CASE STUDY “: A 50-year-old divorced white male named Mr. Jones is… CASE STUDY “: A 50-year-old divorced white male named Mr. Jones is told he has stage 4 lung cancer. He has lost his job and is having difficulty quitting cigarette smoking which is high risk for Cancer. He is irritable, angry and has difficulty processing information about his chemotherapy options. He states he “doesn’t feel like living anymore”. He states he would like to take the gun out of his closet and shoot himself if he returns home. His blood pressure is 90/60 and he has difficulty walking. He is first sent to ER for hydration and then admitted to your inpatient psychiatric unit. His blood pressure upon admission is 120/ 60 with HR 84 and O2 sat 96%. Respirations labored upon admission when ambulating. He is placed on fall precautions before coming to the mental health unit. Mr. Jones is prescribed Trazadone 25 mg for sleep prn, and he is to be started on Celera 20 mg in AM. What are some important considerations regarding his medications and medical issues? What kinds of vital signs would cause concerns? (Mention blood pressure and 02 sat with HR and listening to breathe sounds) He is to be placed on fall precautions. Please find out some specific interventions for fall precautions and determine1;1 sitter for SI and fall precautions.After your assessment, you determine he remains a high suicide risk outside of hospital. He has the means of harming himself outside hospital but has not said he will harm himself when in hospital.. You contact the social worker and MD to clarify the status of the rifle in his closet at home to see if it can be secured.You give him a nursing diagnosis as Risk for Suicide secondary to social isolation and fatigue from Stage 4 Lung cancer.Please complete His Nursing Care Plan with a least 4 interventions a short-term goal and a long-term goal. Include nursing diagnosis at top of page short term goal- what can be accomplished in 24 hours? Long term goal- What can be done in three days or more. ( ie- Pt will no longer be suicidal) Interventions- 1) first is always safety assessment- is overall environment safe- ( safe to be alone in room? impulsive? dangerous sharp objects? IV infiltrated etc? Dont have tunnel vision and miss important safety hazards because you are caught up in EPIC or other problems)Mental status checks in for SI or change in mental status always at least once a shift and prn as first step to safety. Determine level of observation needed and if prn meds such as antipsychotics or pain meds or detox meds are needed. 2) Vitals with parameters for medical instability such as low o2 sat or unstable vitals (please list parameters in interventions for when to call MD).3) Medication administration: know usage, dosage and potential side effects and PT education. Monitor Efficacy- report to MD efficacy and potential side effects and also TEACH BACK to patientWhat consults may be needed- ie social work, Physical therapy, respiratory therapy, dietary- Occupational Therapy and why are they needed- please specify (ie OT consult for problems with ADLs and evaluate life skills)Evaluation: Can this patient follow directions? Does he forget things and is he compliant? These are important considerations for fall precautions and or medication teaching. As well as discharge planning- Will this patient ever be able to safety return home? If not, social worker needs rigirous involvement on day 1 of admission. Health Science Science NursingNURSING N129
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