patient’s history, presenting problems and the related pathophysiological processes to identify priority problems

Question patient’s history, presenting problems and the related pathophysiological processes to identify priority problemscomprehensive assessment, i.e. specifc obsevation, assessment tools and or testsholistic plan of care is developed by setting specific goalsformulate nursing interventions and or treatments, with rationales and consider ways to evaluate the effectiveness of actionsconsider relevance of specific nursing standards, code of conduct, code of ethics and legalities and relevant legislationadherance to cultural awarenes and diversity considerationsConsider patient-centred care, recovery-oriented and trauma-informed practice, patient/consumer perspectives, and or lived experience researchConsider current/future nursing practice and research implicationsPatrick Smith is a 33-year-old male who has previously been diagnosed with Schizophrenia which includes paranoid and persecutory delusions or delusional thoughts, and has been on antipsychotic medication for the past 5 years. However, Patrick has stopped taking the prescribed anti-psychotic medication for approximately the last 3 months. Patrick complains they make him put on weight and make him feel “weird”. Typically, “weird” feelings include making him walk or pace all the time as “my legs feel restless” and he has put on 10 kilos of weight since taking the medication. The GP has previously explained to Patrick that antipsychotic medication for schizophrenia or other illnesses can cause type 2 diabetes when Patrick was diagnosed with type 2 diabetes one year ago. The GP explained the mechanisms for developing diabetes are due to the side effects which are drug-induced weight gain and a direct metabolic effect as the medication causes insulin resistance. Patrick has not followed the GP advice around dietary changes, increasing physical activity, and was only checking his BGL sporadically and taking some oral medications intermittently to control his blood glucose. He is now required to self-administer insulin but has so far been non-cooperative.Patrick presented at the Emergency Department with an ulcer on his left foot. It is malodourous with significant purulent exudate. Patrick has been reviewed by the Endocrinology Team who are concerned with Patrick’s unstable diabetes. He has also been reviewed by the Vascular Surgical team, who are concerned that the ulcer may lead to osteomyelitis and/or sepsis, and believe that Patrick requires urgent surgery and antibiotic therapy.Patrick should be taking the anti-psychotic medication: Olanzapine 20mg (nocte) and Quetiapine 200mg BD. Patrick is fearful of being in a strange place and finds being in hospital frightening as he feels someone might kill him. He tells you he is suspicious of some of the people on the ward including patients and health care professionals as he is scared, they might hurt him. He tells you he is fearful about being locked up for a crime he has never committed but there is a conspiracy against him, and he knows the CIA are involved in some way with this plot against him, and it is them who have caused this injury to his foot. In an earlier conversation with his parents over phoned they told you they were fearful of having Patrick at home as they are frightened as he has been verbally aggressive towards them recently which they feel is out of character. Patrick tells you that he has no thoughts of suicide or self-harm. He no longer wants to the medical treatment and wants to sign himself out of hospital against medical advice. He states he will go and see his GP post leaving hospital and arrange community treatment for his mental health and medical issues. He is very clear with you that he no longer provides informed consent for medical treatment and wishes to discharge himself immediately.The consequences of Patrick not having medical and surgical treatment puts him at significant risk of Sepsis and possible amputation of his left lower limb.Case Study Question:How would you as an Registered Nurse manage this situation?In your answer you will need to consider the Registered Nurse Standards for Practice and relevant legislation. Health Science Science Nursing NURSING HNB2104 Share QuestionEmailCopy link Comments (0)