Nursing case study

Introduction
The scenario is of a nine years Old Tony care as provided by the registered nurse in a community and primary healthcare setting, whereas a community health care worker within the rural, suburban neighborhood. The scenario happens in during the school day where the teacher to Tony shared her concern for Tony. According to Tony's medical history, he had been diagnosed with Type 1 diabetes mellitus some months back; this has also caused him to be absent in school several times. According to the teacher, she has tried to provide Tony with a lot of support for Tony while he is attending school and check in with him regarding his blood sugar and meal checks, which he has been doing independently (P & Menon, 2013). From the initial assessment, the teacher said that she understood a little about diabetes since her father is also diabetic, meaning that Tony's blood sugar is ‘all over the place.' The teacher has also been providing Tony with more food that is sent from home. However, in my observation, Tony has not been following the diet plan required for diabetics as was advised by the diabetic’s clinic because he and his family are vegetarian and the plan is supposed to include meat.

Tony stays at their home with his three siblings and parents. Apart from him, his mother is also ill and suffers from a nephric syndrome, which has led her to depression since the family moved from Australia three years ago. The teacher has tried to dialogue with Tony’s mother about his diet concerns; however, nothing has changed for Tony. The teacher is also very concerned because Tony has told her that he always does his insulin in the morning as his father leaves for work very early and his mother is often not up yet when he is scheduled to take the insulin (P & Menon, 2013). The teacher also noted that his sibling often has to be absent from school, just like Tony. However, they are in a healthy condition. In this regard, as a nurse, the plan on ensuring Tony follows medication and proper diabetic diet as prescribed in the diabetic clinic.

Nursing Care
After the consultation with Tony's teacher, the specific aspect of nursing care currently required was to admit Tony to the self-management education course since he was still at elementary school age. This is supposed to be organized regarding the structured curriculum and the scheduled time based on international standards. Among the element of care would include behavioral therapy, the primary purpose of providing this type of care approach is to establish a patient-centered, systems-oriented, and highly individualized plan (Jayakumar & Prasanna, 2013). The care approach will primarily focus on Tony’s needs and characteristics. Because he is at the development and growth stage, it will be essential to enroll him in a group of other diabetic children living together in a kind of youth hostel. The atmosphere will be a reaction and shall have child-appropriate activities like leisure time and trips, circus activities, and mimicking healthy daily life. Tony's developmental stage is critical as will affect the way he is going to accept his situation as a diabetic and the fact that he shall have to live with the condition all through his life (Chiang et al., 2018).

However, with the companionship and development of new friends with other diabetic children will positively counter this since it will bring him a sense of normalcy to the condition. Struggling with equal difficulties and having to learn coping skills as a group helps to relieve the isolation feelings in the children. Also, they will be well taken care of by other young adults who are experiencing the same condition and have been able to manage it. Tony must undergo the self-management education since it will provide him with details of the diseases, allow for the blood glucose monitoring and interpretation, physiologic response, calculating and injecting insulin, proper diet intake and other relevant information and skills. All of these will be integrated into normalcy and leisure activities (Chiang et al., 2018). One of the main goals for this care plan is to train Tony to manage the condition unobtrusively; however, inspire him not to make it the focus of his life. The initial point of the training will look at the particular problems that Tony encounters daily, expectations, wishes, and goals. This will also include his social, cultural, and family background. It will be relevant to make excessive use of Tony's useful resources which have to be first discovered. In all the time process of care, Tony will be an active and participating partner.

The principles of child-centered care will be incorporate where each day the individual learning units are going to be well discussed and planned with Tony. For example, the learning consequences of physical activities regarding his glucose control and ways that he can prepare for it like ensuring he has eaten in advance. Whenever Tony learns new skills, he is going to be rewarded. In the times of social gatherings and the evening, Tony will be allowed to choose a small toy out of a box while the other children congratulate him. It will also be essential to avoid punishment (Wolfsdorf, Glaser, & Sperling, 2006). No activity should be forbidden, and everything should be allowed; however, this will be done under high supervision. Apart from the primary nurse caregiver, the training will also entail a team of Pediatric diabetes specialists, diabetes adviser, an endocrinologist, a Pediatric nurse, a dietician, a teacher, and a child and adolescent psychiatrist. It will also be essential to involve Tony's parents and sister’s including close friends as they will be vital in ensuring the implementation of self-management; however, they will not always accompany Tony during the course. The results of the care approach are to ensure that Tony learns to inject herself through various injection sites. Considering is perceptual challenges, he is going to be intensely trained to notice and interpret correctly any hypoglycemia symptoms, to adhere to blood glucose monitoring schedules, handle the metabolic status of activities and to calculate the dosage of insulin (Wolfsdorf, Glaser, & Sperling, 2006).

Communication
One of the issue with connection during this care plan was that Tony suffered from dyscalculia, which is difficulty in making arithmetical calculations due to a brain disorder. To address the question thus, specific schemata and tables would be developed with the involvement of Tony's parents. In the tables, the counted carbohydrates will be allocated to a particular factor with respect to multiplication. For example, 30g of carbohydrates x 1.5, this will then be adapted to the blood glucose level. The multiplication factor that will be varied by the child and during the day, all these will have to be adopted by Tony. The schema is also going to enable Tony to determine the right insulin dosage, which is going to ensure his self-management despite having dyscalculia. Other less helpful habits and their potential communication challenges will also be discussed from Tony’s point of view and new arranges are going to be made (Wolfsdorf, Glaser, & Sperling, 2006). Because Tony speaks English as a first language, it will be easy to ensure that adherence and self-management training has been adopted.

There will also be challenges in food intake, as initially observed by Tony's teacher. Tony might end up obese by taking up large food intake in the evening. However, this will be controlled by a food roaster in respect to the dietician. Tony will also be required to participate in all the planning and decisions of all details and all discussions which will take place when Tony felt emotionally comfortable (Jayakumar & Prasanna, 2013). All the self-management goals are going to be written down/ In case the goals are not reached; all the primary reasons will be discussed with the intent recalled. However, this will be done with no hint of blaming and achievement of each intended goal will also be rewarded. This is meant to encourage Tony to adhere to the self-management program.

