Alex, a 23 year old male with schizophrenia is admitted to the Acute Mental Health ward with a drug induced psychosis after 2 weeks of smoking marijuana. His mental status further deteriorated after admission and he became extremely violent and aggressive. His physical status has also begun to decline as evidenced by physical observation and High Blood Glucose level (Bulgari et al., 2018). Staff observed he was unable to walk in a straight line, increased frequency of urination and abnormal body signs and symptoms such as increased respiratory rate, increased blood glucose rate and increased blood pressure level (Segal, Qualls & Smyer, 2018). The vital signs that are presented show that his condition is deteriorating (Scheid & Wright, 2017). For example his respiratory rate (RR) is above normal, the normal range being 12 to 20 (Zeanah, 2018). Other than this it is also found that the BP of the patient is quite high which is132/68 and with this blood pressure his condition is getting worse (Bulgari et al., 2018). His heart rate is also beyond the normal range and that is significant here. This is an acute sign of deterioration. His blood sugar level is 30.2mmol/L is high and this level is trending towards the deterioration of the patient (Scheid & Wright, 2017). These signs identify the patient requires a rapid response as the patient is not “between the flags” and requires immediate attention so his condition is contained and he does not deteriorate further. (Segal, Qualls & Smyer, 2018). The NSW public hospitals always use “ Between the Flags”(BTF) to identify the early detection of deteriorating signs in health condition (Bulgari et al., 2018). The BGL shows that his health condition is in the risk zone and thereby a quick action and clinical review is very much necessary (Scheid & Wright, 2017). What happens if his BGL increase , justify it, whether it effect him , refer it through reference and put reference also (https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631) .
The BGL is already in the risk zone and if it increases then it will have a direct impact on Alex’s physical state. It can lead to increasing the risk of stroke or heart disease and also can lead to the condition of hyperglycemia. Alex is already having high respiratory rate and added BGL can worsen the condition ("Hyperglycemia in diabetes - Symptoms and causes", 2020). It can have other impacts such as increased thirst, fatigue and mood swings. It is thereby necessary that a quick clinical review and action is taken. The vital signs such as respiratory rate, blood pressure, heart rate and blood glucose level are not BTF and may cause potential harm to the patient (Segal, Qualls & Smyer, 2018). The patient requires immediate clinical response (Lau et al., 2018). The signs and symptoms fully justify the decision of immediate clinical response and clinical review as well. It is observed that the fluid intake of Alex is 5 liters a day which is more than the normal leads to increased urination as well (Cecil et al., 2017). The fluid intake amount is mainly due to his unsettled body condition and that is to be noted here (Goncy et al., 2017). Other than this signs of his heart rate can also be seen and his heart rate is above the normal mark and that is 140.
Hello, Dr X, I am an Registered Nurse calling from Mental Health Ward to talk about patient named Alex.
I am a registered nurse in the acute mental health Ward and am calling about a 23 year old male with named Alex.
Alex has a diagnosis of schizophrenia and has been smoking marijuana for past 2 weeks leading to the decline in his mental state. His observations are currently, RR is above normal and is 31, his oxygen saturation level is 96% and his blood glucose level is 30.2mmol/L and his heart rate is 140. He has also become very aggressive and violent while on the ward. His physical observations are currently deranged.
He has a history of substance abuse. It is also known that he has a history of acute psychosis with hallucinations and delusions. His psychosis is further adding to the challenges managing him on the ward.
Currently psychotic, it is unknown if he currently has delusions, hallucinations but he is showing mood disturbances and other symptoms of decline in his mental status. His physical condition presenting main concern. Airway- airway is clear and no obstruction found Breathing – respirator rate is high which is 31 and SPO2 is 96% Circulation- Bp is 132/68 and HR is 140 which is also above normal Disability – he cannot walk straight and is disoriented to time and place Exposure to skin- it is normal Fluids- consuming 5 litres of water each day Glucose level- 30.2mmol/L and this is on a higher side
The recommendation here is patient needs a diabetic Review, and some PRN sedative or antipsychotic to assist with his mood. Could the patient please be reviewed as per Rapid Response protocol and is there anything you would like to do before arriving?
The immediate nursing intervention would include administration of medication charted by Rapid Response Dr. mainly include providing him with necessary medicines so that the high blood pressure level, the blood glucose level and the respiratory rate are decreased and are put into place (Segal, Qualls & Smyer, 2018). To put the oxygen saturation level to normal Hudson mask is used in his case. The rapid nursing management approach is based on all the signs and vital symptoms and also on the psychological condition of the patient (Scheid & Wright, 2017). One necessary step here is to dwell on the use of any kind of sedative drug since he has been very aggressive and violent (Scheid & Wriht, 2017). Any kind of sedative drug such as doxepin, agomelatine, trimipramne and other can be used in this case and these drugs are quite powerful (Segal, Qualls & Smyer, 2018). Over the counter drugs can also be used in emergency or necessary case so that the risk can be put under control and also that the condition of aggression and violence can be done away with (Segal, Qualls & Smyer, 2018).The other emergency step includes Electro Convulsive Therapy if the situation goes out of hand (Segal, Qualls & Smyer, 2018). Other than this it is also that the approach of mental health nursing needs to be adopted and that needs to be a therapeutic one so that the patient feels well connected with the nurse and also that he feels positive and better (Segal, Qualls & Smyer, 2018). This discussion thereby refers to all the necessary points that are there related to immediate nursing management of the patient and also refers to ways that can help in treating Mr. Alex and enhancing his mental state. Other than this it is also important to focus on blood biochemistry and ECG (Bakker et al., 2016). Blood biochemistry is all about assessing the lipid, carbohydrate, nucleic acid and protein proportions and this is needed in this context so that the nursing intervention is proper and to the mark (Bruffaerts et al., 2018). Nursing management also includes ECG and this will provide knowledge about the activity of the heart and given that Alex is already having high RR this intervention is necessary here (Benbow, 2017).
