PCN605 Medical Case Study on Psychiatry
Order ID 53003233773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
PCN605 Medical Case Study on Psychiatry
You are the intake clinician at a large acute inpatient psychiatric facility, which includes a sizable detoxification unit. It is an unusually busy day and the lobby is full of patients seeking treatment. Half an hour before lunch, you pick up another clipboard from the “pending” rack and quickly scan the intake information filled in by the prospective patient and receptionist. Mark is a 45-year-old male who has been waiting since 8:15 AM.
He is requesting alcohol detox. You notice that Mark has been waiting for over three hours and you are frustrated because you will have to begin yet another interview with an apology for the long wait. You notice that the blood pressure assessed by the receptionist is somewhat elevated you make a mental note to inform the nurse: BP = 149/97, pulse 104, respiration rate 18.
You invite Mark into one of the free interview rooms and you notice that he appears much older than his 45 years. He’s dressed casually and is a bit disheveled; his skin looks old/tanned and flushed; in his right hand, he holds an emesis bag. He apologizes and he states that he has been having dry heaves since yesterday evening but he tells you that he is able to keep down some fluids.
You observe that Mark does not look too good and since he’s been waiting in your lobby for three hours, you think it’s a good idea to assess another set of vitals. The receptionist obliges and reports the new vital signs as BP = 154/103, pulse 114, respiration rate 20, oxygen saturation 98% at room air.
You become a little concerned by the increase in blood pressure and pulse and you note that while previously Mark’s shirt was dry, he now has sweat stains on his back and chest; visible sweat beads are also noticeable on his forehead and neck. You noticed that Mark speaks softly now when the door to the interview room is closed to cut down on the noise from the hallway.
He asks you if you can turn off the bright ceiling lights and to keep on only the lamp on your desk. You oblige. Mark tells you that he started drinking at the age of 16 simply because it was popular and the fun thing to do on the weekends in high school. His social drinking increased somewhat in his 20s but it became problematic in his early 30s.
Mark works as a plumber, and along with his older brother, he owned his own plumbing business. Somewhat embarrassed, he tells you that for the past 15 years, he has been more drunk than sober. His longest period of sobriety was seven years ago, after a detox and rehab program he managed to stay clean for nine months.
Slowly he relapsed into drinking, believing that he is one of the few who can only drink socially. For the past 15 years, he has had several DUIs. Several times, his wife of 20 years threatened divorce; now they have come to a truce of sorts, but he describes a disengage relationship. His brother continues to be very loyal to him, but Mark tells you that this is both a blessing and a curse. On one hand, his brother has “covered” for him when his drinking and the hangovers made him an unreliable worker.
On the other hand, he regrets the fact that had his brother been stricter with him he may have sought serious help a long time ago. Mark tried to quit drinking several times on his own. He reports that on one such occasion when he went “cold turkey” after a religious conversion of sorts, he experienced a grand mal seizure and had to be taken to the emergency room. The ER doctor strongly advised him to never stop drinking abruptly or you have another seizure.
The past two years, Mark has been averaging a six-pack of beer and a pint of vodka every day. This is enough to lead to intoxication. He starts with the beers in the morning and after work, he switches to the vodka. On the weekends, he can drink up to a gallon of vodka per day. Those binges lead to blackouts because he often cannot remember most of his Sundays. He often goes out with his brother to a local casino where he gambles $500 to $1000 each weekend.
His wife stopped nagging him about it when he insisted that he works hard for his earned money and that he always pays the bills first. Mark has decided to stop drinking because during a routine doctor’s visit, his liver enzymes were significantly elevated. His primary care physician warned him seriously about liver cirrhosis. On several occasions during the interview, Mark quickly turns away from you and leans into his emesis bag heaving heavily. He apologizes.
You offer him a bottle of water and he takes small sips occasionally. You ask Mark to stand up and to stretch out his arms: you notice visible tremors in both his arms and his shoulders. He reports a headache of 5 out of 10 (subjective units of distress) and he tells you that normally a few Advils help. His last full drink was yesterday morning before going to his doctor’s office and he had only a sip of beer at lunch. You calculate that by now he has been without any alcohol for approximately 24 hours.