The principles of family-centered care will also be incorporated in all communication stages, as stated in dealing with dyscalculia. It will also be essential to ensure clear communication and sharing of complete and unbiased information with parents regarding Tony’s condition and self-management development. There will be a sharing of information between the caregiver and Tony's family where the nurse will provide Tony's parents with access to his medical chart. Since tony is still nine years, he may not be required to write on the chart himself but will do this with the help of the nursing caregiver (Jayakumar & Prasanna, 2013).

Conclusion
In summary, the dietary situation, the insulin intake frustration, and stress of the diabetic child and the people in her circles can be substantially improved when the focus of diabetic care is completely changed. In the previous days and despite having a standard medical care, there has often been strong fluctuations in regard to blood glucose levels with a lot of hypoglycaemic episodes and a complete dependence of the child on his teacher even more than his parents, this led to a lot of anxiety, leading to absenteeism in school and social isolation (Jayakumar & Prasanna, 2013). When it comes to diet care, Tony played a passive role. Standardized training and medical information was an important part of care and must be provided in a theoretical, intellectual level, and not specifically accounting for the individual child situation, including her healthy and developmental capacity. The main aspect of the presented intervention was to look at the primary focus regarding diabetic care based on the child and her context, wishes, needs, hurdles and competency and the age-appropriate active collaboration (Jayakumar & Prasanna, 2013). This also entailed the monitoring of laboratory data and other technical factors regarding management that were also removed from the center of focus to become supportive, secondary, and less obtrusive. By providing the systems-oriented care, all the most important factors were well addressed within the similar process. The schedule of self-management training is going to be evolved out of the daily requirements regarding specific requirements of Tony. Rather than maintaining his glucose levels, the main focus of interest will be Tony himself.

References

• Chiang, J. L., Maahs, D. M., Garvey, K. C., Hood, K. K., Laffel, L. M., Weinzimer, S. A.,Schatz, D. (2018). Type 1 Diabetes in Children and Adolescents: A Position Statement by theAmerican Diabetes Association. Diabetes Care, 41(9), 2026-2044. doi:10.2337/dci18-0023
• Jayakumar, R., & Prasanna, A. (2013). Type 2 Diabetes in Children. Diabetes in Children and Adolescents, 30-30. doi:10.5005/jp/books/12092_3
• P, S., & Menon, V. (2013). Diabetes Education in Children with Type 1 and Type 2 Diabetes.
• Diabetes in Children and Adolescents, 150-150. doi:10.5005/jp/books/12092_15
• Wolfsdorf, J., Glaser, N., & Sperling, M. A. (2006). Diabetic Ketoacidosis in Infants, Children, and Adolescents: A consensus statement from the American Diabetes Association. Diabetes Care, 29(5), 1150-1159. doi:10.2337/dc06-9909

Misuse of Alcohol

Public health is also known as the science of improving and protecting the health of a community

through promotion, education of a healthy lifestyle as well as research for injury and disease

prevention (Scarborough et al. 2011). For the development of programs that promote and protect

the community’s health the community need to be educated on the effect of the environment and

their personal choices to the health. According to professional analysis, community health is

highly threatened by the modern lifestyle such as alcohol misuse. The health dimensions can

encompass “a state of complete physical, mental and social well-being and not merely the

absence of disease or infirmity” as stated by the WHO (World Health Organisations). Public

health is basically concerned with protecting and promoting the health of the whole population.

The population can either be an entire country or a small population such as a local

neighbourhood. The interdisciplinary approaches of biostatistics, health services, and

epidemiology incorporate through the public health. Community health, environmental health,

occupational health and behavioural health are among important subfields (Keyes et al. 2011).

Alcohol consumption can be harmful or beneficial to individuals depending on factors such as

age, amount of alcohol consumed, among other factors. The term ‘alcohol’ may mean ethyl

alcohol or ethanol unless specified (Litten et al. 2012). Alcohol refers to neutral spirits distilled

above or at one hundred ninety degrees whether for industrial or nonindustrial use. Alcohol is a

thin and clear liquid that has a high volatility and a harsh burning taste. Alcohol beverages refer

to any liquid that is suitable for human consumption since it contains a certain percentage of

alcohol. In the UK, alcohol consumption is an integral part social, occupational and family life

for most of the people. Alcohol consumption, especially among the young people, has to be in

the raise for the recent past. The rise has led to a growing concern among the policy-makers with

an aim to moderate the high consumption of alcohol (Kiernan, 2015).

Why Alcohol misuse is a public health issue
Misuse of alcohol among members of the community not only does it affects emotional, physical

but also the social aspects of an individual. Alcohol misuse in the UK has become worrying and

a cause of concern to those responsible for public health (Young-Wolff et al. 2011). For many

years, alcohol has been part of the culture since many people used it rationally. Misuse of alcohol

in the UK has led to serious public health problems and other problems related to misuse of

alcohol such as increased levels of crime. The alcohol misuse whether binge-drinking,

chronically heavily drinking or moderate drinking leads to inappropriate circumstances such as a

threat to the wellbeing and health of the victim as well as affect friends, family, society, and the

community through crime problems, productivity loss, and anti-social behaviours. In addition,

alcohol misuse is directly linked to health concerns such as mental ill-health, high blood

pressure, violence, sexually transmitted infection (STI), liver diseases and accidental injuries

(Litten and Allen, 2012).

