diagnosis of bipolar disorder. While patient is in the patient activities room with other patients on the Psychiatric unit, she flirts with a male patient and disrupts unit activities. What will be the most appropriate action for the nurse to take.

Answer:

A.Distract her and escort her to her room. Non- threatening violence.

B.Do nothing ,it is what it is.

C.He is not violent.

D.Let him disrupt activities.

Correct answer A.

SYMPTOMS OF BIPOLAR DISORDER (Manic Depression).

Inappropriate dress, lack of inhibitions, hyperactivity, regressive behavior, Sexually indiscreet, Persecutory delusions, aggressive.

SOLUTIONS(Manic Depression).

Decrease environmental stimuli.

Meet up with patient physical needs.

Provide high calorie finger foods.

Assess for suicide as elation subsides.

Set limits.

Remain non-judgmental

Treatment:

Lithium medications.

Distract or redirect their energy.

Chose large physical activity to channel energy.

Set limits on the number of time they are on the phone.

Set clear limits and boundaries.

Communication should be firm.

Consistencies of setting limit is very important.For example “I cannot allow you to undress here”. Set limit, don’t be judgmental.

Avoid giving advice.

Encourage them to take care of their life.

Encourage to drink fluids frequently.

Serve patients food in their room because patient is too stimulated to eat in the dining room.

Supervise and encourage them to clean up after themselves.

Encourage expression of their real feelings.

Function as a role model by communicating your own feelings.

Encourage them to understand the needs of others.

Put their actions into words for them.

Lithium is their medication.

Contraindications:

Renal and Cardiac disease.

Signs of Lithium Toxicity.

Check Serum Lithium level in 2 – 3Weeks.

Alzheimer Disease

Alzheimer disease is defined as a progressive disorder that causes the brain cells to degenerate and eventually die. The memory loss associated with Alzheimer’s disease persists and worsens and affects the ability of daily living. Repeating of conversation, appointment, events but will not remember it later. Will get loss in familiar places. Alzheimer is the most common cause of dementia. It is a continuous decline in thinking, behavior and social skills that disrupts a person’s ability to function independently. This is irreversible, progressive brain disorder that slowly destroys memory and thinking skills.

5.Questions:

Question and answer:

What are the early signs of Alzheimer disease?.

Answer:

A.Forget to place her key in the draw.

B.Forgetful of recent events, conversations and eventually develop severe memory loss

C.Get confused with familiar places.

D. It is irreversible progression of brain disorder that slowly destroys memory and thinking skills.

Correct answer B

Rationale: B is the early sign of Alzheimer disease.

D is with the progression of the disease

6.68years old woman hospitalized with pneumonia became disoriented after a two days of admission.What information will be an indication of delirium rather than dementia?

Answer:

A.Patient was oriented and alert when admitted.

B.The onset of delirium occurs acutely. The level of disorientation does not differentiate between dementia and delirium.

C.All of the above.

D.None of the above.

Correct answer A.

7.A 69years old woman with moderate dementia had Appendectomy yesterday. Which intervention will the nurse include in the patient plan of care?

Answer:

A.Provide patient with delicious meals.

B.Reposition patient for pressure redistribution and comfort.

C.Suction patient to decrease the risk of aspiration.

D.Remind the patient frequently that she is in the hospital.

Correct answer D.

Rationale: Patient with moderate Dementia will have problems with short- and long-term memory. And she needs to be constantly reminded that she is in the hospital.

8.The nurse  is assessing a patient with cognitive impairment. And she ask the patient ,where are you?. What day of the week is it?.The nurse is assessing for?.

Answer:

A.Orientation.

B.Delirium and perseveration.

C.Confabulation.

D.Her room number.

Correct answer A

09.Which of the following best describe dementia?.

Answer:

A.Loss of cognitive abilities, impairing ability to  perform activities of daily living.

B.Severe cognitive impairment that will occur rapidly.

C.The memory loss  that will occur as  part of aging.

D.Difficulty coping with physical and psychological changes.

Correct answer A.

A 65years old man alert and oriented x3. Diagnosis I & D with partial right forthcoming Ray Amputation.

WBC 11.5.H on antibiotics Rocephin 1gm IV Q8hours scheduled.

Severe diabetic neuropathy.

Hx of drug abuse, Alcoholism, Nicotine addiction.Frequent flyer. Left the hospital and was later brought back by family.

Right wrist saline lock.

Code Status: DNR.

Patient requested for DNR

.Qac and Qhs.

Cbc with differential, Comprehensive Metabolic panel,LFT at 05am.

Discharge Patient with po antibiotics.

Patient to follow up with Outpatient Wound clinic in 1week.

Questions:

10a.Why did the patient request DNR?.( Do not resuscitate)

10b.What IV antibiotics is patient receiving?.

10c.When is the next laboratory tests?.