Case Study 9

Below is an anecdotal scenario that seeks to prepare students for a typical inpatient work day. It is structured into three phases and begins with arrival at work.

You’ve just arrived at your shift on a mental health unit and are reviewing your client case load.

Student questions

• How do you prioritize the client case load?
• Provide the rationale for the prioritization.
• What information is missing before you can move forward?

Next, you hone in on one patient, a 61-year-old, Caucasian female, with bipolar disorder who is mildly agitated. You review the night shift vital stats, as well as medications including her lithium levels.

Student questions:

• What are you most worried about?
• What should your immediate action be?
• How do the client assessment results impact care?

Despite your interventions, the patient’s agitation is escalating. You would describe her as aggressive.

Student questions

• How do you intervene in a non-confrontational way?
• What psychosocial interventions should you consider?
• When do you use medications, and what PRN medication do you choose and why?
• Which intramuscular site do you choose, what size syringe do you use and how do you prevent a needle stick injury?
• What assessment do you do after you’ve administered PRN?