The health determinants and wellbeing are circumstances or conditions in which individuals

grow, live, and work. The conditions determine the opportunities of individuals maintaining a

good health. This condition can be referred as “causes of the causes” since population’s health is

shaped by the economic and social structure. Some of the factors that influence the population’s

health may be individual factors, lifestyle factors and environmental factors which include

culture, economic and social. According to healthy people 2020, health determinants fall into

five broad categories which include social factors, policymaking, individual behaviour, health

service and biology and genetics. The relationships among the factors determine population

health. Individuals and population’s health is highly affected by the policies at the state, federal

and local level. The increase of taxes on alcohol beverages can improve the health of a

population since it would reduce the number of individuals misusing alcohol. Individual

behaviours is another major health determinant. Individual plays a significant role in their health

outcomes. A good example is when one quit drinking alcohol he or she reduces the risk of

getting diseases associated with excess alcohol consumption such as liver diseases, high blood

pressure among others (Nuutinen et al. 2011).

Alcohol misuse has affected the society since both young and old are engaging in it

(Young-Wolff et al. 2011). Majority of the drinkers tend to have health complication later in the

life due to excess intake of alcohol. Misuse of alcohol has many consequences for the individual,

family, and community at large. Some of the direct and indirect consequences include increased

crime rate, mental health, reduced quality of life, increase in a number of car crashes and the

high cost of healthcare. Alcohol abuse has led to deaths of many citizens who are highly

productive. According to 2017 health report, alcohol misuse contributes to 1 death out of 10

deaths among the working adults. In addition, alcohol misuse has resulted in serious economic

consequences in sectors such as health, lost productivity and high crime rates (Foxcroft et al.

2014).

Alcohol consumption and trends
For the recent past, several surveys have been conducted regarding alcohol consumption trends.

Some survey says that the trend has decreased and other it has increased but as stated by The

NHS Information Centre (2010), the drinking behaviour among children and adults has

increased. According to the report, 71% of men above 16 years and 56% of women above 20%

are reported to drink alcohol once a day. The report further stated that 11% of men are said to

drink on daily basis as well as 6% of women. The report further indicates that men and women

consume an average of 16.8 units and 8.6units per week respectively. Even the students have

engaged in alcohol misuse where 18% of both male and female students are reported to have

engaged in alcohol misuse (Duff et al. 2012). London is reported to have less young people

engaged in alcohol misuse than any other region in the UK. The report further stated that Great

Britain has acknowledged there has been an increase in alcohol misuse from 54% in 1997 to 85%

in 2015.

Alcohol misuse can be said to be the use of alcohol with a purpose not consistent with medical or

legal guidelines. There are a number of alcohol misuse or patterns in drinking alcohol which

include, harmful drinking, and alcohol use that damage mental and physical health. Harmful

drinking mainly results in social challenges as well as economic challenges. Individuals who

engage in harmful drinking risk themselves from getting health challenges. Heavy drinking in the

UK is defined as consuming over eight units a week by men and six units per week by women.

In addition, heavy drinking can be said to be drinking beyond moderate (Foxcroft et al. 2014).

Effects of alcohol misuse on social and health services
Alcohol misuse is highly associated with a number of criminal offenses which include drunk

driving, violence, drunkenness. For many years crimes related to drunkenness have been a cause

of concern for the public (Bowley et al. 2013). Some of the crimes related to alcohol misuse that

are of public concern involve drunk and disorderly, criminal damage offenses among other

public order offenses for young male and females happening in towns and entertainment areas.

In addition, there has been a large number of adult’s death as a result of alcohol misuse.

As stated by NHS guidelines (2012), misuse of alcohol leads to many social, physical and mental

challenges. According to the NHS report, 4% of both male and female in England aged 16 to 60

years are dependent on alcohol. The report further states that 24% of the England population

consume alcohol in levels that can harm their wellbeing in term of health. Misuse of alcohol is a

rising problem in young people and children in the UK. There has been an upward trend of

people being hospitalized on cases related to misuse of alcohol (Nuutinen et al. 2011).

Alcohol is used in and around workplaces since it is perceived as an antidote to pressure

experienced at modern workplaces. In addition, alcohol is used in workplaces to help workers

network and socialize well with colleagues and clients. Despite, its contribution alcohol can

damage the UK economic productivity in different ways. Some of these ways include increased

levels of sickness among the adults engaged in alcohol misuse. Heavy drinking is likely to result

in absenteeism at work due to injuries related to drunkenness. Misuse of alcohol can as result of

worker’s inability to perform their duties and may lead to early retirement and unemployment.

Premature death is the greatest loss which occurs as a result of alcohol misuse among individuals

of the working age. When these factors are put together they result in a loss of £6.4bn in the

UK’s economy (Scarborough et al. 2011).

For many years, alcohol misuse by individuals tends to alter the roles family members play

towards one another as well as to the outside world. Since there are families that operate in a

form of division of labour such as one person supervising the children, the other managing

family finances and others doing other activities such as cooking. Therefore, in such a family if

one individual engages in heavy drinking the consequences may be felt by all the family

members and this would result in other family members taking up his or her roles. In cases

where all the roles are undertaken by one individual, the consequences might be serious. Misuse

of alcohol can also result to poor communication between family members where partners may

fail to talk things out or partners tend to have a loose tongue saying things that shouldn’t be said

(Duff, 2012).

Concept of healthcare delivery
The prevention of misuse of alcohol can benefit the majority of the adults engaging in harmful

drinking. The different care models for alcohol misuse recommends that planners for alcohol

misuse need to focus more on harmful, dependent and hazardous alcohol misusers (Bowley et al.

2013). There have been national campaigns which aim at raising awareness among the general

public of the effects of heavy drinking on individuals and those around them. The campaigns

have been consistent with an aim convey a message that is sensible in clarifying for the

population to understand the amount of alcohol they consume. Due to the harm caused by

excessive drinking, the public should be continuously educated regarding harms associated with

excessive drinking. The public should have access to the information regarding what is available

for the patient locally through clear patient information (Khadjesari et al. 2012).

There has been a commitment in the public health to come up with a programme to improve

alcohol treatment services due to the huge demand and the frameworks of care models. The

programme would be funded through pooled treatment budget of alcohol and substance abuse.

