SAMPLE SOLUTION
NR305 Week 6 iHuman Nurse Notes Template
Complete each item below:
S – F, age 19, 5’3″, 127 lbs. Dx: Ingestion of acetaminophen acutely. brought to the emergency room by EMS with abdominal pain and nausea. Acetaminophen consumption is reported by EMS for SI. Reports taking fifteen extra-strength (500 mg) acetaminophenone ~2000 pills after speaking with her partner on the phone. denies consuming any salt, ETOH, or other chemicals within the previous 24 hours. denies using medicines, over-the-counter medications, or herbal supplements at the moment. After waking up four hours later, I had second thoughts and called EMS. C/o n/v, abdominal ache, and a “clammy, hot” feeling. refutes any unusual bleeding or vomiting. denies palpitations, sobs, and CP. serum acetaminophen was 150 mcg/mL according to the lab results. Other laboratories LFT. IV in LAC NAC began, along with WNL. Dad used to suffer from depression, and mom and dad both suffer from anxiety. took the first steps to prevent suicide. The patient says they are “weary, l denies feeling queasy now; she did previously. denies experiencing unusual bleeding, palpitations, SOB, vomiting, or chest pain. The patient is “a little stressed and overwhelmed.”” Since I haven’t gone out with pals, I feel really alone.
B – h/o: depressive disorder since high school, at age 15. Since age16, I’ve been taking 20 mg of fluoxetine (Prozac) every day; I took my final dose this morning. Present-day psychotherapy is said to be successful. Stressors at college included her boyfriend breaking up with her, failing classes, and lack of friends. sad most of the time these days. Prior attempts at SI in high school. Indicates that her symptoms of depression vary from day to day and are not always present at the same time; she occasionally sleeps more or less, has less appetite, prefers to be by herself, or feels anxious. denies feeling anxious all the time. No chills, fever, sweats at night, or loss of weight.
A – A/ox4 c/o exhaustion. There is erythema surrounding the IV site on the left antecubital region of the arm, extending beyond the clear dressing and tape, but there are no symptoms of respiratory or cardiovascular distress. On both sides, many, varying-length scars on the medial thighs. Pale, warm, and diaphoretic skin.
VS: Full Code status; BP: 116/74, P: 66, RR: 12, T: 99.6 [elevated], SpO2: 96% [decreased].
R – Administer 50 mg of Diphenhydramine as directed and as needed for urticaria from the IV site from NAC due to the observed erythema. on SI safety measures and secure a 1:1 sitter for the patient. Ask the patient if she wants me to get in touch with any family members and give her coping skills training. Suggest starting a patient and family support group and continuing outpatient psychiatry. Given that Prozac is provided at a low dose of 20 mg, it will be recommended to alter the medicine due to depression that is getting worse due to life pressures.
Community Resources
More often than most people realise, nurses are at the forefront of mental health care. Depression is a condition that causes persistent emotions of sadness or hopelessness. Depression could lead to losS interest. Their daily lives could be hampered by these emotions. Many people rely on individual therapy for psychological support, but occasionally patients require more help than can be given by individual therapy alone. I would recommend Ms. Oxendine enrol in an intensive outpatient programme (IOP) because it looks she needs more extensive mental health services. IOP in San Diego can be accessed through Aurora Behavioural Health as one option. https://www.aurorasandiego.com/programs/san-diego-outpatient-services. Intensive outpatient therapy is focused therapy provided over a longer period of time. For instance, daily, three-hour sessions held five days in a row over a two to four week period might be used to deliver intensive treatment. Given that Ms. Oxendine feels lonely, I think enrolling in an IOP can help her develop the coping mechanisms she’ll need to deal with stress in the future.
In a one paragraph response, what findings in your iHuman assessment led you to select these two community resources for Ms. Oxendine?
