Question

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Below is another people post. Please help to write some responds to this post

1. Paragraph #1: Patient’s age, sex, brief PMHx, explanation of current medical situation

JG is a 66 year old male who is on hospice comfort care. His previous and current comorbidities include: Obsessive compulsive disorder, schizophrenia, Parkinson’s disease, alcoholism, hypoproteinemia and anemia. His current hospice status is based on his failure to thrive. He refuses basic care such as eating, drinking, bed bath, oral care, perineum care. Mentally, there is little indication of understanding, and besides the word, “no,” the patient is non-verbal. He responds to touch by moving his arms quickly over his head, scratching at his arms or attempting to strike staff.

2. Paragraphs #2: Clearly describes application of medical surgical concepts discussed in class thus far.

This patient’s refusal of care worsens his medical circumstances. Yelling, saying no and even striking out at staff if attempting to perform care creates an environment where JG does not always get the care his body really needs. Skin breakdown is a serious issue due to the incontinence, cachexia, and lack of movement. At the time of this assessment, the patient had three stage one pressure injuries as well as a reddened but blanchable coccyx.

3. Paragraph #3: Clearly describes application of pharmacology to clinical practice.

Due to comfort care status, this patient’s medications are all PRN, but the patient does not take medications, though they may cause less pain or suffering. Refusal of medications means that the patient’s cognitive state suffers as well for a number of reasons. Firstly, JG is anemic due to liver and bone damage. He is also highly malnourished. Nutrients, like Vitamin B12 or protein, are needed for red blood cell production and are not available due to the patient’s refusals. He also refuses to wear oxygen, though his oxygen saturation is 86%.This leaves the body tissues in a general state of lower than standard oxygen profusion and could be causing some of the confusion. In addition to nutrient deficiencies, the damage done by the patient’s former alcoholism on the brain could have caused a number of cognitive deficits. Parkinson’s disease eventually affects the brain and to make matters more complicated, this patient has schizophrenia. It is difficult to say where the patient is cognitively, since he has been refusing his anti-psychotics and anxiety drugs such as Haldol or LORaxepam. It is possible that this patient is more aware than healthcare workers realize, but his schizophrenic symptoms such as delusions or hallucinations are influencing his behaviors. Certainly the patient striking himself and scratching his arms is a visible indication that the schizophrenic symptoms are actively present in the patient.

Answer 1

The history shows need to restrain the patient till he get some insight. Here says that patient is more aware but his schizophrenic symptoms masks his awareness. So need to restrain the patient is necessary due to his self harm. The first priority is goes to third degree pressure sore. That may deteriorate the patients condition further. Clean the wound and apply sterile dressing. Change the position frequently for 2 hour. Install an air bed or a water bed to alleviate the excess pressure over the pressure points of the body. Then start a nasogastric tube feeding given at a rate of 200ml per 2 hour. Also start oxygenation through facial mask at a rate of 2L per minute. Feeding focused on current patients nutritional deficits. Use of cognitive behavioral therapy helps to change their thinking and behavioral process. Thereby adhere the patient towards the treatment of psychiatric illnesses and then recover the health status progressively.a