Transcript: Pre morbid- Hip strength weakness from surgery Reduced sensation under 1st MTSP previous fractures Leg length discrepancy Tightness in Gastrocnemius Unable to obtain plantigrade bilaterally Reduced exercise tolerance Following the stroke - UL/LL R sided weakness after the stroke Reduced proprioception ?Stroke fatigue Assessing Doris's walking indoors with a kitchen trolley: Forward trunk flexion A wide base of support Reduced foot clearance Reduced hip flexion Trendelemburg Reduced step length Effortful/Antalgic gait pattern She was easily fatigued Reduced confidence It was also unclear which exercises she was doing as she wasnt able to recall her exercises and my thoughts were ?lack of motivation to do HEP. Revisited current goal - mobilising 100m with a walking stick. Rechecked power - R 4/5 hip flexion, knee extension, dorsiflexion but easily fatigueable unable to hold - needed to build endurance. Hypothesis ?lack of Motivation to do HEP ?Too many exercises ?Anxiety ?Unable to make relation between exercises and her goal of walking Burst of 4/7 HEP technique/diary to record. Second week given a blank diary and told to continue HEP independently while we practice gait. Doris's husband also set up stationary exercise bicycle which Doris wanted to use. I encouraged this as it was something she enjoyed and could still help with increasing her ROM and strength through increasing resistance. Now that: Strength - HEP Motivation - Burst/Diary, positive reinforcement and revisited goals. Heel strike - Foot Up Encouraged to reduce WB - hitting inside of the trolley Calf tightness - soft tissue manipulation/stretches Fatigue/exercise tolerance - initially ?OT involvement but believed to be exercise tolerance as improved daily - advised on pacing. New goal/OCM - steps taken across living room approx 2m. No aid - 18 steps required Kitchen trolley - 14 steps required Kitchen trolley and Foot Up - 11 steps required (quality improved) Noticed Doris used her L arm to fix upper body - ?walking stick Repetition - practiced stepping by the kitchen work top and working on hip dropping and lifting. Discussed trialing a quad stick with clinical educator. Called Doris to book an appointment and was told that she had self progressed to try using a walking stick to family members house. New goal to be able to walk a short distance outdoors from the car to the front of the house for Christmas dinner. OCM Steps taken Trialed quad stick + foot up - 11 steps (better quality) Continually encourage Doris to lift from hip into flexion rather than circumduct and to reduce wide base of support. Practiced by kitchen with quad stick- encouraged to walk along kitchen worktop to prevent circumduction. Doris was able to flex through her hip. Quality of gait had improved significantly and so had her confidence. Aim of next session will be to practice outdoor mobility. Gait = Multifactorial Hypothesis testing clinical reasoning How I could influence each of these factors Next goal - is to be able to improve her outdoor mobility. Reflection on Doris's pathway Orthopaedic review Appropriate aid from the beginning Set back with 2 x falls therefore reduced carry over The amount of exercises could cause confusion/overload of information Neuroplasticity - 1000 steps per day/fatigue Will her walking ever be "normal" Range of UL/LL exercises - bed, seated and standing. Practiced walking with assistance, but she had weakness in her hips and it was effortful. Still fatiguing quite quickly after mental/physical exertion. She still had reduced movement in her right upper limb and could not grasp objects. Conclusion Knarr, Brian A et al. 'Changes In The Activation And Function Of The Ankle Plantar Flexor Muscles Due To Gait Retraining In Chronic Stroke Survivors'. Journal of NeuroEngineering and Rehabilitation 10.1 (2013): 12. Web. 6 Dec. 2015. National Institute for Health and Clinical Excellence - IPG278 Guidance: Treating drop foot using electrical stimulation http://www.nice.org.uk/nicemedia/pdf/IPG278Guidance.pdf Merzenich M, Nelson, R J, Stryker M P, Cynader M S, Schoppmann A, Zook J M 19984 Somatosensory map changes following digit amputation in adult monkeys. Journal of Comparative Neurology 224: 591-605 Jenkins W M, Merzenich M M, Ochs M T, Allard T, Guicrobbles E 1990 Functional reorganisation of primary somatosensory cortex in adult owl monkeys after behaviourally controlled tactile stimulation. Journal of Neurophysiology 63: 82-104 Nudo R J, Jenkins W M, Merzenich MM, 1992 Neurophysiological correlates of hand preference in primary motor cortex of adult squirrel monkeys. Journal of Neuroscience 12: 2918-2947 Taub E, Wolf S L 1997 Constraint induced techniques to facillitate upper extremity use in stroke patients. Topics in stroke rehabilitation 3: 38-61 Winstein C J, Merians A, Sullivan K 1997 Motor learning after unilateral brain damage. Neuropsychologia 37: 975-987 Kimberley TJ, Samargia S, Moore LG, Shakya JF, Lang CE. Comparison of amounts
