SOAPIE Worksheet NSG 357 L

SOAPIE # 1
Student Name:
SInitials: *** Unit/Room# ****
Admission Date: *****
Diagnoses: Psych, Personality
disorders, medical diagnoses
Bipolar disorder (manic phase) with
psychotic symptoms, borderline
intellectual functioning, narcissistic
personality trait
Chief Complaint
I dont know

Nicole Rossi

Date: 11/09/15

Age: 53
Gender: Female
HT: 54 Wt: 275 lbs
BMI: 47
VS:
Temp- 98.4 (temporal)
Pulse- 98 (radial)
BP- 143/90 (right arm, sitting)
O2 Sat- 100% room air
Respirations- 19
MSE:

Allergies/Response:
ACE inhibitors, Penicillin, Sulfa
antibiotics (all rash)
Severe Parkinsonian symptoms with
high dose Haldol, peripheral edema
when on Depakote
WRAP/Safety Plan:
Did not have a WRAP/safety plan nor
an advanced directive that I could tell
on chart and did not want to discuss
mental health condition
Psychiatric & Medical History:
Hypertension, type 2 diabetes,
vitamin D and B12 deficiency, Hx UTI,
hyperlipidemia, bipolar disorder with
psychotic symptoms, narcissistic
personality traits, declining
intellectual functioning
Psychiatric symptoms began after
high school
Admissions in WSH, Central State,
SVMHI (1981), VBH
Current Symptoms:
Needy, attention-seeking, minor
Parkinsonian gait, high glucose levels,
agitation
Current Stressors:
Being at WSH gives her stress, does

See next page

Psycho-Social History:
Separated from husband after couple years of marriage (due to
multiple admissions), African American, youngest of 4 children
(sister claims she was babied as a child), used to live with
mother and cared for her until 2012 but now lives alone in an
apartment, no children, no history of drug/smoking/alcohol
abuse, very spiritual (non-denominational, attended church
twice of week when not hospitalized and enjoys reading the
Bible), sister involved in care even though pt does not like this

Medications (see medication page for more

information):
-Lispro (Humalog)
-Metformin (Glucophage)
-Insulin Glargine (Lantus)
-Metoprolol (Lopressor)
-Clozapine (Clozaril)
-Haloperidol (Haldol)
-Losartan (Cozaar)
-Cholecalciferol (Vitamin D)
-Haloperidol Deconate
-Furosemide (Lasix)
-Lorazepam (Ativan) (PRN)
-Benztropine (Congentin) (PRN)
-Magnesium hydroxide (Milk of magnesium) (PRN)
Discharge Plan:
No discharge plan in place currently. Pt believes
that she is going home soon, but under involuntary
civil commitment for 90 days according to her
chart.

History of Present Illness: (HPI)

11th admission to WSH, but came from the ER. Concerned
neighbor brought pt to Lynchburg ER after wandering from
door to door looking for sister and having found walking in
middle of the road. Suspected off medications because of hx of
nonadherence and rehospitalization. Delusional day before and
may have had UTI and high blood sugar. Discharged from ER
just to be admitted to VA Baptist the next day. Was disruptive,
disrobing, emotionally labile and demanding. Did not return to
baseline so transferred to WSH.

Diagnostic Tests & Labs

Fall Risk: Yes

I did not see an EKG conducted, but because of her

antipsychotic and Lasix medication use, I would
recommend it. Antipsychotics cause QT
prolongation (which in turn can cause lethal
arrhythmias) and Lasix has a high chance of
hypokalemia, which can cause arrhythmias, so an
EKG every once in a while would keep the heart in
check.