Ongoing Management (you need to write about ongoing management in the last question such as monitoring of vital signs, management of physical problems, medications, attention of non- medical needs ( food, rest). I think he is a smoker that’s why he had high bp and heart rate, if he is you can talk about managing nicotine dependence, check his bgl , I need 400 words atleast for ongoing management.
Ongoing management includes monitoring of the vital signs and symptoms of the patient and also keeping a note on that. The physical problems here include acute psychosis, schizophrenia and aggressive behaviour as well (Silove, Ventevogel & Rees, 2017). The physical signs determination is also a part of the ongoing management and the signs such as Rr, oxygen saturation level, heart rate and others are known (Kolko et al., 2018). His blood sugar level is 30.2mmol/L, RR is 31, HR is 140 and all these are above normal rates and thereby require attention and observation as well (Silove, Ventevogel & Rees, 2017). In this prospect his diet needs to be monitored and that needs to be very light and simple and on the other hand medication for high blood sugar and heart rate and respiratory rate needs to be administrated (Bakker et al., 2016). The physical problems mainly can be accessed through these signs and other than this the signs such as inability to walk in straight line and aggressive behaviour due to mental illness or unhealthy mental approach can be known from here (Evans et al., 2018). The management of these physical issues can be done through medication administration and also through nursing interventions like keeping a through watch of all the vital records and signs. Management of the physical issues can also be done through medical treatment and that is also considered here. The provision of the registered nurses as well as doctors and healthcare staffs are important here and that is required to be noted in this context (Segal, Qualls & Smyer, 2018). The case is managed by the care team of the mental ward and also at the same time the case is looked after all the registered nurses (Scheid & Wright, 2017). It is the registered nurses who mainly look after the minute details and other than that the healthcare professionals are also there that include the psychiatrists, doctors, educators eg Diabetic, Occupational therapist and on Discharge their GP or Case Manager if assisgned. (Segal, Qualls & Smyer, 2018). The team is active and works towards the betterment of the situation so that the outcome is better and also that the outcome is positive for the patient (Freeman et al., 2017). The interdisciplinary team works in an organized manner so that the goals of treating the patient as per the guidelines and also as per the signs and symptoms are made effective and result oriented (Silove, Ventevogel & Rees, 2017).
Scheid, T. L., & Wright, E. R. (Eds.). (2017). A handbook for the study of mental health. Cambridge University Press.
Segal, D. L., Qualls, S. H., & Smyer, M. A. (2018). Aging and mental health. John Wiley & Sons.
Slade, M., Oades, L., & Jarden, A. (Eds.). (2017). Wellbeing, recovery and mental health. Cambridge University Press.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.
Zeanah, C. H. (Ed.). (2018). Handbook of infant mental health. Guilford Publications.
Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2016). Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR mental health, 3(1), e7. https://mental.jmir.org/2016/1/e7/?source=post_page---------------------------
Evans, T. M., Bira, L., Gastelum, J. B., Weiss, L. T., & Vanderford, N. L. (2018). Evidence for a mental health crisis in graduate education. Nature biotechnology, 36(3), 282. https://www.nature.com/articles/nbt.4089.pdf?origin=ppub
Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological medicine, 47(14), 2393-2400. https://www.cambridge.org/core/journals/psychological-medicine/article/virtual-reality-in-the-assessmentunderstanding-and-treatment-of-mental-health-disorders/A786FC699B11F6A4BB02B6F99DC20237
Silove, D., Ventevogel, P., & Rees, S. (2017). The contemporary refugee crisis: an overview of mental health challenges. World Psychiatry, 16(2), 130-139. https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20438
Cecil, C. A., Viding, E., Fearon, P., Glaser, D., & McCrory, E. J. (2017). Disentangling the mental health impact of childhood abuse and neglect. Child Abuse & Neglect, 63, 106-119. https://www.sciencedirect.com/science/article/abs/pii/S014521341630285X
Bruffaerts, R., Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., ... & Kessler, R. C. (2018). Mental health problems in college freshmen: Prevalence and academic functioning. Journal of affective disorders, 225, 97-103. https://www.sciencedirect.com/science/article/abs/pii/S0165032716324545
Bulgari, V., Ferrari, C., Pagnini, F., de Girolamo, G., & Iozzino, L. (2018). Aggression in mental health residential facilities: A systematic review and meta-analysis. Aggression and violent behavior, 41, 119-127. https://www.sciencedirect.com/science/article/abs/pii/S1359178917301659
Lau, C., Stewart, S. L., Saklofske, D. H., Tremblay, P. F., & Hirdes, J. (2018). Psychometric evaluation of the interRAI Child and Youth Mental Health disruptive/aggression behaviour scale (DABS) and hyperactive/distraction scale (HDS). Child Psychiatry & Human Development, 49(2), 279-289. https://link.springer.com/article/10.1007/s10578-017-0751-y
Goncy, E. A., Sullivan, T. N., Farrell, A. D., Mehari, K. R., & Garthe, R. C. (2017). Identification of patterns of dating aggression and victimization among urban early adolescents and their relations to mental health symptoms. Psychology of violence, 7(1), 58. https://psycnet.apa.org/journals/vio/7/1/58.html?uid=2016-03233-001
Kolko, D. J., Herschell, A. D., Baumann, B. L., Hart, J. A., & Wisniewski, S. R. (2018). AF-CBT for families experiencing physical aggression or abuse served by the mental health or child welfare system: an effectiveness trial. Child maltreatment, 23(4), 319-333. https://journals.sagepub.com/doi/abs/10.1177/1077559518781068
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