VSIM Sandra Littlefield Mental Health Case

VSIM Sandra Littlefield Mental Health Case VSIM Sandra Littlefield Mental Health Case Sandra Littlefield Documentation Assignments 1. Document your findings related to the focused assessment of Ms. Littlefield’s co ...

VSIM Sandra Littlefield Mental Health Case VSIM Sandra Littlefield Mental Health Case Sandra Littlefield Documentation Assignments 1. Document your findings related to the focused assessment of Ms. Littlefield’s coping strategies. Include her responses to your assessment. Ms. Littlefield resorted to anger and saying mean things. She did not have any healthy coping strategies developed. She had a history of self harm and attempted suicide. 2. Document all patient teaching regarding coping strategies and cognitive restructuring techniques provided Ms. Littlefield. Include her response to the teaching. Ms. Littlefield was not eager to learn other coping strategies and was continuously focused on medication. She was not receptive to breathing or relaxation techniques. I offered education regarding other methods such as support groups, heat or cold packs, and exercises. She was receptive to going to the library with me to check out a book and understood that saying mean things and being angry was unacceptable. She was also receptive to learning some exercises to strengthen her back. 3. Referring to your feedback log, document all nursing care provided and Ms. Littlefield’s response to this care. 0:06 You introduced yourself. 0:31 You washed your hands. 0:37 You identified the patient. 0:52 You asked if the patient had any known allergies. 1:00 You asked the patient: Can you tell me a little bit more about what's going on with you today? It was appropriate to ask the patient what was going on with her to get an understanding of this. 1:20 The patient said: I am in so much pain. You are a nurse. Don't you know how to tell when someone is hurting?\nYou answered: Why don't you try some deep breathing exercises to calm down? \nYou used the nontherapeutic technique of giving advice. 1:23 You asked the patient: Over the past year, when did you feel your best? It was appropriate to ask the patient about when she felt her best. 1:42 The patient said: There's no reason for me to be here anymore. No one cares about me at all.\nYou answered: Are you saying you feel hopeless? \nYou used the therapeutic technique of translating to feelings. 1:42 You asked the patient: Do you have any pain? 1:57 The patient said: I'm finished. I'm done with you and your worthless medicine. Guard, take me back now!\nYou answered: What you really mean is that you are mad I did not give you more pain medicine. \nYou used the nontherapeutic technique of interpreting. 2:00 You asked the patient: How would you rate your pain, on a scale of 0 to 10? The patient said: It changes but is always high. Now it is 8 to 9! 2:12 You asked the patient: On a scale of 0 to 10, how would you rate your level of distress? The patient said: I don't know. 10? 2:22 You asked the patient: Where is your pain located? 2:43 The patient said: You are trying to kill me with the pain. Just let me die; I can't live like this!\nYou answered: It seems like you are very frustrated. \nYou used the therapeutic technique of making observations. 2:44 You asked the patient: What other pain management strategies have you used other than medications? The patient said: No. Let's stick with the meds. It was correct to ask if the patient was using any pain management strategies other than medication. 2:54 You asked the patient: How many meals do you eat each day? The patient said: I usually eat three meals a day. 2:59 You asked the patient: Have you had any changes in your appetite over the past month? The patient said: My appetite has been about the same. 3:07 You asked the patient: Have you lost or gained weight over the past month? The patient said: No, I am about the same weight. 3:12 You asked the patient: Tell me about any changes you have had in your sleep over the past few weeks? The patient said: It isn't easy to sleep in this place. 3:21 You asked the patient: Do you have any trouble falling asleep? The patient said: No, not usually. 3:26 You asked the patient: Do you nap during the day? If so, how often and for how long? The patient said: I sleep a lot because there isn't much to do here. 3:34 You asked the patient: Do you have nightmares or vivid dreams on a regular basis? The patient said: No, not usually. 3:40 You asked the patient: Approximately how many hours of sleep do you get each night? The patient said: I sleep about 7 hours a night. 3:47 You asked the patient: Do you have energy to do the normal activities necessary to get through the day? 4:10 The patient said: You think I'm a horrible person because I'm in jail. You are no better than I am.\nYou answered: Are you feeling that no one understands how you feel? \nYou used the therapeutic technique of translating to feelings. 4:11 You asked the patient: Do you have energy to do the activities that give you enjoyment? The patient said: I have plenty of energy when I am not in pain. 4:20 You asked the patient: I would like to ask you a series of questions about how you are feeling to help me better understand how together we can start to plan your care. These are questions I ask all of the patients I see. May I ask you these questions? 4:48 The patient said: Just because you are in love with the guards, you prance around like you own this place and you do not!\nYou answered: Ms. Littlefield, you need to lower your voice now. I am here to help you. \nYou used the therapeutic technique of giving information. 4:50 You asked the patient: Please tell me what today's date is. The patient said: It is the 25th. 4:55 You asked the patient: Have you lost interest in activities that you once enjoyed? 