Li Na Chen Part 1.,WELL EXPLAINED WITH VERIFIED ANSWERS.

Documentation Assignments 1. Document the search of Mrs. Chen and her belongings on admission. Mrs. Chen was explained the reason for the search of her belongings in order to maintain safety for her due to her suicide risk as well as for others. The items removed were a nail file, unwrapped tweezers, a travel sewing kit, a decorative pill box, a personal cell phone, a belt, shoelaces, and a string from her hoodie. 2. Document the safety checks for Day 1. The scene was checked for safety and deemed appropriate because the nurse could get out of the room if needed. 3. Document the findings of the mental status examination of Mrs. Chen on admission. Mrs. Chen is appropriately dressed for age and weather. She is clean and well-kept other than her hair, which is slightly disheveled. She has a slumped posture with no automatisms, such as tics, tremos, akathisia, or restlessness. Her mood is sad and depressed and her affect is congruent with her thought content. She does not have any indications of speech variations, like neologisms, aphasia, or pressured speech. Her thought content involved worries, frustrations, hopelessness/helplessness. She denies hallucinations. Thought process is goal-directed. She acknowledges self-harm or suicide urges as well as acknowledging death wish without suicidal intent. She denies homicidal ideation. She is positive for anhedonia. Mrs. Chen is orientated X3 with long-term memory deficits but a focused attention span. Her insight is good. 4. Document the findings of the suicide assessment of Mrs. Chen. Mrs. Chen stated, “ I cannot even do one thing right,” “I don‘t want help; I just want to get away from this pain,” “I don’t think I can go on,” when asked if Mrs. Chen has any thoughts or wishes to harm or kill herself. 5. Identify and document key nursing diagnoses for Mrs. Chen. Risk for Suicide, Ineffective Coping, Helplessness 6. Referring to your feedback log, document all nursing care provided and Mrs. Chen’s response to this care. Feedback Log 7 harm anybody else? The patient said: No. 12:0 3 You asked the patient: Have you ever tried to harm or kill somebody else? 12:2 0 The patient said: I don't think I can go on.nYou answered: Are you thinking about hurting yourself? nYou used the therapeutic technique of restating. 12:2 5 You asked the patient: Can you tell me what a desired outcome of treatment would be for you? The patient said: I don't know. I can't do anything right. 12:3 8 You supported the patient's husband. 12:5 4 You asked the patient: How do you understand your problems? 13:0 7 The patient said: I'm nothing.nYou answered: Do you feel that you have no self-worth? nYou used the therapeutic technique of translating into feelings. 13:1 1 You asked the patient: Do you ever see or hear things that other people do not? The patient said: No, I do not. 13:1 8 You asked the patient: Do you find that you worry more than others? The patient said: I worry about many things. 13:2 6 You asked the patient: Are you frightened of anything? 13:3 6 The patient said: No one will care about me anymore.nYou answered: Who do you care about? nYou used the therapeutic technique of exploring. 14:3 You removed potentially dangerous objects. 7. Document patient education regarding medications. Mrs. Chen was educated that her physician will be adjusting her medications while she is admitted to the hospital. Mrs. Chen was educated that it’s important for her to adhere to the treatment plan and openly communicate with hospital staff. Mrs. Chen was educated on the healthcare team finding the right mix of medications and other treatments to help her through her difficult time. 8. Document your handoff report in the SBAR format to communicate the care plan for Mrs. Chen to the nurse on the next shift. Situation: Li Na Chen is a 40-year-old Chinese female who presented to the emergency room (ER) accompanied by her husband, Mr. Jack Chen. Mr. Chen reported that upon his return home today, he found his wife crying on the bathroom floor surrounded by several empty pill bottles. He reported that his wife told him "she can’t live like this" and "she simply cannot function this way anymore." She has been admitted from the ER with major depression and suicide attempt. Background: Li Na was diagnosed with depression 3 years ago, and she has had two suicide attempts with drug overdose over the past 3 years, requiring hospitalization both times. Her last attempt was 1 year ago. She sees a psychiatric nurse practitioner with prescriptive authority. Her treatment plan includes pharmacologic antidepressant therapy and biweekly counseling sessions. Her usual dose of sertraline was 100 mg, but 2 weeks ago, the nurse practitioner recommended tapering her sertraline and beginning a trial of venlafaxine. Since then, the nurse practitioner has been on vacation, and Li Na is scheduled for a follow-up upon her return from vacation. During the past 2 weeks, Li Na has made three visits to the community clinic with varying complaints of low back pain and headaches with increasing difficulty sleeping through the night. She has been prescribed extra-strength ibuprofen (600 mg) 4 times a day and as- needed extra-strength acetaminophen (500 mg). These are the drugs she overdosed on in her suicide attempt. Her husband also reports that she has lost 10 lb in the past month due to lack of appetite. Assessment: The pill bottles for her recently prescribed acetaminophen and ibuprofen accompanying her appear empty. Mrs. Chen claims to have been using the medications as prescribed by the community clinic. Her husband reports that she may have taken approximately 6000 mg of acetaminophen and 4800 mg of ibuprofen. Acetylcysteine 7000 mg in 200 mL of 5% dextrose in water was given in the ER, and she underwent a gastric lavage; many recognizable pills were identified in the contents. Her vital signs are being monitored; the last set of vitals done at 1500 are as follows: temperature, 37°C (98.6°F); heart rate, 80 beats/min; respiratory rate, 16 breaths/min; and blood pressure, 112/70 mmHg. Blood for laboratory tests was obtained in the ER. The results are available in the chart. The acetaminophen level was 80 mcg/mL, and the ibuprofen level was 150 mcg/mL. They also assessed her depression in the ER using the Hamilton Depression Scale. The result is in her chart. I performed a Mental Health Status Examination. The result is in her chart. Any potentially dangerous objects were removed from Mrs. Chen belongings. Recommendation: Maintain safety precautions and safety checks. Continue monitoring vital signs. Perform Mental Health Status Examination in five days to compare to baseline