Week 12 Assignment 1: Sarah O'Neil iHuman Case Study Regis College School of Nursing NU 66, Exams of Nursing

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Week 12 Assignment 1: Sarah O'Neil iHuman Case Study Regis College School of Nursing NU 664C: Family Psychiatric Mental Health I

Week 12 Assignment 1: Sarah O'Neil iHuman Case Study

Psychiatric History : None Medical History : Up-to-date immunizations. Childhood asthma. Fatigue. Obesity Social History : Married. Her spouse is kind, but her depression is straining their relationship. There have been no reports of domestic violence. There are no firearms in the house.Working in a pediatrician's office Education – Currently has an Associate's Degree and taking a Bachelor's Degree at a night schoolHas encountered blackouts with drinking in the past (high school) and 5 weeks ago. Drinks 1- 2 alcoholic beverages per week, rarely heavy usage of alcohol. There are no tobacco use. There is no use of illegal drugs. Surgical History: Appendectomy Medications: Multivitamin and Orthotricyclen for birth control Allergies: None Family History: Father abuses alcohol but is in recovery at the moment Mother had schizophrenia and committed suicide Review of Systems

• Constitutional: Patient is positive for fatigue, weight changes, difficulty sleeping but denies fever and sweating at night. - HEENT: Denies headache, blurred vision, difficulty swallowing, nasal congestion, sinus pain, problem hearing, and sore throat.

- Cardiovascular: Denies chest pain, decreased exercise tolerance, palpitations, edema,cold fingers, syncope, and cold toes. - Gastrointestinal: Denies vomiting, bloating, constipation, nausea, early satiety, and diarrhea - Genitourinary: Denies pain, continency, changes in urination frequency, odor, dribbles, and dysuria - Musculoskeletal: Denies cramps, walking limitations, discomfort when sitting, redness, joint deformities, hip and neck pain.

• Neurological: Denies unconsciousness, speech dysfunction, disorientation, sensory disturbances, dizziness, seizures, hallucinations, attention difficulties, tingling, numbness, concentration, and motor disturbances.
• Psychiatric : Positive for nervousness, anxiety, lack of interest, depression, mood changes, memory loss, difficulty, and hearing or seeing things that do not exist.
• Endocrine : Denies appetite change, unusual thirst, cold intolerance, frequent urination,and heat intolerance
• Hematologic/Lymphatic: Denies glands that are swollen, unusual bleeding, and bruising easily.
• Allergic/Immunologic : Denies any kind of allergies. Objective Vitals - Temperature: 98.9 F (oral) - Blood Pressure: 110/76 left arm while sitting - Pulse: 68 bpm

General : Oriented and alert to time and place. Casually dressed and obese. Speech : increased speech rate (Hyperverbal) Mood : Seems anxious and depressed Thought content: Has passive suicidal thoughts, has paranoia, focuses on shame, writing novels, and Judgment: Poor Thought Process: Associations loosening Cognition: Intact attention and impaired concentration Insight : Poor Laboratory And Diagnostics CBC: In the normal range CMP: In the normal range Blood alcohol level: in the normal range ASA level: in the normal range Rationale Since the client takes alcohol, it is essential to perform labs to determine toxicity levels. The blood alcohol level is needed to determine the level of alcohol intolerance and any signs of withdrawal symptoms. CBC is essential since it is drawn to determine if the patient can determine macrocytic anemia due to taking alcohol. A CMP test will be essential since it will determine if the patient has any liver damages due to alcohol intake. There is also a need to takea pregnancy test to determine if the patient is pregnant since she is on birth control. The ASA level tests are drawn to determine any toxicity of drug due to ingestion. Assessment Findings

