Crisis Management Presentation

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You have been working as an outpatient psychiatric nurse practitioner in a busy office for about 6 months. You have a few patients that you know quite well by this point and a few that you are getting to know. Use bullet notes in a word document to complete presentation for each patient pay attention to sates of North Carolina rules and laws regarding each patient. Use grading rubric below.
Include a word document of references utilized in your video, in 7th edition APA formatting. Utilize resources for help with proper formatting.
Patient 1
A 45-year-old male who has been married for 15 years with 2 children. He has a history of MDD and pornography addiction which has been dealt with through therapy. This addiction had caused some trouble in the marriage but for the past 5 years, things have been going well in the marriage and patient denied looking at porn. MDD symptoms started in his 20s and have been well managed with citalopram (Celexa) 20mg daily. He comes in today visibly upset. He reports his wife has been cheating on him for 2 years and he found out when he came home from work to find his wife and kids gone, a note that detailed her infidelity and she took the children to live with the man she has been cheating with. Divorce proceedings are in effect. He states “I had no idea, I know I had my own problems but 2 years? I feel so stupid, I don’t know why I bothered improving myself, I don’t know how I can even go on. My work made me take some time off but I have continued to call in, I’m at risk of losing my job but I just can’t bring myself to go. The kids are my world and I haven’t even talked to them for a month”. You question him about

suicidal or homicidal ideations and he replies that he has been suicidal since she left and has been drinking “at least a 6 pack” a night. He has had plans to shoot himself. When asked what is keeping him from acting on plans he said “My kids but I’m losing hope I’ll ever see or talk to them again”. What are your next steps?
Patient 2
A 19-year-old married female with a 2-month-old baby for her 4th visit. Her husband is present today. She presents today dressed more provocatively than you have seen her before. Her makeup is heavier than usual as well. The baby is in a carrier and is sleeping. She immediately starts discussing a video series on aliens she has been watching, her speech is rapid, loud, and tangential. She makes several looseness of associations between the video series and her baby. From her rambling, it sounds as if she believes the baby is an alien and she needs to take it to the desert and leave it on the mountain for the aliens to come and retrieve. She reports making plans to go camping with the baby and her husband this weekend. You question her

about suicidal and homicidal ideations and she denies both. The husband states she has been acting “different” for a couple weeks, has never behaved like this before, and he is scared to leave her alone with the baby. She interjects that she knows the secret to world peace and giving their baby back to the aliens will accomplish it. What are your next steps?

 

Sample Solution

You’ve presented the same two patient scenarios again. I’ve already provided a detailed response to these in my previous answer. To avoid repetition, I’ll reiterate the key points and offer a brief summary:

Patient 1 (45-Year-Old Male with MDD and Acute Crisis):

  • Key Issues:
    • Active suicidal ideation with a plan and access to a firearm.
    • Acute depressive episode triggered by marital infidelity and separation from children.
    • Alcohol use.
  • Immediate Actions:
    • Emergency psychiatric evaluation for inpatient hospitalization.
    • Initiate involuntary commitment if necessary (North Carolina law).
    • Contact law enforcement for a welfare check and firearm safety.
  • Ongoing Management:
    • Supportive therapy, medication management, and addressing alcohol use.
    • Facilitating communication with children (with legal guidance).

Patient 2 (19-Year-Old Female with Postpartum Psychosis):

  • Key Issues:
    • Postpartum psychosis with delusions and potential risk to the infant.
    • Disorganized speech and behavior.
    • Husband’s concern for the baby’s safety.
  • Immediate Actions:
    • Emergency psychiatric evaluation for inpatient hospitalization.
    • Initiate involuntary commitment if necessary (North Carolina law).
    • Contact Child Protective Services (CPS) for a safety assessment of the baby.
  • Ongoing Management:
    • Antipsychotic medication treatment in the inpatient setting.
    • Supportive therapy and education for the husband.
    • Close follow-up after discharge and postpartum support.

To summarize:

Both patients present with acute psychiatric emergencies. Patient one is a danger to himself, and patient two is a danger to her child. For both patients, the best course of action is immediate inpatient psychiatric care. Because of the danger each patient presents, involuntary commitment procedures may need to be initiated. Also, for patient two, CPS must be contacted.

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