vSim J Jones Clinical Packet Latest Update 2025

DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) Overview ▪ Persistent sad, dysphoric mood with symptoms severe enough to interfere with an individual's ability to eat, enjoy life, sleep, study, or work ▪ Unipolar depressive disorder with onset in early adulthood and recurrences throughout life (at least two more episodes in 50% to 60% of patients) ▪ May occur in clusters or sporadically (typically with increasing frequency); may recur after symptom-free period ▪ Over half of patients do not recognize they are suffering from a treatable disease and do not seek treatment ▪ May be abbreviated as MDD Pathophysiology ▪ Exact underlying changes are not clearly defined; studies show an association with an alteration in serotonin activity in the central nervous system. Other neurotransmitters, including norepinephrine and dopamine, may be involved. ▪ Central nervous system disturbances in serotonin activity have been demonstrated in clinical and preclinical trials. The neurotransmitters norepinephrine, dopamine, brain-derived neurotrophic factor, and glutamate have also been implicated. ▪ Changes occur in the receptor-neurotransmitter relationships in the limbic system. ▪ Changes in the hypothalamic-pituitary-adrenal regulation system may be an adaptive deregulation of the stress response. Causes ▪ Exact cause unknown but appears to be multifactorial ▪ Genetic, familial, biochemical, physical, psychological, and social causes ▪ Pain and other physical causes that result in secondary depression ▪ Drugs such as beta-adrenergic blockers ▪ Seasonal depression DIAGNOSTICS TESTS (Reason for Test and Results) Laboratory ▪ Toxicology screening suggests a drug-induced depression. Diagnostic Procedures ▪ Dexamethasone suppression test results may show a failure to suppress cortisol secretion. Other ▪ The Beck Depression Inventory, Hamilton Depression Rating Scale, or another screening tool shows the onset, severity, duration, and progression of depressive symptoms. PATIENT INFORMATION Jermaine Jones is a 34-year-old African American male who was diagnosed with depression 2 years ago. Takes Sertraline to help with his depression. Patient is a drinker and has been having a harder time coping with his depression due to it being his dad’s death anniversary. ANTICIPATED PHYSICAL FINDINGS ▪ Difficulty concentrating or thinking clearly ▪ Easily distracted ▪ Indecisiveness ▪ Delusions of persecution or guilt ▪ Agitation ▪ Psychomotor retardation ▪ Slow, monotone speech ▪ Flat affect ▪ Decline in grooming and hygiene ▪ Weight loss or gain ANTICIPATED NURSING INTERVENTIONS ▪ Encourage the patient to participate in psychotherapy, as indicated; reinforce the goals of therapy. ▪ Encourage the patient to express feelings. Allow time for the patient to talk; use therapeutic communication techniques to foster a trusting relationship. ▪ Listen attentively and respectfully; note and report any statements suggesting harm to self or others. ▪ Provide a structured routine. Encourage the patient to participate in activities and an exercise program; allow time for the patient to gradually increase the level of participation. ▪ Help the patient develop appropriate sleep hygiene measures to promote restful sleep. ▪ Encourage interaction with others; assist with initiating interactions on a small scale and gradually increasing them as the patient becomes comfortable. ▪ Document observations and significant conversations. ▪ Assume an active role in starting communication; begin slowly and simply to avoid overwhelming the patient. ▪ Plan activities for when the patient's energy levels are highest; encourage patient participation in self-care to foster self-esteem. ▪ Offer positive reinforcement for progress, regardless of how small the progress. ▪ Provide distraction from self-absorption and diversional activities, as appropriate. ▪ Perform suicide risk assessments and institute suicide precautions, as appropriate; maintain one-on-one contact, if indicated. ▪ Develop a safety plan with the patient that includes a list of coping strategies and sources of support. ▪ Administer medications, as prescribed, keeping in mind that it may take 2 to 6 weeks for drugs to become effective. ▪ Prepare the patient for ECT if a rapid response is needed or drug therapy has failed. VSIM ISBAR ACTIVITY Student Worksheet INTRODUCTION Milagros Ballesteros, LPN, Emergency Department Your name, position (RN), unit you are working on SITUATION Jermaine Jones, 34-year-old African American male, was brought to the emergency department by his wife Denise. She reported that he had been drinking a few beers and took one of her prescription tablets, alprazolam, for anxiety. When she got back, he was having trouble talking clearly and responding to her questions. His wife says that she has been getting increasingly worried about his mental Patient’s name, age, specific reason for visit BACKGROUND Diagnosed with depression 2 years ago and was prescribed sertraline 50 mg orally one time daily in the morning. His wife reports that he has been having a difficult time coping with the 1-year anniversary of his father’s death. According to his wife he has been taking his medication for depression as prescribed. Patient’s primary diagnosis, date of admission, current orders for patient ASSESSMENT Mr. Jones is drowsy, but arousable and oriented to person only. His pupils are equal, round, and reactive to light accommodation, and he’s able to move all extremities. His speech is slurred. Vitals signs are BP: 112/66, HR: 96, RR: 12/min, and SpO2 