Answered step-by-stepMarcusJacksonis a 34-year-oldAfrican American male who served…Marcu

Answered step-by-stepMarcusJacksonis a 34-year-oldAfrican American male who served…Marcus Jackson is a 34-year-oldAfrican American male who served four combat tours of duty in Iraq and Afghanistan. He came to the Veterans Administration (VA) today for an outpatient appointment because he has not slept more thantwo hours a night for thepast week. This is hisfourth clinic visit over the past yearwith the same symptoms:inability to sleep, nightmares,increasing anxiety, and isolation.Every time he fallsasleep, he relives the bombingand has flashbacks of bloodybody parts that he witnessed after the explosion.He states that he is more aware of noises and any loud noise such as fireworks and or cars backfiring causeshim extreme anxiety. His medications for PTSD have not beenhelping control his anxiety.He has been spendingmore time in his room watchingTV and avoids spendingtime with his wife and children. Today he told his wife he shouldhavedied and not his friends. Hisprimary care provider encouragedvoluntary admission and his wifebrought Marcus to the emergencydepartment of the closest VA hospital so he can be admitted. During his last tour in combat, Marcus’ best friend drove over an IED. The explosion killed everyone in the vehicle.During the blast, Marcus was hit with shrapnelin his left leg,stomach, and left eye. Theseinjuries left him blindin hisleft eye. He has had multiple surgeries to his abdomen, and six reconstruction surgeries to his leg.He walkswith a limp and continues to complain of severe pain in his left leg.Hewas given a medical discharge from the Marines because of the extensive nature of his injuries and isreceiving disability.Marcus is marriedwith three childrenfrom six to twelveyears of age. He has been married to his wife, Ariel, for fourteen years. While in the service,his family moved six times andendured four combat tours ofduty. Each time he returnedhome from combat, his wifenoted that he has no history of physical aggressionand has been more agitated and had more trouble sleeping with frequent nightmares. Marcus reports he used to drink “a lot” butdecided twoyears ago that alcoholwas making everything worse. Reports he has not had a drink for the past 1 ½ years.Denies other drug use. Marcus’physical exam and routine lab work are as follows:GENERAL APPEARANCE: Appearsanxious, body tense,tired (dark circlesunder his eyes)RESP: Breathsounds clear withequal aerationbilaterally, non-labored respiratory effortCARDIAC: Pink, warm &dry, no edema, heart soundsregular with no abnormal beats,pulses strong, equalwith palpation at radial/pedal/post-tibial landmarksNEURO: Alert & oriented to person, place,time, and situation (x4)GI: Abdomen soft/non-tender, bowel sounds audibleper auscultation in all four quadrantsGU: Voiding without difficulty, urineclear/yellowSKIN: Skinintegrity intact Identify 10 assessments the nurse should utilize to assess Marcus’s mental state?                     (Go back to your Kaplan book and/or the components of the mental status examination!)   Mental Health Assessment1.   2   3.   4.   5.   6.   7.   8.   9.   10.    Diagnostic ResultsBasic Metabolic Panel (BMP)  Na K Gluc. Creat.  Current: 138 4.6 88 1.1   Complete Blood Count (CBC)  WBC % Neuts HGB PLTs  Current: 7.8 69 16.0 229   What additional diagnostic tests would you expect to see for Marcus?           Admitting Orders Admit patient to behavioral health unit under voluntary admission. Initiate milieu therapy. Initiate safety measures according to unitprotocol VS every shift whileawake Paroxetine 40 mg daily Prazosin 4 mg PO HS Mirtazapine 15 mg PO HS What SPECIFIC safety interventions should the nurse implement?           What SPECIFIC interventions should the nurse implement to initiate milieu therapy?                  Marcus has not taken the medications ordered previously. For each of his medications, identify your priority concern and 3 relevant teaching points for each.Medication Priority Concern 3 Prioritized Teaching PointsParoxetine 40 mg daily   1. 1. 2. 3.  Prazosin 4 mg PO HS  1. 1. 2. 3.  Mirtazapine 15 mg PO HS 1. 1. 2. 3.  Identify one specific example of how the nurse can engage and show Marcus that he/she cares, and the Marcus matters to them?     Marcus will be discharged in 2 days. Identify 5 specific objective criteria the nurse will use to evaluate the plan of care for Marcus (i.e., effectiveness of the interventions) prior to discharge?  OBJECTIVE EVALUATION CRITERIA1.   2   3.   4.   5.     The nurse provides discharge instructions to Marcus. The nurse needs to include (A) and (B) with the instructions. Should (C) occur after discharge, Marcus needs to notify the healthcare provider. The nurse knows that Marcus understands the teaching when he verbalizes (D).  (A) (B) (C) (D)  1.   1.   1.   1.  2.   2.   2.   2.  3.   3.   3.   3.  4.   4.   4.   4.  5.   5.   5.   5. Health ScienceScienceNursingNURSING 250Share

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