&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.docx.pdf*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
Patient Name: Mr. Z
MRN: XXXX
Date of Service: 06/05/2025
Start Time: 09:15 AM End Time: 09:55 AM
Billing Code(s): 99304, 90792
Accompanied by: None
Chief Complaint (CC):
Behavioral concerns: aggression, paranoia, wandering, and verbal outbursts
Subjective:
Mr. Z is a 68-year-old male with a history of Alzheimer’s disease who was recently admitted to
the facility after exhibiting physical aggression and paranoid ideation at home. He has shown
ongoing agitation, paranoia, verbal aggression, food throwing, wandering, and attempts to elope
since admission. He is minimally verbal, confused, and does not consistently respond to
questions. He has not reported any pain but appears irritable and distressed.
Family was involved in the ED evaluation and reported that Mr. Z recently threatened to burn the
house down, was suspicious of others trying to harm him, and had become physically aggressive.
Objective:
Vitals: T: 98.8°F, P: 88 bpm, R: 18, BP: 132/78
Appearance: Agitated, hyperactive, poorly cooperative, disoriented to time and place
Speech: Rapid, confused
Mood: Depressed/irritable
Affect: Labile
Thought Content: Paranoid ideation noted
Behavior: Pacing, wandering, food throwing, verbal aggression
Cognition: Disoriented to time and place; unable to complete MMSE
Insight/Judgment: Poor
Gait: Unsteady
Neurological: Cranial nerves grossly intact; DTRs 1+ symmetric
This study source was downloaded by 1827175 from cliffsnotes.com on 01-08-2026 19:21:46 GMT -06:00
&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.docx.pdf*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
https://www.cliffsnotes.com//study-notes/27808102 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
,&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.docx.pdf*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
Assessment:
F02.81 – Dementia in Alzheimer’s disease with behavioral disturbance
R45.1 – Restlessness and agitation
R41.82 – Altered mental status
Z91.83 – Wandering in diseases classified elsewhere
Plan:
Medication Management:
1. Risperidone 0.25 mg PO BID – to address agitation and psychotic symptoms (e.g.,
paranoia). Start with low dose due to age and dementia diagnosis.
2. Trazodone 25 mg PO at HS – for mood symptoms and sleep disturbance.
3. PRN Medications:
o Risperidone 0.25 mg PO q6h PRN for severe agitation
o Lorazepam 0.5 mg PO q6h PRN if agitation is not relieved by risperidone (use
cautiously and sparingly due to fall risk and sedation in elderly)
Instructions to Nursing Home Staff:
Administer medications as scheduled.
PRN medications may be given only if patient is significantly agitated, pacing
excessively, or posing risk to self/others.
Staff must notify PMHNP prior to administration for initial evaluation; if already
approved, administer and monitor per protocol.
Monitor and document patient’s behavior and vitals every 15 minutes for 1 hour after
PRN use, then every hour for 4 hours.
Report any adverse effects (e.g., sedation, EPS, orthostatic hypotension) immediately.
Safety Planning and Behavioral Interventions:
Implement 1:1 supervision until behaviors stabilize.
Redirect patient calmly and provide low-stimulation environment.
Secure exits to prevent elopement.
Engage patient in structured, calming activities.
This study source was downloaded by 1827175 from cliffsnotes.com on 01-08-2026 19:21:46 GMT -06:00
&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.docx.pdf*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
https://www.cliffsnotes.com//study-notes/27808102 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
Patient Name: Mr. Z
MRN: XXXX
Date of Service: 06/05/2025
Start Time: 09:15 AM End Time: 09:55 AM
Billing Code(s): 99304, 90792
Accompanied by: None
Chief Complaint (CC):
Behavioral concerns: aggression, paranoia, wandering, and verbal outbursts
Subjective:
Mr. Z is a 68-year-old male with a history of Alzheimer’s disease who was recently admitted to
the facility after exhibiting physical aggression and paranoid ideation at home. He has shown
ongoing agitation, paranoia, verbal aggression, food throwing, wandering, and attempts to elope
since admission. He is minimally verbal, confused, and does not consistently respond to
questions. He has not reported any pain but appears irritable and distressed.
Family was involved in the ED evaluation and reported that Mr. Z recently threatened to burn the
house down, was suspicious of others trying to harm him, and had become physically aggressive.
Objective:
Vitals: T: 98.8°F, P: 88 bpm, R: 18, BP: 132/78
Appearance: Agitated, hyperactive, poorly cooperative, disoriented to time and place
Speech: Rapid, confused
Mood: Depressed/irritable
Affect: Labile
Thought Content: Paranoid ideation noted
Behavior: Pacing, wandering, food throwing, verbal aggression
Cognition: Disoriented to time and place; unable to complete MMSE
Insight/Judgment: Poor
Gait: Unsteady
Neurological: Cranial nerves grossly intact; DTRs 1+ symmetric
This study source was downloaded by 1827175 from cliffsnotes.com on 01-08-2026 19:21:46 GMT -06:00
&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.docx.pdf*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
https://www.cliffsnotes.com//study-notes/27808102 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
,&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.docx.pdf*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
Assessment:
F02.81 – Dementia in Alzheimer’s disease with behavioral disturbance
R45.1 – Restlessness and agitation
R41.82 – Altered mental status
Z91.83 – Wandering in diseases classified elsewhere
Plan:
Medication Management:
1. Risperidone 0.25 mg PO BID – to address agitation and psychotic symptoms (e.g.,
paranoia). Start with low dose due to age and dementia diagnosis.
2. Trazodone 25 mg PO at HS – for mood symptoms and sleep disturbance.
3. PRN Medications:
o Risperidone 0.25 mg PO q6h PRN for severe agitation
o Lorazepam 0.5 mg PO q6h PRN if agitation is not relieved by risperidone (use
cautiously and sparingly due to fall risk and sedation in elderly)
Instructions to Nursing Home Staff:
Administer medications as scheduled.
PRN medications may be given only if patient is significantly agitated, pacing
excessively, or posing risk to self/others.
Staff must notify PMHNP prior to administration for initial evaluation; if already
approved, administer and monitor per protocol.
Monitor and document patient’s behavior and vitals every 15 minutes for 1 hour after
PRN use, then every hour for 4 hours.
Report any adverse effects (e.g., sedation, EPS, orthostatic hypotension) immediately.
Safety Planning and Behavioral Interventions:
Implement 1:1 supervision until behaviors stabilize.
Redirect patient calmly and provide low-stimulation environment.
Secure exits to prevent elopement.
Engage patient in structured, calming activities.
This study source was downloaded by 1827175 from cliffsnotes.com on 01-08-2026 19:21:46 GMT -06:00
&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.docx.pdf*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0
!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
10/16/2026, 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*Assignment_2_unit_4_MN664.docx10/16/2026,
https://www.cliffsnotes.com//study-notes/27808102 5:42:03 AM*&!#%#&&!%%#^#^&^!#&*^&^*#!(FG*T!^&*#*((*!#&()#_)#!*&$!*#)(!*##(*0Assignment_2_unit_4_MN664.
5:42:03 AM*&!#%#&&!%