at 96% on room air. I started a 20-gauge IV in his right forearm at arrival. Normal saline is infusing at 100 mL/hr. Blood samples for BMP, CBC, and a serum alcohol level as ordered by Dr. Alvarez: waiting on results. Current pertinent assessment data using head-to-toe approach, pertinent diagnostics, vital signs. RECOMMENDATION Continue to monitor patient for level of consciousness and further sedative state. Educate patient on alcohol interactions with medications, especially medications that cause sedation. Monitor patient vitals for decreased level of consciousness. Notify doctor if patient becomes unarousable and gets into respiratory depression. Any orders or recommendations you may have for this patient NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: Sodium Chloride CLASSIFICATION: Minerals and electrolytes, Miscellaneous respiratory agents PROTOTYPE: Sodium Chloride CONTRAINDICATIONS: Sodium chloride interacts with patients who have sodium/water imbalance and acidosis. It also interacts with lithium and tolvaptan. Hypersensitivity and infusion reactions may occur with intravenous sodium chloride infusion. ADVERSE EFFECTS: Severe reactions: coma, seizures, central pontine myelinolysis, bronchospasm, increased intracranial pressure, renal failure, pulmonary edema, heart failure, oliguria, intraventricular hemorrhage, thrombosis, visual impairment. Moderate: hemolysis, hemoptysis, hyperchloremic acidosis, hyponatremia, encephalopathy, hypertension, edema, hypokalemia, hypernatremia, sodium retention, hepatomegaly, hyperchloremia, dehydration, erythema Phlebitis, chest pain (unspecified), dyspnea, hypotension, sinus tachycardia, infusion- related reactions. Mild: pharyngitis, sneezing, sinusitis, cough, hoarseness, weakness, anorexia, nausea, urticaria, injection site reaction, fever, infection, rash, tremor, pruritus, chills, flushing, ocular irritation, ocular pain. BLACK BOX WARNINGS: WARNINGS Sodium Chloride Injection, USP should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states in which there exists edema with sodium retention. In patients with diminished renal function, administration of Sodium Chloride (sodium chloride (sodium chloride injection) injection) Injection, USP may result in sodium retention. PRECAUTIONS Do not connect flexible plastic containers of intravenous solutions in series connections. Such use could result in air embolism due to residual air being drawn from one container before administration of the fluid from a secondary container is completed. Pressurizing intravenous solutions contained in flexible plastic containers to increase flow rates can result in air embolism if the residual air in the container is not fully evacuated prior to administration. Use of a vented intravenous administration set with the vent in the open position could result in air embolism. Vented intravenous administration sets with the vent in the open position should not be used with flexible plastic containers. SAFE DOSE OR DOSE RANGE, SAFE ROUTE Route: IV Dosage: can be given as a 0.45% solution or 0.9% solution. PURPOSE FOR TAKING THIS MEDICATION PATIENT EDUCATION WORKSHEET PATIENT EDUCATION WORKSHEET Normal Saline is a prescription medicine used for fluid and electrolyte replenishment for intravenous administration. Normal Saline may be used alone or with other medications. PATIENT EDUCATION WHILE TAKING THIS MEDICATION ▪ Monitor site for signs of IV infiltration and notify as soon as possible. ▪ Notify provider/staff of adverse effects ▪ Notify if shortness of breath or signs of edema or retaining fluid increases. NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: Alprazolam CLASSIFICATION: Benzodiazepines PROTOTYPE: Lorazepam CONTRAINDICATIONS: ▪ Contraindicated in patients hypersensitive to drug or other benzodiazepines and in those with acute angle-closure glaucoma. ▪ Use cautiously in patients with hepatic, renal, or pulmonary disease or history of substance abuse. ▪ Use cautiously in elderly patients. ADVERSE EFFECTS: CNS: insomnia, irritability, dizziness, headache, anxiety, confusion, drowsiness, light- headedness, sedation, somnolence, difficulty speaking, impaired coordination, memory impairment, fatigue, depression, suicide, mental impairment, ataxia, paresthesia, dyskinesia, hypoesthesia, lethargy, vertigo, malaise, tremor, nervousness, restlessness, agitation, nightmare, syncope, akathisia, mania. CV: palpitations, chest pain, hypotension. EENT: blurred vision, tinnitus, allergic rhinitis, nasal congestion. GI: diarrhea, dry mouth, constipation, nausea, increased or decreased appetite, anorexia, vomiting, dyspepsia, abdominal pain, increased or decreased salivation. GU: dysmenorrhea, sexual dysfunction, premenstrual syndrome, difficulty urinating. Metabolic: increased or decreased weight. Musculoskeletal: arthralgia, myalgia, arm or leg pain, back pain, muscle rigidity, muscle cramps, muscle twitch. Respiratory: URI, dyspnea, hyperventilation. Skin: pruritus, increased sweating, dermatitis. Other: influenza, injury, emergence of anxiety between doses, dependence, feeling warm, increased or decreased libido. BLACK BOX WARNINGS: ▪ Opioids should only be prescribed with benzodiazepines or other CNS depressants to patients for whom alternative treatment options are inadequate. ▪ Caution patient or caregiver of patient taking an opioid with a benzodiazepine, CNS depressant, or alcohol to seek immediate medical attention if patient experiences dizziness, light-headedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness SAFE DOSE OR DOSE RANGE, SAFE ROUTE Route: IV, PO, IM