Transcript: Example Method of Evaluation: Donabedian's Structure Process Outcome Model Emphasis placed on provider to interact with patient and process to achieve improved outcomes Examining Brett's thoughts and feelings about health (i.e., current health status, family diabetic history) and dependency (i.e., cigarette smoking) can open a dialogue. Establishing dialogue is crucial in allowing the patient to conceptualize what health means to them and how current health and lifestyle choices influence that. Stimuli, whether internal or external, will be examined and techniques to reduce stimuli, modify response, or manage stress will be explored. Milio's Framework of Prevention How Theory Relates to Brett Roy's Adaptation Model "Pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is unsatisfactory for meeting specific health goals" (Ralph & Taylor, 2011, p. 314). How Theory Impacts Practice The patient will acknowledge need for continued health management through regular examinations. The patient will verbalize understanding of Diabetes Mellitus and associated maintenance and treatment options. The patient will identify risks associate with smoking and participate in smoking cessation. The patient will participate in treatment discussion and planning. Saint Luke's College of Health Sciences ". . . complicated and dynamic operating systems with multiple processes and teams” and with many members of conflicting goals and regulations “it is an interdisciplinary process involving adaptation, coordination, collaboration, and cooperation on all levels of the system” (Utley et al., 2018, p. 262). Stresses the interchangeability between factors which contribute to its structure, as well as the resiliency and flexibility to keep it sustainable (Utley et. al., 2018). The healthcare organization must be able to adapt to the changing needs of its clients by identifying areas of weakness and coordinating efforts to achieve resiliency. Villareal (2003) Study Patient Outcomes: Figure 4: Nursing Complex Adaptive System (Chaffee & McNeill, 2007) To provide effective care in an ever-changing field, the nurse must consider the varying influences (i.e., biopsychosocial factors) a patient has in their life. Utley, Henry and Smith (2018) define theory as "a description, explanation, or prediction of things or ideas of our world, a statement of the relationship between two or more concepts" (p.7). Allows nurses to generate perspective on how care is determined, provided, and advanced Utley et al. (2018) refers to theories as providing frameworks to ". . . understand our patients and the situations that affect them" (p.19) Roy's Adaptation Model 45 year old African-American male Denies having an exam for the last 10 years Positive family history for Diabetes Smokes 2 packs of cigarettes per day Ineffective Self-Health Management Relevant Theories The organization must identify his reasoning for lack of consistent healthcare, what places him at risk for readmission, what resources does he currently have, and what resources does he need prior to discharging. “CASs must recognize their unpredictable complexity and develop processes to address uncertainty and enhance productivity to achieve goals” (Utley et al., 2018, p. 262). Utley et al. (2018) identify that health is a complex concept consisting of multiple areas of society, culture, and family which impact a person’s ability to achieve optimal health Coordination of resources is key! References How Theory Relates to Brett Brett What are concepts? Milio's Framework of Prevention Milio's Framework of Prevention and Brett Figure 3: Roy's Adaptation Model (Gall, 2013) Figure 1: African American Male (African-American Male, n.d.) Complex Adaptive Systems and Brett Nursing Care Plan: Summary Roy's Adaptation Model Continued Evaluation A key motivator in role development focus on individual discovering meaning Considers social structure and personal experience to establish role and interpersonal structure Figure 2: Greatest Nursing Theories (Greatest Nursing Theories, n.d.) Theory in practice Considers the patient as a bio-psycho-social being which interacts with the environment in four varying modes of adaptation. The four modes identified by Utley et al. (2018) are the following: 1. Physiologic mode – concerned with the basic needs of the individual 2. Self-concept mode – concerned with the identity and integrity of the self 3. Role function mode – concerned with social integrity 4. Interdependence mode – concerned with the need to feel secure Theory in practice "Concepts are words we use to label or identify people, objects, events, situations, experiences, beliefs and values" (Utley et al., 2018, p.7). Roy's Adaptation Model Smoking Cessation and identification of internal and external stimuli Bandura's Social Learning Theory Increasing self-efficacy through problem solving, decision making, self-projection and communication
