CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)

CONCEPT MAP WORKSHEET

DESCRIBE DISEASE PROCESS AFFECTING PATIENT

(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)

Major depressive disorder is categorized by a persistent sad, dysphoric mood with symptoms severe enough to interfere with daily function. It is not known exactly what causes MDD but it is believed to be the cause of alterations of neurotransmitters.It is believed to be cause by genetic, familial, biochemical, physical, psychological and social causes.Risk factors include being female, familial history of MDD, stress, traumatic life events, chronic illness, and lack of social support.Complications include impaired daily functioning and increased risk of suicide.

DIAGNOSTIC TESTSPATIENT INFORMATIONANTICIPATED PHYSICAL FINDINGS

(REASON FOR TEST AND RESULTS)

Laboratory Toxicology screening suggests a drug- induced depression.Diagnostic Procedures Dexamethasone suppression test results may show a failure to suppress cortisol secretion.Other The Beck Depression Inventory, Hamilton Depression Rating Scale, or another screening tool shows the onset, severity, duration, and progression of depressive symptoms.Poor affect Loss of interest in activities Poor sleep hygiene Loss of appetite Hopelessness Difficulty concentrating or thinking clearly Easily distracted Indecisiveness Delusions of persecution or guilt Agitation Psychomotor retardation Slow, monotone speech Flat affect Decline in grooming and hygiene Weight loss or gain

ANTICIPATED NURSING INTERVENTIONS

Ineffective coping mechanisms related to inadequate coping skills AEB inablility to meet basic needs.-Identify situations that trigger suicidal thoughts this can help the client to develop more adaptive coping skills.-Assess the client’s social supports and supportive individual’s- client’s husband is present on admission.Hopelessness related to perceived hopelessness, helplessness AEB decreased affect and lack of motivation.-Work with client to determine areas of strength to rely on when feeling overwhelmed.-Identify things of joy that can help to reawaken the client’s abilities and inspire joy.-Encourage the client to express negative feelings to better understand causes of depression and hopelessness. This study source was downloaded by 100000809404281 from CourseHero.com on 04-06-2021 09:52:38 GMT -05:00

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vSim ISBAR ACTIVITYSTUDENT WORKSHEET INTRODUCTIONI am Veronica Mueller RN, working on the mental health unit.Your name, position (RN), unit you are working on SITUATIONLi Na Chen is a 40-year-old female who was admitted through the emergency room (ER) to our unit 5 days ago accompanied by her husband, Jack. Mrs. Chen was admitted for major depression and a suicide attempt, having ingested approximately 6000 mg of acetaminophen and 4800 mg of ibuprofen, medications that had been prescribed by the community clinic for complaints of back pain and headaches. Acetylcysteine was administered, and she underwent a gastric lavage in the ER and was then admitted to our unit for suicide precautions, stabilization, and mental health assessment.Patient’s name, age, specific reason for visit

