Setting Inpatient Surgical Assignment Help: How to Answer This Question
This type of question evaluates analytical and critical thinking skills.
What This Question Is About
This question relates to setting inpatient surgical and requires a structured academic response.
How to Approach This Question
Use appropriate theories and support your answer with clear reasoning.
Key Explanation
This topic involves setting inpatient surgical. A strong answer should include explanation, application, and examples.
Original Question
Setting: Inpatient/surgical floor. Reason for visit: Scheduled for a left mastectomy this morning at around 0830 (it is 0700 at this time). HPI: LW is a 48-year-old Native American woman who is diagnosed with an aggressive form of breast cancer after a biopsy just a few days ago. This morning, she was admitted to a room on the surgical floor and is awaiting the operating room call for transfer. Her cousin, Alice, brought her to the hospital and is staying with her until she has to go into surgery. LW is anxious, flushed, and breathing rapidly and states that she “can’t get her breath.” After ruling out other medical conditions, the hospitalist requested a psychiatric consult due to severe anxiety. As soon as you enter patient’s room, you find patient’s belongings in disarray. Her cousin (Alice) tells you that pt has searched her belongings to find her “medicine bundle” but has realized that she accidentally left it at home. She states that her family lives far away and that they wanted her to come home to meet with the tribal healers before scheduling the surgery. She did not do that and instead took the first available date for the surgery. She’s been “very nervous” now, and while getting checked in, she mentioned that she has not been sleeping well for the past 2-3 days. She shared that her mother died of complications of surgery. She also said she’s very much “worried” about cancer and very “unhappy” about losing her breast. She tells the PMHNP that she knows she is going to die and that she does not want to have the surgery. You noticed that her consent forms have been signed. She has an IV to her right arm and her vital signs at check-in were as follows: Temperature 37.2°C (99.0°F); Heart rate 86 beats/min; Respiratory rate 18 breaths/min; Blood pressure 135/85 mmHg; SpO2 94% on room air. She has a small incision on the left breast from a biopsy last week. Her stitches were removed yesterday. The incision is dry and uncovered. She’s able to get to the toilet without assistance, and she will receive a urinary catheter in surgery. She reports she has had nothing by mouth since before midnight. She takes no regular medications at this time. You put the orders in for Lorazepam 2 mg once orally and you left the surgical floor. While you were on another unit, around 0730, you received a call from her nurse that the patient has become irritable now and has refused to take the preoperative lorazepam you had prescribed earlier. Answer the following questions: 1. What should be your next step? 2. How will you distinguish between an anxiety attack and a heart attack? 3. What are the four levels of anxiety? 4. List at least three differential diagnoses. 5. Calculate the level of anxiety using the Hamilton Anxiety Scale. 6. Based on DSM5TR, what is your working diagnosis? (list ICD 10 code). 7. Discuss the importance of a medication bundle for Native Americans. 8. Briefly discuss some non-pharmacological interventions (De-escalation techniques) for patients with anxiety. 9. If PMHNP did not recognize or respond appropriately to the patient’s concerns, what could the ramifications be? (Include legal and ethical issues). 10. What other individuals, in addition to the health care team should be involved in this case?
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