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vSIM for Nursing Describe Disease Process Affecting Patient (Include Pathophysiology of Disease Process) Major depressive disorder is one of the most common psychiatric disorders. It is characterized by a persistent depressed mood, or major depression lasting for a minimum of 2 weeks. The length of the depressive episode may be 5-6 months. About 20% of cases become chronic (lasting more than 2 years). While depression begins with a single occurrence, most people experience recurrent episodes (Halter, 2018). Diagnostic Tests (Reason for Test & Results) Patient Information Anticipated Physical Findings ●Liver function tests (ex: ALP, ALT, AST, BILI) due to patient taking Acetaminophen and Ibuprofen ingested for suicide attempt ➔All of pt’s labs were within normal ranges ●Ammonia, PT/INR, Glucose, Renal function studies (electrolytes, BUN, CR). ➔These also need to be assessed to determine possibility and effects of Acetaminophen and Ibuprofen toxicity Patient: Mrs. Li Na Chen DOB: 02/05/80 40 Y.O Female Pirmary Dx: Depression Hx: Dx of depression about 3yrs ago, suicidal attempts x 3, brought in for suicide attempt by ingestion of Acetaminophen and Ibuprofen ●Depressed mood most of the day, nearly every day (ex: feels sad, empty, hopeless) or observations made by others (ex: appears tearful). ●Markedly diminished interest or pleasure in all, or almost all activities ●Significant weight loss when not dieting or weight gain (a change in more than 5% of body weight in a month). ●Insomnia or hypersomnia nearly every day ●Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness). ●Fatigue or loss of energy nearly every day ●Feelings of worthlessness or excessive or inappropriate guilt (which are delusional) nearly every day (not merely self-reproach or guilt start being sick). (Halter, p. 245). Anticipated Nursing Interventions ●Assessment of suicide potential
●Assessment for risk of self harm or harm to others ●Inspection of patient’s belongings ●Removal of all unsafe belongings that patient has brought in ●Health teaching and health promotion ●Promotion of self care activities ●Coordinated care with team of providers ●Administration of antipsychotics/antidepressants ●Family support and education ●VS Q6H ●Encourage fluids ●Suicide precautions, observation Q15min ●Participation of unit milieu (Halter, pp. 253-263). vSIM ISBAR Activity Introduction (Your name, position (RN), unit you are working on) Hi Dr ____________ and I am a Nurse in the ED. Situation (Patient’s name, age, specific reason for visit) I have your patient Li Na Chen. A 40 y.o Chinese female who was admitted due to an attempt of suicide by ingestion of Acetaminophen and Ibuporfen. Background(Patient’s primary diagnosis, date of admission, current orders for patient) She was admitted on 07/16/20. has a Hx of Major depressive disorder and admits to several suicide attempts.