Mainly, alcohol treatment is provided by specialist addition services and GPS while most

treatment services in the UK are mainly offered by the voluntary sector. For the recent past, the

emphasis has been put on treatment for class A and B drugs instead of alcohol treatment. As a

result, this has led to underfunding of alcohol misuse services as well as taking much longer time

to treat alcohol cases as compared to drug misuse (Foxcroft and Tsertsvadze, 2012).

According to the government’s policies, the prevailing views of the public is that reduction of

alcohol consumption to lower levels is sustainable even to those who are dependent on alcohol

(Menezes et al. 2013). The government through public health department have assessed alcohol

needs and reduction of alcohol harms through interventions of alcohol misuse. As a result of the

government efforts, there has been a development of a programme to guide both healthcare

providers and drinkers. The strategy put in place further states the actions that need to be taken in

order to reduce alcohol-related crimes and health issues. The “Greater London Alcohol and Drug

Alliance (GLADA)” has released statements of priorities related to alcohol in the capital. The

body based its decision on three main objectives which include; reducing alcohol-related health

issues through raising awareness, easy and better access to treatment as well as early

intervention. The second objective is to reduce alcohol-related crimes, anti-social behaviours,

drunkenness, and disorder. Lastly, to reduce risks of harm to young people and children as a

result of drunkenness (Jones and Fear, 2011).

The government has provided advice regarding the recommended levels of alcohol consumption.

According to the guideline, men should consume four units in daily maximum while on the other

hand women consume three units per day maximum. The alcohol consumption has been

increasing over the years and this has been a cause of concern for all the stakeholder in the public

health.

For the problem to be dealt with both the government and the involved individuals need to

acknowledge the existence of the problem. Denying the problems could worsen the situation,

therefore, acknowledging the problem would help all the parties reduce the problem. Some of the

where one can avoid harmful drinking is by taking short alcohol breaks and learn to say NO.

Developing self-control is the best way to overcome harmful drinking since self-control is a key

element at workplaces and in the society (Sundin et al. 2014).

Conclusion

Alcohol misuse has been an issue of concern in the UK for many years. Alcohol drinking in the

UK is traditional and in some cases cultural. In addition, alcohol is included in all meals and all

gathering in the today’s society. Therefore, the public need to be educated so as not to misuse

alcohol which could lead to health and social problems. Lastly, alcohol treatment needs to be

accessible to all as is the case with drug abuse (McAleer et al. 2011).

Understanding Mental illness

Mental Health care

From your research provide a brief overview of the history of mental health care in Australia.

During 1811Mental illness perceived as madness and called as ‘bad blood’ or personality defects rather than illness. Mental illness was treated by restraints, isolation and controlled by people. During the period of 1950 – 1980 nursing curriculum is been expanded. Mental illness is approached as disorder. Health care teem focused on cure and the prevention of mental illness. People with mental illness are treated with medicines and therapies not with restraints. Now days people with mental illness are well managed and treated in hospital. Family members also included in medical and nursing care of client with mental illness.

Part - B

Research the bio psychosocial model of health and illness. What are the key points of the bio psychosocial model of health and illness?

Bio psychosocial model of health and illness is biological and social factors inducing mental illness. Combination of Biological, psychological and social factors determine the health of a person. A very good example for bio psychosocial model of health and illness is chest pain. Cause for the chest pain is stress and other psychological factors and also some of the social factors play a role in physical illness. A biological, psychological land social factor goes hand in hand causing physical illness. Some of the key points of bio psychological model of the health and illness are biological component, behavioral component, psychological and environmental component.

Part – C

List the domains and discuss how you will ensure that you provide nursing care with in your scope of practice to contribute to the recovery of a person with a mental health condition.

• The source and uses of domains to organize and manage mental health services
• supporting a culture of hopefulness
• promoting professional ethics
• combined partnerships and significant arrangement
• motivate on strengths
• complete and personalized care
• Family care and support
• community involvement
• awareness about diversity

Thinking and learning.

Nursing care of client with mental health condition is a unique and matchless role to play as a nurse. Client with mental health condition is cared and provided a holistic care. Nurses form a bridge between the physical and mental health of the clients. Both physical healthcare and mental health care is needed to be offered to the clients with mental health condition. Nurses are expected to handle and care the mentally ill clients with less understanding, non-responsive, less listening capability and a childlike behavior.

Question 2

Part – A

Discuss the Mental Health Act 2014. Include in your answer

Clients with mental health condition are cared and treated under the mental health act 2014.This act offers right the clients with mental condition to make a decision on the treatment and care. It also provides autonomy, justice, respect and dignity to the people with mental health condition.

 Rights and Advocacy

Mental health act 2014 provides rights to make decision on their treatment and seek for second psychiatric opinion. Client can choose a person and nominate him for a better care and support. Client can directly complain to mental health commissioner about any issues in hospitalization and care.

 Privacy and confidentiality

These are the laws that protect the privacy and confidentiality of the treatment, medication and the client’s document. Privacy and confidentiality need to be maintained as per law and clients request.

 Diversity

Mental health service need be provided to all clients equally irrespective of age, sex, religion, color, cultural and spiritual believes.

 Holistic care

Mental health services focus on a complete care for clients with mental health condition to treat and care physically, psychologically and socially. Mental health services focus on holistic care.

Part- B

To whom does the Mental Health Act apply?

Mental health Act applies to all the citizens of country. Especially it supports the people with

mental health condition and health care practitioners involved in mental health care. The Act

also supports the act of nominating a person in the place of client. It protects the rights of the

mentally ill people and permit to admit a client with mental health condition without their

consent and will for the welfare and safety of the clients and other people.

Part – C

Define mental illness

Mental illness is also called as mental or psychiatric disorder with Drastic change in behavior

or functional pattern of thoughts. Mental disorder affects a person’s thinking, feeling and

behavior,perception and oral interactions with other people.