General Diet: Normal, but some modifications due to

hypertension and diabetic medical conditions

RBC (norm 4.2-5.4 cells/L)- 3.68 cells/L LOW

Hemaglobin (norm 12-16g/L)- 10.6 g/L LOW
Hematocrit (norm 37-47%)- 32.7% LOW
MCHC (norm 33-37 g/dL)- 32.3mg/dL LOW
These low CBC values indicate anemia present,
which could be due to multiple medications that
the pt is on (EX: Haldol, Losartan)

SOAPIE Worksheet NSG 357 L

not think that she belongs there and
just wants to go home, stressed when
not getting her way
O- Mental Status Exam
General Appearance- appearance matches age, clothing not fitting for individual (wearing scrubs) and is dirty and covered in stains, hair dry and braids
starting to come undone, no cosmetics, no real care for grooming (appeared as if just got out of bed), slight odor especially after urinating (might not have
washed hands), looked fatigued and not of excellent health, manner friendly and cooperative until discussing mental condition
Behavior/Motor Activity- agitated, restless (cannot stay in one spot for long), no presence of tics or tremor, poor impulse control in that she always has to
make herself center of attention or presence known (even when other people asked questions or got in their way to achieve own way), evasiveness with
discussing mental health condition, very touchy and liked to establish possession (bragged about having me as a shadow and held on to me when walking the
halls), slow shuffled gait that may be Parkinsonian symptoms from medications, no abnormal involuntary movement
Speech Patterns and Communication- slightly pressured, coarse, low, verbose mumbling speech when having individual conversation; louder when trying to
get attention of others but still coarse mumbling so sometimes hard to understand
Mood/Affect- range of facial expressions minimal but did smile when happy, friendly and outgoing but then irritated and angry when does not get way (Hx of
throwing jelly at nurse when she did not get the breakfast that she wanted), when asked how she was feeling she was feeling pretty good, eye contact there
for the most part (slight gaze issue where eyes looking to side on own), appropriate expression during shift though except slight displeasure when she did not
get what she wanted
Thought Process and Clarity- loose associations, vagueness, sometimes illogical/unclear, declining intellectual functioning over life, only high school education,
claims to have worked for Tricare but also stated that she would have been a great nurse or lab tech but did not want to go to school for it (incongruence with
stories), repeated questions because she did not like the answer
Thought Content- denies suicidal or homicidal thoughts (did have past suicide attempt with suffocation though), denies delusions and obsessions (however,
with narcissistic personality may be delusional that she is all important and knowing), spirituality common topic of conversation, some confabulation
Perception- denies hallucinations or illusions
Cognition- Alert and oriented times 3, slight lethargy, according to chart: had bad long-term memory, good short-term memory, insight to diagnosis and
medical conditions poor because does not understand why hospitalized and poor judgment due to history of nonadherence despite countless hospitalizations,
attention and concentration pretty strong unless not interested in activity.
AAxis 1: Bipolar disorder (manic) with severe psychotic features
Bipolar disorder is a mood disorder characterized by mood swings from extreme euphoria (mania) to depression that can be attributed possible to excess of
norepinephrine and dopamine and low serotonin neurotransmitters. The pt currently displays irritable mood when does not get her way and over trivial
matters, has slightly pressured speech, minor distractibility when not interested in what is occurring, some racing thoughts evidenced by changing topics
during conversation frequently. There was a recent incidence where she threw jelly at a nurse because she did not get the breakfast that she wanted. Upon
admission, she was going on in public partially clothed, walking around the neighborhood in a confused and active state looking for her sister who was
nowhere nearby.
Axis 2: narcissistic personality traits, borderline intellectual functioning
With concerns to narcissistic personality disorder, my pt always tries to hold the attention of her peers, talks out in group so that everyone can hear her
opinion, and is usually social and optimistic but gets angry and irritated when things do not go her way. She also continuously tries to get food from other
people to fulfill her desires to eat more. Narcissistic personality traits share commonalities with someone in a bipolar manic episode because of the grandiosity

