A patient with severe anxiety and suicidal ideation is being treated with an increased dose of sertraline and cognitive behavioral therapy but continues to experience persistent symptoms and difficulty concentrating at work. What is the most appropriate next step for the nursing team to ensure the patient's safety and promote effective treatment?

B) Recommend inpatient psychiatric care for comprehensive monitoring.

A) Schedule more frequent outpatient therapy sessions.

B) Recommend inpatient psychiatric care for comprehensive monitoring.

C) Suggest a switch to a different class of antidepressants immediately.

D) Encourage the patient to take a leave of absence from work to reduce stress.

A patient with severe anxiety and depression, who has an increased dose of sertraline and has started cognitive behavioral therapy, continues to experience symptoms and reveals a specific plan for suicide. What is the most appropriate nursing intervention at this time?

B) Assess the patient's environment for potential safety hazards and discuss inpatient psychiatric care

A) Encourage the patient to continue outpatient therapy and follow up in one week

B) Assess the patient's environment for potential safety hazards and discuss inpatient psychiatric care

C) Increase the frequency of cognitive behavioral therapy sessions to twice weekly

D) Educate the patient on relaxation techniques and provide a pamphlet on coping strategies

A patient experiencing increased psychomotor agitation, auditory hallucinations, and an elevated blood pressure is being evaluated by the healthcare team. The team is considering the introduction of olanzapine. What is the most appropriate nursing intervention to prioritize for this patient?

B) Monitor the patient's vital signs and mental status closely for any changes.

A) Encourage the patient to participate in group therapy sessions to reduce isolation.

B) Monitor the patient's vital signs and mental status closely for any changes.

C) Educate the patient and family about the potential side effects of olanzapine.

D) Prepare the patient for immediate discharge with outpatient follow-up care.

A patient with a known history of depression has recently developed auditory hallucinations and psychomotor agitation. Which of the following nursing interventions is most appropriate to prioritize in this scenario?

B) Initiate 1:1 observation to ensure the patient's safety.

A) Encourage the patient to engage in quiet activities to distract from hallucinations.

B) Initiate 1:1 observation to ensure the patient's safety.

C) Educate the patient about the side effects of antipsychotic medications.

D) Schedule a family meeting to discuss long-term care options.

A patient is admitted to an inpatient psychiatric unit with psychomotor agitation, auditory hallucinations, and elevated vital signs. The team initiates olanzapine and lorazepam. The patient develops mild akathisia. Which nursing intervention is most appropriate to address the patient's side effect while continuing to manage her symptoms?

B) Administer propranolol to manage akathisia and monitor the patient's response.

A) Increase the dose of olanzapine to enhance symptom control.

B) Administer propranolol to manage akathisia and monitor the patient's response.

C) Discontinue olanzapine and switch to a different antipsychotic medication.

D) Encourage the patient to engage in physical activity to alleviate restlessness.

A patient with significant psychomotor agitation and auditory hallucinations has been admitted to an inpatient psychiatric unit. She is started on olanzapine and lorazepam but begins to show signs of mild akathisia. What is the most appropriate nursing intervention to address her akathisia while continuing to manage her psychotic symptoms effectively?

B) Administer a beta-blocker, such as propranolol, to alleviate the akathisia.

A) Increase the dose of olanzapine to control the psychotic symptoms.

B) Administer a beta-blocker, such as propranolol, to alleviate the akathisia.

C) Discontinue lorazepam and replace it with a different benzodiazepine.

D) Encourage the patient to continue with cognitive-behavioral strategies and monitor for improvement.

A patient on an inpatient psychiatric unit is experiencing persistent tachycardia and hypertension despite treatment for anxiety and hallucinations. Blood tests reveal elevated cortisol levels, and an ECG indicates sinus tachycardia without other abnormalities. Which intervention should the nurse prioritize to address the patient's cardiovascular symptoms effectively?

A) Administer a prescribed beta-blocker to manage heart rate and blood pressure.

B) Increase the dose of lorazepam to further reduce anxiety symptoms.

C) Encourage the patient to participate in daily physical exercises to decrease stress.

D) Arrange for a dietary consultation to reduce sodium intake and manage blood pressure.

A patient with persistent tachycardia and hypertension related to anxiety and psychotic symptoms is being treated with a beta-blocker. Which nursing intervention is most important to implement to ensure safe and effective management of the patient's cardiovascular symptoms?

A) Monitor the patient's blood pressure and heart rate before and after administering the beta-blocker.

B) Educate the patient on the signs and symptoms of hypotension to watch for at home.

C) Encourage the patient to perform relaxation techniques immediately following beta-blocker administration.

D) Schedule the patient's beta-blocker doses during meal times to reduce gastrointestinal upset.

A patient with a history of hypertension and anxiety is being treated with a beta-blocker. She reports experiencing dizziness and lightheadedness upon standing, and her blood pressure drops significantly during position changes. Which nursing intervention is most appropriate to address her orthostatic hypotension while maintaining her mental health stability?

B) Advise the patient to change positions slowly and incorporate gradual mobilization exercises.

