17/05/2012
23:59
Inpatient –
Nursing
Title:Night Shift
Li was in bed and appeared asleep when checked at the start of the shift and when checked
throughout the night.
– —————————- Confirmed By [email protected], 18/05/2012
17/05/2012
19:53
Inpatient –
Nursing
Title:late shift
li complained of feeling low in mood but did not want to talk about it. I rung the solicitor this
afternoon re: his appeal against section 2 and he will be visiting Li tomorrow morning in order to
get his instructions. Li’s mood has lifted now and he has become more engaging with staff and
peers. – —————————- Confirmed By [email protected], 17/05/2012
17/05/2012
17:00
Psychological
Therapy
Title: Psychology Session 3
When I asked Li how his day had been he said he had been feeling very low and didn’t want to do
anything, including groups and education. When I asked what thoughts and/or feelings he was
having, he said he couldn’t remember details, but it was around family, past and self harm. He
eventually shared that it was around our session and knowing what he would have to talk about.
Li was obviously emotional and struggling to speak. I suggested it might be easier to start to think
around it, where this self harm happened, how often. Li managed a couple of these questions, but
struggled the closer we got to the detail. He expressed real frustration at not being able to speak
about it, as he knew it might help.
We thought about what he thought would happen if he told me and what might happen if he didn’t.
Li said the only person he had ever told was a friend over text. I suggested me sitting outside the
room while he tried to write it down. I came back in after 10 minutes and he had not been able to
write anything. He asked what time I was leaving, and could he go away and try and find me later.
I agreed this and we both agreed that I could tell staff that he had had a difficult session and they
need to keep an eye on him.
I will try to talk to him later today, otherwise his next session will be on Wed 23rd May.
– ————————— 17 May 2012 18:09, Oliver Sindall
Event By: Oliver Sindall
17/05/2012
16:00
Inpatient –
Medical
Title:Raised Prolactin levels Dr.Prasad
Prolactin: 600 mIU/L (86-324) – mild elevation + other bloods (FBC, U+E, LFT, TFT) WNL
Raised and probably secondary to Risperidone.
Informed Li of thie result. Enquired about syx of raised Prolactin: Li denied having any at present.
Plan: – Continue Risperidone – To monitor Prolactin levels regularly – To monitor for clinical syx of raised prolactin: Li
– —————————- Confirmed By [email protected], 17/05/2012
17/05/2012
13:35
Inpatient –
Nursing
Title:Early shift
Li has been nursed on intermittent observations. He has been bright in mood, interacting with
peers and staff. He attended education and group. Good food and fluid intake.
Group notes
Li was persuaded to attend stress management today. He was talkative but reluctant to take part
in the relaxation activities. When asked what helped him to relax, he replied “his computer.” He
stayed until the end. – —————————- Confirmed By JMoon@, 17/05/2012
0 Comments