SOAPIE Worksheet NSG 357 L

and irritability when situations do not go their way. Within treatment, it would be important to address this by reinforcing behavior that allows turn taking with
speaking and delayed gratification and not bending to every will of the pt. When it comes to intellectual functioning, pt was a good student growing up but has
had steady cognitive decline. This decline could be due to nonadherence with antipsychotic medications.
Axis 3: diabetes, hypertension, hyperlipidemia, obesity
Obesity, diabetes, hypertension, and hyperlipidemia are all conditions composing of metabolic syndrome. It is imperative to make healthy lifestyle choices via
diet and exercise in order to address these conditions, but also management with medications is important, especially for this pt. This pt does not curve easily
to suggestions about what she should do, but also she has an issue with treatment adherence. Education is really important in this situation then so that these
comorbid conditions can reduce and she can live a longer and healthier life. For diabetes specifically, insulin management and glycemic control is important
especially with avoiding issues with other body systems like the kidneys. Certain medications, like Lopressor, mask the effects of hypoglycemia, so it is
imperative for the pt to be aware of this and to know the signs of hypoglycemia so that quick intervention with dextrose can occur. For hypertension, many of
the medications, especially the antipsychotics, can increase the risk of orthostatic hypotension. With this effect, it is key to educate the pt on getting up and
changing positions slowly in order to avoid falls. She is also obese, weak, and shuffles her gait, so the fall risk is greater. Atypical antipsychotics, like Clozaril,
also increase weight gain and metabolic syndrome effects, so with a pt that already has these concerns, it is especially important to make lifestyle changes.
Axis 4: death of mother in 2012 who she cared for and lived with, separation from husband of a couple years because of multiple admissions, does not like
sister support of health care, unemployment
Axis 5: 57 according to my own insight. This is because she still displays some manic and personality symptoms, but they are mild to moderate and do not
affect her socially too much. She interrupts people and wants to say her piece, and this can sometimes turn people away. She is actually very social and
appears to have made a few acquaintances on the unit. There can be more improvement made with the symptoms though. She is functioning pretty well, but
with some minor self-care issues.
Clinical Prep Worksheet p. 2: Nursing Care Plan
Pathophysiology Current psychiatric, personality or intellectual disorder, and medical Diagnoses for your patient described from the literature Include your
patients actual symptoms:
( Link Diagnoses, behaviors, safety
Nursing Dx:
(Note priority and
pathophysiology of disease
process)
Axis 1
Impaired social interaction
related to narcissistic and
egocentric behavior within
bipolar disorder as evidenced by
talking out of turn, attention
seeking, neediness, and slight
disregard for others.

risks with 3-4 pertinent nursing goals and interventions. Address Axis I & III at a minimum.)
Patient Outcomes
ASSESSMENT Intervention
ACTION Intervention
SMART goals
(assess/monitor for)
Pt will allow others to speak
first during question and
answer time within group at
least 80% of the time
before stating her own
opinion by discharge.

-nurse will perform MSE

once every shift and
observe pt in group settings
during the day in order to
assess for attention seeking
behaviors (Ex: talking over
people/out of turn, wanting
physical contact, yelling,
interrupting, etc.)
-nurse will perform MSE
once every shift and will
observe pt during
communication and
everyday activities for

-nurse will reinforce pt

every time she performs a
positive social behavior by
first offering verbal praise
and then asking the pt what
she thought she did
correctly in that situation to
warrant praise
-nurse will help reinforce
positive pt behaviors by
pointing out when she
performs a negative
behavior, ask her what she
did wrong in that situation,

TEACHING Intervention

-nurse will educate through

brainstorming with pt about
positive and negative
behaviors in social situations
once every shift by asking
them to write down a list for
each and explain how she
can actively implement
positive changes while at
WSH and upon discharge

SOAPIE Worksheet NSG 357 L

Knowledge Deficit
Ineffective self-health
maintenance related to cognitive
impairment and inability to make
appropriate judgments/lack of
insight to health conditions as
evidenced by demonstrated lack
of knowledge about basic health
practices, history of multiple
readmissions, and lack of
interest in improving health
behaviors.

Pt will be able to verbally

discuss and confirm
understanding of the
various medications that
she is on by explaining
relative information (use,
side effects, dose, time to
take) by discharge.

mood and behavior (What is

she expressing? Is it the
same throughout the day?
Changing? Appropriate?)
and notify physician on
progress
-nurse will inquire pt about
her level of support (family
and friends, what sources of
support are the most
beneficial for her) once
during the clinical shift and
if not adequate, will make
suggestions on how to
reach out to others
appropriately (not seeking
attention, talking out of
turn, ask about others
interests, etc.) if pt verbally
states desire to have that
social support

and how she can improve

upon a future similar
scenario
-nurse will administer
antipsychotic medications
during pts scheduled
medication time

