Chapter 8, Case 2 Fiona is a 29-year-old woman who works in a medical factory ma
Chapter 8, Case 2 Fiona is a 29-year-old woman who works in a medical factory making medical equipment. She lives with her husband and in-laws. Over the last week, she has been more isolative, saying strange things to her husband, and not sleeping due to unidentified fearfulness. The only stressor that her husband can identify is that they started talking about having children. Fiona refuses to do her ADLs, eats very little, and appears intermittently in a trancelike state. The family was becoming more and more concerned and attempted to get Fiona to see their family doctor, but she was refusing. Finally, police were called due to worsening regressed behavior and Fiona was brought to the local emergency department (ED) for evaluation. The ED physician examined her and reported after labs and neuroimaging that she was medically stable. Although the patient reported no history of psychiatric illness, she did report that her maternal grandmother was in a state hospital for most of her life. The physician recommended psychiatric hospitalization for new onset of a psychotic illness.
Chapter 10, Case 1
Eleanor is a 77-year-old white female resident of a skilled nursing facility. Recently her daughter requested an evaluation from the staff psychologist because she noticed that her mother’s Alzheimer’s symptoms appeared to be getting worse. Eleanor was admitted to the facility six months ago with moderately severe cognitive and physical decline and had to be placed in a skilled facility since she could no longer manage herself at home. Her daughter is a single mother of four teens and works too many hours to care for her mother in her home. She had attempted to care for her until Eleanor left the stove on, resulting in a minor kitchen fire. Eleanor has no history of mental illness, but she began to show signs of cognitive decline in her late fifties. The symptoms became much more pronounced after her husband’s death five years ago.
Recently her daughter and other members of the nursing staff noticed that Eleanor has become rather restless and combative. When she gets confused over her surroundings, she wanders through the halls attempting to open fire doors. When nurses attempt to redirect her back to her room, she swears at them and even struck one of them in the face. Her PCP authorized the use of restraints one day after she managed to wander out the front door and was found standing in the middle of the street trying to take a dog away from a woman who was walking it. She yelled at the woman, telling her that she needed the dog to protect her from people who were stealing her clothing in the nursing home.
Questions: Remember to answer these questions from your textbooks and clinical guidelines to create your evidence based treatment plan. At all times, explain your answers.
Summarize the clinical case.
Create a list of the patient’s problems and prioritize them.
Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
Include an assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.