Managing Mood Disorders and Adjunctive Tx Options

Rebecca Cole is a 39 years old, single, African American female. She has never been married or had children. She has been institutionalized at a state mental health hospital for more than 7 years since she was diagnosed with unspecified schizophrenia. She was diagnosed at age 21 and has undergone more than 8 psychiatric hospital admissions over her lifespan. Ms. Cole has been transferred to a local acute care hospital due to uncontrolled diabetes and hypertension. She has been refusing blood glucose monitoring daily, so the charge nurse on the women’s floor has not been able to check her blood sugar for 2 days. She has also been refusing her antihypertensive and antipsychotic medication for 3 days. This has now led to more uncontrolled hypertension and an increase in psychosis and behavioral issues today. The nursing staff has become very frustrated and voiced their issues with hospital administration because they don’t feel the administration is listening to their concerns about the challenges faced on the psychiatric units, and particularly the challenges they are facing in caring for Rebecca.

You are the PMHNP who is assigned and is managing her psychiatric care while in the acute care hospital.

 At this point, can Rebecca make her own healthcare decisions? Why or why not? What legal risk for the PMHNP could be associated with caring for Rebecca in the acute care hospital setting?
How can integrative care be an approach that is utilized with this patient?
What other specialties should be involved and when she they be involved?
Discuss the potential ethical issues facing the staff nurses caring for Rebecca in both the acute care hospital setting currently and the state psychiatric hospital setting?
Why is continued integrative care a better option for patient outcomes and a better option from an ethical and legal perspective?
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer-reviewed journal evidence to support the student’s position.

Sample Solution