Posted: March 2nd, 2023

The patient is a 70-year-old female with a history of depression

Read the case study located in the reading document.
Complete a SOAP Note on the patient. (In your SOAP note: Give an example of documentation for the PMHNP provider; (include prescription details as well as instructions for staff to give medication and monitor patient))
In your SOAP note, design a treatment plan that includes PRN medications in case the patient continues to be agitated.
Answer the questions listed below:
• What medications would you prescribe? Why?
• What doses?
• Would you have these listed as standing orders for the nursing home staff or would you want to be notified before given to verify and determine need?
• Would you want to visually see the patient before having the medications given?
• What monitoring would need to be provided after medication is given?
• What documentation would need to be provided and how often for the medication to be continued?
• Would the medication be considered chemical restraints? Why or Why not?
Please see the template provided to guide your writing of SOAP notes.

Unit 4 Assignment
Read the case study and complete a SOAP note.

Student work demonstrates an attempt to appraise a consistent approach to the Assessment and management of mental health disorders and conditions for adult/geriatric clients and clients across the lifespan presenting in the acute and/or primary care setting. The content was thorough, relevant to the topic, and illustrated critical analysis.

Review the video case: Suicide assessment of Client with initially Subtle Warning Signs of Suicide

Subjective:
The patient is a 70-year-old female with a history of depression, anxiety, and mild cognitive impairment. The patient was admitted to the nursing home with agitation, aggression, and hallucinations. The patient’s family reports that the patient has been experiencing increased agitation and has been displaying aggressive behavior towards staff and other patients. The patient has been refusing to take her medications and has been experiencing auditory and visual hallucinations.

Objective:
The patient presents as agitated and confused. The patient is disoriented to time, place, and person. The patient is experiencing auditory and visual hallucinations. The patient’s vital signs are within normal limits.

Assessment:
The patient is experiencing an acute exacerbation of her depression and anxiety, resulting in agitation, aggression, and hallucinations. The patient’s refusal to take her medications has likely contributed to the exacerbation of her symptoms.

Plan:
The patient will be started on a low dose of an antipsychotic medication to address her hallucinations and agitation. The medication will be administered orally once a day at bedtime. The nursing home staff will be instructed to monitor the patient for any adverse effects, such as extrapyramidal symptoms, sedation, and hypotension. The medication will be considered a standing order for the nursing home staff. The patient will be seen by the PMHNP weekly to assess her response to the medication and to adjust the dose if necessary.

In addition, the patient will be prescribed a PRN medication to address any future episodes of agitation. The PRN medication will be an anxiolytic medication that can be administered orally as needed, up to three times a day, with a minimum of four hours between doses. The nursing home staff will be instructed to administer the medication only if the patient exhibits signs of agitation and after attempting non-pharmacological interventions. The PMHNP will need to be notified before the medication is given to verify and determine the need for the medication.

The patient’s medication administration record will need to be updated to reflect the new medication regimen. The nursing home staff will need to document any adverse effects, the patient’s response to the medication, and the administration of any PRN medication. The PMHNP will review the documentation during weekly visits.

The medications prescribed will not be considered chemical restraints as they are being used to treat the patient’s symptoms and improve her quality of life.

Prescription details:

Antipsychotic medication: risperidone 0.5 mg orally once a day at bedtime
Anxiolytic medication (PRN): lorazepam 0.5 mg orally, up to three times a day, with a minimum of four hours between doses.
Monitoring:

Monitor for adverse effects of antipsychotic medication, such as extrapyramidal symptoms, sedation, and hypotension.
Monitor for signs of agitation and effectiveness of PRN medication.
Monitor the patient’s response to the medication during weekly visits with the PMHNP.
Documentation:

Medication administration record
Documentation of adverse effects, response to medication, and administration of PRN medication
Weekly progress notes by the PMHNP.

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