Passage / Scenario

The following scenario applies to the next 1 items
The nurse in the behavioral health unit has completed the morning assessment of a client.
Item 1 of 1
Progress Notes
Day 1
1100: Client transferred from the emergency department to behavioral health. The client is experiencing an acute manic episode and was found wandering the street with bizarre behavior. The client is alert, oriented to place and time only. Bright and expansive affect. Speech is slightly pressured with a normal pitch. The speech is circumstantial. The client's appearance is disheveled. The thought process is disorganized, and the client denies any hallucinations, although grandiose delusions were noted. Impaired insight and judgment. Psychomotor agitation was present as the client paced in the room during the interview. The plan is to admit involuntarily and start valproic acid to stabilize mood.

Day 3
0915: Nursing reports that the client has refused all medications and only eats 5-10% of all meals. The client is alert and oriented to place only. Expansive affect. Speech is pressured with a high pitch. The speech is nonsensical and tangential. The client is dressed in normal hospital attire. The thought process is disorganized, with significant derailments. The client denies any hallucinations, although grandiose delusions were notedÔÇöseverely impaired insight and judgment. Considerable psychomotor agitation was present as the client paced relentlessly in the room during the interview.

Vital Signs
Day 1
ÔÇó Oral Temperature 97.8┬░ F (36.6┬░ C)
ÔÇó Pulse 82
ÔÇó Respiratory rate 18
ÔÇó Blood pressure 133/81 mm Hg
ÔÇó Pulse oximetry reading 98% on room air
Day 2
ÔÇó Oral Temperature 98.9┬░ F (37.2┬░ C)
ÔÇó Pulse 94
ÔÇó Respiratory rate 16
ÔÇó Blood pressure 127/71 mm Hg
ÔÇó Pulse oximetry reading 97% on room air

Day 3
ÔÇó Oral Temperature 99.5┬░F (37.5┬░C)
ÔÇó Pulse 104
ÔÇó Respiratory rate 18
ÔÇó Blood pressure 110/74 mm Hg
ÔÇó Pulse oximetry reading 96% on room air

Orders
Day 3
ÔÇó discontinue oral valproic acid
ÔÇó valproic acid intravenous piggy-back (IVPB) 15 mg/kg every 12 hours
ÔÇó obtain previous psychiatric medical records from the most recent hospitalization
ÔÇó obtain a complete blood count (CBC) and complete metabolic panel (CMP)
ÔÇó 0.9% sodium chloride (normal saline) 1000 mL, IV, once