Transcript: Case Study Tad Spading Sarah Miller Tad Spading Age: 64 Father of 7 children Married for 42 years Patient Info Hobbies: Cooking Spending time at cabin Consent Form Consent Form Tad's Medical History Click to add text Medical History Tad's Dental History Not consistent with dental cleanings. Last cleaning was 6 years ago. Had a tissue graft at 19 due to gingival recession. Has family history of periodontal disease (father's side) Lost #24 due to periodontal disease Dental History Intra & Extra Oral Photos Patient Assessments Radiographs Radiographs Radiographic Interpretation Etiologic Factors Probe Measurements Periodontal Assessments Dentition Charting Dentition Nutrition Counseling Dental Hygiene Diagnosis Treatment Plan Subtopic 3 Treatment Plan Master Treatment Plan Patient Notes Re-evaluation Appt. Re-eval Periodontal Assessments Letter of Referral Topic 4 Study Model
Transcript: Rx from there on... H1- Piriformis syndrom causing scatic pain 1) Trigger point Piriformis and taught pt how to self trigger point 2) Glute exercises 2 Rx and the pain subsided. Advised Pt to remember exercises and use them when he works Typically intermittent Most patients will have a persisting point of tenderness Typically more discomfort in extension LBP commonly radiates down into the buttock and back of the thigh H1- increased tightness hamstring with trigger point present 40% of adults at some point in their lives experience sciatica Described as pain in the hip and the lower extermity secondary to pathologies affecting the sciatic nerve within is INTRA SPINAL or EXTRA SPINAL course Anatomy Derived from the lumbosacral plexus. It leaves the pelvis and entres the gluteal region via greater sciatic foramen. The nerve leaves the greater sciatic foramen inferior to the piriformis muscle, then decends in the place between the superficil and deep groups of gluteal muscles. Continues down the postierior thigh, giving rise to the motor branches for the hamstring muscles. When the sciatic nerve reaches the apex of the popliteal fossa, it terminates by spliting into tibial and common fibular nerves. Inflammation of one or both Sacroiliac joint Can cause pain in buttock and can refer down into back of legs edema can compress nerve Aggravated by prolonged standing and stair climbing Difficult to diagnose as may ? LBP X-ray and MRI Objective Ax A - Climbing stairs - Immed Pain Bending down - Immed Pain Sitting for long periods - 20mins E- Don't do aggs Tried to massage it but didn't help Couldn't find ease What could have causes Sciatic pain? 1) Hamstring stretch taught in standing 2) soft tissue massage with trigger points 2 Rx and no improvement Chris popped in and trigger pointed Left piriformis and causes patients Pain Bilateral Sacroiliitis Conclusion Aggs & Eases Treatment Is one form of a genetic disorder called Neurofibromatosis Schwann cells mylinate the axons of the cell and it is a lipid When the over grow and are out out of control with in its capsule its called a Schwannoma These are often benign but can be detrimental if the grow and compress a nerve MRI / CT Schwannomatosis EXTRA SPINAL Narrowing of the nerve path ways in the spine Often aggravated with walking on eased with sitting Flexion exercises are common to increase the passageway and allows the irritation or impingement to resolve MRI INTRA SPINAL something to be aware off Journal - 55 yr old man with right buttock pain. Had L4/5 discectomies 5 & 3 years ago. Neuro exam showed no deficit. The buttock was painful with palpation Lx MRI showed age changes in L4/5 Pelvic MRI showed 6cm soft tissue mass Pelvic CT showed destruction of the anterior surface of the sacrum FAIR Flex Adduction Internal Rot Peace Sign Pt sitting and abducted and then physio resists adduction When supine laying the painful legs rests in external rotation Sooo Left leg pain - Can be sharp and dull VAS - Worst 8/10 Best 3/10 No Cauda Eq