5:13 The patient said: I know you have some stronger pain medicine. You gave some to another patient, and she wasn't even in pain like me.\nYou answered: We are here together today to talk about you. \nYou used the therapeutic technique of giving information. 5:14 You asked the patient: Can you name the last five American presidents starting with Barack Obama and going back? The patient said: Barack Obama, George W. Bush, Bill Clinton, George H. W. Bush, Ronald Reagan. 5:30 You asked the patient: Do you have any thoughts or wishes to harm or kill yourself? The patient said: If they don't help with my pain, I will. 5:40 You asked the patient: Have you ever tried to harm or kill yourself? The patient said: I slit my wrists in the past but nobody really cared. 5:48 You asked the patient: Do you have any thoughts or wishes to harm or kill yourself? The patient said: If they don't help with my pain, I will. 5:56 You asked the patient: Have you ever tried to harm or kill somebody else? The patient said: Yes, that police officer but he deserved it. 6:03 You asked the patient: Can you tell me what a desired outcome of treatment would be for you? 6:23 The patient said: Everyone is against me. You, the other nurses, the provider—you all hate me. The only one who likes me is that cute guard.\nYou answered: You feel that people hate you? \nYou used the therapeutic technique of restating. 6:24 You asked the patient: How do you understand your problems? 6:44 The patient said: The other nurse is nicer than you. She is better looking and has newer clothes too.\nYou answered: The next time you feel frustrated, what are things you can do to handle it appropriately? \nYou used the therapeutic technique of formulating a plan of action. 6:45 You asked the patient: Are you frightened of anything? 7:03 The patient said: You look so nice today. And you smell good. What perfume are you wearing?\nYou answered: Are you uncomfortable when you talk about your feelings about being here? \nYou used the therapeutic technique of making observations. 7:03 You supported the patient about suicide attempts. 7:11 You supported the patient about pain medication. 7:22 You supported the patient about relaxation techniques. 7:35 You educated about strategies for pain management. It was correct to educate the patient about pain management strategies other than medication. 8:01 You educated about coping strategies. 8:47 You educated about medications. 9:20 You assessed the respiration. 9:29 You checked the pulse oximetry. 9:46 You checked the radial pulse. 10:01 You measured the blood pressure. 10:17 You measured the temperature. 10:32 You observed the appearance. 10:50 You assessed the attention. 10:55 You observed the motor activity. 11:03 You assessed the speech. 11:08 You assessed the thought processes. 11:16 You auscultated the lung sounds. 11:28 You auscultated the heart sounds. 13:07 You submitted the Mental Status Examination form. Some of your assessment answers were incorrect.Regarding the indicator "3. Mood. Indicate mood": You should have indicated "Angry."Regarding the indicator "6. Thought content. Indications of": You should have indicated "Worries," "Frustrations," and "Hopelessness or helplessness."Regarding the indicator "8. Thought process. Indicate thought process": You should have indicated "Goal directed."Regarding the indicator "11. Orientation and cognitive functions. Insight.": You should have indicated "Partial." 13:28 You called the provider. 4. Document all interventions associated with boundary and limit setting directed toward managing Ms. Littlefield’s manipulative behavior. I made observations and redirected the patient when she pointed the conversation at me or another patient and told her that she seemed uncomfortable when I asked about her feelings of being in jail or when the conversation was about her feelings. I also told her it was unacceptable to yell and redirected her when she commented on my perfume and clothes. 5. Document all of Ms. Littlefield’s attempts at “splitting” and include interventions implemented to respond appropriately. • There's no reason for me to be here anymore. No one cares about me at all: I used the therapeutic technique of translating feelings. • You are trying to kill me with the pain. Just let me die; I can't live like this: I used the therapeutic technique of making observations and said she appeared to be very overwhelmed. • You think I'm a horrible person because I'm in jail. You are no better than I am: I used the therapeutic technique of translating feelings and asked “are you feeling that no one understands how you feel? • Just because you are in love with the guards, you prance around like you own this place and you do not! I told Ms. Littlefield that she needed to lower her voice and I was there to help her. I used the therapeutic technique of giving information. • I know you have some stronger pain medicine. You gave some to another patient, and she wasn't even in pain like me: I redirected her and said we were here to talk about her. I used the therapeutic technique of giving information. • Everyone is against me. You, the other nurses, the provider—you all hate me. The only one who likes me is that cute guard: I asked if she felt that people hated her. I used the therapeutic technique of restating. • The other nurse is nicer than you. She is better looking and has newer clothes too: I asked her what she thought she could do the next time she felt frustrated, what things she could do to handle it appropriately. I used the therapeutic technique of formulating a plan of action. • You look so nice today. And you smell good. What perfume are you wearing? I observed and asked if she felt uncomfortable when we