Part – D

Outline the involuntary review processes for your State.

On the review, all the tribunal members review the documented medical files related to client.

Tribunal members expect psychiatrist to be available to discuss with client prior to the review.

If the above process has not taken place then tribunal members will give a report copy to the

Client. Review will be provided once tribunal members red the report. The actual review starts

after the proper explanation and announcement. Tribunal members invite all the attendees of the

review. Either the client or health care team starts the conversation, fixed orders are not followed

in this issue. All the attendees of the review must abide the rights. Tribunal members acts as a

middle man for the better understanding. Both client and healthcare team must express their

views and remarks in the presence of tribunal members. Final comments sought from both client

or their representatives and health care team. Tribunal members ask everyone to leave that room

and discuss and decide about the continuation of involuntary status of the client.

Part – E

Outline the restraint policies and procedures in the nursing home.

Restraints are used to control movement and to keep the client in right position during nursing care or any invasive procedures carried out in nursing homes. Two types of

restraints are used for the wellbeing of the client and staff safety Physical restraints are commonly used for the safety of the health practitioners. The restraint policies and procedures include continuous monitoring and assessment needs to be followed. While using physical restraints staff need to take extra care on clients skin, soft side of the restraint should be fronting the clients skin and there should be one finger moving between the restraint and clients skin. Restraint should not be act of punishment. Nurse need to follow the professional ethics while taking care of client on restraints. Restraints should allow the client to perform slight movement and it should not completely arrest the movement of the client. Chemical restraints are medication used to control the client’s behavior.

Part- F

Access a policy and procedure for restraint and seclusion in a health care setting in your state. Discuss the legal implications and your role as an EN.

There are some legal challenges a nurse should face on restraining a client. The first and foremost policy carried out in restraining a client is to apply only when it is necessary. Clients consent and family consent need to be taken before the application of restraints. Documentation also plays a vital part whereby type of restraints used, client’s comfort, care of skin on restrained part and the level of movement need to be documented. Especially while taking care of client with mental illness restraints are use with extra care. Seclusion is leaving a person in a room during any time of the day closing the doors and windows of the room. A registered medical officer or psychiatrist must produce a written order for seclusion. Seclusion order is valid only for 8 hours and then expires. Psychiatrist can renew seclusion order after examining the client. An enrolled nurse can initiate order for seclusion during an emergency situation but it should be notified to the psychiatrist immediately. Once a period of seclusion is reached 72 hours, it has be notified to the mental health inspector and/or the Mental Health Commission.

Question 3

Communication in nursing is an essential component of all therapeutic interventions. The knowledge and interpersonal skills that a nurse uses to communicate are essential aspects of helping the person who is experiencing a mental health illness, as well as facilitating the development of a positive nurse-client relationship. This requires the nurse to use a range of appropriate and effective communication and engagement skills with individuals, their carers and other significant people involved in their care.

Nurse –client relationship is based on the communication. There are various aspects that support and promote communication skills in a nurse.

Listening

Communication starts in an act of listening. Listening is the first step in communication. Nurse must express the manner of listening by leaning forward and nodding the head.

Non-verbal communication

Non- verbal communication also plays an active role in communication. Non-verbal communication in nursing includes an eye contact, control over the voice and modulation. It can also be expressed in our body language and a smile

Keep up personal rapport

While taking care of clients a nurse can communicate through compassion, kindness, and sympathy. Convey and communicate with concern to maintain personal relationship.

Respect in all aspects

Respect and dignity is one of the professional ethics need to be carried out as a nurse. Call the client by his name during all the time. This fact is applicable for unconscious client also.

Maintain nursing ethics

While communicating, a nurse should maintain and keep up nursing ethics. Autonomy, beneficence, non-maleficence, respect and dignity, justice are the ethical issues in nursing.

Educate the client friendly

Health education plays a major part in nursing care. Educate the client and family about disease condition, treatment, medication, possible outcome and complication in simple terms.

Verbal communication

Verbal communication need to be carried out at every aspects of treatment. Verbal communication can be documented. Communication skills are likely to be used in verbal communication. Provide information in a simple and clear statement.

Question 4

Discuss the values and philosophies that underpin mental health care.

Compiled participation

Complied participation is the inclusion all people breaking the cultural, language, religious barrier in community. This act of inclusion will promote teamwork, co-operation and responsiveness.

Respect and trust

Respect is common asset belongs to everyone .Respect and trust results in better mental health care. Flexibility and fulfilling promises values more.

Flexibility

Unity in diversity principle works out very well. Australia is the country with multi-cultural population. Promote community with mixture of cultural values by social activities and communicating wellbeing of an individual and society.

Accountability

Discussing and exchanging the opinion will be the most responsible action. It is necessary to provide information that is worth and evidence based. Seek for good opportunities which lead to positive progress.

Action and Replication

Development of sound mental health is achieved by working together regardless culture and language. Consider the consequences that are related to culture and social stigma.

Unity & Diversity

Working together to improve awareness about mental health and mental health services in the community. Treat and respect all the people with mental disorder and their families.

Question 5

Discuss the rights of the person with a mental health condition

Following are the four principle rights of a person with mental illness.


Right to be informed

A Person with mental illness deserves all rights to be informed about his/her disease condition, treatment, medications and its side effects and the complications of the illness. Client also has rights to go for second opinion. Psychiatrist must provide a copy of medical orders, involuntary orders if any, and also he should help in understanding the medical files.


Right to have a caretaker

Client has right to have an attender to interpret during examination and treatment if he is an illiterate or unable to communicate in English. He/she can be involved in planning for treatment and care. He/she can be assisted by a guardian, medical agency, family, friends, and relatives. And also they can get help from advocate.


Right for privacy and confidentiality

A person with mental illness owns the right for privacy, confidentiality and respect. Psychiatrists are not supposed to share or disclose clients’ personal information and medical condition with anyone without clients’ knowledge.


