QUESTIONS: If all 4 of these patients were assigned to you, which…

Question Answered step-by-step QUESTIONS: If all 4 of these patients were assigned to you, which… QUESTIONS:If all 4 of these patients were assigned to you, which one would you visit first and why? How would you ensure a safe environment for these patients? Discuss the medications that you would anticipate each of these patients to be prescribed and why. What risks are associated with these meds? Develop an individualized list of discharge planning needs for each patient.  JAMES, ADOLESCENT PATIENT WITH BIPOLAR DISORDERJames, a passionate, 16-year-old high school sophomore is an honors student who loves science. He says he was always very moody and changeable and could “just switch moods in a moment.” In the past year or two his moods were getting more extreme. His heart would start to race and his thoughts would be “all over the place” like on a roller coaster. His friends would let him go on for a while and then try to rein him in to no avail. He would feel “tall and confident.” James had “big life plan,” like it was “his time.” Ideas and ambitions came clearly and easily; then too fast. He couldn’t make them stop. He would bang his head against the wall at home to try to stop them. He started hiding alcohol in his room to calm himself down. Sometimes, he would not get out of bed to go to school. He lost focus in school and couldn’t concentrate on doing the work. He fell behind and was failing courses. James started lying to cover up his behaviors. He pushed his friends away because they didn’t “get” him. He stopped trusting his family and his family lost trust in him. He started screaming at his parents and siblings at home and threw things at them. They could not manage him. In his room, he started to think of ways to kill himself. James told this to his older brother who managed to talk James into going to doctor and he was admitted 3 days ago. Now that he is here, he is refusing to participate in therapy and says everyone here is a “loser”—patients and staff. When you go into his room, he is facing the wall and sounds angry. He said he hates the food in this place.1)  Name five therapeutic communication techniques you would use with James. Define each and give an example for each that you would use in speaking to James.2)  Name three coping mechanisms James used in trying to deal with his illness. Were they positive or negative? What might you suggest to him as alternative coping mechanisms, consider including online apps and resources.  DORIS, ADULT PATIENT WITH CHRONIC BIPOLAR DISORDERDoris, age 42, is single and has a daughter who is 12. Doris grew up in and out of foster care due to her parents’ struggles with addiction. She suffered with chronic insomnia as a teenager. She would have racing thoughts, hopelessness and constant suicidal ideation. She was told she was bipolar at the age of 20 and was put on a drug which made her made her gain weight and feel “like a slug.” She stopped taking the pills and changed doctors. Since then, she has been to many doctors. None of them ever asked her if she had been diagnosed with a mental illness and Doris didn’t mention it. She didn’t believe she was “a mental case.” She wasn’t “one of those.” She has had recurrent manic episodes preventing her from maintaining employment and leading to two bankruptcies. She once spent $300 on different colored duck tape. She sold whatever belongings she had at a street fair, thinking she would make enough to open a gift shop where she could sell her drawings and art. She engaged in compulsive, hypersexual behavior and lived for years with whoever she was sleeping with at the time. At times, Doris would get depressed and stay in bed for days, feeling intense shame about her life and behavior. In moments of lucidity, she regretted not being the mother she wanted to be to her daughter who is in foster care. At one point, the person she was staying with told Doris she had to leave. She began sleeping on her aunt’s porch since the aunt would no longer let her live in the house. She began to feel utterly hopeless and began fantasizing about death. She made a plan for suicide and took a bottle of barbiturates. Then Doris went walking on Route 30. She was trying to build up the courage to step out in front of a truck. Instead, she fell asleep and fell down on the shoulder. She was found by a driver who stopped and called 911. She was admitted to Phil Haven 6 weeks ago. She is stable now and enjoys talking with you.1)  Discuss the incidence of suicide in bipolar patients. If you suspected during your shift that Doris was suicidal, what would you say to her? What actions would you take? What is the National Suicide Hotline number?2)  At what level of Maslow’s Hierarchy of Needs is Doris functioning? How would you address helping her at that level? IVAN, ADULT PATIENT WITH ACUTE BIPOLAR EPISODEIvan is a 37-year-old physician working in a family medicine practice in his home town. It is his father’s practice and Ivan began working there as his father nears retirement. Ivan was successful in school and has always been ambitious. He wanted to build the practice larger and busier. He kept pushing his father to open to more patients, expand their services into diagnostics and lab work and hire more