Individual Portfolio Project Part I: The UNC Investment Endo

2Individual Portfolio Project Part Iithe Uncw Investment Endowmentth

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

Paper For Above instruction

The case involves a client displaying subtle warning signs of suicidal ideation, requiring a comprehensive assessment to ensure safety and appropriate intervention. As a psychiatric mental health nurse practitioner (PMHNP), the SOAP note must reflect a thorough understanding of mental health evaluation, medication management, and safety protocols.

Subjective: The patient is a 68-year-old male presenting with isolated reports of feeling "down" and occasional feelings of hopelessness over the past two weeks. Family reports indicate no active suicidal ideation but note recent withdrawal and decreased participation in social activities. No current suicidal thoughts, but expressed concern about feeling "unsure" and "numb." The patient's medical history includes hypertension and mild COPD. No known drug allergies. The patient is currently not on any psychotropic medication.

Objective: Vital signs are within normal limits. The patient appears alert, cooperative, but occasionally tearful. No psychomotor agitation or retardation observed. Mental status exam reveals that the patient is oriented times three, with a stable affect but limited eye contact. Thought process is logical but somewhat constrained. No evidence of hallucinations or delusions. Risk assessment indicates a low immediate suicide risk but warrants close monitoring due to subtle warning signs.

Assessment: The patient exhibits early depressive symptoms with subtle warning signs of potential escalation to suicidal behavior. The absence of active suicidal ideation does not negate the importance of preventative strategies. Diagnoses include Major Depressive Disorder, recurrent, moderate (F33.1). The need for pharmacologic intervention alongside safety planning is indicated.

Plan: To address the patient's agitation and potential suicidal risk, the treatment plan includes medication management, safety monitoring, and patient education:

• Medications: Initiate low-dose SSRI, such as sertraline 50 mg daily, considering its efficacy and tolerability in older adults (Byers et al., 2020). PRN medications include lorazepam 0.5 mg BID for acute agitation, due to its rapid onset and short half-life, minimizing fall risk (Liu & Sampson, 2019).
• Drug Administration and Monitoring: Standing orders for staff to administer sertraline once daily, with initial monitoring of blood pressure, mood, and side effects at weekly intervals for the first month. Lorazepam PRN to be given only after visual assessment confirming agitation and after verifying the patient's current mental state, ensuring no contraindications or adverse interactions.
• Patient and Staff Instructions: Educate staff to observe for increased sedation, dizziness, or paradoxical agitation. The patient should be visually assessed before administering PRN medication. Monitor for signs of excessive sedation or deterioration in mental status post-administration.
• Documentation: All medication administration, including time, dose, response, and any adverse effects, must be meticulously recorded in the patient's chart daily. Progress notes should be reviewed weekly and updated accordingly.
• Chemical Restraints: The PRN lorazepam, when used solely for agitation management and not as a means to control behavior penalizing or restricting movement, would not be classified as a chemical restraint. It is administered for obvious clinical reasons, aiming to maintain safety rather than restrict patient movement.

This approach aligns with current best practices for managing depression and agitation in geriatric patients, emphasizing safety, individualized care, and judicious medication use (American Psychiatric Association, 2018). Periodic review and adjustment of medication regimens are essential, and collaboration with a multidisciplinary team ensures comprehensive care.

References

• American Psychiatric Association. (2018). Practice guidelines for the psychiatric evaluation of adults. American Psychiatric Publishing.
• Byers, A., et al. (2020). Pharmacotherapy considerations for depression in older adults. Journal of Clinical Psychiatry, 81(4), 20-26.
• Liu, J., & Sampson, P. (2019). Benzodiazepine use in elderly: Risks and safety considerations. Geriatric Nursing, 40(2), 157-164.
• Morgan, P., & Kellogg, M. (2017). Assessing and managing suicidal risk in primary care. American Family Physician, 96(4), 245-250.
• Oquendo, M. A., et al. (2019). Suicide risk assessment and management. Harvard Review of Psychiatry, 27(4), 161-173.
• Sampson, P., & Liu, J. (2020). Medication safety in psychiatric care of older adults. Clinical Interventions in Aging, 15, 1897-1908.
• Stewart, R., et al. (2019). Pharmacological management of agitation in older adults. International Journal of Geriatric Psychiatry, 34(10), 1573-1580.
• U.S. Food and Drug Administration. (2017). Medication safety alert: Benzodiazepines in elderly patients. https://www.fda.gov
• Zimmerman, M., et al. (2018). Monitoring and managing side effects of antidepressants in elderly patients. Psychiatric Services, 69(3), 367-374.
• Neeraja, M., & Sobanraja, M. (2020). An empirical investigation on portfolio decision-making of individual investors. Journal of Contemporary Issues in Business and Government, 26(2), 750.