-nurse will assess pt current

knowledge of medication
regimen and information
through active questioning
about why it is used, side
effects, dose, and time to
take it during each
medication administration
-nurse will assess pt
willingness to accept and
listen to education by
observing whether the pt is
actively engaged in learning
by asking questions,
coming up with answers to
questions, etc. during times
of pt teaching

-nurse will ask the pt why

she thinks that it is
important to adhere to
medication management
for her own health
maintenance at least 3
times during time at WSH
-nurse will brainstorm with
pt on an easy medication
management strategy
tailored to her needs (ex:
pill box, timer) once
medication education
begins and once before pt
discharge
-nurse will administer
medications and educate
while doing so at pts
scheduled times

-nurse will provide education

on pts medications and
inform her of important
information for each of them
(dosages, timing, route, side
effects, relation to
conditions) during
medication administration
while the pt is new to
learning about her
medications by giving her a
written copy of the
information to reference to
later (will have daily
schedule for times to take
and info on each med)
-with initial medication
education and the day of pt
discharge , the nurse will
teach the pt to have the
important numbers to her
doctor, local hospital, and
others involved in her care
on hand so that she can
contact them if there is an
adverse reaction to her

SOAPIE Worksheet NSG 357 L

medication or if the
medications are not working
to relieve symptoms while
she is out of WSH
Axis 3
Imbalanced nutrition: more than
body requirements related to
excessive intake of nutrients as
evidenced by BMI in the morbidly
obese category, 18 lb increase
since the summer, sedentary
activity level, large abdominal
circumference.

Pt will identify and attempt

modification at least 3
changes that she can make
to her diet that can aid in
weight loss and control that
also aid in managing her
diabetic and hypertensive
conditions by discharge.

Clinical Preparation Worksheet p. 3: Medications

Name &
Dose/route/sche
MOA
Class
dule
(trade &
Recommended
generic)
dosage range and
your patients

-nurse will assess pt daily

intake amount and food
components (can record
food record via Foodtracker
or informally in a Food
Diary) for each meal for a 35 days in order to observe
eating habits in WSH
-nurse will ask assess
typical pt daily intake while
outside of WSH once by
asking her to write down a
food log of what she would
normally eat for an entire
day (food, amount,
preparation, times, etc) and
this will serve as basis for
future education initiatives
-nurse will assess pt weight
daily via a scale in the
morning, will record the
value, and notify the doctor
if there are extreme
fluctuations in weight
(greater than 2 lbs lost or
gained in a week)

Rationale

-nurse will deny pt

additional food outside of
scheduled meal-times (and
if snacks allowed then give
healthy options that she will
enjoy) while pt is at WSH
-nurse will have pt identify
foods that she enjoys and
help her figure out healthy
modifications that she can
implement herself once she
is out of WSH and can cook
for herself (provide online
and book resources,
educational handouts, etc.
if available) at least 3 times
during WSH stay
-nurse will administer
medications (Ex: insulin, BP
meds, etc.) at pts
scheduled times

Adverse reactions & Side

effects
Possible & Actual

-nurse will educate pt about

MyPlate and nutrition
information by showing the
pt online resources and will
ask pt to draw the MyPlate
with some healthy food
options for each category in
order to test learning at least
3 times during stay at WSH
-nurse will educate on
tracking meals on
Supertracker (online) and
how it can breakdown
nutrients and caloric content
to guide her for areas of
improvement and where she
is doing well with diet (if pt
will have access to internet
outside of WSH) once right
before discharge
-nurse will educate on the
importance of monitoring
sugar and simple carbs
intake for diabetes and
sodium for hypertension and
will test pt learning by asking
her to name foods that she
should monitor/decrease in
her diet specifically
(teaching can be done when
blood sugar and BP levels
are high, once every week
during medication
administration)

Nursing Implications

SOAPIE Worksheet NSG 357 L

current dose.
Lispro
Recommended(Humalog)sliding scale
rapid-acting
common, but can
insulin
initiate a dose of
0.1 units/kg or
10% basal dose
before largest
meal
Pts Dose- sliding
scale
Route- SubQ
Time- ACHS