Right to choose

Voluntary clients has right to choose or refuse psychiatrist, treatment and medication. He/ She also have rights to decide who should stay with him/her. Voluntary clients can have advocate as their representatives.

Rights related to caretaker, relatives and friends


Allows to share the personal information’s between care taker and mental health practitioners.


A client with an involuntary order must be assisted or accompanied by a care taker, relative or a friend.


Psychiatrist or an authorized medical officer should give all the copies of treatment, medication and involuntary order to the client assistant.

Involuntary order

SACAT is South Australian civil and Administrative tribunal is the legal tribunal which handles custody, involuntary, treatment and community treatment orders. The tribunal hears the petitions about medical orders made by psychiatrist or mental health professionals. During the time of hearing appeals tribunal has authority to make and review level 3 detention ,treatment, involuntary order, treatment order and level 2 community treatment orders. On case hearing SACAT has power to alter any previous order, confirm order, and withdraw an order. Tribunal will manage and plan treatment. It also monitors and plays vital role in decision making regarding clients treatment and regulates interstate involuntary client transfer.

Question 6

Case study

What signs and symptoms is Julie displaying?

Signs

Mrs. Julie Davis is agitated, worried, crying, and visibly shaking, fearful, nervous, anxious, feeling tired, sleepy, face gaunt, terrified.

Symptoms

Mrs. Julie Davis is complaining of chest pain, reporting of fear of dying, frequently going through this problem, complaints of night sweat, sleeplessness, avoiding fear about socializes, ruminating negatively, repeats answer several times, clutches her hand several times, speaking nervously and rapidly.

Part – B

Client rights are protected by legislation, codes of ethics and standards. What are Julie’s rights as a patient?


Well informed about illness and treatment

Mrs. Julie Davis is very much worried about her health condition and wants to know, what is happening to her. She has right to know about her disease condition and treatment proposed. She also has rights to go for second opinion. Psychiatrist must inform and issue a copy of medical orders.


Respect and privacy

She has to be respected because she might be having a mental illness but she is a teacher by profession. Respect and privacy is the basic right own by all. Psychiatrists are not supposed to share or disclose Mrs. Julie’s personal information and medical condition with anyone without her knowledge.


Can choose or refuse

Mrs. Julie has all rights to choose or refuse treatment and hospitalization as she doesn’t come under involuntary order. As she is much worried she may not co – operate for the further investigation and treatment. She or her advocate can approach South Australian civil and Administrative tribunal.

Part C

How can you incorporate the values and philosophies that underpin mental health care in your nursing care for Julie while working within your scope of practice as an Enrolled Nurse?


Inclusive participation

As Mrs. Julie is very much worried and has fear of death all her family members need to be included in the treatment .Provide complete information about the disease condition of Mrs. Julie and encourage the family members to involve in the treatment process. Allow her family members to stay with her and to take part in client recovery.


Respect and dignity

Mrs. Julie needs to be respected and treated with dignity. Respect and dignity is one of the nursing ethics need to be followed all mental health practitioners. Promises made are to be fulfilled and respected.


Be flexible

Care of clients like Mrs. Julie, health practitioner need to be flexible and feasible. Each client is unique; they differ in culture, language and nationality. Enrolled nurses are supposed to be flexible to make yourself easily approachable person.


Be responsible

Enrolled nurse is a more responsible person in a clinical environment. Be more attentive and responsible for the speedy recovery of the clients. Discuss with client about her disease condition and allow her to express her opinion. Provide information that is worth and evidence based to the client. Use every opportunity to educate the client for the positive progress.


Focus on recovery

High quality care needs to be provided for the speedy recovery. Care and focus on timely treatment and client’s safety. A mental health services must try to achieve positive progress.

Part B

What are the nursing priorities for Julie?


Lessen fear and anxiety

Proper explanation need to be provided to Julie about her disease condition, its signs and symptoms, treatment and recovery period. Introduce another client with same mental illness who is recovered.


Explain and Educate

Good knowledge about their disease condition will reduce their anxiety and promote healing. Client will also co-operate well for the treatment process.


Follow medical orders

Medical orders need to be carried out with professional ethics and professional skills. Medications and therapy are need to be administered and followed to promote clients mental health.


Safety

Safety also plays an important role in recovery of clients’ mental illness. Due to unawareness clients may harm themselves and may not know how to protect themselves.

Part C

What are the discharge goals for Julie?


Discharging Julie should be planned and carried out carefully.


It is a team work, where all the mental health practitioners and Julie’s family members involved.


Julies discharge is planned soon after admission.


Negotiate the arrangements for discharge with everyone.


Review before planning for discharge, which helps to plan for aftercare.


Discharge Julie with agreement, which includes family and health care practitioners.


Provide a copy of discharge care plan


Discharge plan need to be documented and complete instruction about after care need to be provided.


Document it with Julie’s name, date of discharge and Julie’s signature


Ensure that Julie understands discharge process and agree to discharge.

Part - D

Discuss the interdisciplinary team members that may be involved in Julie’s care and the community resources that are available in your community. Discuss your role as an Enrolled Nurse in the interdisciplinary team.

Interdisciplinary team members

The mental health team includes – team of physicians, internists, psychologist, physiatrists (taking care of patients’ care plans and their exclusive medical need)

Community resources

Community services for mentally ill clients are as follows


Mental health services for children and young people


Mental health services for adult


Mental health services for aged people.


Support through telephone and online for mental health problems


Professional and specialized mental health services

Role of Enrolled Nurse in the interdisciplinary team

Enrolled nurse plays a vital role in interdisciplinary team in care of client with mental illness. Nurse takes up the responsibility to carry out the orders by interdisciplinary team and act as a middleman between client and interdisciplinary team

Part E

Stigma is a major issue for people affected by mental illness, influencing how they are viewed, and they view themselves. It can appear at home, at school, at work, in hospitals, clinics, clubs, in the media and in the offices of decision-makers. Julie feels “ashamed” of her diagnosis and disempowered. Discuss your nursing actions.

