RNSG 1125 Psychiatric Nursing: Mental Health Promotion, Maintenance, and Restoration across the Lifespan CRN-14511 Spring 2022 Semester 202014 Unit 2: Therapeutic Communication Schizophrenia Scenario #1 Zane Mart is a 32-year-old male who was recently diagnosed with schizophrenia. Mr. Mart is being treated with paliperidone, which has decreased the severity of his auditory hallucinations. Mr. Mart tells you that he wants to talk about the voices he is hearing. Mr. Mart states that the voices are telling him to kill his mother. He states that his medicine is given to him by the government and will make him lose his mind so that the government will control him, and Jesus will come back to get him. Add on to this scenario with typical behaviors found in the book for Schizophrenic Patients. Remember you will have to give lots of subjective and objective data so that the students looking at your group can get an adequate care plan. Present therapeutic and non-therapeutic techniques. HINTS: Use communication when assisting the patient with discharge education and address patient fears related to discharge. Non-therapeutically and therapeutically. Use open ended questions to discover patient resources and support available. Assist the patient by reflecting and allowing the patient to explore feelings. Assist the patient with remaining calm if possible. Assess the patient for safety measures and provide for patient safety. Using multiple therapeutic techniques as defined in your book, role play this scenario with multiple students being the nurses on the team and participating in the assessment. This scenario should last approximately 15 minutes with audience participation at the end. List the therapeutic techniques used while communicating with the patient as well as the non-therapeutic techniques. At the end of the scenario, ask the nursing students to identify the techniques that were used in the scenario and then advise them of the types that were used and why these were therapeutic. Submit the written scenario to your instructor WITH NO GROUP NAMES ON IT. RNSG 1125 Psychiatric Nursing: Mental Health Promotion, Maintenance, and Restoration across the Lifespan CRN-14511 Spring 2022 Semester 202014 Unit 2: Therapeutic Communication PTSD Scenario #2 Blake Griffin is a 26-year-old male admitted with posttraumatic stress disorder (PTSD). He was diagnosed with PTSD after being deployed twice in Afghanistan during his military service. Blake has been experiencing hypervigilance, difficulty sleeping, and nightmares of a bombing he witnessed. Blake wakes up in the middle of the night and stands guard pacing the floor and experiences panic attacks when hearing loud n noises such as fireworks, gunshots, and tornado sirens. He cannot go where there are loud crowds as that triggers him. Blake has not been able to navigate the VA to get any assistance for his anxiety he has sometimes because he has difficulty driving without having flashbacks on the road. HINTS: Use communication when assisting the patient with discharge education and address patient fears related to discharge. Non-therapeutically and therapeutically. Use open ended questions to discover patient resources and support available. Assist the patient by reflecting and allowing the patient to explore feelings. Assist the patient with remaining calm if possible. Assess the patient for safety measures and provide for patient safety. Using multiple therapeutic techniques as defined in your book, role play this scenario with multiple students being the nurses on the team and participating in the assessment. This scenario should last approximately 15 minutes with audience participation at the end. List the therapeutic techniques used while communicating with the patient as well as the non-therapeutic techniques. At the end of the scenario, ask the nursing students to identify the techniques that were used in the scenario and then advise them of the types that were used and why these were therapeutic. Submit the written scenario to your instructor WITH NO GROUP NAMES ON IT. RNSG 1125 Psychiatric Nursing: Mental Health Promotion, Maintenance, and Restoration across the Lifespan CRN-14511 Spring 2022 Semester 202014 Unit 2: Therapeutic Communication BIPOLAR DISORDER Scenario #3 Joann has been brought to the emergency department (ED) after driving her car into a ditch. When the police came to her aid, she told them that she has been having trouble with the car and that she now wants to “leave it right there with the witch in the ditch!” She appears to be overly cheerful; she is constantly talking, laughing, and making jokes and is wearing copious amounts of perfume and makeup. She is actively pacing back and forth beside the car and is impatient when they indicate to her it may “take a while to clear up the situation.” Joann attempts to leave the scene of the accident. The officers thwart this action and decide that in addition to her impulsivity, she is obviously a danger to herself and others in her present state. They place her in the squad car for transportation to Virginia Beach General Emergency Department. After admission to the ED, Joann is seen by the psychiatric emergency response nurse, who orders a psychiatric consultation. Joann is by now becoming increasingly impatient and upset. While pacing, Joann states, “I don’t want to be here, and you can’t make me. Let me go, you’re the one with the problem. I am the doctor here over the entire hospital, and I am going to fire anyone who does not let me go out this door. Right now!” She asks to call her sister who is really a “guardian angel.” Her sister, Mary, is called. She comes to