LindaWaterfall_ScenarioOverviewAnxiety.,WELL EXPLAINED GRADED A 100% CORRECT.

Scenario Overview Patient: Linda Waterfall Diagnosis: Left mastectomy. Severe anxiety Brief Summary: Linda Waterfall is a 48-year-old female of Native American descent. A few days ago, she was diagnosed after a biopsy with an aggressive form of breast cancer. Her provider recommended that she have a left mastectomy as soon as possible, followed by chemotherapy. This morning she was admitted to a room on the surgical floor and is awaiting the operating room call for transfer. Her cousin, Alice, is with her in the room. The scenario starts with the nurses responding to the call light, and when they enter the room, they find Linda’s belongings in disarray. Alice tells them that Linda has searched her belongings to find her medicine bundle but has realized that she forgot it at home. Linda is anxious, flushed, and breathing rapidly and states that she “can’t get her breath.” She tells the nurses that she knows she is going to die and that she does not want to have the surgery. The student nurses should recognize signs and symptoms of severe anxiety and use de-escalation techniques to help the patient reduce anxiety, including demonstrating active listening, using therapeutic communication, and offering to contact support people. They should also advocate for the patient in her right to delay or reschedule the surgery. Learning Objectives General: □ Identify the psychopathology of mental health disorders □ Assess contributory factors affecting care, including but not limited to psychosocial, cultural, spiritual, environmental, and socioeconomic factors □ Establish a therapeutic milieu that engages psychiatric patients and their families □ Identify the indications, therapeutic effects, side effects, and teaching implications of drugs used to treat the symptoms of mental health disorders □ Provide a safe environment for both patients and staff □ Recognize communication patterns and use therapeutic communication techniques that illustrate caring for the patient’s overall well-being □ Apply the nursing process to prioritize the plan of care □ Communicate appropriately with the therapeutic team in a timely, organized, collaborative, and patient-specific manner Scenario-Specific: □ Differentiate between acute anxiety and respiratory/cardiac distress □ Recognize and respond appropriately to level of anxiety demonstrated (mild, moderate, severe, panic) □ Incorporate respect for spiritual/cultural issues into the plan of care □ Advocate for the patient Patient Case Introduction to Students Location: Hospital surgical floor Time: 07:00 Handoff report from the nurse leaving the shift: Situation: Linda Waterfall is a 48-year-old patient of Dr. Samuels. She is scheduled for a left mastectomy this morning at around 08:30. Background: Linda is a Native American woman who was diagnosed with an aggressive form of breast cancer after a biopsy just a few days ago. She told me that her family lives far away and that they wanted her to come home to meet with the tribal healers before scheduling the surgery. She did not do that and instead took the first available date for the surgery. She’s been a little nervous, and while getting checked in, she mentioned that she has not been sleeping well. She shared that her mother died of complications of surgery. She also said she’s worried about the cancer and very unhappy about losing her breast. Her cousin, Alice, brought her to the hospital this morning and is staying with her until she has to go into surgery. Assessment: I’ve checked her in, and she is settled in room 2046. Now we’re just waiting on the call from surgery (Dr. Samuels). Her consent forms are signed and on the chart. I started her on intravenous (IV) dextrose 5% lactated Ringer’s. It’s infusing at 80 mL/h through an 18-gauge catheter in her right forearm. Her vital signs at check-in were as follows: heart rate, 80 beats/min; respiratory rate, 18 breaths/min; blood pressure, 135/85 mmHg; and temperature, 37.2°C (99.0°F). She has a small incision on the left breast from a biopsy last week. Her stitches were removed yesterday. The incision is dry and uncovered. She’s able to get to the toilet without assistance, and she will receive a urinary catheter in surgery. She reports she has had nothing by mouth since before midnight. She takes no regular medications at this time and refused to take her preoperative lorazepam. Recommendation: As I mentioned, she seems pretty nervous, so I recommend checking in on her and introducing yourself. I told her I would be leaving at 07:00, so she should be expecting someone new. Patient Details Patient Data: Female, Native American, 48 years old. Weight: 61 kg; Height: 163 cm Date of Birth: 4/7/XX Allergies: No known Past Medical History: □ The patient reports good health until this diagnosis, and she takes no regular medications. Provider’s Orders Yesterday at 08:00 □ Surgical oncology service □ Admit to surgical ward □ Nothing by mouth except for medications □ Lorazepam 2 mg once orally preoperatively at 06:00 □ Initiate IV dextrose 5% lactated Ringer’s at 80 mL/h on admission □ Consent forms have been signed under witness and placed on the chart. □ Vital signs once every 8 hours Overview of Proposed Correct Treatment □ Perform a scene safety check □ Wash hands □ Identify the patient □ Get consent from the patient for letting her cousin be a part of the interview □ Assess chest pain and difficulty breathing □ Auscultate lung and heart sounds □ Obtain vital signs □ Support the patient in deep breathing □ Provide patient education about possibilities and advocating for the patient □ Call the provider □ Provide patient education about discharge plans □ Use therapeutic communication throughout the case Case Considerations Generally, anxiety is divided into four levels: • Mild: Mild anxiety may increase the person's sensory perceptions. The person is alert and can see, hear, and understand what is happening around him or her. • Moderate: Perception is narrowed. The person may benefit from the guidance of others. The person may experience difficulty concentrating, a change in voice pitch or volume, or trembling. • Severe: The person may be unable to attend to events even when they are pointed out by others. Generally, the person experiences distorted perceptions, a sense of impending doom, a rapid heart rate, and rapid breathing. • Panic: The person may be unable to focus, want to flee, feel paralyzed by fear, or be completely withdrawn or extremely agitated. De-escalation techniques for patients with anxiety include the following: speaking while positioned directly in the patient’s field of vision; sitting down and asking the patient to sit down; giving the patient concrete directions; and keeping a clear, calm voice. As the patient calms, breathing exercises may be used. It is important to be able to distinguish between an anxiety attack and a heart attack. Physiologic concerns should always be initially ruled out, as symptoms of panic and a heart attack are often indistinguishable. Although it is important to never assume that an individual has a certain belief system based on his or her culture, assessing a patient’s spiritual beliefs is vital. This case illustrates how greatly a person’s spiritual beliefs can influence his or her health outcomes.