NURS 4005- Week 3 Discussion – Psychological Complications Resulting From Illnesses and Injuries
Working at an inpatient psychiatric facility, I regularly encounter challenging situations due to the acuity of this population. Most of my patients are actively suicidal, in physical withdrawal from drugs and alcohol, and acutely psychotic. When working with such a delicate population, a nurse must be extremely vigilant as it is easy to overlook underlying issues that may not have been presented at admission or the root cause of their anxiety and depression. The Dual Diagnosis Unit at my facility houses patients with mental health and substance abuse diagnoses. Many of the patients I have cared for experienced injuries, were prescribed opiates for pain and consequently became addicted. Others have suffered chronic pain for many years, which led to depression and subsequent substance abuse. Studies have shown that 14 percent to 34 percent of patients in opioid treatment have also used illicit substances. (Cummins & Tobian, 2018). This is of great concern, as patients on the Dual Unit have psychiatric and substance abuse diagnoses and are often prescribed anti-anxiety and anti-depressant medications. Benzodiazepines, SSRIs, and SNRIs combined with illicit substances significantly increase the risk of overdose (Cummins & Tobian, 2018).
I once had a patient who was transferred to our hospital from Emergency Mental Health for suicidal ideation and “med-seeking behaviors.” She was described as a “frequent flyer” who continually sought pain medication. Upon assessment, the patient was visibly disheveled, tearful, and uncooperative. During her skin assessment, I noticed multiple scars on her arms that appeared to be self-inflicted. She was also actively scratching her wrists, breaking the skin, which required antibiotic ointment and a dressing. As I applied her bandage, the patient was visibly upset and flinched when I touched her hand. She began pleading for pain medication and stated, “If I don’t get something for this pain, I’m going to kill myself.” I completed a pain assessment, which she rated 10/10 pain in her right arm and right hand. I relayed this information to the NP on the unit, and she replied, “Did you see her arms? If she really wanted to kill herself, she would have done it already.” Taken aback by the comment, I told the patient that doctors were working on her medication plan, and it may take some time. I offered her ibuprofen per protocol in the interim, which she reluctantly accepted. Once the patient was calm and situated, I began charting and reading through the admission notes. I noticed the note from intake stated the patient was punching walls and being violent with staff while at EMH. I immediately thought she might have injured her hand, hence the wincing and tearfulness during my assessment. I re-assessed her hand, and although it was not red or swollen, she again expressed 10/10 pain and was unable to make a fist. I relayed this information to the NP, and she finally agreed to send her out for evaluation. Unfortunately, imaging showed the patient had fractured her hand, which required splinting. The patient returned to the facility less aggravated and satisfied that her pain was sincerely addressed. She was upset she did not receive opiates for pain, but after a few days, she eventually became more cooperative and engaging – participating in groups, compliant with meals, and had a reduction in self-harm and suicidality. I am unsure of what the outcome was of her stay because I was off when she was discharged. I hope that she was sent to a long-term facility to address her mental health and substance abuse issues adequately.
NURS 4005- Week 3 Discussion – Psychological Complications Resulting From Illnesses and Injuries
Behavioral health and substance abuse patients can be challenging. Many times, providers are so focused on the mental health diagnosis they inadvertently overlook physical ailments or neglect to treat vital medical issues such as diabetes and heart disease. If not addressed, facilities and providers can face legal implications if a patient is injured, has a diabetic emergency, or experiences a cardiac event. Unfortunately, mental health is gravely underserved. Many facilities are understaffed, providers are jaded, and the employees are burnt out. Regardless, nurses must continue to be attentive as we are the eyes and ears of our patients, and it is our responsibility to advocate for them regardless of their “labels.”
References
Cummins, D. M., & Tobian, R. (2018). Motivational Enhancement Therapy for Veterans with Chronic Pain and Substance Use. Health & Social Work, 43(4), 269–273. https://doi- org.ezp.waldenulibrary.org/10.1093/hsw/hly026
Simsek, N., Evli, M., & Uzdil, N. (2019). Learned Resourcefulness, Anxiety and Depression Levels in Patients with Chronic Pain. International Journal of Caring Sciences, 12(1), 240–247. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx? direct=true&db=rzh&AN=136698189&site=eds-live&scope=site
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Question 
NURS 4005- Week 3 Discussion – Psychological Complications Resulting From Illnesses and Injuries
For this Discussion, you will consider delicate situations that nurses often face and analyze the implications of these situations. Reflect on a patient care situation in which you have encountered one of the following:
A suspicious illness or injury
Depression resulting from illness or injury then locate at least one scholarly journal article related to your patient care situation that offers strategies for managing the circumstances.