Week 3 Discussion Post Responses (Essay Sample)

instructions Write a reply to each of the following posts Katelyn R Heying Yesterday Sep 11 at 11:56am Currently, I work in a medical-surgical unit at our local hospital. There, we treat patients across the lifespan with various illnesses, diseases, and surgical needs. We recently cared for an older gentleman with alcoholism; one night, he had too much to drink and fell, resulting in multiple lacerations, abrasions, hematomas, and a minor concussion. While hospitalized, it was discovered his bilirubin and ammonia were critically elevated, and was also hypokalemic. During his prolonged hospitalization of nearly two months, we as nurses worked with the healthcare team to ensure proper medication administration that was everchanging, encouraged bidaily walks, and cooperation with therapy services. We educated the gentleman on his treatment process as he was frustrated and defeated with his length of stay. This led to depressive symptoms; he was no longer interested in his care, seemed sad or disassociated during staff-patient interactions, and had a decreased appetite. Staff became aware of his daily routine and favorite snacks and used their downtime to visit him; this sounds simple, but it significantly improved his overall mood each day. We also were able to help him contact his loved ones, making him feel less alone. Advocacy methods included speaking with the provider when things were not going as planned, leading to a better-formulated medication regimen. We informed therapy services of his progress and nightly walks, and helped him with financial assistance. Other strategies we could have used to improve his satisfaction with care would include encouraging his daily routine outside the hospital, such as his sleep or bathing routine. Staff could have tried to promote more independence in routine cares to ensure safety when returning home. Finally, we could have evaluated him for a mental health disorder such as depression, which would have helped the team better care for him. According to a study completed by Verbosky and Franco, there is a strong correlation between a patient’s hospitalization length and depression. They also found that when treating those who were depressed with antidepressants and therapy, their stay was shortened. Verbosky and Franco concluded that when treating the patients’ coexisting illnesses, there is an improved patient satisfaction, shortened hospitalization period, and potential effect on the overall cost of care (Verbosky & Franco, 1993). This article supports my idea of how we could have provided better care for the patient discussed. Not only would screening for depression help us determine medication needs, but it would have also allowed us to include psychiatric assistance, potentially shortening his lengthy stay. In conclusion, our patients are more than their diagnoses. When formulating a treatment plan with the healthcare team, it is essential to look at the whole picture. Depression is all too common, and knowing the signs can tremendously impact the patient. When noticing symptoms of depression, it is important to remember the legal and ethical implications that should be considered. Is the care provided enough, or should the patient be referred for further psychiatric care? Is the patient safe in their room alone? Are there any suspicious injuries that need to be reported for further investigation? Our patients are more than their admitting diagnosis. Reference: Verbosky, L. A., Franco, K. N., & Zrull, J. P. (1993). The relationship between depression and length of stay in the general hospital patient. The Journal of clinical psychiatry, 54(5), 177–181.https://pubmed.ncbi.nlm.nih.gov/8509347/ Mercy Olotu Yesterday Sep 11 at 3:01pm Week 3 Discussion Psychological Complications Resulting from Suspicious Illnesses or Injuries Depression Resulting from Illness or Injury Illnesses and Injuries can take a negative toll on someone physically. Not being able to care for yourself the way you were once able to and having to depend on others to do simple activities of daily living can have some psychological effects as well. In my current practice as a travel Med-Surg nurse, I have taken care of patients who have gone from being completely healthy to all of a sudden being diagnosed with a chronic illness. As the nurse taking care of such patients, I see the stages of grief more often than not. I can see how a patient's mental state starts to decline and eventually end up depressed. In the journal article "Depression and Health Status in Elderly Hospitalized Patients with Chronic Illness", patients with chronic illnesses are at more risk of becoming depressed the longer they stay in the hospital. This was an actual experimental study that focused on elderly patients. However, not only do I encounter patients with depression in the elderly, but I encounter them with young adults as well. I was assigned to a patient who was a young and generally healthy female. She was brought in by her husband for altered mental status. Now usually when