Jenna Taylor _ Depression / Overdose with Psychosis_UNFOLDING Reasoning | Depression / Overdose with Psychosis_UNFOLDING Reasoning_2022/2023

Depression / Overdose with Psychosis: UNFOLDING Reasoning Jenna Taylor, 18 years old Primary Concept Mood and Affect Interrelated Concepts (In order of emphasis) 1. Safety 2. Psychosis 3. Clinical Judgment 4. Communication 5. Collaboration Depression/Overdose with Psychosis PART 1: History of Present Problem: Jenna Taylor is an 18-year-old woman who is brought to the emergency department by ambulance after she admitted to her mother that she had taken a “handful” of dextroamphetamine/amphetamine (Adderall) this morning. Mom noted that there are 20 tablets missing. Jenna admits that she has been hearing voices telling her that she is worthless and would be better off dead. She denies visual hallucinations. As the primary nurse explores these comments further, Jenna states, “The devil is in the place! I can feel it! The voices are telling me that I am going to hell forever.” Jenna appears fearful, anxious and does not maintain eye contact. When she briefly glances and looks your way, she appears to be looking through you. Personal/Social History: She was hospitalized three weeks ago for depression and suicidal ideation and was discharged ten days ago. Jenna lives with her mother. Her parents were divorced 12 years ago. She graduated from high school, has few close friends, and has no current plans for her future. What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: - 18-year-old woman - Admitted to her mother that she had taken a “handful” of dextroamphetamine/amphetamine (Adderall) this morning. Mom noted that there are 20 tablets missing. - Jenna admits that she has been hearing voices telling her that she is worthless and would be better off dead. - “The devil is in the place! I can feel it! The voices are telling me that I am going to hell forever.” - Jenna appears fearful, anxious and does not maintain eye contact. - Adolescent women with a history of depression and anxiety have a higher risk for suicide, especially when suicide attempts have been made in the past (Austin, Kunyk, Peternelj-Taylor, and Boyd, 2019). - Patient had intended to harm/kill herself as she was hearing voices telling her she would be better off dead. Hearing voices are triggering her suicidal ideation (Austin et al., 2019). - Auditory hallucinations can affect people’s lives tremendously. This is just one of the criteria for diagnosing someone with schizophrenia (Austin et al., 2019). Patient exhibiting auditory command hallucinations is serious and needs to be dealt with promptly, as this can cause suicide attempts and suicide (as seen in this case) (Austin et al., 2019). - Knowing what the patient is hearing can further help the nurse to establish a therapeutic relationship and reassure the patient they are safe (Austin et al., 2019). - People in acute psychosis are usually anxious and very fearful. Approaching the client calmly and quietly is important for the nurse to ensure they are therapeutic (Austin et al., 2019). RELEVANT Data from Social History: Clinical Significance: - She was hospitalized three weeks ago for depression and suicidal ideation and was discharged ten days ago. - Lives with her mother. - Parents divorced 12 years ago. - Has few close friends. - No current plan for her future. - People with a history of depression or suicidal ideation/attempts are high-risk patients (Austin et al., 2019). Also, because she was just recently discharged, the patient might need to stay in PICU longer this time around. - Patient lives with her mother and she is her main support. - Divorce may have been a significant trauma in her life, which has led to depression. - Having support systems is important in a patient with depression, anxiety, and acute psychosis (Austin et al., 2019). This could also indicate the patient is isolating herself from people (Austin et al., 2019). - Having no future goals can be a symptom of depression (Austin et al., 2019). Can be important to note as the nurse can refer the patient to the social worker to speak to the client about goals. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect.) PMH: Home Meds: Pharm. Classification: Expected Outcome: ● Attention deficit hyperactivity disorder (ADHD) [1]. ● Anxiety [2]. ● Depression with psychosis [3]. 1. Dextroamphetamine/amphetamine XR 20 mg PO daily 2. Clonazepam 0.5 mg PO BID 3. Bupropion HCL SR 100 mg PO BID - CNS Stimulant (Adams, Urban, El-Hussein, Osuji & King, 2018). - Benzodiazepine (Adams et al., 2018). - Antidepressant (Atypical antidepressant) (Adams et al., 2018). - Patient will be able to focus on tasks, control impulsiveness, and pay more attention to tasks, people, and all situations (Adams et al., 2018). - Patient will have a decrease in anxiety attacks (Adams et al., 2018). - Patient will show a decrease in anhedonia. They will express feelings of overall well-being and express an increase in pleasure in activities they did not enjoy with depression (Adams et al., 2018). One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if applicable), which disease likely developed FIRST, then initiated a “domino effect” in Jenna’s life? ● Circle the PMH problem that likely started FIRST. Attention deficit hyperactivity disorder (ADHD). ● Number the PMH problem(s) that FOLLOWED as domino(s). - - - - Continued