S&S No P&N No Numbness No LBP No other pain any where else Patient Case Study Body Chart Spinal Stenosis PMH : L THR 5 years ago R THR 10 years ago L TKR 8 years ago - limited flextion Cover all tests so you can rule out certain hypothesis We can't be 100% Soft tissue tumor 6% of Sciatica is caused by PS Most common is over use Hypertrophy, inflammation, anatomic variations & traumatic injury Pain in posterior gluteal and back of leg 1) local tenderness or greater trochanter 2) Pain with stretch (FAIR) 3) resisted internal rotation Weakness is uncommon Duygu Geler Kulcu & Sait Naderi (2008) Mr X Facet Syndrome Inflammation of the nerve symptoms include pain, altered sensation such as numbness or hypersensitivity muscle weakness usually resolves on its one MRI Sciatic Neuritis Sciatica is common, and is frequently caused by lumbar disk herniation. However, some intraspinal or extraspinal pathologic processes along the sciatic nerve may also cause sciatica. Lumbar spine imaging reveals the causes of intraspinal non-discogenic sciatica (NDS), Extraspinal sciatica is often misdiagnosed because routine diagnostic tests focus on the lumbar spine. A careful patient history and clinical examination are important in identifying extraspinal sciatica. Altered gait - due to hip replacement Good ROM at Lx and Hips Limited to full Hip and Lx Ax due to THR PAVIMS - NAD SLR - increase tightness bilat in both legs Palpation - Pain and increased tone in mid belly of hamstring 72 year old Man PC - 3 Month Hx of Left posterior leg pain - Mid Hamstring HPC - Had niggle in back of leg during working but gradually got worse Job - He works as Father Christmas over the festival period which involves a lot of sitting and lifting children - some times heavy onto his knee Piriformis Syndrome
Transcript: Additional Solutions and Treatments Circumstances and Discovery Patient Outcome Examination & Detection Unfortunately, this woman was a high risk candidate for developing this cancer and did absolutely nothing to obtain it. She was one of the "unlucky ones" as the doctor put it. Luckily, her cancer was at its early stages and hadn't metastasized throughout her body to other parts of her body. The women underwent through the lymph node biopsy as well as the removal of part of her lower right jaw to stop the cancer from spreading. A metal beam was placed to replace that portion of her jaw that had been removed. Weeks after surgery, tests came for reevaluation of her diagnosis. All the cancer had been removed completely and had not spread. Causes for Diagnosis Solutions and Treatment Upon examining all the tests and results the doctor concluded that the women in fact had Lymphoma or most commonly known as Lymph Node Cancer around her upper lymph nodes located around her neck and bottom jaw area. Examination which determined the diagnosis includes: Medical History: When and how her swollen lymph nodes developed and if she has any other signs or symptoms. Physical exam: Check lymph nodes near the surface of your skin for size, tenderness, warmth and texture. Blood tests: Complete blood count (CBC), which helps evaluate your overall health and detect a range of disorders, including infections and leukemia. Imaging studies: Chest X-ray or computerized tomography (CT) scan of the affected area may help determine potential sources of infection or find tumors. Biopsy: remove a sample from a lymph node for microscopic examination. Diagnosis Patient Case Study Yael Viniegra A 38 year old Caucasian women comes into the doctors office complaining about congestion and inflammation around her neck and shoulder area. She also complains about chest pain, pressure, shortness of breathe, night sweats and fever. "I feel like I cant breathe sometimes and have to stop to catch my breathe." This could most likely just be allergies causing these symptoms in normal cases. There is a high chance that the cancer might come back after the removal of the cancerous lymph nodes. The removal of lymph nodes can also lead to lack of drainage of lymph fluid which is very vital for fighting of bacteria, viruses and toxins. This backup of lymph fluid is known as Lymphedema and it can be a life-long problem. Risks of Biopsy Treatment A biopsy of her cancerous lymph nodes was made to stop it from spreading. This means surgeons removed the lymph nodes that were cancerous to try and control it. Upon removing them they also removed a section of her jaw because once cancer reaches bone it spread all over the body. Chemotherapy and radiation are other treatments that can be given to try and remove lymph node cancer.