Friendly support

Friendly approach can support and provides positive progress in client’s recovery. Educate the client that mental illness is similar to the physical illness. Clients with mental illness need to approach with more care and skill. As nurse play many roles in patient care. Friendly attitude inpatient care will help to build a healthy relationship with client.

Show her similar clients

Feeling of loneliness will lead to low self-esteem related to disease condition. Introduce a client with similar disease condition who is recovered. This act will encourage and make her feel that she is not the only one to face this problem.

Encourage to overcome

Mrs. Julie is a teacher and a well-educated woman who is capable to overcome the mental illness she is going through. Boost her self-esteem in a friendly manner. Be more flexible and responsible. Encourage positive thoughts and attitude.

Question 7

Provide a definition, signs and symptoms, social impacts and describe the therapeutic nursing interventions that you would undertake for consumers with the following diagnoses. Discuss two medications that may be prescribed for each diagnosis and their adverse effects.

Part – A

Anxiety




Anxiety is defined as unusual fear without reason accompanied by a thought of danger or worrying about future.

Signs and symptoms

Uneasiness, Increased respiratory rate increased and irregular heart rate, sweating, abdominal discomfort and pain, loses stools, dizziness and dry mouth, urgency and frequent urination, diarrhea, increased blood pressure, confusion, restlessness, irritable.

Social impacts

Clients with anxiety disorder undergo a feeling of fear that no one can understand even though with proper explanation. They avoid usual social gathering and family get together. Since it is unique feeling, other people including family member will tease that he/she is acting.

Nursing interventions


Ensure that client is comfortable both physically and psychologically.


Allow client to express her feeling of fear.


Educate the client about disease condition and encourage that recovery is possible.


Administer anti-anxiety medication as prescribed.

Medications and side effects

Benzodiazepines

Benzodiazepines act as sedatives and muscle relaxant.it helps the client to stay calm. It stimulates some neurotransmitters. Neurotransmitters exchange the message between brain cells. It is used for short term treatment. Side effects are increased drowsiness, affects memory, danger of addiction

Buspirone

Buspirone is widely used to treat acute and chronic condition of anxiety disorder. Actual action of buspirone is unknown. It regulates the chemicals in brain. Long term intake of medicine gives good result and act effectively. Some of the side effects are dizziness, head ache, nausea and vomiting.

Part B

Depression

Depression is defined as a mood disorder with marked feeling of sadness, feeling down. Lack of happiness and reduced interest in daily routine are the typical factors of depression.

Signs and symptoms

Signs and symptoms of depression are reduced interest, loss of sexual interest, unplanned weight loss, loss of appetite, insomnia or hypersomnia, Delayed speech and movement, feeling tired or fatigue, guilty feeling and worthlessness, unable to concentrate, suicidal thoughts and suicide attempt.

Social impacts

Depression may lead to abuse of drugs or addiction to liquor. Depression may lead to withdraw from family and friends. Depression may give a guilty feeling due to any loss or failure. Depression may lead to lack of interest and performance in school and work.

Nursing interventions


Encourage the client to interact with other clients and family


Encourage client to express the feelings.


Identify and prevent the chances of suicide.


Administer antidepressants as per physicians order.

Medications and side effects

Norepinephrine-dopamine reuptake inhibitors – Bupropion

Bupropion is the medicine most commonly used for the clients with depression. It is also used to treat anxiety. It has minimal side effects

Tricyclic anti-depressants

TCAs boosts the mood and provide prolong benefits. It reduces the effects of depression. It is a safer medication to use. Some of the side effects includes weight gain, dry mouth, drowsiness, irregular and increased heart rate, confusion, constipation, urinary irritation, loss of sexual interest.

Part-C

Schizophrenia

Schizophrenia is defined as disturbance in mood which is characterized by hallucination, delusion, and cognitive problems. Schizophrenia is said to be a lifelong problem.

Signs and symptoms

Delusion, hallucination, mood disorder, lack of interest and motivation, improper expression of mood, cognitive disorders

Social impacts

Schizophrenia affect the major part of your life as it affects a person’s ability to think, behave and feel. It affects a person physically, emotionally, socially. Early diagnosis will help to plan for treatment and rehabilitation.

Nursing intervention


Never allow the client to stay alone as the patient is suffering from hallucination and delusion.


Encourage the client to do drawing or listening music, gardening, art and craft works which are known to be reality based actions.


Administer prescribed medications to lessen the symptoms.

Medications and its side effects

Chlorpromazine HCL

Chlorpromazine HCL is widely used to treat many psychiatric disorders like schizophrenia, psychotic disorder, manic and bipolar disorder. It helps in clear thinking. Reduce nervousness, helps to lead normal routine life. It lessens the symptoms like aggressive behavior, suicidal attempts. It balances the chemicals in brain and maintains normal level. Some of the side effects are Lethargy, dizziness, giddiness, dry mouth, blurred vision, nausea and vomiting.

Perphenazine

It is used to treat many psychiatric disorders like schizophrenia, manic condition in bipolar disorder. It helps to balance a natural substance called dopamine in the brain. It reduces most of the symptoms caused by disease condition called schizophrenia. Side effects for this medicine are lethargy, constipation, lightheadedness, blurred vision, dizziness, unexplained weight gain.

Part D

Bipolar Affective Disorder

Bipolar affective disorder is also called as maniac depression in which a person experiences both extremes of high and low moods. It alters the sleep pattern, energy level, thinking and behavior of a person.

Signs and symptoms

A person with bipolar affective disorder experiences both manic and depression symptoms. Maniac symptoms includes Extreme happiness, Sudden changes from joyful mood to irritable mood, restlessness, rapid speech and poor attention, increased energy level, increased sexual desire. Symptoms of depression phase in bipolar disorder includes sadness, low energy level, low self-esteem, feeling useless, poor concentration, irritated, uncontrolled crying, lack of appetite and sleep, suicidal thoughts and attempts.

