The psychiatrist on call comes in to evaluate J.B. after meeting with J.B., the psychiatrist writes an order for escitalopram (Lexapro) 10 mg daily at bedtime.
J.B. is scheduled to see the psychiatrist the day after he
is discharged from the hospital.
What special instructions will you give him regarding the Lexapro? Select all that apply.
a. The full effects of the medication might not be seen for 4 to 6 weeks.
b. The medication may cause nausea, dry mouth, sedation, and insomnia.
c. There are no known food interactions.
d. The herbal product St. John's wort will enhance the action of the Lexapro.
e. Taking a glass of wine at bedtime will help him go to sleep.
Why do you think that a drug in the SSRI class was chosen over a tricyclic antidepressant or a
monoamine oxidase inhibitor (MAOI)?
Question 2You decide to notify J.B.'s physician about your findings. the attending physician calls in a psychiatrist to evaluate J.B.
Identify two treatments that are available for depression.
Would J.B. be a candidate for electroconvulsive therapy (ECT)? Why or why not?
Question 3You use the sadPeRsONsscale to assess J.B.'s potential for suicide and find that he is at a 4 on the 10-point scale. J.B. tells you that he has just had general thoughts of suicide
but has not really thought about how he would do it. you recall that there are two types of suicide methods based on lethality:
higher-risk or hard methods, and lower-risk or soft methods.
Which of these would be considered soft methods of suicide? Select all that apply.
a. Using a gun
b. Slashing one's wrist
c. Hanging
d. Poisoning with carbon monoxide
e. Ingesting pills
f. Inhaling natural gas
What immediate interventions would you carry out for J.B.?
Question 4You are working the day shift on a medical inpatient unit. you are discussing discharge instructions with J.B., an 86-year-old man who was admitted for mitral valve repair
His serum blood glucose had been
averaging 250 mg/dL or higher for the past several months. during this admission, his dosage of insulin
was adjusted and he was given additional education in managing his diet. While you are giving these
instructions, J.B. tells you his wife died 9 months ago. He becomes tearful when telling you about that loss
and the loneliness he has been feeling. He tells you he just doesn't feel good lately, feels sad much of the
time, and hasn't been involved in his normal activities. He has few friends left in the community because
most of them have passed away. He has a daughter in town, but she is busy with her work and grandchil-dren. He tells you that he has been feeling so down the past few months that he has had thoughts about
suicide.
What other information should you ask J.B. regarding his thoughts of suicide?
What characteristics of J.B. put him at high risk for suicide?
Which psychiatric disorders can result in suicidal ideations or gestures? Name at least three
What questions would you ask J.B. to determine whether he is clinically depressed? Name at
least six.
Ill people often have trouble sleeping, experience a change in appetite, reduce their level of
activity, and have thoughts of death. How can you tell the difference between old age with
illness and depression?
List five of the most common signs of depression in the older adult.
Question 5K.B. is discharged and sees his primary care physician 2days later. K.B. receives a prescription for donepe-zil (aricept) 5 mg PO per night
as you review the prescription with K.B.'s daughter, she tells you that she is
excited because she did not know there were medications that could cure alzheimer's disease.
How do you respond?
What is the best answer for her question?
K.B.'s daughter mentions that she has found him out in the front yard and once in the
neighbor's yard. What are some interventions that you can suggest to promote safety
for K.B.?
Question 6After review of K.B.'s history and diagnostic test results, K.B. is diagnosed with alzheimer's dementia. the physician calls a family conference to discuss the implications with K.B. and his daughter.
What neuroanatomic changes are seen in individuals with Alzheimer's disease?
List at least three interventions you would plan for K.B.
Question 7You are the nurse working triage in the emergency department. this afternoon, a woman brings in her father, K.B., who is 74 years old
the daughter reports that over the past year she has noticed her father has
progressively had problems with his mental capacity. these changes have developed gradually but seem
to be getting worse. at times he is alert and at other times he seems disoriented, depressed, and tearful.
