Admission Orders:
1. Primary Dx: Schizophrenia
(Rationale: Symptoms of schizophrenia include auditory hallucinations, fear with no
apparent
... [Show More] precipitant, physical restlessness, incoherent responses to questions, racing
thoughts, history of not sleeping, extreme impatience, and anger or aggression (Barkley
& Myers, 2020).)
2. Admit to inpatient psychiatric unit.
(Rationale: Inpatient psychiatric programs, based on social learning principles, offer
incentives for patients to engage in functional behaviors that increase daily living skills
and independence (Coelho, Palha, Gonçalves, & Pachana, 2008).)
3. Isolation/Precautions: No Isolation
4. Allergies: No known drug allergies.
5. Diet: Regular
6. Activity as tolerated.
7. IV: Insert peripheral IV
8. IVF: No IV fluids at this time
9. AM labs: CBC & BMP
(Rationale: Daily labs can help identify infections or electrolyte imbalances that may
need treated.)
10. Radiology: Functional MRI of the brain
(Rationale: Structural magnetic resonance imaging, positron emission
tomography, diffusion tensor imaging, and functional Magnetic
Resonance Imaging (fMRI) can all be used to examine the structure and
function of the brain and help confirm a schizophrenia diagnosis (Wiem &
Ali, 2021).)
11. PT/OT: Not needed for this patient.
12. Consult psychiatry.
(Psychiatric evaluation is recommended for newly diagnosed schizophrenia patients
(Barkley & Myers, 2020).)
13. Medications:
Seroquel 20 mg PO daily
Haldol 5 mg PO Q6H prn
(Rationale: Zyprexa or Seroquel may be used for agitation while Haldol or Ativan can be
used for irrational behaviors (Barkley & Myers, 2020).)
ihuman case 1 adults health care
Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology
acute care nurse practitioner (3rd ed.). Barkley & Associates.
Coelho, C., Palha, A., Gonçalves, D., & Pachana, N. (2008). Rehabilitation Programs for Elderly
Women Inpatients with Schizophrenia. Journal of Women & Aging, 20(3/4), 283–295.
https://doi-org.ezp.waldenulibrary.org/10.1080/08952840801984816
Wiem, T., & Ali, D. (2021). Schizophrenia Diagnosis from fMRI data Based on Deep Curvelet
Transform. 2021 18th International Multi-Conference on Systems, Signals & Devices (SSD),
Systems, Signals & Devices (SSD), 2021 18th International Multi-Conference On, 35–40.
https://doi-org.ezp.waldenulibrary.org/10.1109/SSD52085.2021.9429333
Week 3
Bacterial Endocarditis Admission Orders
Admission Orders:
1. Primary Dx: Bacterial Endocarditis
(Rationale: Presenting symptoms of bacterial endocarditis include fever lasting several
weeks, cough, night sweats, heart murmur, painful red nodules on distal phalanges, and
splinter hemorrhages under the nails (Barkley & Myers, 2020).)
2. Admit: Cardiac Stepdown Unit
(Rationale: With a high mortality rate, up to 24%, and an uncertain long-term prognosis,
it would be important for the patient to be closely monitored in a cardiac stepdown unit
that specializes in cardiac issues and has a lower nurse to patient ratio if the patient would
turn bad quickly (Scheggi et al., 2021).)
3. Isolation/Precautions: No Isolation
4. Allergies: No known drug allergies.
5. Diet: Heart Healthy
(Rationale: Due to the patient’s history of HTN and current murmur and cardiac
infection, it would be best to have the patient consume a heart-healthy diet low in salt and
cardiac irritants such as caffeine.)
6. Activity as tolerated.
(Rationale: Depending upon heart rate, the patient should be up as tolerated. Activity
orders such as bedrest are known to cause cardiac disuse changes, such as a reduction in
muscle strength and exercise capacity, and worsening prognosis in patients (Hama et al.,
2021).)
7. IV: Insert 2 peripheral IVs (PICC line placement should be brought up if the patient will
remain on antibiotics long term.)
(Rationale: Patient may need several IV antibiotics and may need IV HTN or tachycardia
medications rapidly in the event that his heart rate or BP becomes too elevated, therefore
it would be best to have 2 available IVs for all medications needed. )
8. IVF: No IV fluids at this time
(Rationale: With the patient’s HTN, murmur, and impaired cardiac function, excessive IV
fluids could be more harmful than helpful for this patient.
9. AM labs: CBC, BMP, and blood culture & sensitivity.
(Rationale: Daily labs can help identify infections or electrolyte imbalances that may
need treatment. Blood cultures are considered the most important diagnostic test and
should be performed from 3 different sites (Barkley & Myers, 2020). Sensitivity testing
can ensure the prescription of the correct antibiotics.)
10. Radiology: TTE and brain MRI
(Rationale: A TTE echocardiogram should be performed to assess valvular involvement
(Barkley & Myers, 2020). A brain MRI is needed to help further assess the facial
paralysis issue and determine if further neurological workups should be performed.)
11. PT/OT: Not needed for this patient at this time unless bedrest is needed at some point
during his admission.
12. Consult: Cardiology and Infectious Disease
(Rationale: Cardiology should be consulted to assess any further possible cardiac needs,
assess the new heart murmur, and help manage HTN and tachycardia medications.
Infectious disease should be consulted to ensure proper antibiotic treatment is being
prescribed (Barkley & Myers, 2020).)
13. Medications:
Cefazolin - IV 2 g Q8H for 6 weeks
Atenolol – PO 100 mg daily
Chlorthalidone – PO 25 mg daily
Multivitamin - 1 tablet daily
Hydrocortisone cream – BID topical application to psoriasis
(Rationale: Recommended cefazolin treatment for native valve bacterial endocarditis is
6g/24 hours divided into 3 doses for 6 weeks (Barkley & Myers, 2020).) [Show Less]