What Should the Nurse Do?
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Tonya is a nurse at a busy level-one trauma center. Working in the ER, she sees all types of patients. Her new patient, Lin, is a 24-year-old female who complains of having trouble leaving her home because the local radio station can access her brain and broadcasts her thoughts to the whole town. Her family convinced Lin to visit the ER to address her symptoms. The nurse knows that she needs to assess Lin for mental illness, but Lin is afraid of the loud noises in the ER and is not sure she trusts Nurse Tonya with her secrets. What should the nurse do?
Lucy is a 19-year-old female who lives at home with her mother. She assists her mother in caring for her grandfather who has dementia and is a hospice patient. She recently lost her grandmother and father to cancer and has a strained relationship with her mother. Lucy has a long history of severe anxiety and depression. She has taken several antidepressants in the past, but she stopped taking them a month ago and her symptoms returned. Lucy says she does not like how the medications give her a dull outlook on the world. Lucy is an artist who feels she cannot create art while her senses are clouded by medication. Lucy was brought to the ER by ambulance shortly after midnight. She had taken all of her grandfather’s hospice medications, including an entire bottle of morphine, a whole bottle of Ativan, and a compounded cream called HABR, containing Haldol, Ativan, Benadryl, and Reglan prescribed for treating intractable nausea. Lucy admits to ER staff that she initially drank a bottle of wine and intended to end her life with the medications. Lucy has had two previous suicide attempts and has a history of substance use disorder since she was 13. She currently uses marijuana, mushrooms, ecstasy, and cocaine regularly.
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What factors are contributing to Lucy’s physical and mental well-being?
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What is the main reason that Lucy is not complying with treatment?
4
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Lucy’s nurse is putting together a treatment plan for her. What issues should be addressed in the nurse’s treatment plan?
Molly is a 15-year-old female who ran away from home two weeks ago. She was found asleep on a sidewalk and the police brought her in to have her evaluated because she complained of right-side pain and bruising in her ribs and chest. While getting her settled and performing an assessment, the nurse notices that she is guarding her right side and taking only shallow breaths. The physician orders labs and a chest x-ray. The chest x-ray shows a displaced fracture on the right rib cage and two older, healing fractures on her left rib cage. After seeing the x-ray results, the nurse speaks to Molly to gather more details about her history and to inquire about how the injuries occurred. Molly tells the nurse that her stepfather Shane gets mad sometimes when she forgets to do chores and that he sometimes becomes violent when he’s angry. When the nurse asks about Molly running away from home, Molly only says, “It was best for all of us if I left. There are too many mouths to feed, and half of us didn’t get to eat most nights.”
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What would be an appropriate way to document the patient’s visit to the ER?
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What facts were you able to note in Molly’s story?
7
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Write a list of information you will give Child Protective Services when you call.
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Home health nurse Faith cares for Tony, a homebound veteran who has rheumatoid arthritis, diabetes, and COPD. He lives with his daughter and her boyfriend in a rural area with limited access to medical care, so he is pleased to have Faith come twice a week to bathe him and change his dressings. Faith arrives one day to find Tony on the bathroom floor, and no one else is home. Tony told her he had fallen yesterday morning and that no one was there to help him. He had spent all night and most of the day lying on the cold floor. When Faith asked about his family members, Tony told her they always do this. He said they sleep here sometimes but they like to stay out at night barhopping. After getting Tony up and assessing him for injuries, what should the nurse do?