In this third and final submission of your Course Project, you will be completing a comprehensive care plan. This written assignment should include the following:
Comprehensive Plan of Care
Develop a comprehensive plan of care/treatment with short and long term goals and include safety needs, special considerations regarding personal needs, cultural/spiritual implications, and needed health restoration, maintenance, and promotion.
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Diagnosis
A brief medical/health history
Disruptions in one's standard patterns of thought, perception, emotion, language, and sense of self and behavior define schizophrenia, a long-lasting and plain mental condition that disturbs more than 21 million personalities universally. Hallucinations, most often including inquiry voices or seeing effects that be situated there, and misbeliefs, characterized by firm, incorrect beliefs, are common. A man in his 20s who sought help at a mental health facility said that he had lost weight and heard voices for the last ten months. He also said he wandered throughout the town and was occasionally violent against his mother and sister when he did come home. The patient elaborated that he also felt threatened and believed that others intended to hurt him. The patient said he called in sick to work and requested a replacement, but he never showed up for his shift again. His leave of absence began a month after he earned payment for tasks completed while on the job. He decided to try withdrawing money from many banks by hopping around to each one. After his third unsuccessful effort at a single branch, he was taken in for four days of arbitrary incarceration. He also claimed to have received death intimidations and finished phone calls from unidentified sources (Newbury, 2022). No actual words were verbal, but he understood it to be a sign that his life was about to be stolen. His family background described him as having grown up in the city with his mother and sister. His sweetheart lived in a separate city suburb. He had a history of paranoid delusions, according to his medical records. No family member has ever suffered from a mental or physical disorder. His introverted character existed prior to his sickness. Relevant symptoms also include the physician's resulting in a reduction history of physical violence towards his mother and sister, as well as his complaints of sleeping problems, lack of food, roaming about town, and trips to the psychiatric unit. Upon admittance to the hospital, the patient was examined and found to be mentally unstable. He or she was also underdressed and seemed to be malnourished. He acted timidly, laughed irrationally, and was hesitant. Hearing hallucinations plagued the sufferer. He spoke to himself in the third person and claimed to be conversing with a male and female voice. The patient also said he had overheard individuals speaking negatively about him, including those he knew. As a result, he became wary of and uncomfortable with new people. Because of this, the patient said he had spent the night with an acquaintance and was scared to return to his parent's home. He felt like he was the intended victim. Paranoid and referential delusions were evident in the substance of his thoughts. (According to the patient's sister, he often expressed concern that he was in danger and would be attacked by others (Edwards, 2022).
Summary of laboratory diagnostic results related to the illness/condition and what they mean
As soon as he was hospitalized for his aggressive behavior, the patient was given 10 milligrams (mg) of both intramuscular (IM) haloperidol and intravenous (IV) diazepam for quick tranquilization. After 24 hours, injectable (IM) phenelzine 10 mg and injectable (IM) diazepam 10 mg were administered again, with the same results. Clinical pharmacists intervened, and he was subsequently moved to subcutaneous (IM) midazolam 7.5 mg and intramuscular (IM) haloperidol 5 mg. The patient's hostile behavior was lessened after taking this combo on the second day at the hospital. On the day of admission, the person was also set olanzapine 10 mg tablets to manage their schizophrenia. The patient experienced mild tremors on the third day of the hospital due to the initiation of olanzapine medication. However, no medicine had been recommended to help with the patient's little shakiness. Until recently, this has been seen as a non-curable symptom. As a result, under the advice of the clinical pharmacists, he was given a trihexyphenidyl 5 mg pill. The clinical pharmacists also suggested reducing the daily dosage of olanzapine to 5 mg, which was done. Four cycles of electroconvulsive treatment were administered, with 500 mg of IV ketamine and 10 mg of IV haloperidol (Luo, 2021). These were performed on days 2, 13, 16, and 18 of the hospital stay. After starting treatment, the patient showed remarkable improvements in their state of mind, outward demeanor, perceptions, and insights. Sometimes fidgety, but always helpful. The patient's medicine was given by DOT guidelines. However, the nurses reported that he refused to take his olanzapine 5 mg pill for a few days when he was agitated and difficult. Clinical pharmacists urged nurses to keep patients on their recommended dose of 5 mg olanzapine tablets to reduce the risk of recurrence (Hoffmann, 2018).
