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
© 2016 Keith Rischer/www.KeithRN.com
, Depression/Overdose with Psychosis
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:
Patient!took!a!“handful”!of!dextroamph Patient!is!a!danger!to!herself,!because!she!intended!to!harm/
etamine/!amphetamine!(Adderall)!this! kill!herself!when!she!took!the!drugs.!The!drug!used,!amount!
morning!and!mom!noted!20!tablets!mi of!drug!used,!and!time!it!was!consumed!are!important!to!trea
ssing.!Patient’s!symptoms!include;!fea ting!the!patient.!The!patient's!symptoms!are!important!for!tre
rful,!anxious,!she!doesn't!make!eye!co atment!and!diagnosis.!Auditory!command!hallucinations!are!
ntact,!and!she!is!hearing!voices!telling serious!and!need!to!be!handled!immediately,!because!they!p
!her!she!is!“worthless!and!would!be!be ut!the!patient!at!risk!for!harming!others!or!themselves.!Patien
tter!off!dead”!also!voices!telling!her!sh t!is!also!fearful,!anxious,!and!doesn't!make!eye!contact!which
e!is!“going!to!hell!forever”" !could!mean!the!patient!is!in!a!psychotic!state.!
RELEVANT Data from Social History: Clinical Significance:
Patient!was!hospitalized!3!weeks!ago! Patient!had!a!history!of!depression!and!suicidal!ideatiom!whi
for!depression!and!suicidal!ideation!an ch!put!the!patient!an!increased!risk!for!suicide.!Patient!was!di
d!was!discharged!10!days!ago.!Patien scharged!10!days!ago,!and!a!readmission!within!30!days!afte
t’s!parents!were!divorced!12yrs!ago.!P r!discharge!calls!for!observation.!The!divorce!could!be!a!caus
atient!has!few!close!friends.!Patient!liv e!of!depression.!Patient!seems!to!be!isolating!herself!for!soci
es!with!mom!and!has!no!current!plans ety,!because!she!has!few!close!friends!and!has!no!future!goa
!for!her!future. ls.!Isolation!can!make!depression!worse.!!!"
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:
x Attention deficit 1. Dextroamphetamine/amphetamine XR 1.!CNS!stimulants" 1.!Patient!will!have!i
hyperactivity 20 mg PO daily 2.!Benzodiazepines!" ncreased!attention!s
disorder (ADHD) 2. Clonazepam 0.5 mg PO BID 3.!Antidepressants!" pan"
x Depression with 3. Bupropion HCL SR 100 mg PO BID 2.!Patient!will!have!d
psychosis ecreased!anxiety!"
x Anxiety 3.!Patient!will!have!d
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?
x Circle the PMH problem that likely started FIRST.
x Underline at PMH problem(s) FOLLOWED as domino(s).
© 2016 Keith Rischer/www.KeithRN.com
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
© 2016 Keith Rischer/www.KeithRN.com
, Depression/Overdose with Psychosis
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:
Patient!took!a!“handful”!of!dextroamph Patient!is!a!danger!to!herself,!because!she!intended!to!harm/
etamine/!amphetamine!(Adderall)!this! kill!herself!when!she!took!the!drugs.!The!drug!used,!amount!
morning!and!mom!noted!20!tablets!mi of!drug!used,!and!time!it!was!consumed!are!important!to!trea
ssing.!Patient’s!symptoms!include;!fea ting!the!patient.!The!patient's!symptoms!are!important!for!tre
rful,!anxious,!she!doesn't!make!eye!co atment!and!diagnosis.!Auditory!command!hallucinations!are!
ntact,!and!she!is!hearing!voices!telling serious!and!need!to!be!handled!immediately,!because!they!p
!her!she!is!“worthless!and!would!be!be ut!the!patient!at!risk!for!harming!others!or!themselves.!Patien
tter!off!dead”!also!voices!telling!her!sh t!is!also!fearful,!anxious,!and!doesn't!make!eye!contact!which
e!is!“going!to!hell!forever”" !could!mean!the!patient!is!in!a!psychotic!state.!
RELEVANT Data from Social History: Clinical Significance:
Patient!was!hospitalized!3!weeks!ago! Patient!had!a!history!of!depression!and!suicidal!ideatiom!whi
for!depression!and!suicidal!ideation!an ch!put!the!patient!an!increased!risk!for!suicide.!Patient!was!di
d!was!discharged!10!days!ago.!Patien scharged!10!days!ago,!and!a!readmission!within!30!days!afte
t’s!parents!were!divorced!12yrs!ago.!P r!discharge!calls!for!observation.!The!divorce!could!be!a!caus
atient!has!few!close!friends.!Patient!liv e!of!depression.!Patient!seems!to!be!isolating!herself!for!soci
es!with!mom!and!has!no!current!plans ety,!because!she!has!few!close!friends!and!has!no!future!goa
!for!her!future. ls.!Isolation!can!make!depression!worse.!!!"
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:
x Attention deficit 1. Dextroamphetamine/amphetamine XR 1.!CNS!stimulants" 1.!Patient!will!have!i
hyperactivity 20 mg PO daily 2.!Benzodiazepines!" ncreased!attention!s
disorder (ADHD) 2. Clonazepam 0.5 mg PO BID 3.!Antidepressants!" pan"
x Depression with 3. Bupropion HCL SR 100 mg PO BID 2.!Patient!will!have!d
psychosis ecreased!anxiety!"
x Anxiety 3.!Patient!will!have!d
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?
x Circle the PMH problem that likely started FIRST.
x Underline at PMH problem(s) FOLLOWED as domino(s).
© 2016 Keith Rischer/www.KeithRN.com