He reports mild anxiety, but you observe him to fidget during the interview. You complete the CIWA scale (attached) and you observed that with a score of 25 he is in severe alcohol withdrawals. You notify the nurse immediately, urging her to come and have a look at Mark and to call the doctor for admitting orders.
CIWA scale for Mark
a. Vitals, Assessment Now.
b. If initial score 8 repeat q1h x 8 hrs, then
if stable q2h x 8 hrs, then if stable q4h.
c. If initial score < 8, assess q4h x 72 hrs.
If score < 8 for 72 hrs, d/c assessment.
If score 8 at any time, go to (b) above.
d. If indicated, (see indications below)
administer prn medications as ordered and
record on MAR and below.
Date Today’s date Time 11:30am Pulse 114 RR 20 O2 sat 98% BP 154/103 Nausea/vomiting (0 – 7)
0 – none; 1 – mild nausea, no vomiting; 4 – intermittent nausea;
7 – constant nausea, frequent dry heaves & vomiting.
7 Tremors (0 – 7)
0 – no tremor; 1 – not visible but can be felt; 4 – moderate w/ arms extended; 7 – severe, even w/ arms not extended.
4 Anxiety (0 – 7)
0 – none, at ease; 1 – mildly anxious; 4 – moderately anxious or guarded; 7 – equivalent to acute panic state
1 Agitation (0 – 7)
0 – normal activity; 1 – somewhat normal activity; 4 – moderately fidgety/restless; 7 – paces or constantly thrashes about
4 Paroxysmal Sweats (0 – 7)
0 – no sweats; 1 – barely perceptible sweating, palms moist;
4 – beads of sweat obvious on forehead; 7 – drenching sweat
4 Orientation (0 – 4)
0 – oriented; 1 – uncertain about date; 2 – disoriented to date by no more than 2 days; 3 – disoriented to date by > 2 days;
4 – disoriented to place and / or person
0 Tactile Disturbances (0 – 7)
0 – none; 1 – very mild itch, P&N, numbness; 2-mild itch, P&N, burning, numbness; 3 – moderate itch, P&N, burning, numbness; 4 – moderate hallucinations; 5 – severe hallucinations;
6 – extremely severe hallucinations; 7 – continuous hallucinations
0 Auditory Disturbances (0 – 7)
0 – not present; 1 – very mild harshness/ ability to startle; 2 – mild harshness, ability to startle; 3 – moderate harshness, ability to startle; 4 – moderate hallucinations; 5 severe hallucinations;
6 – extremely severe hallucinations; 7 – continuous. hallucinations
1 Visual Disturbances (0 – 7)
0 – not present; 1 – very mild sensitivity; 2 – mild sensitivity; 3 – moderate sensitivity; 4 – moderate hallucinations; 5 – severe hallucinations; 6 – extremely severe hallucinations; 7 – continuous hallucinations
1 Headache (0 – 7)
0 – not present; 1 – very mild; 2 – mild; 3 – moderate; 4 – moderately severe; 5 – severe; 6 – very severe; 7 – extremely severe
3 Total CIWA-Ar score: 25 PRN Med: (circle one)
Dose given (mg): Route: Time of PRN medication administration: Assessment of response (CIWA-Ar score 30-60 minutes after medication administered) RN Initials
Scale for Scoring:
Total Score =
0 – 9: absent or minimal withdrawal
10 – 19: mild to moderate withdrawal
more than 20: severe withdrawal
Indications for PRN medication:
a. Total CIWA-AR score 8 or higher if ordered PRN only (Symptom-triggered method).
b. Total CIWA-Ar score 15 or higher if on Scheduled medication. (Scheduled + prn method)
Consider transfer to ICU for any of the following: Total score above 35, q1h assess. x more than 8hrs required, more than 4 mg/hr lorazepam x 3h
PCN605 Medical Case Study on Psychiatry
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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