Question

This is the mental health case:

Background: Mrs. Cole sustained the injury when she fell from the stage in a bar. According to the paramedics who responded to the 911 call at the bar, she was ranting about the government and talking about how she was the only one who could help rectify Washington's problems. She jumped up on the stage and grabbed the microphone from the band leader, and in the struggle that ensued, she fell off of the stage and fractured her ankle.

Her husband was contacted by the emergency department, and he was here prior to her surgery. He and her sister had been searching for her for hours before the accident. He reported that she was diagnosed with bipolar disorder 6 years ago and that she had not been sleeping or eating much for the past 2 weeks. The family was worried that she was at risk of another manic episode, but she became irritable when they questioned her behavior or her compliance with her medication. Her husband reports that she is normally adherent to her medication regimen, which is lithium 600 mg twice a day. The last time she stopped her medications was 2 years ago, and she had a manic episode after that. A psychiatric consult was initiated, and her medications and diagnosis were confirmed by her regular psychiatrist. Lithium will be restarted this afternoon.

Assessment: She has been very loud and verbal since she came from the postoperative unit. She is somewhat oriented; she knows that she’s in the hospital, but doesn’t really remember the details of the fall. She knows her name and recognized her husband, but her recollection of the events of last night is inconsistent as she relays the story to different staff members. She does not know what day it is. She is having grandiose thoughts, her speech is pressured, and she is talking constantly, exhibiting a flight of ideas, with thoughts ranging from issues in Washington to suggestions about running the hospital better. She has used the call light several times, saying that she needs to get out of here, and keeps asking whether she can use the unit phone to call Washington. So far, she has responded to redirection with irritability. She has a fentanyl patient-controlled analgesia (PCA) pump for pain control. Her vital signs are stable: temperature, 37.2°C (99°F); heart rate, 88 beats/min; respiratory rate, 16 breaths/min; blood pressure, 134/70 mmHg. She denies pain, but she says she never feels pain. She has threatened to take her intravenous (IV) line out to get rid of the pain medicine, which she says makes her feel like she's "not herself." So far, we've been able to talk her into keeping it. She takes small sips of water when it is directly given to her. There is a sitter present for the patient's safety.

Questions:

How did the simulated experience of Sharon Cole’s case make you feel?

Talk about what went well in the scenario.

Reflecting on Sharon Cole’s case, were there any actions you would do differently? If so, what were these actions and why?

Scenario Analysis Questions*

PCC What issues have you identified that could be barriers to a successful treatment for Sharon Cole?

How would you address the manic state?

PCC/I Identify a support group that would be beneficial to Sharon Cole’s husband.

PCC/S What action should be initiated due to Sandra Cole’s medication regimen?

Concluding Questions

How would you apply the skills and knowledge gained in the Sandra Cole case to an actual patient situation in different acute care units (emergency room, intensive care unit, obstetrics unit, etc.)?

Answer 1

#. The simulated experience of Sharon Cole’s case make me feel very much disturbed as it is depicting a bipolar disease patients struggles through her disease .

#. Correct time transfer of the patient to the emergency department.

#. I would not use the PCA pump because patient is not in a stable condition to use it correctly . It would cause addiction and harm to her .

#.

#. A support group for families with mental illness where they can share their struggles and advice, and overall be an additional support system of strength for him. An example includes the Mood Disorder Society of Canada and the National Alliance on DBSA Depression and Bipolar Support Alliance.