a patient is brought in for a change in mental status, it is an exacerbation of an underlying condition. This is usually presented in the older adult. Cat scans and MRIs of the brain showed cephalic encephalopathy which doctors were not able to determine the etiology of the diagnosis. Then, she appeared to have a growing tumor on the frontal lobe of her brain as a repeat MRI showed. She underwent a craniotomy and ended up having some of her mental status restored. When she was fully alert and oriented and was able to comprehend her situation, it was clear that she became depressed. She stopped eating, stopped talking, and even started to become incontinent of bladder and bowel. I have been assigned to her multiple times as a patient as she stayed in the hospital for 6 months. I advocated for her stating that she may need a psychiatric evaluation to diagnose her depression. The attending at the time listened to me and got her a psych consult. The psychiatrist stated that she was diagnosed with depression and prescribed her some anti-depressants. It was unfortunate to see the decline in this specific patient because not only was she young and diagnosed with brain cancer, but she was also a mother who wasn't able to take care of her child due to her physical and now mental illness. It was challenging to care for this patient as she would oftentimes have extreme outbursts and would even threaten to hit staff members. I would give positive reinforcement strategies such as giving her extra vanilla pudding if she would comply with the treatment of her care. I also had to talk to her as if she was a child sometimes. I would use words such as "blanky" or "nap time" just to get her to listen. When her family wasn't present and she would act out, I would call her husband or her mother just so she could hear a familiar voice and calm down. I have used a lot of measures to get her out of her depressive state. Most strategies that I've used worked and others fell short. Honestly, I remember going above and beyond for her so I don't think there was anything else that I could've done that wouldn't involve me overstepping my boundaries. Yes, she was a patient who I was very familiar with, and I was assigned to her often because she liked me personally, but I still had to remain professional. I advocated for her many times in many ways. One way I advocated for her was by getting her a psychiatric consultation. She was holding on to situations from her past that she was finally able to talk about during her session with the psychiatrist. She was on an anti-depressant that made her feel nauseous sometimes. I tried different ways for her to take her medication so that she wouldn't have that nauseous feeling such as taking the medication with food or crushing it and putting it in the vanilla pudding that she liked, but nothing worked. I finally asked her attending for PRN anti-nausea medication, and it was ordered. Because of her mental instability, she was not allowed to walk in the hallways because she was deemed "disruptive" to other patients. However, I spoke with my manager and asked for her to walk with a staff member in the hallways as long as she was cooperative. My manager permitted me to do so on a trial basis. This helped the patient so much because she was able to get out and see something other than the four walls of her room. Some of the legal implications that need to be considered when it comes to providing care for patients with suspected illness or injury resulting from a chronic illness are veracity and autonomy. Even though patients may suffer from depression or have some self-inflicted injuries does not make them incompetent. Ultimately, a patient is in charge of their care with the help of the healthcare team. They have the right to refuse treatment even if we as nurses want it for them. Autonomy is the right to self-determination without the influence of any members of the healthcare team. Veracity is truthfulness. As nurses, we must be truthful within our scope of practice. Any sort of imaging or lab draw that we needs to be done on the patient should be told to them. Regardless of the patient's condition, it is necessary to keep them informed about their plan of care. References: Unsar, S., & Sut, N. (2010). Depression and health status in elderly hospitalized patients with chronic illness. Archives of Gerontology and Geriatrics, 50(1), 6-10. Haugan, G., Innstrand, S.T. & Moksnes, U.K. (2013). The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patientsLinks to an external site.. Journal of Clinical Nursing, 22(15–16), 2192-2205. http://doi.org/10.1111/jocn.12072 Matthew Schweitzer Yesterday Sep 11 at 3:22pm The comorbidity of physical and mental illnesses has been an increasing problem. As the population ages and life expectancy increases, this problem will worsen (Sartorius, 2018). Some mental health issues are recognized more frequently in certain physical illnesses than others. In people diagnosed with diabetes, depression is seen twice as often as those with no history of diabetes (Sartorius, 2018). As