Sarah seems to be having bipolar II disease with psychotic characteristics. For the last month, Sarah says she's been sad every day, and for the past two weeks, she's felt sad "every minute of every day." Because of her faith and family, she admits to having suicidal thoughts, but she saysshe will not act on them. As a result of some delusional thinking, she believes she's being targeted for dismissal by her colleagues. About six weeks ago, Sarah says she went days withoutsleeping and behaved in a way that was clearly out of character for her. An extra- marital affair was discussed at the pub, she nearly departed with a stranger, and she became blackout drunk. Sarah has also recently gained weight and is dissatisfied with the way she looks, she tells us. For a mother with schizophrenia, a father with alcoholism, and a sister with depression, the family history is significant. Differential Diagnosis: Generalized Anxiety Disorder DSM- 5 300.02 (F41.1) Generalized anxiety disorder is characterized by excessive, irrational anxiety and stress in the face of ordinary daily situations. An alternative term for it is GAD. GAD sufferers constantly worry about their health, family, finances, employment, and education (Kim, 2020). His feelingsof despair are exacerbated by her emotional and behavioral reactions.. Worry and sleeping issuesare also among her complaints. Even though her partner is supportive, she finds it impossible to focus on anything, even her relationship. Bipolar II disorder 296.89 (F31.81) Bipolar II disorder patients commonly appear during a major depressive episode, while hypomanic episodes are rarely the cause of disability (Jain, 2021). Impairment is caused bysignificant episodes of depression or recurrent trends of irregular mood fluctuations and inconsistent interpersonal or vocational functioning.

Diagnostics: Drug toxicology, thyroid function test, CBC , blood alcohol concentration hCG, complete metabolic panel, and acetaminophen Pharmacological Treatment:

1. quetiapine fumarate 50 mg/day PO divided q12hr. As a single drug or in conjunction withother mood stabilizers, quetiapine has been found to be useful in the treatment of bipolar disorder, including manic, mixed, and depressed episodes. Continuous monitoring of metabolic side effects is necessary to detect dyslipidemia and hyperglycemia (Savva, 2019).
2. Prozac 20 mg PO qDay. A depressive disorder can be treated with fluoxetine. The patient's mood, sleep, appetite, and activity level may improve as a result of taking this medicine. Fear, anxiety, undesirable thoughts, and panic attacks may be reduced (Tayloret al, 2021).
3. Ramelteon 8 mg qD. The patient's insomnia is alleviated by using this drug (insomnia). As a result, she will be able to get a good night's sleep sooner (Townsend & Morgan,2017). Non-Pharmacological Treatment: Anxiety and coping skills can be improved with cognitive- behavioral therapy (CBT). Yoga and other forms of exercise can aid in her recovery from issues like suicidal ideation (Taylor, 2021). Patient Education: Quetiapine has been demonstrated to be useful as a stand - alone treatment or as an addition to other mood stabilizers as a therapeutic treatment for or in manic, mixed, anddepressed exacerbations of bipolar disorder. To check for dyslipidemia and hyperglycemia, metabolic side effects must be monitored on a regular basis. Ascertain patient safety and informthe patient and family about the necessity of medication adherence and the signs and symptoms

of hypomania. In those with bipolar disorder, psychoeducation has been demonstrated to have considerable preventive effects. Medicine decisions like atlering drugs and psychological decisions as well as lifestyle alterations are examples of shared decision-making (diet, exercise, and complementary therapies). Treatment compliance and outcomes improve when people makedecisions together. Suicide and substance addiction education are essential for her, too.. Follow up: After two weeks, she should return to check on her condition's progress.

Jorge, B. (2020). SCIATICA PAIN RELIEF: A complete guide to sciatica causes, symptoms, treatments, and exercises for effective sciatica pain relief. Independently published. Kim, Y. (2020). Anxiety disorders: Rethinking and understanding recent discoveries (advancesin experimental medicine and biology, 1191) (1st ed. 2020 ed.). Springer. Savva, M. (2019). Pharmaceutical calculations: A conceptual approach (1st ed. 2019 ed.). Springer. Taylor, A. W. (2021). Physiology of exercise and healthy aging (Second ed.). Human Kinetics. Taylor, D. M., Barnes, T. R. E., & Young, A. H. (2021). The Maudsley Prescribing Guidelines in Psychiatry (The Maudsley Prescribing Guidelines Series) (14th ed.). Wiley-Blackwell. Townsend, M., & Morgan, K. (2017). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (9th ed.). F A Davis Co.