Patient

D.H, 26-year-old male Hispanic, was admitted from home from the ED for inpatient psychiatric evaluation and treatment. Allergies to latex, shrimps. He has a history for depression, PTSD, paranoia, anxiety and pseudo-seizures.

Chief complain: Pt has neglected his ADLS and hygiene, not slept and eaten in the past few days before his admission. Pt expressed he has no motivation to live, admits suicidal ideation with no plan, denies homicidal ideation, auditory and visual hallucinations. He stated, “the recent anxiety and depression is from working from home due to COVID, I usually work at the warehouse as a call center representative.”  The pt lives with spouse and after he signed the release of information form, pt’s spouse was unavailable when called.

The individual counselling therapy, bio/psychosocial was completed as pt was cooperative, redirectable despite having racing thoughts. He admitted to sexual abuse at 5 years old by the maid but stated he didn’t want to talk about it. The pt was easily distracted, showed signs of depression. He has had 1 prior hospitalizations for mental problems but stated “I was anxious and wanted to calm down at that time.” Pt admits to alcohol use, but no usage lately, also admits to marijuana use 6 months ago.

Dx: Risk for suicide, danger to self, depression, Unspecified Bipolar disorder and related disorder, Major depressive disorder w/o psychosis features, unspecified trauma disorder, unspecified anxiety disorder.

Psychosocial and contextual factors– trauma, marital stress, substance use

Meds: Sertraline 100mg PO qAM, Zyprexa 5mg QAM PO, Xanax 0.25mg PO q6h PRN for anxiety.

Treatment plan:

Problems: Suicide ideation w/o plan Goals: no SI.   Modalities: medication and therapy Problems: Anxiety   Goals: decrease anxiety.   Modalities: medication and therapy

Problems: Insomnia  Goals: Improve sleep   Modalities: medication and therapy

Medication Plan: Initiate Seroquel 50mg at HS for mania and Prazosin 1mg at HS for trauma.

Activity therapy: Engage pt in group focused therapy, improve coping skills and managing moods.

The post D.H, 26-year-old male Hispanic, was admitted from home from the ED for inpatient psychiatric evaluation and treatment. Allergies to latex, shrimps. He has a history for depression, PTSD, paranoia, anxiety and pseudo-seizures. appeared first on Infinite Essays.

510 replies week 2

Discussion 1

 

1- Kaori

Health care industry is the biggest industry in U.S.  It saddens me to know that there are people that receive better care because of their financial state and that some people can’t receive benefits from SNFs, clinics and pharmacy companies and hospitals. If you have been nursing for a long time in your community, you already know which hospitals and clinics can provide excellent care to their patient as well as excellent compensation to their employee. The business will succeed if it can provide a product that the market (customers) wants (Austin & Wetle, 2016, p. 23). This is true.

There’s a very simple way for the business to grow. Increase income, decrease expense, and always looking for tax wisely. For example, home health company under huge hospital system would take Medicare patients only capped to the hospital system. The home health division does not need authorization from insurance company and patient does not need to pay co-pay, which would be a win-win situation. It would be easy to discuss winning model for huge hospitals, which already won.

On the other had we have people living in lower income communities. In these communities there is a well-known community clinic taking care of the majority of GMC patient. GMC means Medi-Cal and paying limited. MD in these systems are harder to reach because they do not have money to improve their office settings eg. receptionists. These clinics cannot improve because the patients they take in only have Medi-Cal which does not provide enough money to give their patents adequate care. So how do we help these clinics in the lower income communities?

 

2- Ivana

 

To improve overall patient experience, satisfaction and outcomes in the medical field, healthcare workers must have great communication with staff and patients, take care of the clinicians, promote well-informed diagnosis, ensure continuity of care and support for patients following discharge (Montag; 2020). Patients want to be listened and have their needs met, they do not want to be ignored or feel as if their concerns do not matter. Other strategies that could possibly help is giving patients the power to make decisions over their health, have them engage in their plan of care, this can help them better comply to treatment and become more educated about their health, and provide a safety and clean environment. If patients receive great patient care or overall patient experience, they would recommend others to attend the hospital they were admitted and received treatment. By doing so, this will bring more patients to the hospital or facility and they will benefit financially from it and have a good reputation.

Hospitals have expenses on medical supplies, equipment, personnel, etc. “Supply chain is becoming an increasingly important area for health system cost reduction. The supply chain represents close to a third of the average hospital’s overall operating expenses. Health system leaders are making supply chain optimization a priority, they are also focusing on improving the consumer experience and reducing clinician burnout (RevCycleIntelligence; 2019). A cost reduction that hospitals or facilities can do is lower the number of medical tests for patients, if specific tests are not necessary, then it should not be performed. If health care workers improve their clinical outcomes and reduce the chances of their patients from acquiring an infection during their stay at the hospital, then labs or other medical tests will not bed necessary to perform. Reducing clinician burnout is important, if caregivers are overworking, they cannot provide the same patient care or quality of care due to being tired and stressed. “Staff scheduling software can help to monitor and prevent overtime work, which will decrease payroll costs and keep nurses from being chronically overworked. Optimization of care must occur to reduce costs and maintain quality care” (Nersi; 2018).

 

Discussion 2

 

1-Leticia

 

COLLAPSE

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Policies affect us as nurses in our daily practice.  Sadly, when policies are being made these determine what type of health care a person gets it determines the “when, how, from whom, and at what cost” (Mason et al., 2016, p. 10).  In the policy development model, our role as nurses are that of advocacy and activism.  As nurses we advocate for our patients and many times, we don’t have any issues doing so but when it comes to getting involve with policy making and politics many times we choose to stay away.  Its important to be active and be involved.  Our role as nurses not only involves providing excellent clinical care but also to speak up for those that we care for daily.  We are the front-line health care workers and we know what our patients needs are as well as our needs to be able to care for those patients.

I’ve attended a fall risk policy meeting at my previous job at a nursing home.  Where I used to work fall rates where increasing especially doing the day and we had to come up with solutions on how to decrease the amount of falls we where having.  Each unit had to look back at their fall incidents and some key points that where brought in was the time of the falls.  We determined that most of the falls where happening after lunch.  Patients where trying to either get back to bed unassisted or where trying to use the restroom.  We implemented ideas how to decrease the falls during this time for toileting the patient before going to eat lunch to having more staff available on the floor to assist those patients wanting to go back to bed after lunch.  The new ideas worked we seen a decrease in falls.  We also updated the fall policy by determining who needed to have a safety alarm in place based on fall risk scores and patient condition along with fall history.

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3- Kimberly

 

Nurses play a huge role in the modification and development of health care policies since nurses have to make sure it protects patient’s quality of care and quality of life. According to the article Nurses’ policy influence: A concept analysis, “Nurses’ policy influence is nurses’ ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurses’ job environment and increases patient outcomes” (Arabi, et al., 2014). The policy meeting that I will be attending is about Coronavirus Vaccine Development. Its goal is to make a vaccine that is effective and safe and produce mass quantities as soon it has been tried and trested. Key points that a nurse could bring or questions to ask to this meeting is how did they make sure that it is safe and effective, who did they try it on and what could be the possible side effects. Would it offer lifetime protection? These questions are critical and need to be addressed since this is the first vaccine being created.

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