Case Study: Patient Care Plan in Acute Inpatient Facility Analysis

This assignment presents a case study focused on the care of a 60-year-old Cambodian woman admitted to an acute inpatient facility due to a manic schizophrenic episode. The patient care plan emphasizes a recovery-oriented, personalized approach, addressing both her mental and physical health needs. It details medication management, including Cariprazine and Zuclopenthixol, while considering her renal impairment and history of non-compliance. The plan also incorporates psychosocial therapy, promoting patient involvement in decision-making and addressing potential triggers. The critical review highlights the challenges faced during her care, including initial hyperactivity and the need for compassion and understanding. The case study also discusses the importance of addressing her physical health conditions, such as thyroid and diabetes medications, and providing support to her family to improve her overall well-being and reduce the chances of relapse. The assignment emphasizes the need for nurses to establish a connection with the patient and provide a calm and supportive environment.

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

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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).

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In case of an emergency, like in case, the patient experiences another manic episode,
the nurses should be ready to soothe and sedate her. The major priority must be to keep her
grounded and deescalated. Once the patient can take care of herself and can communicate
cohesively with her family members, she will be released with instructions to the family
members to bring her back in case of a relapse and with some basic instructions to avoid
possible triggers like mentioning the war or her deceased father. It is important to give the
patient a calm, loving environment and comfort.
Critical Review
The plan of care is personalised and well suited for Carolyn from the medical staff’s
point of view. The nurses have planned a full-fledged intervention for the patient. This is
meant to aid both in destabilising her and preventing a relapse. As a nurse who was present at
the situation planned out the interventions both for her mental disorders and physical
difficulties. However, we were bound to face certain difficulties while caring for the patient.
When the patient was initially brought to the acute facility, she was hyperactive in
general. When we first tried to de-escalate her, she proved to be difficult to control and non-
cooperative. She nurses unsuccessfully tried to soothe her for about half an hour, after which
she patient eventually calmed down and entered a more withdrawn phase where she still did
not communicate with us but was more responsive towards us with her actions. She did not
seem any more understanding of our words, but she co-operated by letting us lead her to a
room and sit her down for the psych evaluation. She allowed us to restrain her lightly and she
seemed to be calming down when we talked to her. However, she was still occasionally
yelled out obscenities to seemingly no one and sometimes laugh out loud. After her psych
evaluation, she still seemed relatively calm, so we lead her to her room. The patient seemed
responsive, although occasionally, she did try to drawback and get irritated. Once we reached

5PATIENT CARE IN ACUTE INPATIENT FACILTY
her room, we sedated her lightly so that she could rest, since she did not seem quite there yet
(Heretohelp.bc.ca., 2020). She was kept in isolation so as not to distress other patients (Aksoy
Poyraz et al., 2015). I talked to her family members who seemed more irritated rather than
concerned about her. This hinted at possible lack of attachment between Carolyn and her son,
no doubt which aided to her condition. I asked about possible triggers that may have
happened to cause her outburst. After a couple of hours, the patient was roused, and I asked
her name, age and general information about her background, all of which she answered
correctly. However, she did not seem to remember much about her episode and claimed she
had a ‘black-out’. It is rather rare for patients who have experienced a manic episode to
remember their experience, so I took it as a sign of honesty. I gave her a meal and the
cariprazine, which she was reluctant to take at first. I explained to her about the need for the
medication and what might happen if she does not take it. She seemed very irritable but took
it. This showed that she was willing to listen to reason. When I enquired her about what she
remembered last, she claims to remember watching a movie about the war. Nostalgia can
often trigger unpleasant memories that can be a potential cause of an episode. The patient did
claim to sometimes talk with her deceased father and told me that her father came back from
heaven to talk to her. This explained her non-compliance with the medicine as the patient
could not talk to her father if she continued her medications. So nostalgia could be her reason
for not adhering to her medications (Bulteau et al., 2018). Overall, when the patient was
grounded, she seemed to be talking coherently, and in fact, she was rather pleasant to talk to.
She did seem to get very irritated if I probed her with too many questions, but she eventually
volunteered most of the answers herself. I saw that she was generally more responsive if she
was spoken to with compassion, and she was willing to cooperate as long as I was friendly.
Throughout her short stay, she seemed to like the company, even though she criticised being
in a routine and complained about having to take her medications. She decided that we relied

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too much on medicines to keep a person healthy and we should focus more on interacting
with the patients. She also let us know that she did not appreciate us insisting on medicines
and would rather talk to her father again. However, she did take the medicines properly after
politely talking. This and her way of talking led me to believe that she feels left out and
neglected in her family. I opted to talk to her family about my concerns and gave her son
some advice on how to take care of her and make her feel more connected (Testerink et al.,
2019). Apart from our schedules and ‘love for medicine’, Carolyn seemed to have no
criticism for us. When Carolyn was discharged, she seemed mostly reasonable and no longer
experiencing hallucinations. She was relatively cheerful and greeted her family correctly.
Excluding few mild episodes where she simply was not responding to the staff and talking to
seemingly no one, she was mostly rational and cooperative through her stay. She was
stabilised and had not experienced an episode in 48 hours when she was released. We
referred her to a therapist in order to combat her bipolar disorder and schizoaffective disorder
and keep her mind stabilised. We instructed her family to keep her away from triggering
elements like movies and books depicting war and keeping her happy. We recommended
keeping her company as often as possible, and enrolling her in a support group was also an
option.
From this report, it can be concluded that the plan of care that was proposed for
Carolyn was successfully implemented and carried out without too many obstacles. The
emergency alternatives were not required as the patient was mostly cooperative, excluding
the problem in initially de-escalating and communicating with her. Once she was roused from
her sedation, she was cooperative for the majority of the time. Her stay at the acute care
facility was mostly obstacle-free, and she was discharged after a couple of days with a
referral and care instructions. Overall, her episode was milder than most, and she recovered
pretty quickly.

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