A) Encourage the patient to increase her sodium intake to raise blood pressure.

B) Advise the patient to change positions slowly and incorporate gradual mobilization exercises.

C) Suggest the patient reduce her fluid intake to prevent fluid overload.

D) Instruct the patient to discontinue the beta-blocker until symptoms resolve.

A patient on a beta-blocker for hypertension and tachycardia is experiencing episodes of orthostatic hypotension. Which of the following nursing interventions would be most appropriate to address the patient's symptoms while maintaining effective management of her cardiovascular condition?

B) Advise the patient to perform slow position changes from sitting to standing.

A) Increase fluid intake to expand blood volume.

B) Advise the patient to perform slow position changes from sitting to standing.

C) Discontinue the beta-blocker to eliminate the cause of hypotension.

D) Encourage complete bed rest to prevent falls.

Suicidal ideation - Nursing Case Study

Pathophysiology

• Primary mechanism: Neurotransmitter imbalance, specifically involving serotonin, dopamine, and norepinephrine, can lead to mood dysregulation and increased risk of suicidal thoughts. Reduced serotonin levels are particularly associated with impulsivity and aggression, contributing to suicidal ideation.

• Secondary mechanism: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis results in abnormal stress responses. Chronic stress and elevated cortisol levels can alter brain function and structure, exacerbating feelings of hopelessness and despair.

• Key complication: Persistent suicidal ideation can lead to major depressive episodes, increasing the risk of suicide attempts. Early identification and intervention are crucial to prevent progression to self-harm or suicide.

Patient Profile

Demographics:

32-year-old female, software engineer

History:

• Key past medical history: Major depressive disorder, generalized anxiety disorder

• Current medications: Sertraline 100 mg daily, Lorazepam 0.5 mg as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent suicidal thoughts with a plan

• Key symptoms: Increased anxiety, insomnia, feelings of hopelessness, social withdrawal

• Vital signs: Blood pressure 150/95 mmHg, heart rate 110 bpm, temperature 98.6 F, respiratory rate 22 breaths per minute

Section 1

As the healthcare team conducts an initial assessment, they observe that the patient, despite being alert and oriented, exhibits signs of severe distress. She reports worsening anxiety and describes an inability to find joy in previously enjoyable activities. Her mental status examination reveals a flat affect, diminished eye contact, and psychomotor agitation. The patient's blood pressure remains elevated at 152/96 mmHg, with a persistent heart rate of 112 bpm, suggesting an autonomic response to heightened anxiety or stress. Furthermore, the patient admits to having a specific plan for suicide, which she has not divulged to anyone else, indicating a high risk for potential self-harm.

Laboratory tests reveal a slight elevation in cortisol levels, pointing to an overactive HPA axis. Additionally, the patient's thyroid function tests return normal, ruling out thyroid dysfunction as a contributing factor to her mood changes. The interdisciplinary team, including psychiatry, decides to increase the dosage of sertraline to 150 mg daily, aiming to address the neurotransmitter imbalance more effectively. The team also initiates cognitive behavioral therapy to help the patient develop healthier coping mechanisms and challenge her negative thought patterns.

Despite these interventions, the patient's symptoms persist over the next 48 hours, and she reports increasing difficulty in maintaining concentration at work, leading to concerns about her ability to perform her job effectively. This exacerbates her feelings of hopelessness and worthlessness, contributing to further social withdrawal. The clinical team recognizes the need for more intensive support and considers inpatient psychiatric care to ensure the patient's safety and provide a controlled environment for more comprehensive treatment and monitoring.

Section 2

Over the subsequent 24 hours, the patient's condition experiences a notable shift, prompting further evaluation by the healthcare team. During routine monitoring, the patient begins to exhibit signs of increased psychomotor agitation, pacing the room and expressing a sense of impending doom. Her blood pressure remains elevated at 160/98 mmHg, and her heart rate has increased slightly to 118 bpm, indicating sustained autonomic arousal. Additionally, the patient reports experiencing auditory hallucinations—hearing voices that are derogatory and command her to harm herself. This new symptom, coupled with her existing suicidal ideation, significantly heightens the concern for her immediate safety.

In response to these developments, the interdisciplinary team convenes to reassess the patient's treatment plan. Given the emergence of psychotic symptoms, the team considers introducing an antipsychotic medication, such as olanzapine, to address the acute psychotic features and augment the effects of the increased sertraline dosage. Concurrently, the team evaluates the potential benefits of inpatient psychiatric care, which would provide a structured setting for medication adjustments and intensive therapeutic interventions. The patient's family is contacted to discuss the need for a higher level of care, emphasizing the importance of a supportive environment to facilitate her recovery.

The emergence of psychotic symptoms and the patient's continued distress underscore the complexity of her condition. The healthcare team remains vigilant, recognizing the need for ongoing assessment and prompt adjustment of therapeutic strategies. As the patient's status evolves, the focus remains on stabilizing her immediate mental health crisis while laying the groundwork for long-term recovery, ensuring she has the necessary support and resources to navigate this challenging period.