He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and
sugar in the refrigerator. K.B. reports that he has been having memory problems for the past year and
at times has difficulty remembering the names of family members and friends. His neighbor found him
down the street 2 days ago, and K.B. did not know where he was. this morning he thought it was night-time and wondered what his daughter was doing at his house. He could not pour his own coffee, and he
seems to be getting more agitated. a review of his past medical history is significant for hypercholester-olemia and coronary artery disease. He had a myocardial infarction 5 years ago. K.B.'s vital signs today are
all within normal limits.
What are some cognitive changes seen in a number of elderly patients?
You know that physiologic age-related changes in the elderly can influence cognitive
functioning. Name and discuss one.
For each behavior listed, specify whether it is associated with delirium (DL) or dementia (DM).
______ a. Gradual and insidious onset
______ b. Hallucinations or delusions
______ c. A sudden, acute onset of symptoms
______ d. Progressive functional impairment
______ e. Inability to perform activities of daily living (ADLs)
______ f. Incoherent interactions with others
______ g. Possible wandering behavior
______ h. Behavioral disorders that often worsen at night
Based on the information provided by the daughter, do you think K.B. is showing signs of
delirium or dementia? Explain.
You know that there are several types of dementia that result in cognitive changes. List two of
these types of dementia.
How can the level or degree of the dementia impairment be determined?
A number of diagnostic tests have been ordered for K.B. From the tests listed, which would
be used to diagnose dementia?
______ Mental status examinations
______ Toxicology screen
______ Mini-Mental State Examination
______ Electrocardiogram
______ Electroencephalogram
______ Complete metabolic panel
______ Complete blood count with differential
______ Thyroid function tests
______ Colonoscopy
______ Rapid plasma reagin (RPR) test
______ Serum B12 level
______ Bleeding time
______ Human immunodeficiency virus screening
______ Liver function tests
______ Vision and hearing evaluation
______ Magnetic resonance imaging (MRI)
Question 8One month ago, J.P., a 50-year-old man, came to the outpatient clinic with complaints of mild shortness of breath and some mild intermittent chest pain
He described himself as a high-stress, type apersonal-ity who owns his own business and works long hours. He has smoked one pack of cigarettes per day for
the past 30 years. He has tried to quit several times and was successful for as long as 6 months at a time,
but when business became stressful, he started smoking again. J.P. said he has been trying to lose the
extra 30 pounds he is carrying but stated it is difficult to exercise because of the long hours of work. The
cardiac workup is negative for coronary artery disease, and he has returned for a follow-up visit. during
the discussion about lifestyle changes, J.P. expresses interest in medical hypnosis for stress management
and smoking cessation. He would like more information. you are the case manager for the clinic and meet
with J.P. to discuss medical hypnosis.
J.P. asks, What is hypnosis? What will you tell him?
J.P. asks what you mean by trance state. Explain the term.
J.P. wants to know what you mean by subconscious mind.Explain the term
J.P. asks, How does hypnosis work to help someone change a subconscious belief? How will
you respond?
J.P. states he has seen TV shows where people did silly things on stage during hypnosis. He
wants to know how medical hypnosis is different. Explain.
J.P. asks, Is there a way to know if hypnosis will work? Please respond.
J.P. wants to know what happens during a hypnosis session. You inform him that medical
hypnosis has several components: patient preparation and education, establishing a rapport
and a trusting relationship, induction and deepening, hypnotic suggestions, and reawakening
from the trance state. Briefly explain each step.
J.P. asks, How effective is hypnosis in helping someone stop smoking? How will you
respond?
J.P. asks whether hypnosis is contraindicated for anyone. What will you tell him?
J.P. apologizes for being full of questions but wants to know whether hypnosis has to be
done with a hypnotist or if he can do it himself with a downloadable mp3 file. How will you
respond?
J.P. asks you how he would go about finding a hypnotist. What will you tell him?
J.P. states he would like to read more about hypnosis on the Internet. List three credible
websites you could give him.
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