a new nurse in a behavioral health unit, I encountered a patient admitted for suicidal ideation. She was an African-American woman in her late fifties. Among her medical diagnoses was type 2 diabetes, which she had been diagnosed with nine years prior. Her stated reason for her suicidal thoughts was depression caused by living with diabetes. An article published in Dialogues in Clinical Neuroscience (2022) titled “Depression and Diabetes” describes the risk factors, consequences, and treatment for these comorbid conditions. First, risk factors described include lifestyle, obesity, adverse events in childhood, and complications of diabetes. It was also noted that women and migrants were at an increased risk (Sartorius, 2018). Next, the consequence of having both diabetes and depression is linked to increased diabetic complications and reduced self-care (Sartorius, 2018). Last, effective treatment for this comorbidity was listed as psychotherapy with diabetes education, psychopharmacological treatment with SSRIs, and a collaborative approach with other healthcare professionals (Sartorius, 2018). The challenges faced by this patient included providing effective diabetes education to allow her to live more comfortably, finding the correct medication regimen, and setting up the proper outpatient appointments. Strategies used to overcome these challenges included a collaborative approach. The hospital’s diabetes educator was consulted to speak with the patient regarding diabetes self-care. The psychiatrist and hospitalist determined the most effective medications and wrote prescriptions, and the social workers set up outpatient appointments. I and other nursing staff advocated for the patient by monitoring her blood sugars throughout the day and reporting results to the interdisciplinary team, ensuring her safety on the unit, and helping her connect with resources in the hospital. Other strategies that could have been beneficial were to include her family in diabetes education and to follow up with the patient after discharge to evaluate further needs. The primary legal and ethical considerations for this patient and others in the behavioral health unit are maintaining privacy and confidentiality and preventing harm. Reference: Norman Sartorius (2018). Depression and diabetes, Dialogues in Clinical Neuroscience, 20:1, 47-52, DOI: 10.31887/DCNS.2018.20.1/nsartorius Links to an external site. https://www.tandfonline.com/doi/full/10.31887/DCNS.2018.20.1/nsartorius Amy Kaitlyn Brewer Sunday Sep 10 at 9:14am Discussion 3 Emphasizing a suspicious client's illness. As a nurse, you often find yourself taking care of many patients every day. Some that are having a simple procedure done and others that are very sick. I was working on step down cardiac unit in which I found myself getting this elderly man patient. He was being monitored for Afib. A little background on this patient. When he came into the emergency room, the only problem he faced was not being able to use the bathroom. He was ambulatory, in his right state of mind, but scared. I entered the patient's room where a MD was giving the horrible news. “Sir I think it would be in your best interest if we sign you up for hospice, I am 99% sure the mass we found on your colon is cancer and it has spread” “ I will give you and your family a few minutes to decide what you want to do and I will return.” The little man immediately broke down. He did not know he was walking in to be told he was going to die. When the physician left I got to speak with the patient, I asked if he had any history of Diverticulosis, he stated yes. I quickly began educating the patient and family back the s/s of diverticulitis. I explained that the physician had not tested anything for cancer yet, so this may not be true. The longer the patient set the more depressed he was getting. I stayed with the patient comforting him. He asked if I could talk to the MD for him. I called the MD, she said “there was nothing else they could do, he has cancer, and if they did surgery, he would not make it through anyways.” Okay and I hung up. I told the patient and family to tell the MD they wanted another opinion at another facility. They proceeded. It made the doctor mad, but he was able to be transferred to a bigger hospital. There, they had the surgery, he had no cancer. Diverticulitis had blocked part of his colon. He is still living today. It is important to advocate for these patients. This is one of the most important jobs as a nurse. Not every MD is correct all the time, and as a nurse you are allowed to state your opinion. The MD had no right to tell a patient they were going to pass away without being 100% of the problem. Doing this situation differently, I would have checked for medical errors, and protected the patient's rights more. You can't be forced into hospice no matter the problem. Alene Nitzky, P. (2021, February 9). Six ways nurses can advocate for patients. Oncology Nursing News. https://www.oncnursingnews.com/view/six-ways-nurses-can-advocate-for-patients Links to an external site. source..