Natalie is a 21 year old woman who was admitted to an acute psychiatric unit following a suicide attempt. She had taken an overdose of quetiapine (~800 mg).

Natalie is a 21 year old woman who was admitted to an acute psychiatric unit following a suicide attempt. She had taken an overdose of quetiapine (~800 mg). A flat mate found her difficult to rouse in the bath in the early evening (~ 2 hours latter) and called an ambulance. Natalie had previously presented with generalised anxiety disorder and hypomanic symptoms at the student health clinic and she had been prescribed quetiapine (200 mg daily) after consultation with a visiting psychiatrist.
Natalie was admitted to the emergency department. She initially presented with drowsiness tachycardia (160 / min) hypotension (90/60) and akathisia. After gastric lavage and 2mg lorazepam IV she was monitored for 8 hours before transfer to the psychiatric ward at 2200 hrs.
You are the nurse assigned to care for her on the morning shift and to complete an initial assessment.
Natalie is a 21 year old student who attempted overdose yesterday afternoon on Seroquel. She was transferred to us at 2200. She was quite drowsy at the time and not very coherent but did indicate that she had intended to die and did not anticipate her flatmates discovering her so soon. She has been experiencing considerable stressors recently: She has been struggling with her studies She is in her second semester at University studying statistics and believes she is failing She recently split up with a boyfriend of several years who lives in her home town (about three hours drive away) because of the difficulty maintaining a relationship over such a distance and she appears to have depleted most of her savings by gambling on an on-line casino several months ago.
Natalie was fairly sleepy so we didnt glean much more history from her. Her obs are all fine weve been checking hourly. She has a ferociously dry mouth and shes drunk approximately 2 litres of water over night. Shell need to see the psychiatrist this morning and have repeat bloods.
Natalie has been admitted to the ward for post-attempted suicide for monitoring. The Health team (nurses) will have to gain a better understanding on Natalies background and future thoughts. For instance Natalie is a college student and therefore will constantly be under pressure for submission of assessments. The following questions seek to establish why Natalie tried to commit suicide:
? Whether she is under any form of stress?
? What is the relationship between Natalie and the boyfriend teachers and students at college?
? What is pushing Natalie to commit suicide?
? Does Natalie take illegal drugs/ substance?
Taking these questions into account the nurses will professionally formulate the clinical strategies that will seek to address Natalies problem. In order to come up with these strategies the nurse will critically reason professionally. The nurse from her findings will formulate a working policy to be used by the psychiatrist and expected medical treatment. This therefore demands that Natalie should be given special and proper attention by the mental health facility whilst in her condition. The nurse should try as much as possible to check on Natalie from time to time to see whether there are changes. By doing so the nurse should keep records for both negative and positive changes on Natalie. This will enable the psychiatric to make necessary recommendations on Natalie. (Scheffer & Rubenfeld 2000)
Scheffer B. and Rubenfeld M. (2000). A consensus statement on
critical thinking in nursing. Journal of Nursing Education 39 352-359
Clinical reasoning strategies are needed to establish a working formulation by nurse to handle the situation effectively with Natalie by asking questions such as;
? Are suicidal thoughts present?
? When did these thoughts begin?
? How persistent are they?
? Can you control them?
The working formulations that the nurse will present should clearly state the problem of Natalie based on the findings and investigations carried out on presentation/ admission. By identifying problems/ issues this will consequently structure the problem whether it is mental adult illness or a community situation. This will help act accordingly on the interpretation analysis on the earlier documents presented when Natalie was admitted to the facility. The nurse will make the right decisions and make recommendations that will address the problem at hand.
Reflection plays a major key to identifying another aspect that will help the nurses and psychiatrist to contemplate and carefully evaluate and structure a care plan for Natalie best alternative for recover and diagnosis. (levett-Jones et al 2010)
Levett-Jones T. Hoffman K. Dempsey Y. Jeong S. Noble D. Norton C. Roche J. & Hickey N. (2010). The five rights of clinical reasoning: an educational model to enhance nursing students ability to identify and manage clinically at risk patients. Nurse Education Today. 30(6) 515 -520.
Each Question must be answered separately in alignment with marking rubric and clinical reason cycle and contain 150 words.
Section 3 Question 1
What have you learned from this scenario?
Section 3 Question 2
How will you apply this to future practice?
BACKGROUND case study 2
Betty aged 88 was admitted to hospital following a fall in which she fractured her right neck of femur (#NOF). Betty fell at home in her backyard and was found by her neighbour who heard her cries for help. Bettys daughter lives 800km away and has been concerned about her mothers memory and general health for the past 18 months and wants her to move into a nearby aged-care facility. Betty has a history of hip and wrist pain for which she takes osteo-eze and ibuprofen.
Betty was admitted to the orthopaedic ward on a Saturday morning where a fentanyl PCA and bucks traction were commenced and surgery scheduled for the following Monday. It is now Wednesday and Betty is day 2 following an open-reduction and internal fixation (ORIF) for her #NOF. Her surgery went well except for a 2 hour period of hypotension requiring fluid resusitation and a blood transfusion. It is 0800hrs and you are allocated to care for Betty on the morning shift.
Betty appeared to sleep intermittently and was stable until this morning. At 0600 hours Betty needed to use her bowels and mobilised to the bathroom on her forearm support frame with assistance. We opted to shower her whilst up but she became short-of-breath and somewhat confused and mildly agitated. She appeared tachypneoic though less so once resting on a chair. Her oxygen saturations ranged from 90%-94% on a Hudson mask though she kept moving her hand and removing her mask so I dont know how reliable these readings were. We returned Betty to bed as she was attempting to get out of the chair without her FASF. She remained a bit tachycardic around 100 and hypertensive but not so much once resting. She complained of some chest pain but provided a vague description. We did an ECG which showed sinus tachycardia with no ST changes. Betty was encouraged to use her PCA more and she has since settled down somewhat though I think she may be developing some post-op delirium as she is not orientated to time or place. Her vital signs have settled somewhat but it might be worth requesting a clinical review as her heart rate is still elevated and her oxygen sats remain borderline around 95%. Oh well at least she has been showered and used her bowels though she has not voided much over the past 24 hours. Her wound looks good theres minimal drain loss and shes afebrile. Shes not trying to get out of bed just now but if she does she might need specialling.
Each Question must be answered separately in alignment with marking rubric and clinical reason cycle and contain 150 words.
Section 1 Question 1