In the provided case scenario, the nurse is presented with Mr. Beardley, a 28-year-old man with bipolar illness type I

QUESTION

Radiology Reports What radiology findings are most important and noticed by the nurse as clinically significant? Radiology: Chest X-Ray Results Clinical Significance The cardiac size is enlarged. There are no focal infiltrates or consolidations or pleural effusions. IMPRESSION: 1. No acute disease in the chest. 2. Moderate to severe cardiomegaly Lab Results Hematology: Complete Blood Count (CBC) WBC HGB PLTS % Neuts % Lymphs % Monos % Eosin Bands Which diagnostic findings are most important and noticed by the nurse as clinically significant? Most Important Data Clinical Significance Metabolic Panel Na K Cl CO2 AG Gluc Ca BUN Creat GFR Which diagnostic findings are most important and noticed by the nurse as clinically significant? Most Important Data Clinical Significance Urinalysis Color Clarity Sp Grav pH Protein Glucose Ketones Bili Blood Nitrate LET UA Micro RBCs WBCs Bacteria Epithelial Which diagnostic findings are most important and noticed by the nurse as clinically significant? Most Important Data Clinical Significance UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Misc. Troponin CK CK-MB BNP Hgb A1C Which diagnostic findings are most important and noticed by the nurse as clinically significant? Most Important Data Clinical Significance Lipid Profile Total Cholesterol LDL Cholesterol HDL Cholesterol Triglycerides Which diagnostic findings are most important and noticed by the nurse as clinically significant? Most Important Data Clinical Significance Lab Planning Activity Lab Name Clinical Significance Priority Nursing Assessments/Interventions Hgb A1C Current Value: Critical Value: Lab Name Clinical Significance Priority Nursing Assessments/Interventions BNP Current Value: Critical Value: UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Lab Name Clinical Significance Priority Nursing Assessments/Interventions LDL Cholesterol Current Value: Critical Value: Part II: Developing Responding Skills 1. Interpreting clinical data collected, list at least two problems that are possible for this patient? Which problem is the priority? Possible Problems Priority Problem Pathophysiology of Priority Problem 2. What body system(s) will you assess most thoroughly based on the primary problem? What specific assessments will you implement? Priority Body System(s) Priority Assessments Medical Management of Care 3. Identify the rationale for each provider order and its expected outcome. Care Provider Orders: Rationale: Expected Outcome: Emergency transfer to Hospital and admit to inpatient care. Labetalol 20 mg IV push every 10″. Maximum 300 mg dose. Goal-BP: 160/100 Heart echocardiogram in the morning Hydrocodone 5 mg/acetaminophen 325 mg 1-2 tabs PO every 4 hours PRN-Headache Hydrochlorothiazide 25mg PO daily UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Lisinopril 10 mg PO daily Simvastatin 20 mg PO daily Aspirin 81 mg PO daily Humulin N 10 units SQ daily at bedtime Regular insulin sliding scale 4x a day based on blood sugar readings Vitamin Therapy Cardiac diet Diabetic diet Referral to a smoke cessation program Referral to a nutritionist Priority Setting 4. Determine the order of priority the nurse will implement each order and the rationale for the order you chose. Care Provider Orders: Order of Priority: Rationale for Order of Priority Hydrocodone 5 mg/acetaminophen 325 mg 1-2 tabs PO every 4 hours PRN-Headache Hydrochlorothiazide 25mg PO daily Lisinopril 10 mg PO daily Cardiac diet Labetalol 20 mg IV push For the order of labetalol complete the table below. Mechanism of Action Most Common Side Effects Priority Assessments Pt. Education UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Dosage Calculation: Labetalol 20 mg IV push Medication Time frame to Administer Show Work Volume to Administer 100 mg/20 mL vial Nursing Management of Care 5. After interpreting clinical data collected, identify the nursing priority and three priority interventions. For each intervention write the rationale and expected outcome. Nursing Priority Priority Intervention(s) Rationale Expected Outcome UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Problem Recognition 6. To prevent a complication based on the primary problem, answer each question in the table below. Identify the most likely and worst possible complications. Most Likely Worst Possible What interventions can prevent them from developing? What clinical data/assessments are needed to identify them early? What nursing interventions will the nurse implement if the anticipated complication develops? Education/Discharge Planning 7. Identify three priority educational topics that need to be included in a teaching plan to prevent complications and prepare this patient for discharge? Teaching About Illness Treatment Priorities Lifestyle Priorities 8. Which interprofessional team member would the nurse need to consult and collaborate with to promote and maintain health after discharge? Team Member Rationale UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Part III: Developing Evaluation Skills 1. You collect the following clinical data. For each finding, make a clinical judgment by placing an “x” in the appropriate column if the patient’s condition has improved, has not changed, or has declined. Assessment Finding Improved No Change Declined T: 98.6 F (37.0 C) oral P: 82 (regular) R: 16 BP: 170/95 O2 sat: 96% room air Headache remains, rates severity 4/10 2. Is the overall status of the patient: Current Status Rationale a. Improved b. No change c. Declined 3. After evaluating the patient, identify the current nursing priority and which action(s) the nurse should

ANSWER

In the provided case scenario, the nurse is presented with Mr. Beardley, a 28-year-old man with bipolar illness type I. Despite being prescribed lithium ER 300mg PO BID, he continues to experience symptoms of depression, feeling alone, and lacking motivation. As the nurse, there are several considerations to address in order to optimize Mr. Beardley’s care plan.

Medication Adjustment: Given Mr. Beardley’s persistent depressive symptoms, it may be necessary to add or change his current medication regimen. One potential option supported by literature is the addition of an antidepressant such as a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI). A study by Geddes et al. (2019) demonstrated the efficacy of SSRIs and SNRIs in treating depressive episodes in bipolar disorder. An example of an SSRI that could be considered is escitalopram at a starting dose of 10mg PO daily, with dose adjustments based on response and tolerability.

Education: If a medication adjustment is made, it is crucial to provide Mr. Beardley with education regarding the new medication. This includes information on the medication’s purpose, potential side effects, and the importance of adherence. Additionally, the nurse should address the importance of maintaining regular follow-up appointments with the healthcare provider to monitor medication effectiveness and manage any adverse effects.

Atypical Antipsychotics: Atypical antipsychotics have been theorized to be effective in bipolar disorder due to their ability to modulate dopamine and serotonin receptors. These medications help stabilize mood, reduce manic symptoms, and may have adjunctive antidepressant effects. Examples of atypical antipsychotics commonly used in bipolar disorder include aripiprazole, quetiapine, and olanzapine. The specific choice of medication and dosage should be determined by the prescribing healthcare provider based on Mr. Beardley’s individual needs and considerations.

In conclusion, optimizing Mr. Beardley’s care plan requires careful consideration and potential adjustments to his medication regimen. Adding an antidepressant, such as an SSRI or SNRI, may help alleviate his depressive symptoms. It is crucial to provide him with education regarding the new medication and ensure regular follow-up appointments. Atypical antipsychotics may also be considered to stabilize his mood and manage bipolar symptoms. Collaborating with the healthcare provider and implementing evidence-based practices will support Mr. Beardley in his journey towards improved mental health and well-being.