Metformin
(Glucophag
e)- oral
antidiabetic
agent
(Biguanide)

Recommendedsince concurrent
insulin therapy,
start off at 500 mg
then increase
every week by 500
mg until glycemic
control achieved
Pts Dose- 1000
mg
Route- oral tablet
Time- Q 0730,
1700

Acts on the liver,

skeletal muscle, and
adipose tissue to
regulate the
metabolism of
carbohydrates,
protein, and fats
(stimulation of
glycogen synthesis
in the liver, storage
in adipose,
triglyceride
hydrolysis inhibition)

For pts high

blood glucose
levels, since she
does not have a
history of great
glycemic control

Possible- headache,
hypoglycemia, hypokalemia,
hypersensitivity reaction, flu-like
symptoms

Decreases liver
glucose production,
decreased GI
absorption of
glucose, improves
insulin sensitivity

For pts high

blood glucose
levels, since pt
has not been
able to manage
condition with
diet and exercise

Possible- nausea and vomiting,

diarrhea or constipation, chest
discomfort, palpitations,
headache, dizziness, diaphoresis,
abdominal distention or distress
or pain, flu-like symptoms,
hypoglycemia

Actual- peripheral edema, weight

gain (also just from sedentary
lifestyle and poor eating habits)

Actual- decreased Vitamin B12,

chills

-check blood sugar before meals and

before bedtime
-monitor for signs of hypoglycemia so can
provide emergency dextrose or glucagon
-educate pt on diabetic condition and the
importance of short-acting insulin to help
with quick glycemic control, especially with
meals
-educate on insulin administration
techniques
-educate pt on diabetic condition and how
effective insulin management helps
especially along with lifestyle changes
such as diet control and exercise since she
has Type II diabetes
-educate pt on signs and symptoms of
hypoglycemia (shaky,
nervousness/anxiety, confusion, rapid HR,
hunger, headaches) and hyperglycemia
(headaches, polyuria, fatigue, polydipsia,
polyphagia, blurry vision) and that she
should seek medical help if she cannot
control blood sugar levels at these
extremes
-monitor glucose levels while on this
medication
-monitor for signs of hypoglycemia
-teach and encourage pt to use fingersticks, especially with low adherence to
diabetic interventions and management
-monitor renal function and B12 serum
levels
-avoid use of contrast while on this
medication
-educate pt on diabetic condition and how
effective insulin management helps
especially along with lifestyle changes
such as diet control and exercise since she
has Type II diabetes
-educate pt on signs and symptoms of
hypoglycemia (shaky,
nervousness/anxiety, confusion, rapid HR,
hunger, headaches) and hyperglycemia
(headaches, polyuria, fatigue, polydipsia,
polyphagia, blurry vision) and that she
should seek medical help if she cannot

SOAPIE Worksheet NSG 357 L

control blood sugar levels at these
extremes
Insulin
Glargine
(Lantus)long-acting
insulin

Metoprolol
(Lopressor)Beta-Blocker
antihyperte
nsive

Clozapine
(Clozaril)Antitypical
antipsychoti
c

Recommended0.2 units/kg once

daily
Pts Dose- 20 units
(0.2 mL)
Route-SubQ
Time- once daily

24 hour control on
the liver, skeletal
muscle, and adipose
tissue to regulate the
metabolism of
carbohydrates,
protein, and fats
(stimulation of
glycogen synthesis
in the liver, storage
in adipose,
triglyceride
hydrolysis inhibition)

For pts high

blood glucose
levels, in order to
control blood
sugar better
throughout the
day

Possible- hypoglycemia,
diarrhea, limb pain, flu-like
symptoms, headache.
Pharyngitis, rhinitis

Recommended50-100 mg BID
unless extended
release then 25100 mg
Pts Dose- 25 mg
Route- oral tablet
Time- BID

Selectively inhibits
beta 1 adrenergic
receptors to
decrease
sympathetic activity
on the heart
(decrease HR, BP)

For pts high

blood pressure

Possible- hypotension,
bradycardia, chest pain,
dizziness, fatigue, headache,
constipation or diarrhea, nausea
and vomiting, musculoskeletal
pain, blurred vision, tinnitus

