Mental Health Case Studies Questions and Answers

Mental Health Case Studies Questions and Answers A 22-year-old patient presents to the emergency room after a motor vehicle accident. The patient had airbag deployment and was wearing his seatbelt. The patient was hit on the passenger side by a vehicle going about 40 miles per hour. Extraction time was 5 minutes and the patient was ambulatory on the scene. No loss of consciousness was reported and the patient denies hitting their head. The patient is complaining of chest pain. Question: Which tests should be checked on this patient? An EKG shows sinus tachycardia and the patients cardiac markers come back negative. The patient states, "I know what is happening to my body and I am having a heart attack! They hit me so hard that my heart stopped working! That is the only explanation for this pain in my chest! My grandfather died of a heart attack, so check again. Isn't there another test we can do to make sure?" Despite reasoning with the patient and informing him Question: Which tests should be checked on this patient? Answer: EKG and cardiac markers such as troponins. Question: What is the best approach for this patient? Answer: This patient will not listen to science per-se so building a trusting relationship is key to help this patient listen to you. VALIDATE their concerns and feelings!!!! For example, "Being hit by another car is very jarring to the body, I have you on the cardiac monitor, so if anything shows up we will be able to intervene. Your heart is pumping at a fast rate so we will keep monitoring you." Never tell the patient that they are being ridiculous/overly worrisome or that they are making it up. Comfort them by letting them know you are concerned and will be monitoring them. Question: What medication could help this patient calm down? Answer: Potentially a benzodiazepine such as Ativan or Xanax. This patient likely has a lot of adrenaline on board due to the intensity of being hit by another car, making their heart rate high. (Don't forget to always have the antidote for benzo's on hand just in case: Romazicon!) Question: What is this patient likely suffering from? Answer: Somatoform disorder The patient is a 45-year-old male who is a frequent flyer in the emergency room for abdominal pain. The patient always has a high ETOH level and demands to be given 3 macaroni and cheese dishes, 2 chicken sandwiches and 2 whole milk cartons. The patient reports he drank 2 pints of liquor and a 6-pack of beer. Vital signs are as follows: Heart rate: 103 Respirations: 20 Blood Pressure: 125/67 Temperature: 98.6F orally Oxygen Saturation: 98% Question: What protocol medication needs to be ordered for this patient? Question: What question needs to be asked in regard to the patient alcohol intake? The patient is telling the nurse that he is serious this time and is going to quit drinking for the holidays so that his family will let him come over for Christmas. The patient is slurring his speech and has a history of trying to elope from the hospital. Question: What precautions does this patient need to be placed on? T Question: What protocol medication needs to be ordered for this patient? Answer: Benzodiazepine (Librium, Ativan) Question: What question needs to be asked in regard to the patient alcohol intake? Answer: When the last drink was. Question: What precautions does this patient need to be placed on? Answer: Seizure precautions, fall precautions and elopement precautions. Question: When will this patient likely be no longer legally intoxicated? Answer: in 12.6 hours. Question: What medications will the doctor likely order for this patient to replace vitamins? Answer: IV fluids with folic acid, thiamine and magnesium sulfate added. This is also called a banana bag or rally pack. Question: What medication could be ordered for this patient to help keep him sober? Answer: Antabuse Question: What education does this patient need to be successful on this medication? Answer: Avoiding mouthwash, cold medications, aftershaves or anything else that has alcohol in it to avoid having a reaction. As well as the reaction (they become immediately ill N/V/D) if they consume alcohol while on Antabuse. A 21-year-old male is found outside of a gas station and according to by standers, he was constantly talking for hours straight about the end of the world and the conspiracy of the government to control our minds. The patient appears to not have taken a shower in a long time, his hair is matted, his skin is dirty, he has a strong body odor and his nails are long with dirt under them. The patient is quoting the bible and asking everyone who enters the room if God has saved them yet. The nurse is assessing this patient and is asked if she could get Jesus a glass of water. Question: How should the nurse respond to the patient? Question: The patient states, "Don't you know who Jesus is? He will kill you if he wanted to. Don't upset Jesus and get him a glass of water." What should the nurse do at this point? The patient cooperates and is answering the nurses' questions. Vital signs are stable and the patient tells the Question: How should the nurse respond to the patient? Answer: Ask the patient if they can see Jesus and if Jesus is telling the patient to do something. Safety first! Assessing the reality of a patient is more important than re-orienting them. Re-orienting them happens after the nurse knows the patient doesn't think Jesus is saying to kill everyone. Question: The patient states, "Don't you know who Jesus is? He will kill you if he wanted to. Don't upset Jesus and get him a glass of water." What should the nurse do at this point? Answer: Inform the patient that the only people the nurse can see are the patient and the nurse. Do not say you see the patient's hallucination or validate the patient's idea by getting 'Jesus' a glass of water. Try to divert the conversation back to the assessment and avoid getting stuck talking about the delusion. Question: What is the nurses' priority at this time? Answer: Confirm an exit plan for their self and make sure that the nurse is not in any danger of being trapped in the room with the patient and no way out. Question: How should the nurse handle the new found mistrust with this patient? Answer: The nurse should make positive statements and then move the focus of the conversation such as, "I will not poison you, I promise. You seem nervous, do you want to take a break for a few minutes?" Allowing the patient a break can help interrupt the concerning thoughts the patient was having. Question: What is the most important thing for the nurse to do at this time? Answer: Get out of the room and call security. Do NOT attempt to take the pencil away or question the patient about the drawing before making sure you the nurse are safe and secure. Do not go into the room without a security officer present. And Chart CHART chart everything that is happening. This patient will need to b