Section 3

The interdisciplinary team decides to admit the patient to an inpatient psychiatric unit to closely monitor her condition and adjust her treatment plan in a controlled environment. Upon admission, a comprehensive psychiatric evaluation is conducted. During the assessment, the patient continues to exhibit significant psychomotor agitation and reports persistent auditory hallucinations that intensify her distress. Her blood pressure remains elevated, now at 162/100 mmHg, and her heart rate increases to 122 bpm, suggesting sustained sympathetic nervous system activation. The psychiatric team also notes that the patient is exhibiting signs of sleep deprivation, with dark circles under her eyes and an inability to recall the last time she had restful sleep, which may be exacerbating her psychotic symptoms.

In response to these findings, the healthcare team initiates olanzapine at a low dose, with a plan to titrate based on her response and tolerability. They also introduce a short-term benzodiazepine, such as lorazepam, to help manage her acute agitation and facilitate sleep. Alongside pharmacotherapy, the team incorporates cognitive-behavioral strategies to help the patient develop coping mechanisms for managing distressing thoughts and hallucinations. The patient is encouraged to engage in relaxation techniques and mindfulness exercises, which are facilitated by the unit's therapy staff.

Despite the introduction of these interventions, the patient's condition presents additional complications. She begins to exhibit signs of medication side effects, including mild akathisia, characterized by an inner restlessness and an increased urge to move. This development requires careful management to balance the therapeutic benefits of the antipsychotic medication with the potential for discomfort and non-compliance. The team discusses these challenges with the patient and her family, emphasizing the need for ongoing collaboration and adjustment of the treatment plan to optimize her recovery trajectory. As the patient's journey unfolds, the focus remains on stabilizing her acute symptoms while preparing for a gradual transition to outpatient care, ensuring continuity and support throughout her recovery.

Section 4

As the patient continues her stay in the inpatient psychiatric unit, the healthcare team closely monitors her response to the interventions. Initially, there is a slight improvement in her sleep patterns following the administration of lorazepam, allowing her brief periods of rest. However, the patient reports that while the auditory hallucinations have decreased in intensity, they remain intrusive and contribute to ongoing anxiety and distress. Her blood pressure remains elevated at 158/98 mmHg, and her heart rate has only marginally decreased to 116 bpm, indicating persistent sympathetic nervous system activation. These findings suggest a need for further adjustment in her treatment plan to better address both her psychological and physiological symptoms.

In light of these developments, the interdisciplinary team decides to conduct a series of diagnostic tests to explore underlying causes that may be contributing to the patient's sustained hypertension and tachycardia. Blood tests reveal elevated cortisol levels, suggesting a significant stress response. Additionally, an ECG is performed to rule out any cardiac complications, given her persistent tachycardia. The results show sinus tachycardia without other abnormalities, leading the team to conclude that her cardiovascular symptoms are primarily driven by anxiety and the psychotic process.

Given the new diagnostic insights, the healthcare team reevaluates the patient's medication regimen. They decide to introduce a beta-blocker to help manage her cardiovascular symptoms, aiming to reduce both her heart rate and blood pressure, thereby alleviating some of her physical discomfort. The team continues to emphasize the importance of cognitive-behavioral strategies and relaxation techniques, integrating these approaches with pharmacotherapy to support her recovery holistically. As the patient gradually responds to these tailored interventions, the focus shifts towards preparing her for a safe transition to outpatient care, ensuring she has the necessary tools and support to continue her recovery journey.

Section 5

As the interdisciplinary team implements the new treatment plan, including the addition of a beta-blocker, the patient initially shows promising signs of improvement. Her heart rate decreases to 88 bpm, and her blood pressure stabilizes at 138/86 mmHg over the next 48 hours. This physiological stabilization seems to offer her some relief, and she reports feeling slightly less anxious. However, the auditory hallucinations, while less frequent, persist and continue to cause distress, especially during moments of solitude or stress. The patient engages in cognitive-behavioral therapy (CBT) sessions more actively, starting to identify triggers for her anxiety and hallucinations, and practicing relaxation techniques with guidance.

Despite these positive strides, a new complication arises: the patient begins experiencing episodes of orthostatic hypotension, characterized by dizziness and lightheadedness upon standing. Her blood pressure drops to 110/70 mmHg when transitioning from sitting to standing, and her heart rate momentarily spikes to 98 bpm, indicating a compensatory mechanism. These symptoms suggest that while the beta-blocker effectively manages her hypertension and tachycardia, it may be contributing to these new episodes. The team conducts a thorough medication review and decides to adjust the beta-blocker dosage, balancing the need to control her cardiovascular symptoms while minimizing adverse effects.

This development prompts the team to enhance their clinical reasoning, considering the complex interplay between the patient's mental health condition and her physiological responses. They explore incorporating additional supportive therapies, such as gradual mobilization exercises, to improve her orthostatic tolerance while maintaining the focus on mental health stabilization. As these adjustments are implemented, the goal remains to prepare the patient for outpatient care, ensuring that she possesses both the psychological resilience and physical stability necessary for a successful transition.