Patient Introduction Location: Patient room Time: 15:00 Report from…

Patient Introduction Location: Patient room Time: 15:00 Report from… Patient IntroductionLocation: Patient roomTime: 15:00Report from the day shift nurse:Situation: David Carter, a 28-year-old male with a 10-year history of schizophrenia who was admitted 9 days ago after a violent outburst, is preparing to go home tomorrow.Background: David has been treated with olanzapine and venlafaxine for the last year and was stable on his medications until recently, when he stopped taking them; his mother believes he stopped because he thought the medications were responsible for his 20-lb weight gain. On admission he stated that he believed that other people could hear his thoughts and that the hospital food was poisoned. He had trouble conversing and vacillated between being withdrawn and agitated. Since then, the provider has prescribed new medications, including sertraline 150 mg every day and fluphenazine 10 mg at bedtime. David has been taking these medications since day 2 of his stay without problems and seems to be tolerating them well. The provider is planning to see him in 2 weeks, when he will discuss changing his fluphenazine to fluphenazine decanoate 25 mg intramuscularly every 2 weeks (see the discharge orders). A partial hospitalization day program is recommended in the meantime.Assessment: Today, David’s thoughts are more organized, and he denies having any hallucinations. He still has some delusions but is less preoccupied with them. Positive symptoms have decreased. Paranoia has lessened. Although he initially refused to eat in the hospital, because he believed the food was poisoned, he has now resumed eating. He has also been participating in the activities here.Recommendation: Please complete a mental status examination and review the result of the AIMS. His mother is visiting, and they would like to go over the discharge information, so please also provide discharge teaching about medications, specific side effects, the use of AIMS to assess side effects, and possible referral sources. Please also call social services and report the need for a partial program and follow-up after discharge.  Opening QuestionsHow did the simulated experience of David Carter’s case make you feel?Talk about what went well in the scenario.Reflecting on David Carter’s case, were there any actions you would do differently? If so, what were these actions and why?Scenario Analysis Questions*PCC       What needs to be stressed during discharge teaching related to his new medication regimen (sertraline and fluphenazine)?PCC/I     Identify community resources in your area that are available to David Carter and his family. One should be for David Carter, one for his mother, and one for the family.PCC/S    What other discharge teaching is recommended for David Carter and his family?Concluding QuestionsHow would you apply the skills and knowledge gained in David Carter’s case to an actual patient situation in different acute care units (emergency room, intensive care unit, obstetrics unit, etc.)?_______________________________*The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/ Health Science Science NursingShare QuestionEmailCopy linkComments (0)

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