Recommendedstart with 25 mg
daily then increase
by 25 mg daily
until effective (but
max is 550 mg

Antagonizes
dopamine type 2
receptors and
serotonin type 2 A
receptors (in addition
to alpha-adrenerfic,

Actual- hypertension (has history

of this condition though),
peripheral edema, UTI (had
around admission), back pain

Actual- sleep disturbances

(history of needing sleep aids
PRN), shortness of breath
(mainly upon exertion)

For pts
psychotic issues,
especially during
manic phase
(disrobing,
agitation,

Possible- tachycardia,
drowsiness, dizziness,
hypotension, constipation,
nausea and vomiting, heartburn,
headache, seizures,
leukopenia/agranulocytosis, EPS,

-monitor glucose levels before bed

-monitor for signs of hypoglycemia
-educate on insulin administration
techniques
-teach pt about the various diabetic
medications and insulins (peak, when to
administer, effects, etc.) and that this one
acts as a baseline control throughout the
day
-educate pt on diabetic condition and how
effective insulin management helps
especially along with lifestyle changes
such as diet control and exercise since she
has Type II diabetes
-educate pt on signs and symptoms of
hypoglycemia (shaky,
nervousness/anxiety, confusion, rapid HR,
hunger, headaches) and hyperglycemia
(headaches, polyuria, fatigue, polydipsia,
polyphagia, blurry vision) and that she
should seek medical help if she cannot
control blood sugar levels at these
extremes
-monitor pts blood pressure and heart rate
before and at least 1 hr after
administration
-explain that may cause hypotension, so
tell pt to get up slowly when lying
down/sitting in order to avoid falls
-beta blockers alter glucose tolerance and
may mask signs of hypoglycemia, so
educate pt on this since she is diabetic
-educate pt about hypertension condition
and lifestyle changes that can help
improve the condition in combination with
the medication (exercise, diet low in
sodium and saturated/trans fats, etc.)
-monitor pt for EPS and tardive dyskinesia
using AIMS scale and NMS by observing pt
appearance (diaphoresis, rigidity, etc.) and
vitals especially pulse, temperature, and
blood pressure (have the Benzotropine
ready just in case)

SOAPIE Worksheet NSG 357 L

daily)
Pts Dose- 100 mg
Route-oral tablet
Time- HS

Haloperidol
(Haldol)typical
antipsychoti
c

Recommended0.5-5 mg 2 to 3
times daily (for
psychosis)
Pts Dose- 5 mg
Route- oral tablet
Time-BID

Losartan
(Cozaar)Angiotensin
II Receptor
Blocker
antihyperte
nsive

RecommendedPts Dose- 50 mg
Route- oral tablet
Time-once daily

Cholecalcife
rol (Vitamin
D)- Vitamin
D Analog

RecommendedPts Dose- 2000

units
Route-oral tablet
Time- once daily

histamine H1,
cholinergic
receptors) to
decrease positive
and negative
psychotic symptoms

restlessness,
confusion,
deficient selfcare, loose
associations)

NMS, QT prolongation, urinary

retention, abnormal LFTs

Blocks dopimergic
D2 receptors in the
brain to mainly work
for positive psychotic
symptoms

For the psychotic

symptoms
(disrobing,
agitation,
restlessness,
confusion,
deficient selfcare, loose
associations)

Possible- prolonged QT interval,

anxiety, EPS, NMS, headache,
sexual dysfunction,
agranulocytosis, hypotension,
constipation, urinary retention,
photosensitivity, blurred vision

For pts high

blood pressure

Possible- chest pain,

hypoglycemia, diarrhea,
hypotension, dizziness, fever,
hyperkalemia, muscle cramps

Antagonizes
angiotensin II to help
decrease blood
pressure

Actual- slight Parkinsonian

shuffle, weight gain, agitation,
confusion (slightly, more so in
history), slight sedation,
hyperglycemia, metabolic
syndrome

Actual- slight Parkinsonian

shuffle, agitation, lethargy, slight
pruritus , confusion (slightly,
more so in history), anemia
(H&H, RBC low)