staff. He wanted to become the premier family practice in town and build a new office building of their own. Toward this goal, Ivan felt optimistic and energetic and worked very long days. He became intensely focused and began to feel like he had a superior ability to connect with his patients. He believed he had special gift to “feel their energy” and began to diagnose them without ordering the appropriate tests. He could sometimes hear a voice in his head prompting him to lay out a whole life plan for his patients. He tried to keep up with this inner voice, strongly urging his patients to change their diets, activities and medications, and make radical decisions in their personal lives. Some patients were uncomfortable with this and began to complain to his father. Arguments ensued between them. For a while Ivan could talk his way out of these situations, but at length his father told Ivan he had to take a break from the practice. Ivan was crushed and angry. At home, he began to drink heavily and fight with his wife and children. He wrote himself prescriptions for alprazolam and zolpidem to try to calm himself down, and he continued drinking as well. He began to act erratically and accrued dozens of traffic tickets and subpoenas to appear in court which he ignored. At one point when he was pulled over, Ivan became aggressive and began fighting with the police. They took him to the ER where he trashed the cubicle he was in and was admitted involuntarily for 3-days. He was diagnosed with bipolar disorder. When he went home he stayed in bed for 3 weeks. He felt like “a rug on the floor with piano on top of him.” His wife had to “peel him off the floor.” She managed to get him to accept going to a doctor he knew from school. He was admitted to Phil Haven a week ago. Ivan has never failed before. Now, he is afraid he will not be able to return to his profession due to the stigma around mental illness. He is afraid he will lose his lifestyle and even his marriage. He feels his life is over. In group sessions, he says he is trapped and can never recover. 1)  Describe the two types of stigma associated with mental illness and how they might relate to Ivan’s situation.2)  How do you think Ivan’s dual diagnosis may affect his treatment plan and outcome? JEN, ADULT PATIENT WITH ACUTE BIPOLAR EPISODEJen is a 53-year-old housewife who is on her fourth marriage. She works part-time as a receptionist in the Water Company. Jen did not go to college. She had no problems with drugs or alcohol. Jen does not remember much about her previous marriages. They were just “bad guys” who didn’t “work out.” She has a son who is attending a community college and still lives at home. She also has 3 new step-children, ages 10, 12, And 14 who live with her and her husband part-time. They had to move into a bigger house to accommodate everyone. Jen makes the meals, cleans the house and does the laundry for everyone except her son, who does his own. She likes a clean and tidy house and she keeps her own appearance up with heavy make-up and hair that is sprayed in place. Every few months, Jen would get into an argument with her husband. It would escalate until everyone in the house could hear her screaming and calling them all names. Her husband’s efforts to calm her and reason with her were like pouring gasoline on a fire. She would slam things around and then throw her clothes in a suitcase and leave for days to her elderly parents’ house. They could not settle her down but felt they could not refuse her. Once there, she would play their piano incessantly, creating one song after another claiming that this music was what the world needed to hear, that it would bring the world together. Once, she remembered something a co-worker had said to her that she didn’t like. She wrote page after page of insulting, curse-filled rants of untrue stories about the co-worker which she emailed for days to her employer, saying he should fire that person. Instead, he fired her. Recently, while she was vacuuming the living room carpet, she was stewing about how much she hated the color of the rug. She had asked her husband many times for a new one. In a fury, she poured red paint all over it. When her stepchildren came home from school, they were frightened and went to a neighbor’s house. This prompted action which led to her admission to Phil Haven last week. She is insisting that there is nothing wrong with her and she was misunderstood. She says she needs to get back to the house and family.1)  Identify some Defense Mechanisms that Jen has been using to cope with her illness and give specific examples of her behaviors that demonstrate them.2) What are some internal and external barriers that Jen might face in following-up with behavioral health care after discharge?  Part 2https://www.ted.com/talks/eric_chase_destigmatizing_bipolar_depressionhttps://www.ted.com/talks/ellen_forney_finding_balance_in_bipolar Watch the two Ted Talks posted on D2L. “Destigmatizing Bipolar Depression” and “Finding Balance in Bipolar.” Discuss, in paragraph form, things that Eric and Ellen have in common, a few things you learned from watching these videos, and how you will apply this information to your nursing career.         Health Science Science Nursing NURS 201 Share QuestionEmailCopy link Comments (0)