Sharon Cole_vSim Mental Health_2020 | NSG 350 vSim Mental Health_Graded A

Mental Health Case: Sharon Cole Documentation Assignments 1. Document your findings related to the focused assessment of Mrs. Cole’s signs and symptoms of acute agitation. Include her responses to your assessment. I observed her appearance. She was in a hospital gown and hair is unbrushed. I assessed the attention. She was unable to focus on my questions. I observed her motor activity. She was constantly moving around and paranoid. I assessed the speech. Speech was loud and forced . I assessed her thouthgt processes. Her thoughts were all over the place and she exhibited grandious behavior and a flight of ideas that didn’t make sense. One minute she was nice the next minute she was angry and irate. 2. Document all interventions made to manage Mrs. Cole’s acute agitation through medication administration. Include her responses to the medication administered. I administered Lorazapam 2mg to her, she was calmer than when we started her initial assessment. 3. Referring to your feedback log, document all nursing care provided and Mrs. Cole’s response to this care. 0:27 You asked if the patient had any known allergies. 0:33 You performed medication reconciliation. 0:47 You assessed the respiration. 0:53 You checked the pulse oximetry. 1:03 You checked the radial pulse. 1:14 You measured the blood pressure. 1:25 You measured the temperature. 1:35 You auscultated the lung sounds. 1:43 You auscultated the heart sounds. 1:53 You checked the patient's skin. 2:05 You assessed the cast. 2:33 You assessed the patient's IV. 2:44 You administered lorazepam. 3:02 You educated about medications. 3:15 You asked the patient: I would like to ask you a series of questions about how you are feeling to help me better understand how together we can start to plan your care. These are questions I ask all of the patients I see. May I ask you these questions? 3:28 The patient said: Who put all these wires on me? I don't like them; they remind me of snakes. Take them off!nYou answered: This is your IV for your medicine. Please leave it alone. nYou used the therapeutic technique of giving information. 3:29 You asked the patient: Do you feel alert to answer questions? 3:38 The patient said: This little red button is a direct line to Washington. - -- - - - - Continued