Case Study: Carolyn, a 60-year-old Cambodian woman admitted to the acute inpatient facility

Running head:PATIENT CARE IN ACUTE INPATIENT FACILTY
Patient Care Plan in Acute Inpatient Facility
Name of the Student
Name of the University
Author Note

PATIENT CARE IN ACUTE INPATIENT FACILTY1
Formulation of Case Study
Carolyn is a 60-year-old Cambodian woman who has been admitted to the acute
inpatient facility due to suffering from a manic schizophrenic episode. This involved unstable
and threatening behaviour, throwing anything she can grab in her general vicinity. A state of
withdrawal followed this. This involved refusing to communicate with anyone and talking to
herself and having delusions about someone in the room. In the initial psych evaluation, she
gave no sign of comprehending the psychiatrist.
Plan of care
In the inpatient facility, the patient will be cared for over a short time frame and
stabilised. The plan should be recovery-oriented, articulate and personalised for Carolyn.
However, it is important to remember than nurses do not have a clear instruction manual to
follow from, so the plan must be adaptable and implemented steadily (McKenna et al., 2014).
The major priority of the care plan is to administer a patient-oriented and succinate
treatment to stabilise the patient enough to send her home. It is crucial that the nurses provide
her with proper care, keeping condition and background in mind. It is also important to
consider that since this manic episode is considered to be a relapse, it must not happen again.
The plan of care must be to ensure that she is completely over her manic episode.
It is essential to remember that the patient had a less than ideal childhood and married
life. The underlying trauma of her father’s death and abuse by her spouse no doubt had a
profound effect on her, which manifested into mental conditions like bipolar disorder and
schizoaffective disorder (Who.int., 2020). It is safe to say something in her environment
triggered her manic episode. So the nurses must take care that the patient must not experience
a similar trigger during her stay in the facility. The nurses must be compassionate towards the
patient and focused on mental and physical well-being. It has been observed that in acute

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inpatient facilities, the quality of care is higher when the nurses are sympathetic and try to
understand the patient more. This helps the patient recover quicker and is especially crucial in
terms of mental health (Coffey et al., 2019).
The first plan of action must be to simply calm the patient down so that treatment can
be administered. During the initial consultation, the patient gave no sign of comprehending
the psychiatrist and occasionally shouted obscenities, laughed uncontrollably or was engaged
in an argument with someone who was not there. A calmer state followed this. The nurses
must establish a connection between themselves and the patient. For this, they must talk to
the patient and try to make her understand and respond to them. If this is not possible, the
nurses must restrain the patient lightly so that they are not a threat to themselves of the people
around her (Health.qld.gov.au., 2020). The patient should be de-escalated by communicating
them with them verbally and non-verbally so that they are actually open to the treatment
(Lavelle et al., 2016). Since the patient has already been hyperactive, it is a good idea to
sedate the patient lightly. The nurses must keep the patient under close observation, keeping a
note of her facial features and way of communication to understand whether the patient is
experiencing any visual or auditory hallucinations (Jensen & Clough, 2016).
The patient has previously been prescribed Aripriprazole and Sodium Valproate but
sue to her non-compliance with the medication; she has been administered Zuclopenthixol
injections. In the facility, the patient is put on a treatment of Cariprazine (Sachs et al., 2015).
It is a novel drug; hence very little information is available on it. This drug is generally
considered to be well-tolerated among patients and is reported to have minimal side effects
(Nasrallah et al., 2017). The patient suffers from renal impairment, and thus she must be kept
under close observation while administering this drug (Campbell, Diduch, Gardner &
Thomas, 2017). This must be given to the patient once daily with food. For patients with
mixed symptoms and manic episodes like that of Carolyn, the dose of 3 mg is recommended

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daily. The patient must be given 1.5 mg on the first day, and the dose should be elevated to 3
mg on the next day if no side effects are observed in the patient (Accessdata.fda.gov., 2020).
In case she is unwilling to take the medication, she must be given Zuclopenthixol as it is an
intramuscular injection and can be administered safely to the patient without chances of them
throwing it up. In case if Cariprazine does not work, Clozapine is a good antipsychotic drug
that can be taken as an alternative (Lally & MacCabe, 2015).
Apart from the therapeutic interventions, the patient should be taken care of mentally
and sensitively. She requires proper psychosocial therapy. A nurse should be allotted solely
to care for her in the days she is admitted to the inpatient facility. Even though she is here for
short about of time, the nurses must ensure they reduce the chances of relapse by as much as
possible. They must enable the patient to be able to support herself as much as possible so
that she can lead a functional life. The nurses must talk to the patient and encourage her to
take her own decisions as soon as she can adequately communicate with healthcare
professionals. It has been seen that making the patient feel involved in the decision-making
process and letting them know the procedure and outcomes helps them stay more connected
to reality. This is especially important in cases like schizoaffective disorder and acute
schizophrenia (Mahone, Maphis & Snow, 2016). The patient must feel connected to her
surroundings and hence have a lesser chance of experiencing hallucinations.
Apart from that, the physical abnormalities must be also be taken care of. She must be
routinely administered her thyroid and diabetes medications. She should be referred to a
physician about her hyperprolactinaemia to avoid complications. If she is administered
Zuclopenthixol at any point due to non-compliance, her blood glucose must be checked
frequently, as it can destabilise the blood glucose level of the patient. This should also be
done if the patient is administered Clozapine at any point (Lally & MacCabe, 2015).