Psychiatric Nursing Case Study

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PICOT: For psychiatric mental health staff nurses providing direct care to patients with mental health conditions and or dementia-related syndromes, would atypical second generation antipsychotics pharmacology program and screening tool for complications, during routine second generation antipsychotics medication management, increase nurse efficacy in SGA patient management? 1. Setting: The setting in which my project will take place is a Skilled Nursing Facility. SNFs are typically medical facilities that staff license personnel and others to provide direct patient care. The setting generally consists of a rehabilitation unit. The unit is for patients who may have gone to an acute setting hospital and after medical and psychological …show more content…
In all settings, I have acknowledged the preferred usage of the second generation antipsychotics medications (i.e. Risperidone, Zyprexa, Seroquel, Ability, etc.) over the typical first-generation antipsychotics (i.e., Haldol, Thorazine, etc.). FGAs have significant side effects such as extrapyramidal and tardive dyskinesia which are quite often irreversible. SGAs have a less potential for these type of side effects secondary to their unique balance of dopamine and serotonin balance, however, there is a significant risk for metabolic syndrome. This syndrome is defined as conditions that may increase blood pressure, sugar level, body fat around the waist and cholesterol levels with abnormal results. Metabolic syndrome place patients at a higher risk of developing heart conditions, stroke, and diabetes (Hausman, Wang, & Chen, n.d).

During my care and consultations mainly in the Skilled-Nursing Facilities, A lack of education and tools for staff to assess the risks factors associated with patients taking SGAs was acknowledge as essential to medical practice change. Primary medical care providers such as physicians and NPs also seem to have a lack of awareness of the risks thus diminished early detection and treatment of patients at such risks. Establishing a protocol
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Nurses in SNFs typically make the initial calls to the medical doctors in charge of the patients and reconcile medications the patients arrived on the unit with and any additional standing orders assessed as appropriate for individual patients and in accordance with the facility’s protocol. The primary medical doctor/nurse practitioners in the SNFs specifically to my practice change project are essential stakeholders. Prescribers are more likely to abide by a facility’s protocol once the protocol is understood based on the rationale. Director of nursing, administrator and social services are stakeholders. They are the force behind initiation and continuity of the practice change as a protocol. Cognitively intact patients are stakeholders as receivers of the practice change. Patients should be aware of risks versus benefit of their treatments to make an inform decision regarding care-plan. Families are stakeholders as they are often the health care proxy for those who are unable to make informed care decisions. The legal system may also be stakeholders as they often designate guardianships for patients taking antipsychotic medications and the same information of risks versus benefits that would be presented to a cognitively intact patient or family should be

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