Transcript: Functional gains Social treatment plans Exposure Costa coffee Continuation of treatment onto the wards Ensure patients communicate can develop (Happ Et al 2011) Test for cognitive/psychological changes (Pandharipande Et al 2013) Offering time to test ADLS as able Relied on mature problem solving skills and interpersonal techniques Complications Difficult members of staff who made treatment sessions stressful and caused conflict (Daniel & Rosenstein 2008) Had to rely heavily on clinical reasoning and decision making and sought out regular feedback on treatments Reflection (Donaghy & Morss 2000) Long term Expectation/prognosis management Increased anxiety and depression Risk of post traumatic stress disorder and Post ICU depression (NICE 2009) Multiple cardiac events Phase 2 Psychological Biological Complex Case Management Introduce the patient and their situation Show the initial assessment that took place Look into the patho-physiology and psychosocial conditions Goals for treatment and a prioritized problem list A treatment plan and a holistic management scheme Evaluation of complications Long term Long term goals wean from all ventilation and oxygen Increase mobility and functional gains Manage psychosocial implications Provide long term treatment plan for muscle mass Engage in long term support with follow ups and referrals Problem List Respiratory compromise Multiple organ failure Reduced mobility and function Extreme fatigue Communication issues BASSETT, Sandra F. and PETRIE, Keith J. (1999). The Effect of Treatment Goals on Patient Compliance with Physiotherapy Exercise Programmes Physiotherapy, 85 (3), 130 <last_page> 137. BAUER, Michael, et al. (2009). Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence Journal of clinical nursing, 18 (18), 2539 <last_page> 2546. BERNEY, Susan and DENEHY, Linda (2002; 2006). A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients Physiotherapy research international, 7 (2), 100 <last_page> 108. BHOWMIK, A., et al. (2009). Improving mucociliary clearance in chronic obstructive pulmonary disease Respiratory medicine, 103 (4), 496-502. CAMPBELL, c. (2011). Deconditioning : the consequence of Deconditioning : the consequence of bed rest. Geriatric Research Education Clinical Center. Clinical guideline - cg83-critical-illness-rehabilitation-guideline2 [online]. http://www.nice.org.uk/guidance/cg83/evidence/cg83-critical-illness-rehabilitation-guideline2. DAVIS, C. (2015). Pleural Effusion. [online]. http://www.medicinenet.com/pleural_effusion_fluid_in_the_chest_or_on_lung/article.htm#pleural_effusion_definition. DAVYDOW, D. S., et al. (2009). Depression in general intensive care unit survivors: a systematic review Intensive care medicine, 35 (5), 796-809. DE LA CERDA, G. (2013). Implementation of an ICU follow-up clinic: outcomes and patient satisfaction after 1 year Critical care, 17 (Suppl 2), P538. DENEHY, L. and BERNEY, S. (2001). The use of positive pressure devices by physiotherapists The european respiratory journal, 17 (4), 821-829. DONAGHY, Marie E. and MORSS, Kate (2000). Guided reflection: A framework to facilitate and assess reflective practice within the discipline of physiotherapy Physiotherapy theory and practice, 16 (1), 3 <last_page> 14. ENGEL, G. L. (1981). The Clinical Application of the Biopsychosocial Model Journal of medicine and philosophy, 6 (2), 101 <last_page> 124. GRIES, C. J., et al. (2010). Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU Chest, 137 (2), 280-287. HADJILIADIS, D. (2014). Pleural effusion. [online]. http://www.nlm.nih.gov/medlineplus/ency/article/000086.htm. HAPP, M. B., et al. (2011). Nurse-patient communication interactions in the intensive care unit American journal of critical care : An official publication, american association of critical-care nurses, 20 (2), e28-40. KNOWLES, R. E. and TARRIER, N. (2009). Evaluation of the effect of prospective patient diaries on emotional well-being in intensive care unit survivors: a randomized controlled trial Critical care medicine, 37 (1), 184-191. KRESS, J. P. (2009). Clinical trials of early mobilization of critically ill patients Critical care medicine, 37 (10 Suppl), S442-7. LAISAAR, T. (2006). Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis Interactive CardioVascular and thoracic surgery, 5 (3), 307 <last_page> 310. LANNEFORS, L. and WOLLMER, P. (1992). Mucus clearance with three chest physiotherapy regimes in cystic fibrosis: a comparison between postural drainage, PEP and physical exercise The european respiratory journal, 5 (6), 748-753. MYHREN, H., et al. (2010). Posttraumatic stress, anxiety and depression symptoms in patients during the first year post
Transcript: Medications Present History 4/26/13 PFT Values RCP 252 - Right lobectomy - No pneumothorax or pulmonary edema. Assessment Ox: 92 Room Air 130/60 -Pleural effusion Aortic Calcification X-RAY Allergies RBC: 3.34 (4-5.40) HGB: 9.8 (11.7-15.7) Lab Values -Patient was calm, pleasant, alert in no serious distress and - Frequent coughing. Non-productive. sitting upright. - BS -No use of accessory muscles. -Vital signs - Breathing pattern normal - lives at home with sister in law - likes to gamble - retired - occasional drinking - quit smoking (50 pk years) RR: 20 -Aspirin (anticoagulant) -Moderate obstruction and some restriction with severe small airway obstruction. -Xopenex 3ml inhalations b.i.d -Pt. was discharged and was told to continue taking the given medications. -Follow up with the doctor. (pain relieving) Mode of Therapy & Plan anemia - Patient: 72 year old female, 168 lbs, 62in - Admitted for syncope after coughing. - Pulmonary diagnosis- community acquired pneumonia & pre-existing lung cancer. -FVC 2.57 1.95 76% -FEV1 2.01 1.08 54% -FEV1/FVC 78.86 44.16 56% -FEF 25-75% 1.94 .46 24% - Posterior/anterior ronchi, as well as expiratory wheezes When instructed to cough, aeration increased. RR: 18 - CC " I was coughing so hard and I passed out" Measured -Xanax: .25mg t.i.d BP Breath Sounds Pre drug % Ox: 95 Vital Signs Pre & Post - Atropine (antimuscarinic) -Levalbuterol: 3ml b.i.d - Spiriva: 1 capsule qd DPI - No O2 therapy Predicted Social History -Coronary artery disease -Diabetes Mellitus type 2 -Lung carcinoma -Right lobectomy -Iron deficiency anemia-needs blood transfusion every 3 months. -COPD - Hypertension - Anxiety/Depression WBC: 9.4 (4.5 – 11) -When asked how she was feeling, she said "I feel a little congested." BP 74 bpm Post Tx Percocet & Tylox Creatinine: 1.9 (.4-1.1) Case Study 80 bpm Past History -Lisinopril: 10mg qd (ACE inhibitor) mmhg - Pt. was admitted for syncope after coughing but blood cultures showed staph aureus. This determined she has community acquired pneumonia. It was uncertain if it was contaminated or if it was a true infection. - A CAT scan was taken & pt. showed to have multiple lung nodules which was suggestive of septic emboli. CT guided biopsy was performed and showed pulmonary infarcts. A consensus was reached that it was secondary bronchiolitis organizing pneumonia. - During hospitalization, her BP was worsening. A CO2 angiogram showed renal stenosis. Since her BP medications were not working, an angioplasty was performed and BP was controlled. - Lung cancer, pt. had received a right lobectomy in the past. -Zoloft: 50mg qd Pre Tx -Blunting of right costophrenic angle