BACKGROUND

Li Na was diagnosed with depression 3 years ago. She is an art historian, but she has been unable to work in recent years because of the depression. Prior to this hospitalization, her treatment plan included pharmacologic antidepressant therapy and biweekly counseling sessions. Two weeks ago, her nurse practitioner recommended tapering sertraline from 100 to 75 mg every day and adding venlafaxine 37.5 mg every day. This has now been adjusted again to 50 mg of sertraline daily and 37.5 mg of venlafaxine twice daily. Prior to the current suicide attempt, Li Na had two other attempts with drug overdoses over the past 3 years, both requiring hospitalization. Her last attempt before this admission was 1 year ago.Patient’s primary diagnosis, date of admission, current orders for patient ASSESSMENTMrs. Chen has been compliant with the treatment plan on the unit, attending her individual and group therapy sessions. Her mental health team would like to discharge her to home with continued pharmacologic and weekly therapy, both group and individual. Her last Hamilton Depression Scale reading showed only slight improvement. Her husband has expressed concern about his ability to continue to manage her in their home. He is concerned about how her illness affects their two children, Connie, aged 12 years, and Jack Jr, aged 14 years, and he feels she may not be ready for discharge. He has indicated that he would like to continue to be supportive, but with her three suicide attempts, he is simply worn out and wonders whether she needs to be in a more closely supervised environment. He just arrived and is in the room with her now. Mrs. Chen is eager to return home. Last night she slept better than on previous nights, but she still wakes up during the night and has trouble falling asleep again. Her vital signs at the beginning of our shift were as follows: temperature, 36.4°C (97.5°F); heart rate, 80 beats/min; respiratory rate, 12 breaths/min; and blood pressure, 114/72 mmHg. We have been checking complete blood count, liver and kidney function tests, and acetaminophen and ibuprofen blood levels daily. Acetaminophen and ibuprofen levels were high on admission but have decreased markedly. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin, total protein, and prothrombin time peaked on day 2 but then started falling again and are now back to or close to normal limits. Kidney function tests were also affected, but they are also on the way back to normal now. All of the results are available in the chart.Current patient assessment data using head to toe approach, patient diagnosis, vital signs RECOMMENDATIONYou will need to implement a discharge assessment for Mrs. Chen and the family, including a mental status examination of Mrs. Chen, to transition her to a partial hospitalization program before formal transition to home. You will also need to provide education for Mrs. Chen and her husband regarding available resources to assist her with self-care, stress management, and identifying signature trigger events. Please also complete a medication reconciliation and review it with Mrs.Chen and her husband. They may also benefit from education on nonpharmacologic interventions as well as a conversation on risk factors for readmission to the inpatient mental health setting.Any orders or recommendations you may have for this patient This study source was downloaded by 100000809404281 from CourseHero.com on 04-06-2021 09:52:38 GMT -05:00

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PATIENT EDUCATION WORKSHEET

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE

MEDICATION: s e r t r a l i n e h y d r o c h l o r i d e

CLASSIFICATION: SSRI antidepressants

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

Depression Adults: 50 mg PO daily. Adjust dosage as needed and tolerated; dosage range is 50 to 200 mg daily.

PURPOSE FOR TAKING THIS MEDICATION

Linked to drug’s inhibition of CNS neuronal reuptake of serotonin.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Adverse reactions include fatigue, headache, tremor, rash, myalgia, hot flashes, dry mouth, hypertension, suicidal behavior.Instruct patient to avoid stopping the drug abruptly.Do not consume with alcohol and to consult prescriber prior to taking OTC medications.Avoid taking the medication prior to activities that could be hazardous or require alertness.Patient should recognize symptoms of serotonin toxicity: fever, mental status changes, muscle twitching, excessive sweating, shivering or shaking, diarrhea or loss of coordination. This study source was downloaded by 100000809404281 from CourseHero.com on 04-06-2021 09:52:38 GMT -05:00

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PATIENT EDUCATION WORKSHEET

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE

MEDICATION: v e n l a f a x i n e h y d r o c h l o r i d e

CLASSIFICATION: antidepressant, SSNRI

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

75mg initially, increased to maximum of 225mg daily.

PURPOSE FOR TAKING THIS MEDICATION

This medication is used to treat depression through potent and selective inhibition of neuronal serotonin and norepinephrine reuptake and weak inhibition of dopamine reuptake.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Do not stop medication abruptly if on medication regiment longer than 6 weeks, must be tapered over 2 weeks.Avoid hazardous activities that require alertness and good coordination until effects of drug are known.Monitor for signs of worsening condition or suicidal ideation.Take with food and a full glass of water.Do not crush or chew extended release medications.Contact provider if she becomes pregnant or plans on becoming pregnant.Recognize signs and symptoms of serotonin toxicity; fever, mental status changes, muscle twitching, sweating, shivering, diarrhea, loss of coordination. This study source was downloaded by 100000809404281 from CourseHero.com on 04-06-2021 09:52:38 GMT -05:00

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