I would give her phone numbers for 24/7 resources that can help her if she feels suicidal as the second community resource. Given that she has a long history of SI attempts, I think giving her a crisis resource can stop any further behaviour. Suicide Hotline: 1-800-784-2433 (1-800-SUICIDE), and National Suicide Prevention Lifeline: 1-800-273-8255 (1-800-273-TALK). I would also suggest that she abstains from alcohol and narcotics because these can make depression worse, and that she routinely consults with a therapist or PCP to track how well her antidepressants are working. I would advise her to maintain a balanced diet and do regular exercise because these activities create “feel-good” endorphins that can improve her mood. The majority of support groups that were formerly offered in person have shifted online to Zoom sessions as a result of COVID-19, according to websites like https://namisandiego.org/services/support-groups/. This is a problem in my neighbourhood, where many depressed people feel trapped in their homes and search for a change of environment to make them feel less isolated. I think that face-to-face support groups are helpful for people who are depressed, and I hope that they will reopen in the future.
1. In a one paragraph response, do you feel there are adequate resources available for patients suffering from mental health concerns and/or addiction residing in your area? Why or why not?
My local area has a relatively well-developed mental health care system, with a focus on prevention and early intervention. There are also a number of specialized services available for people with more severe mental health problems or addictio
Week 6: Discussion: Reflection on Nursing Assessment for Violence (Graded)
Purpose
The purpose of this reflection is for learners to reflect on the nurse’s role in health assessment in various care settings.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
- CO 3: Describe physical, psychosocial, cultural, and spiritual influences on an individual’s health status. (PO 1)
Due Date
During the assigned week (Sunday the start of the assigned week through Sunday the end of the assigned week):
- Posts in the discussion at least two times, and
- Posts in the discussion on two different days
Total Points Possible
50 points
Directions
- Reflection is an activity that involves your deep thought into your own experiences related to the concepts of the week. Answers should be detailed. In reflections students:
- Demonstrate understanding of concepts for the week
- Engage in meaningful dialogue with classmates and/or instructor
- Express opinions clearly and logically, in a professional manner
- Use the rubric on this page as you compose your answers.
- Scholarly sources are NOT required for this reflection
- Best Practices include:
- Participation early in the week is encouraged to stimulate meaningful discussion among classmates and instructor.
- Enter the reflection often during the week to read and learn from posts.
- Select different classmates for your reply each week.
Reflection Questions
Reflect on your current or prior practice experiences.
- Paragraph One
- Patients of any age, gender, cultural background or socio-economic status can be victims of violence. Consider a patient population you are currently working with or have worked with in the past. For what type of violence might they be at risk? What are some related findings that might alert you to investigate further?
- Paragraph Two
- Screening for signs of violence and abuse is a part of patient health history assessments. Have you observed the questions being asked by nurses or have you asked them to patients? Do you believe these screenings are typically completed in detail? Explain your answer.
Grading
To view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric. See Syllabus for Grading Rubric Definitions.
SAMPLE SOLUTION
I tend to work with older adult/geriatric patients in my day-to-day practice. This population is typically more vulnerable to neglect as opposed to outright violence and abuse. I fortunately cannot say that I have witnessed any violence or evidence of violence toward my patients, however this is not always easy to see. Most often, I will see cases of neglect from when my patient is admitted from a SNF or from home when they require the aid of a caregiver. It usually takes the form of weight loss, pressure ulcers that are worsening, moisture damage from incontinence, etc. A small handful of times, I have had patients admitted from trauma who were gunshot wound victims, but the evidence of violence for them is quite obvious and the police are almost always conducting an investigation.
Most of our patients are transferred from the ICU, but in the few times we admit a patient, we have a screening tool on our EHR that we are required to fill out upon admission. Most of the questions regarding abuse and neglect are asked to the patient directly. I tend to ask a single, open-ended question to my patients: “Do you feel safe at home?” and then extrapolate from there. This question is purposefully vague because I want my patient to tell me about anything in their home that concerns them. Recently, one of my patients expressed concern because his house had no power and he could not refrigerate his IV inotrope for his home pump. Other patients express concern about mobility. Some patients express concern about not having enough help at home, but I do not believe I have ever had someone report outright abuse to me. In addition to screening questions, we are also required to perform a two-person skin check to look for any wounds or skin conditions present when the patient is admitted. I have yet to witness any wounds that appear inflicted by another person.