Transcript: 14 year old female N.D. originally presented to PES following intentional ingestion of 6 tablets of 300 mg extended release Wellbutrin (~2400 mg). "Adolescents and young adults show evidence of escalation of recurrent suicidal behavior, with increasing suicidal intent and decreasing time between successive attempts," (Goldston et al., 2015). Drug information from Davis Drug Guide for Nurses, 2016 in Michgan Thank You! Due to the large amount of stigma surrounding mental illness, identification and treatment of depression and other conditions can be a big challenge. S/S (non-exhaustive list): Fatigue, loss of energy Lack of eye contact Loss of pleasure in usual activities (anhedonia) Feelings of helplessness, guilt, hopelessness, or worthlessness Thoughts of suicide, death, or suicide attempts Withdrawal Poison Control was contacted and recommended activated charcoal (oral) and whole bowel irrigation with Golytely (NGT). N.D. was admitted to 11W for cardiac and neurological evaluation. (Andrew, 2017) Unknown; thought to be multifactorial, no single cause Receptor-neurotransmitter relationships in the brain Family hx, exposure, lifestyle References: Expresses wishes of completing the suicide * (Andrew, 2017) No abnormal labs to report N.D. is at risk for more, and more dangerous, suicide attempts as she enters young adulthood. Dealing with depression and anxiety for the past year, one prior attempt(?) two weeks earlier Admitted on the evening of 1/29/2018 following an intentional drug overdose (suicide attempt) After age 17-18, majority of suicide attempts were repeat attempts ↑ intent to die with ↑ age and ↑ attempts ↑ medical lethality with ↑ age ↓ time between attempts Patient Case Study (with poisoning Nursing Actions: closely monitor the pt when commencing or changing dosing of antidepressants d/t Black Box Warning (increased risk for suicide) Intense social stressors and frequent bullying/emotional abuse from peers Both mother and patient showing resistance to psychiatry's strong recommendation for N.D. to undergo inpatient treatment Facts About Suicide Suicide Attempts in a Longitudinal Sample of Adolescents Followed Through Adulthood: Evidence of Escalation Background: Pt Medications On average, one person dies by leading cause of death for ages 10-14 Hx of ADHD, anxiety, depression, and cutting Freshman in high school (grade 9) Lives at home with her mom, dad, two cats, and a dog Family hx of depression, anxiety, and suicide Greater strides need to be made with suicide prevention efforts and education # * = discontinued for now d/t the nature of the case Pt VSS Mariel Arbogast-Wilson, PNE 326 hours Types of treatment may include, but are not limited to: Inpatient psychiatric treatment Intensive outpatient therapy Electroconvulsive Therapy (ECT) Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Pharmacologic therapy Combinations of any of the above Evidence Based Practice With repeat assessments... Stating N.D. will start going to therapy twice per week instead of once per week, and will continue medication regimen Nausea w/o vomiting Mild headache N.D. - 14 y.o. female More pt hx: Pt reports feeling numb to the entire situation. "Not happy to be alive today" Depression and Suicidality (Pathophysiology) Regular visits to the psychiatrist (q6wk) and therapist (1x weekly) Facts from American Foundation for Suicide Prevention and MedScape * What YOU can do: as the predominant method) Presenting S/S: suicide every Treatment of depression, anxiety, and suicidality is highly individualized to suit patient needs. 180 adolescent participants, repeatedly interviewed into young adulthood (for ~13.5 yrs) following psychiatric hospitalization Intermittent blurry vision Sensation of things moving slowly around her Treatment All images retrieved from Google Images Stomp out stigma Don't be afraid to talk about mental health Educate others Be receptive to subtle clues in patient interviews (i.e. body language, affect, etc.) Training programs aimed at health professionals (Bolster, 2015) Implications Females attempt suicide twice as often as males 1/30/18 * Patient N.D. Insistent that N.D. will be fine at home
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