Summary of a head-to-toe physical assessment
This is only a brief overview of possible diagnoses, treatments, and medications. The information above is not designed to serve as a substitute for professional medical advice but as a guide in evaluating possible diagnoses and treatments. It does NOT include every possible medical issue, therapy, drug, side effect, or danger in a given patient's case. This information is not meant to replace the advice, diagnosis, or treatment provided by a physician after a thorough evaluation of a patient's individual medical history and current condition. Patients should consult with their doctor if they have concerns about their health, symptoms, or treatment choices (including the potential hazards and benefits of any drugs). The patient reported fine tremors after starting olanzapine treatment. But no medicine for controlling the patient's small tremors had been given. Until recently, this has been seen as a non-curable symptom (Danielson, 2019).
Your nursing diagnosis
In the field of psychiatry, schizophrenia is defined as a condition characterized by persistent or recurring psychosis. Impaired social and vocational functioning is a frequent symptom. According to the World Health Organization, it is one of the top 10 diseases that contribute to the global burden of disease, making it one of the most crippling and economically disastrous medical ailments. Positive symptoms, such as hallucinations or delusions; disordered speech; negative symptoms, such as a flat attitude or speech poverty; and cognitive deficits, including attention, memory, and executive skills, are characteristic of schizophrenia. Schizophrenia is diagnosed when these symptoms persist for at least six months with social or occupational impairment, and no other diagnosis is more appropriate. Schizophrenia's clinical presentation, evaluation, and diagnosis, as well as the disease's prognosis, are discussed here. Separate sections are devoted to explaining the causes and effects of schizophrenia, known as epidemiology and pathogenesis. Separate sections address the roles of anxiety, depression, and drug misuse in the development of schizophrenia. Treatment options for schizophrenia and other psychoses are examined independently. A second section examines the nuances of pediatric schizophrenia (Feldman, 2021).
References
Newbury, J. B., Arseneault, L., Caspi, A., Moffitt, T. E., Odgers, C. L., Belsky, D. W., … & Fisher, H. L. (2022). Association between genetic and socioenvironmental risk for schizophrenia during upbringing in a UK longitudinal cohort. Psychological medicine, 52(8), 1527–1537.
Edwards, G. G., Uy-Evanado, A., Stecker, E. C., Salvucci, A., Jui, J., Chugh, S. S., & Reinier, K. (2022). Sudden cardiac arrest in patients with schizophrenia: A population-based study of resuscitation outcomes and pre-existing cardiovascular disease. IJC Heart & Vasculature, 40, 101027.
Luo, Y., Xie, Y., & Xiao, Y. (2021). Laboratory diagnostic tools for syphilis: current status and future prospects. Frontiers in cellular and infection microbiology, p. 10, 574806.
Hoffmann, G., Bietenbeck, A., Lichtinghagen, R., & Klawonn, F. (2018). Using machine learning techniques to generate laboratory diagnostic pathways—a case study. J Lab Precis Med, 3, 58.
Danielson, A. R., Venugopal, S., Mefford, J. M., & Clarke, S. O. (2019). How do novices learn physical examination skills? A systematic review of the literature. Medical education online, 24(1), 1608142.
Feldman, M., Valeriano‐Marcet, J., Slone, F., Jacovino, C., Aslam, S., Khalil, F., & Kumar, A. (2021). Pre‐clerkship physical examination assessment rubric. The Clinical Teacher, 18(1), 69-72.
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The patient was selected from a group of adult patients who presented to the clinic complaining of experiencing intermittent chest pains. Most patients who contributed to the clinic with this chief complaint were older adults over 62 with terminal illnesses such as heart attacks, cancers, and lung diseases. As a result, the patient became a perfect candidate for this project. The patient has consented to be involved in the project and has agreed to provide the information required.
