Assessment 3: Patrick Smith case study

Assessment 3: Patrick Smith case study

Patrick Smith is a 33-year-old male who has previously been diagnosed with Paranoid Schizophrenia and has been on antipsychotic medication for the past 5 years. However, Patrick has stopped taking the prescribed anti-psychotic medication for approximately the last 3 months. Patrick complains they make him put on weight and make him feel weird. Typically, weird feelings include making him walk or pace all the time as my legs feel restless and he has put on 10 kilos of weight since taking the medication. The GP has previously explained to Patrick that antipsychotic medication for schizophrenia or other illnesses can cause type 2 diabetes when Patrick was diagnosed with type 2 diabetes one year ago. The GP explained the mechanisms for developing diabetes are due to the side effects which are drug-induced weight gain and a direct metabolic effect as the medication causes insulin resistance. Patrick has not followed the GP advice around dietary changes, increasing physical activity, and was only checking his BGL sporadically and taking some oral medications (Metformin 2g), intermittently to control his blood glucose. He is now required to self-administer insulin (Lantus - glargine insulin - a long-acting insulin once a day) but has so far been non-adherent. His most recent HbA1c was 10.1%.

Patrick presented at the Emergency Department with an ulcer on his left foot. It is malodourous with significant purulent exudate. Patrick has been reviewed by the Endocrinology Team who are concerned with Patricks unstable diabetes. He has also been reviewed by the Vascular Surgical team, who are concerned that the ulcer may lead to osteomyelitis and/or sepsis and believe that Patrick requires urgent surgery and antibiotic therapy.

Patrick should be taking the anti-psychotic medication: Olanzapine 20mg (nocte) and Quetiapine 200mg BD. Patrick is fearful of being in a strange place and finds being in hospital frightening as he feels someone might kill him. He tells you he is suspicious of some of the people on the ward including patients and health care professionals as he is scared, they might hurt him. He tells you he is fearful about being locked up for a crime he has never committed but there is a conspiracy against him, and he knows the CIA are involved in some way with this plot against him, and it is them who have caused this injury to his foot. In an earlier conversation with his parents over the phone they told you they were fearful of having Patrick at home as they are frightened as he has been verbally aggressive towards them recently which they feel is out of character. Patrick tells you that he has no thoughts of suicide or self-harm. He no longer wants the medical treatment and wants to sign himself out of hospital against medical advice. He states he will go and see his GP post leaving hospital and arrange community treatment for his mental health and medical issues. He is very clear with you that he no longer provides informed consent for medical treatment and wishes to discharge himself immediately.

The consequences of Patrick not having medical and surgical treatment puts him at significant risk of Sepsis and possible amputation of his left lower limb.

Case Study Question:

How would you as a registered nurse (RN)prioritiseandmanagethis situation? To address this question, you are required to identify, rationalise, and explain, in order of priority, a minimum of three priorities of care in the first 24 hours of presentation. Priorities must be supported with evidence.

In your answer you are required to consider the Registered nurse standards for practice, (Nursing and Midwifery Board of Australia [NMBA], 2016), clinical practice guidelines and relevant legislation.

CASE STUDY- ESSAY STRUCTURE

(The clinical reasoning cycle & essay key points will also be interwoven into below structure. DO NOT submit a clinical reasoning cycle).

Your case-study essay should be structured to include:

An introduction

Start by setting the context and providing relevant background information.

Include a statement that is a response to the case-study-essay question, and that summarises the main aim or points of the case-study essay.

Outline the main ideas to be discussed in the case-study essay, in the order they appear in the body of the essay.

Body/discussion

Each paragraph should cover a single idea expressed in a topic sentence, followed by supporting evidence and examples from contemporary academic literature, including peer-reviewed journal articles.

A conclusion: A summary of your appraisal.

Restate your essay question, and sum up your main points

This is an academic assignment; therefore, academic standards inclusive of grammar, sentence structure, paraphrasing and APA 7th edition referencing for both in-text citations and referencing apply.

All written assessments must align to the following academic standards:

use high-level quality contemporary evidence-based literature to inform the discussion and critical analysis, date of evidence within five years. Do not use references over five years unless it was a landmark study or brought about a significant change in practice. Legislation or professional standards/guidelines i.e. Registered nurse standards for practice (Nursing and Midwifery Board of Australia, 2016), can be used as long as it the most recent.

for this assignment a minimum of 8 references should be used. It is about quality of the reference not the quantity. Aim for 1 reference per 150 words (standard academic writing), and anytime you are making a statement that requires evidence to support it.

write in thethird person, do not use personal pronouns;APA 7th edition for in-text citations and reference list;