the ED and reports that her sister, Joann, was diagnosed with bipolar disorder when she was 16 years old. She is usually admitted to the hospital twice a year. “She stopped taking her lithium about 2 months ago.” Joann told Mary that she did not need lithium anymore because she was not sick. Mary adds that their mother had bipolar disorder. Mary reports that Joann appears like she has not been eating because her sister looks very thin. However, Mary cannot tell the staff anymore because Joann has not allowed her to enter her apartment. Mary warns the staff that Joann has made serious suicide gestures in the past. The ED physician determines that Joann is not safe, is delusional and confused, and is not capable of caring for herself at home. He decides to detain her involuntarily at the psychiatric facility. When the attending physician informs Joann of this decision, her agitation escalates, and she curses and spits in the direction of her sister and verbally threatens the staff. The physician orders Haldol and Ativan to be administered orally, but Joann refuses to take it and kicks the physician. “You are trying to poison me.” Security is called, and Joann is restrained and given Haldol, Cogentin, and Ativan intramuscularly. The psychiatrist contacts the local community services board, and an intake officer arrives to perform an assessment for a temporary detention order. It is decided that Joann should be hospitalized during the acute manic phase and started on lithium therapy immediately. It is hoped that medications and a controlled environment will prevent further escalation of the manic state and prevent possible exhaustion and cardiac collapse. HINTS: Use communication when assisting the patient with discharge education and address patient fears related to discharge. Non-therapeutically and therapeutically. Use open ended questions to discover patient resources and support available. Assist the patient by reflecting and allowing the patient to explore feelings. Assist the patient with remaining calm if possible. Assess the patient for safety measures and provide for patient safety. Using multiple therapeutic techniques as defined in your book, role play this scenario with multiple students being the nurses on the team and participating in the assessment. This scenario should last approximately 15 minutes with audience participation at the end. List the therapeutic techniques used while communicating with the patient as well as the non-therapeutic techniques. At the end of the scenario, ask the nursing students to identify the techniques that were used in the scenario and then advise them of the types that were used and why these were therapeutic. Submit the written scenario to your instructor WITH NO GROUP NAMES ON IT. RNSG 1125 Psychiatric Nursing: Mental Health Promotion, Maintenance, and Restoration across the Lifespan CRN-14511 Spring 2022 Semester 202014 Unit 2: Therapeutic Communication Substance Abuse: Addiction Scenario #4 Ms. Krocker, a 64-year-old widow, is brought to the emergency department by her niece after she was called to pick up her aunt from her job for allegedly being intoxicated while working. Ms. Krocker has worked in the ladies’ cosmetics section of a local department store for over 35 years. The psychiatric emergency response nurse, Ann Jones, is paged and called to the emergency department to perform an initial screening. Nurse Jones begins the assessment by asking all the typical drug and alcohol screening questions—“Do you drink alcohol?” “Have you taken any medicine or drugs?”—to which Ms. Krocker answers “No” or “Never” to each question. “Why are you asking me these questions? Certainly, I am sure I have taken a vitamin or two or an aspirin for a headache now and then, but to all your questions—no ma’am, I do not and I have not.” Nurse Jones returns to the attending physician and inquires whether the laboratory reports are back. Ms. Krocker’s blood alcohol level (BAL) is 280. She is at risk for alcohol withdrawal because she drinks a large amount of alcohol and has done so for 4 years. Nurse Jones asks her, “When was your last drink of Listerine?” Ms. Krocker states that she had her last bottle of Listerine 3 hours earlier. Nurse Jones asks her, “About how much Listerine do you drink a day?” Ms. Krocker opens her purse and reveals seven 4-ounce bottles of Listerine. She says she fills them every day and uses all of them through the course of her 8-hour shift. Nurse Jones immediately looks up the chemical composition of Listerine and consults with the attending physician, who orders an immediate assessment of the salicylate levels. Ms. Krocker is admitted to the intensive care unit (ICU), where the staff can monitor her liver function tests, blood studies, and hydration. Ms. Krocker complains that she is being admitted to the ICU. “I do not see why I need to. I only drink Listerine.” Nurse Jones tells her that a substantial amount of alcohol and salicylates are in Listerine, and that admitting her to the ICU is necessary to monitor her withdrawal symptoms. HINTS: Use communication when assisting the patient with discharge education and address patient fears related to discharge. Non-therapeutically and therapeutically. Use open ended questions to discover patient resources and support available. Assist the patient by reflecting and allowing the patient to explore feelings. Assist the patient with remaining calm if possible. Assess the patient for safety measures and provide for patient safety. Using multiple therapeutic techniques as defined in your book, role play this scenario with multiple students being the nurses on the team and participating