Month: July 2021

Throughout the semester, I’ve been excited to finally be in a psychiatric setting. Much of our hours in clinical throughout nursing school are in a med-surge-like floors. When I found out I was going to BHU Sanford I was quite excited. As this class has gone on though, I’ve realized that mental health isn’t just for the behavioral health units, it’s everywhere. During my 6^th week on the medical-surgical unit I met a young man who was going to change my perspective on mental health in all health care settings. 

During my clinical shift, I was assigned a man in his late twenties who came in with stroke-like symptoms. Upon reading his chart I found out he had recently been hospitalized out of state for an alcohol withdrawal seizure while on a plane. His flight was diverted and he had hyponatremia upon arrival. The hospital staff had increased his sodium levels too fast causing his pons to demyelinate. His symptoms of slurred speech, left-side weakness, and unsteady gait got worse over the week after his discharge. Because of his worsening symptoms, his parents decided to bring him in. Prior to coming into any hospitals, this patient worked down in the Florida coasts as a merchant marine. Both him and his wife lived down in Florida as merchant marines but they worked on separate boats and didn’t live together. Around the new year, the patient began drinking out of boredom. He stated that “it started as a few drinks once a week or twice a week then turned into a 750mL of whiskey or vodka a night”. It didn’t appear that the patient had any close support system down for him in Florida. When he became bored he turned to the bottle. He never reached out to his parents or wife about this drinking issue. His parents noticed a change in his behavior and became very worried so they decided to fly him back to Maine. 

The patient’s psychological problems of isolation and maladaptive behaviors have now turned into a physical disability he will have for the rest of his life. When talking to the patient, he appears very depressed. He doesn’t talk much and gives short answers to questions. He understands that it is drinking that got him here but I don’t see that he’s making the connection between the deeper issue and his drinking. I would have liked to gain rapport with him and possibly find out if there are any other reasons besides boredom that caused the alcohol binging. I would also like to see if the wife has been contacted and her knowledge about her husband’s current condition; both mental and physical. If the patient didn’t appear so tired and express that he wanted to rest, I would have tried to talk to him more to try and find out more information regarding support systems. I would also like to sit down with him and gain insight as to how much he knows about his current diagnosis of osmotic demyelination syndrome.

This is a condition that will stay with him forever. It could have been potentially corrected if he went to the hospital within 24-48 hours after raising his sodium. I wish I would have had more time with the patient but I unfortunately didn’t. If I could have more information on him I would have wanted to gather a family history of any mental illnesses and substance use. I would also like to assess the substance use of his wife, is this something they do together too? The patient has ineffective role performance so I would want to assess what his daily activities entail and if he’s performing his basic ADLs (brushing teeth, bathing, etc). I would also want a mental health examination to take place because drinking 750mL of liquor a day usually has a reason. This could uncover if the patient is dealing with any stressors and is ineffectively coping. With the binge drinking, I would also be very concerned for his nutrition. Drinking heavily puts you at risk for malnutrition and is most likely what caused his hyponatremia. I would want to assess his diet, where he gets his food from, and if he is able to afford it. 

Some examinations I would want to perform would include the mini mental status exam, and CAGE. I would want to assess for any mental illness as well as his own perception on his drinking. The CAGE will give me insight as to what he perceives other thoughts to be about his drinking. Once the reason behind his drinking is uncovered, more support can be directed as needed. I would see what the patient’s thoughts on rehab or programs such as AA are.  I feel that the hospital that we were at did a good job in addressing his physical problems, but didn’t pay so much attention to the psychological issues. I didn’t find anything in his chart regarding psychological examinations. The only thing regarding substance use that I could see was a CIWA. I think since the reason for his physical issues is his psychological issue, the medical staff should take a deeper dive into what the major issue is. 

(5) Explain the importance of managing medication information to the patient when he or she is discharged from the hospital or at the end of an outpatient encounter:

So many medications come with adverse effects and drug-to-drug interactions. Performing a medication reconciliation prior to discharge is so important. It can help prevent drug interactions and can prevent the same drug from being prescribed twice. When someone is discharge, it’s important to get a gauge on their knowledge of their medications. It’s important patients know how to take, when to take, and where to store their medications in order to receive the proper effect. I learned the importance of managing medication information when interviewing my friend for this assignment. I had realized the dangers of not knowing proper administration and dosage of medications. In todays society, we feel very comfortable taking over the counter meds and often don’t realize they come with adverse reactions just like our prescriptions. By making sure a patient is on the same page as their provide, in regard to medications, it can help promote healthy patient outcomes. Managing medication information can also identify any potential problems. For example a patient could be taking an OTC drug that interacts with a prescription they received in their hospital stay. By providing proper medication education prior to discharge, we can ensure patient safety.