Actual- fatigue, UTI (had upon

admission), anemia (H&H, RBC
low), weakness, back pain,
weight gain

Supplement to
increase amounts of
Vitamin D3 in the
body

For pts low

serum Vitamin
D3

Possible- hypervitaminosis D
(hypercalcemia, headache,
nausea, vomiting, lethargy,
confusion, sluggishness,
abdominal pain, bone pain,
polyuria, polydipsia, weakness,

-monitor vital signs, WBC and ANC,

glucose, triglycerides, electrolytes, LFTs,
weight
-if heart issues, monitor EKG
-check pt mental status

-monitor pt for EPS and tardive dyskinesia

using AIMS scale and NMS by observing pt
appearance (diaphoresis, rigidity, etc.) and
vitals especially pulse, temperature, and
blood pressure (have the Benzotropine
ready just in case)
-monitor vital signs, CBC, electrolytes, LFTs
-if heart issues, monitor EKG
-check pt mental status
-educate pt that may be photosensitive, so
wear sunscreen and have sunglasses on
hand
-educate pt that sexual dysfunction is a
common side effect and to talk to the
doctor if it becomes an issue in her life
-monitor pt blood pressure before and at
least 1 hour after administration
-monitor kidney function, CBC
-explain that may cause hypotension, so
tell pt to get up slowly when lying
down/sitting in order to avoid falls
-educate pt about hypertension condition
and lifestyle changes that can help
improve the condition in combination with
the medication (exercise, diet low in
sodium and saturated/trans fats, etc.)
-since there is a chance of hypoglycemia
as a side effect, monitor blood glucose
levels and signs of hypoglycemia (have
dextrose ready)
-monitor serum calcium and phosphorus
levels, vitamin D
-educate that can also gain Vitamin D
(milk, fish, yogurt, fortified cereal) from
food choices and sunlight exposure, but do
not overdo intake with this supplement

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cardiac arrhythmias), soft tissue
calcification
Actual- none except the
weakness and lethargy from the
hypervitaminosis signs

(maybe can be used instead of the drug,

but hx of nonadherence and food
preferences so diet change may not be as
helpful)

Haloperidol
Deconateinjection
typical
antipsychoti
c

Recommendationmaximum of 100
mg or 10-15 times
daily oral dosage
Pts Dose- 100
mg/mL (1 mL)
Route- IM
Time- Q4W1600

Unclear but seems to

depress the CNS at
subcortical level,
antagonize
extrapyramidal
system, inhibit
catecholamine
receptors,
antidopaminergic

For pts
psychotic
symptoms,
especially since
hx of
management
nonadherence

Same as with Haldol, this is just

a longer-lasting injection for
easier management

-monitor pt for EPS and tardive dyskinesia

using AIMS scale and NMS by observing pt
appearance (diaphoresis, rigidity, etc.) and
vitals especially pulse, temperature, and
blood pressure (have the Benzotropine
ready just in case)
-monitor vital signs, CBC, electrolytes, LFTs
-if heart issues, monitor EKG
-check pt mental status
-educate pt on how this drug in particular
only needs to be given once a month since
it is long-acting

Furosemide
(Lasix)- loop
diuretic

Recommendation20-80 mg dose
Pts Dose- 20 mg
Route-oral tablet
Time- once daily

Inhibits reabsorption
of sodium and
chloride in ascending
loop of Henle and
distal renal tubule

For pts edema

and high blood
pressure

Possible- dizziness, fever,

headache, hypotension,
hypokalemia, constipation,
decreased other electrolytes
(sodium, magnesium, chloride,
calcium), urinary frequency

-monitor electrolytes (especially potassium

because can cause arrhythmias and many
of these medications she is taking can lead
to arrhythmias as well)
-if concerned about arrhythmia effects, do
EKG
-since potassium depletion is common,
education on potassium-rich food choices
is important and encourage eating them
since not being given K-Dur (leafy greens,
bananas, avocados, beans, fish, etc.)
-have pt near a bathroom at all times
because of increased urinary frequency
-replenish fluids lost but not too much
because of edema
-monitor I&O, weight every day in the
morning
-monitor renal function
-explain that may cause hypotension, so
tell pt to get up slowly when lying
down/sitting in order to avoid falls
-educate pt about hypertension condition
and lifestyle changes that can help
improve the condition in combination with
the medication (exercise, diet low in
sodium and saturated/trans fats, etc.)