The patient identifies himself as Shawn Davis (S.D). The patient is a 47 year old African American male who presents to the clinic complaining of experiencing intermittent chest pains that began two weeks ago when he was trimming grass in his backyard. The patient suggests that he has been feeling generally weak and tired for the past two days after the onset of the symptoms. The patient explains that the pain mainly occurs in the midstream and intermittently twice or thrice in one week. The patient states that he feels like the pressure is being exerted on his chest or a pressing heavy weight. The patient suggests that he has tried self-medication using anti-acids and massaging the chest to relieve the feeling, but there is no relief. He explains that when he ignores the pain, it radiates to the neck. He also suggests that he experienced symptoms such as shortness of breath when he was experiencing pain and reduced pain after rest, coughing, and nausea. The patient appears to be generally strong, and he sits upright. He has clear communication, and he has dressed appropriately for his age. After the assessment, the patient was diagnosed with pneumonia, which affected the lungs, thus causing chest pain.
The patients live with his wife, and he has two sons. He works as a janitor in the city and primarily works in dusty compounds that can cause bacterial infections. His wife works as a teacher in an elementary school; one of his sons is a police officer; the other is in college pursuing a degree in mechanical engineering. The patient’s wife has no health complaints or conditions. The patient’s grandparents are both deceased. The grandfather died at the age of 93 years due to hypertension and obesity, while the grandmother died at 90 due to Alzheimer’s disease. Both parents are alive and live in the countryside, where they work as farmers. The father is 70 years old and has a history of diabetes. The mother is 68 years old, and he has a history of asthma and eczema. The patient explains that he does not smoke tobacco or use illegal drugs but consumes a can of beer daily after work. He also explains that he exercises regularly to stay fit and avoid obesity. The patient denies being allergic to any foods or medication. The patient states that he has been involved in two surgeries. One of the surgeries was on his knee due to an injury he acquired while playing football. He also had back surgery due to an injury received while playing football leading to the end of his career as a football player. The patient is a Christian and appears very religious since he keeps stating that God will help him overcome the pain.
The patient explains he is currently under pneumonia medications, BOTH azithromycin, and erythromycin. Pneumonia is a bacterial infection that affects the air sacs in the lungs, causing fluid or pus to fill in the air sacs and causing difficulty breathing, chest pain coughs, and nausea (Kumar & Raghavendran, 2021). Patients with pneumonia can present different signs and symptoms, such as experiencing chest pains, fatigue, shortness of breath, and coughs. Other germs cause pneumonia, the most common being bacteria and viruses that an individual inhales. Based on the patient assessment, he suggested that he works as a janitor and may have encountered pneumonia germs while working. The patient has been introduced to antibiotic medications to treat pneumonia and relief chest pain and shortness of breath. In the patient's case, his pneumonia has been caused by a bacterial infection, which makes it possible to treat it using antibiotics. In cases where a virus infection has caused a patient's pneumonia, the patient cannot receive antibiotic medication since they are ineffective. The patient has been prescribed azithromycin antibiotics since they are most effective in adults. Antibiotics help in killing the bacteria and make them unable to replicate.
As a result of consuming antibiotics, the patient will experience different side and adverse effects. One of the side effects is that they may experience gastrointestinal discomforts such as diarrhea, stomach upset, loss of appetite, and vomiting. Other side effects the patient may experience are skin issues such as allergic reactions, skin swelling, yeast infection, and sensitivity to sunlight. Antibiotics help the body by killing all bacteria in the body. Some of these bacteria are useful in the body since they assist in digesting food and boosting our immune system (Hamao et al., 2019). When one consumes antibiotics, it destroys some beneficial bacteria, which causes some complications in the body. After the patient was prescribed the antibiotics, he was educated on the side effects that he may experience and how to deal with the side effects. He was also educated on the most appropriate lifestyle to help him heal faster and boost his immunity.
References
Hamao, N., Ito, I., Konishi, S., Tanabe, N., Oi, I., & Hirai, T. (2019). Frequency of side effects in the antibiotic treatment for pneumonia.
Kumar, A., & Raghavendran, M. (2021). Ventilator-associated pneumonia. RGUHS Journal of Nursing Sciences, 11(2).