CRITICAL PATHWAY of Care for the Client Experiencing a Manic Episode
Estimated length of stay: 14 days-variations from designated pathway should be documented in progress notes.|
Nursing Diagnosis and Categories of Care
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Time Dimension
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Goal/Actions
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Time Dimension
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Goal/Actions
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Time Dimension
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Discharge Outcome
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Risk for injury/ violence
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Day 1
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Environment is made safe for client and others.
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Ongoing
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Client does not harm self or
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Day 14
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Client has not harmed self or
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Referrals
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Day 1
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Psychiatrist Clinical nurse specialist
Internist (may need to determine if symptoms are caused by other illness or medication side effects)
Neurologist (may want to check for brain lesion)
Alert hostility management team
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Day 14
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Discharge with follow-up appointments as required.
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Diagnostic studies
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Day 1
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Drug screen Electrolytes Lithium level
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Day 5
Day 10
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Lithium level.
Lithium level.
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Day 14
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Lithium level and discharge with instructions to return monthly to have level drawn.
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Additional assessments
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Day 1
Ongoing Ongoing |
VSq4h
Restraints prn Assess for signs of impending violent behavior:
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Day 2-14
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Ongoing assessments.
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Medications
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Day 1
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Antipsychotic medications, scheduled and prn
Lithium carbonate, 600 mg tid or qid
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Day 2-14
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Administer medications as ordered and observe for effectiveness and side effects.
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Day 14
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Client is discharged on maintenance dose of lithium carbonate.
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Client education
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Day 9
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Teach about lithium: Continue to take medication even when feeling okay.
Teach symptoms of toxicity.
Emphasize importance of monthly blood levels.
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Day 14
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Client is discharged with written instructions and verbalizes understanding of material presented.
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Altered nutrition: less than body requirements
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Day 12
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Reinforce teaching.
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Day 14
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Nutritional condition and weight have stabilized.
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Referrals
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Day 1
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Consult dietitian
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Day 1-14
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Fulfill nutritional needs.
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Diet
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Day 1
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High-protein, high
calorie,
nutritious
finger
foods; juice and snacks as tolerated
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As mania subsides
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Regular diet with foods of client's choice.
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Diagnostic studies
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Day 1
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Chemistry profile Urinalysis
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Day 2-13
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Repeat of selected diagnostic studies as required.
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Additional assessments
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Day 1-14
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Weight l&O
Skin turgor
Color of mucous membranes
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Medications
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Day 1-14
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Multiple vitamin / mineral tablet
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Client education
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Day 9
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Principles of nutrition, foods for maintenance of wellness, adequate sodium, 6-8 glasses of water per day.
Contact dietitian if weight gain becomes a problem.
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Day 12-14
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Client demonstrates ability to select appropriate foods for healthy diet and verbalizes understanding of material presented.
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Day 12
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Reinforce teaching.
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