in the assessment. This scenario should last approximately 15 minutes with audience participation at the end. List the therapeutic techniques used while communicating with the patient as well as the non-therapeutic techniques. At the end of the scenario, ask the nursing students to identify the techniques that were used in the scenario and then advise them of the types that were used and why these were therapeutic. Submit the written scenario to your instructor WITH NO GROUP NAMES ON IT. RNSG 1125 Psychiatric Nursing: Mental Health Promotion, Maintenance, and Restoration across the Lifespan CRN-14511 Spring 2022 Semester 202014 Unit 2: Therapeutic Communication Anorexia: Eating Disorder Scenario #5 Binge Eating Disorder Angela is a 25-year-old lawyer who gives a history of overeating since 10 years of age. She seeks treatment at a community mental health center because she has recently felt more depressed. She is a lawyer in a prestigious firm and has been adjusting to a new director and her new director’s style of management. “This isn’t an easy process. She demands results without giving me enough time on the projects. It is really stressful. My other boss was supportive and encouraging. Eating relieves the feelings of anxiety following work.” She is eating more than usual and has begun to stop at fast food restaurants prior to dining with her partner at home. Secretly eating large amounts is a regular event, followed by guilt and shame. “I have been doing this since grade school and have never found a way to stop. There isn’t a diet that I haven’t tried; it’s hopeless. I don’t vomit or use diuretics after eating.” She denies thoughts of suicide and presents with mild depression. Her concern is her eating disorder more than her weight or mood. HINTS: Use communication when assisting the patient with discharge education and address patient fears related to discharge. Non-therapeutically and therapeutically. Use open ended questions to discover patient resources and support available. Assist the patient by reflecting and allowing the patient to explore feelings. Assist the patient with remaining calm if possible. Assess the patient for safety measures and provide for patient safety. Using multiple therapeutic techniques as defined in your book, role play this scenario with multiple students being the nurses on the team and participating in the assessment. This scenario should last approximately 15 minutes with audience participation at the end. List the therapeutic techniques used while communicating with the patient as well as the non-therapeutic techniques. At the end of the scenario, ask the nursing students to identify the techniques that were used in the scenario and then advise them of the types that were used and why these were therapeutic. Submit the written scenario to your instructor WITH NO GROUP NAMES ON IT. RNSG 1125 Psychiatric Nursing: Mental Health Promotion, Maintenance, and Restoration across the Lifespan CRN-14511 Spring 2022 Semester 202014 Unit 2: Therapeutic Communication Major Depressive Disorder Scenario #6 Denise is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhereanywherebut Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea.” In fact, she does not even have the energy to dream; getting out of bed and preparing to go to work is simply too labor intensive. Each evening Denise retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the evening; consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last two months. She does not attend to her makeup or clothes; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her coworkers and does not initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete them. Telephone calls and email messages from friends are ignored. Attendance at work is spotty. Stephanie, her sister, becomes alarmed with Denise’s unanswered telephone calls and emails. Worried, she decides to visit her sister at home. She finds the apartment unclean and in disarray. Denise is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Denise tells Stephanie that she feels “sad and hopeless. Nothing is ever going to change. I am a bad person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time.” Stephanie is alarmed at the changes in her sister and arranges for Denise to visit a health care worker at the medical clinic. A nurse practitioner greets Denise in the clinic. She completes an initial physical and psychological assessment and determines that Denise is suffering from major depression. The nurse makes an appointment for Denise the following day. HINTS: Use communication when assisting the patient with discharge education and address patient fears related to discharge. Non-therapeutically and therapeutically. Use open ended questions to discover patient resources and support available. Assist the patient by reflecting and allowing the patient to explore feelings. Assist the patient with remaining calm if possible. Assess the patient for safety measures and provide for patient safety. Using multiple therapeutic techniques as defined in your book, role play this scenario with multiple students being the nurses on the team and participating in the assessment. This scenario should last approximately 15 minutes with audience participation at the end. List the therapeutic techniques used while communicating with the patient as well as the non-therapeutic techniques. At the end of the scenario, ask the nursing students to identify the techniques that were used in the scenario and then advise them of the types that were used and why these were therapeutic. Submit the written scenario to your instructor WITH NO GROUP NAMES ON IT.
