Tom a 26-year-old male who presents to the Emergency room.

Tom a 26-year-old male who presents to the Emergency room. He is brought into the ER by his roommate who states that Tom is not acting normal and is far off his baseline. He presents with Bradykinesia, mask-like faces, tremors, rigidity, shuffling gait, drooling, cogwheeling. You look into his history and note that Tom is established with behavioral health and note that he has a history of schizophrenia:

1. The nursing student with you is interested in knowing more about this condition. In your own words, provide an overview of this condition and the features that correlate.

2. In reviewing his medication history you see that Tom is on Chlorpromazine which was started approximately 30 days ago. Which you recall is in what drug class?

3. You also see that his symptoms correlate with what side effect (term),______________,specifically___________________.

4. What would you anticipate treatment to look like (discuss measures)what is the intervention based on the side effects.

5. How do you categorize extrapyramidal symptoms (2 major categories), describe treatment for each.

 

Scenario#2The nurse is collecting data from your patient, Jerome, who states that they are struggling in life with their recent loss of employment and divorce. The patient states he is feeling sad, unmotivated, has lost about 10 lbs. in the past month, finding it difficult to maintain concentration and has poor self-esteem. Jerome admits that he has poor compliance with medication adherence, so he is nervous about starting a regimen.

1. These symptoms correlate with what diagnosis?

2. The provider is planning to start the patient on Fluoxetine.

3. What if the classification of Fluoxetine?

4. What Neurotransmitter is involved, discuss how this occurs and it therapeutic effect.

5. Jerome has been divorced for 5 years and is hopeful that this new plan will help him get back on track. He would especially like to find a partner. Jerome continues to inquire about the medication, discuss the potential side effects he can anticipate when starting Fluoxetine?

6. When should Jerome contact the provider once started on Fluoxetine?

7. What will you emphasize in regarding the implications with adherence while on Fluoxetine?

8. Jerome wants to know when he should anticipate that he will be feeling better. What will you tell him?

 

Scenario #3You are working the nurse line for the behavioral health clinic. Sofia is a 39-year-old woman will Bipolar Disorder calls into the clinic because she can’t recall or find her discharge instructions on her treatment plan. You review the electronic health record and note that Sofia was started on Lithium about 1 week ago. You ask Sofia to share her questions with you and she can’t tell you anything. You will send her treatment plan via overnight mail but give her instructions over phone.1

1.  describe Bipolar disorder.

2. What is the drug treatment of Bipolar Disorder? Discuss all three drug regimens and what they do.

3. Sofia does not understand why she needs to come in for a lab next week. All of her labs were drawn in her previous office visit. You review the orders and relay the information to her letting her know that she will be needing what lab with what desired range?

 

Scenario #4Mary a 63-year-old retired nurse, recently retired who had worked night shift for 30 years. She has been retired for 5 months and is having difficulty sleeping. Although it is safe to assume that her sleeping problem may be related to her recent change in employment. However what is essential in your assessment?

1. The provider writes a prescription for Zolpidem po prn, 15 tablets with no refills. Mary is beside herself with the prescription. Annoyed that she may have to come back for a refill. What do you discuss with her regarding the prescription?

 

Scenario #5Lenny a 26-year-old college student presents to the clinic; upon chart review you note the only medical history is anxiety. He states that he feels anxious most days, and is finding it difficult to go to class, and being around people. The provider plans to start the patient on Paroxetine.

1. What drug class is paroxetine in?

2. What is the MOA, involving what neurotransmitters?

3. What is the therapeutic effects?