Actual- increased triglycerides

(metabolic syndrome),
hyperglycemia (diabetes)

Lorazepam

Recommendation-

Enhances inhibitory

For pts sleep

Possible- hypotension, sedation,

-educate pt that this is an addicting drug

SOAPIE Worksheet NSG 357 L

(Ativan)0.02-0.04 mg/kg or
Benzodiaze
2 mg single dose
pine
Pts Dose- 2 mg
Route- oral tablet
TIme-Q4H PRN

effect of GABA

issues and
agitation (as
stated on chart),
anxiety

euphoria, suicidal ideation,

constipation, agranulocytosis,
addiction, muscle relaxation,
respiratory depression
Actual- agitation, drowsiness,
memory impairment (hx of this
though)

Benztropine
(Cogentin)AntiParkinsons
agent,
anticholiner
gic

Recommendation1-2 mg 2-3 times

daily for EPS
Pts Dose- 1 mg
Route- oral tablet
Time-Q6H with EPS
(PRN)

Anticholinergic and
antihistaminic
effects to help
decrease EPS

Magnesium
hydroxide
(milk of
magnesium)
- laxative

Recommendation30-60 mL/day
Pts Dose-2400 mg
(30 mL)
Route- oral
solution
Time- Q12H PRN

Promotes bowel
evacuation by
causing osmotic
retention of fluid
which increases
peristaltic activity

For pts EPS

reaction to
antipsychotics
(PRN)

Possible- tachycardia, confusion,

constipation, numbness of
fingers, memory impairment,
visual hallucination, blurred
vision, urinary retention
Actual- (NOT ON CURRENTLY)

For pts
constipation
PRN, especially
given the many
medications that
she is on that
can cause
constipation

Possible- electrolyte imbalance,

diarrhea, polydipsia, headache,
stomach cramps, nausea and
vomiting
Actual- (NOT ON CURRENTLY)

and to use with caution

-instruct pt not to drink alcohol with this
medication and do not drive
-monitor RR, BP, HR
-monitor LFTs, kidney function tests, CBC
-explain that may cause hypotension, so
tell pt to get up slowly when lying
down/sitting in order to avoid falls (be
especially careful since sedating)
-instruct to not suddenly stop taking this
drug
-for the times when she is taking it for
sleeping issues, educate pt on how she
should limit too much stimulation/activity,
caffeine and food intake, and TV/electronic
time before bed, since these can prolong
the time it takes to get asleep (give at
least 30 minutes to settle and get ready
for bed)
-teach pt nonpharmacological
interventions for relieving anxiety (deep
breathing, progressive relaxation, yoga,
etc.)
-administer as soon as you see signs of
EPS (observation and AIMS scale can help
determine this) and NMS (seen through
observation and vitals)
-monitor pulse
-assess for therapeutic response (decrease
EPS)
-monitor renal functioning
-there is a chance of blurred vision, so
avoid driving or doing activities that rely
heavily on vision while experiencing this
symptom
-make sure the pt is near a bathroom so
that they can evacuate bowel after
administration
-monitor electrolytes and serum
magnesium in particular
-monitor renal function
-educate the pt on why she is experiencing
constipation (medications, maybe diet and
lack of exercise)
-educate pt on nonpharmacological ways
of relieving constipation (increase fluid and

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SOAPIE Worksheet NSG 357 L

fiber intake, physical activity/mobility)

Resources:
Access Behavioral Health. (n.d.). Global assessment of functioning. Retrieved from
https://www.omh.ny.gov/omhweb/childservice/mrt/global_assessment_functioning.pdf
Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: an evidence-based guide to planning care (10th ed.). Maryland Heights, MO: Mosby Elsevier.
Lexi-Comp Online. (n.d.) Retrieved from http://online.lexi.com/ Hudson, OH: Lexi-Comp, Inc.
Townsend, M.C. (2014). Essentials of psychiatric mental health nursing (6th ed.). Philadelphia, PA: F.A. Davis Company.

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