Social impacts

It is a complicated psychiatric disorder in which both mania and depression contribute the changes in mood and thinking. It affects the social life of a person in school, and work places. A person with bipolar affective disorder must try to break the barriers to reach out family friends and society.

Nursing intervention


Encourage planned activities under supervision of a nurse.


Assure enough rest and nutrition is provided.


Provide comfortable environment.


Administer medications prescribed by psychiatrist

Medications and its side effects

Valproate or Valproic Acid (Depakote)

It is used as anticonvulsants to treat seizure. It also acts as mood stabilizer for the person with bipolar affective disorder. It is used to prevent migraine headache. It regulates neurotransmitters in the brain. Common side effects are diarrhea, lethargy, and irregular menstrual periods, ringing in the ears, physical instability, blurred vision and hair loss.

Carbamazepine (Tegretol)

It is a mood stabilizer used along with antidepressants exclusively used for person with bipolar affective disorder. It is also used as an anticonvulsant which acts on nerve impulses to reduce the episodes of seizures and nerve pain. Common side effects are nausea, vomiting, lethargy, drowsiness, dry mouth, unsteadiness, swollen tongue.

Part - E

Personality disorders

Personality disorder is unnatural pattern thinking and behaving. A person with personality disorder will face difficulties in perception and common social involvement. This leads to major problems in relationships, work and school.

Signs and symptoms

Typical symptoms of personality disorder are fear of rejection, low self-esteem, unbalanced relationships, Self – harm, self- damaging behavior, and mood swings, chronic feeling of unworthiness, short-tempered.

Social impacts

A typical symptom of personality disorder is fear of rejection, which leads to social withdrawal behavior. It gives the feeling of hesitation to seek for a simple friendly proposal. It may lead to fear of sharing personal information even to the closer relationships.

Nursing interventions


Encourage the client to express the feeling of fear and its intensity


Engage in simple social activities


Use friendly approach in nursing care.


Administer prescribed medications.

Medications and its side effects

Zyprexa

Zyprexa is used in treating mood disorders.it helps in improving confused thinking. Most commonly it is used in combination with anti- depressants to treat depression. It supports to reduce symptoms of hallucination which may lead to clear thinking. Side effects are drowsiness, dizziness, constipation, stomach upset, and lightheadedness.

Xanax

Xanax is widely used in treat a person with panic and anxiety disorder. It acts on brain nerves to make the person calm and quiet. Side effects are drowsiness, increase saliva secretion, dizziness.




Part F

Psychosis

Psychosis is a sign and symptom of chronic mental illness it is not a mental illness. Psychosis is caused by mental illness, unexplained stress, or any injury. Schizophrenia is one of the mental illnesses that involve psychosis.

Signs and symptoms

Impaired concentration, depression, more sleep, anxiety, hallucinations, delusion, talking in an unorganized manner, suicidal thoughts and attempts.

Social impacts

Psychosis is a combination of psychiatric symptoms which make a person to be in confused state. It leads to emotional tiredness due to mixture of various psychiatric symptoms.

Nursing intervention


Never allow the client to stay alone as the patient is suffering from hallucination and delusion.


Encourage family interaction boost up confidence.


Encourage to stay calm and quite.


Watch for symptoms of suicidal thoughts and remove all potential materials for suicide.

Medications and side effects

Clozapine

This medicine is used to treat mental disorders such as schizophrenia and schizoaffective disorder.it is an anti-psychotic medicine that balances the chemical substances in brain. Side effects of the medicine include drooling of saliva, lethargy, dizziness, headache, shaky hands, and blurred vision.

Ziprasidone

This medication is used in treating certain mood disorders like schizophrenia and bipolar disorder. It reduces symptoms of hallucinations and promotes clear thinking .Side effects for this medication are lethargy, dizziness, faintness, nausea, vomiting, cough and runny nose.

Part G

Organic disorders

Organic disorder is also called as organic brain syndrome. It is characterized by decreased mental function because of any injury, medical or physical medical conditions. It is not due to mental illness.

Signs and symptoms

The signs and symptoms of the organic disorders are irritated mood, unstable behavior, and weakness in brain function, cognitive ability and memory.

Social impacts

Organic disorder influences the normal routine at home, work or school. It also leads to social withdrawal due to symptoms of the disease condition. It also affects the person physically and mentally.

Nursing intervention


Extra care need to be provided as a person is affected both physically and mentally.


Encourage to do deep breathing exercise and meditation to reduce irritation.


Administer prescribed medication to boost brain function

Medication and side effects

Duloxetine

Duloxetine is used to treat various psychiatric conditions like anxiety and depression. It also helps in relieving nerve pain for people with diabetes, arthritis, orthopedic condition, chronic back pain. Side effects for the medication include nausea, dry mouth, profuse sweating, and drowsiness, loss of appetite, tiredness and weakness.

Meloxicam

Meloxicam is used to relieve pain caused by orthopedic conditions like arthritis. It reduces joint stiffness, pain and swelling. A side effect for meloxicam includes nausea, vomiting, dizziness, and diarrhea.

Part H

Social phobia and specific phobias

Social phobia is also called as social anxiety disorder. It is an unnecessary and excessive fear of social gatherings. Specific phobia is fear or aversion towards something.

Signs and symptoms

Signs and symptoms of social and specific phobia are increased heart rate, dry mouth, shaky hands sweating, nausea, and fear of loss of control.

Social impacts

Social and specific phobia limits daily routine and activities. It can cause anxiety and depression. A person affected with phobia avoids the things causes fear and anxiety.

Nursing interventions


Encourage the client to express the feeling of fear


Remove the things believed to cause fear in clients with phobia.


Repeatedly tell the client that nothing will harm


Follow medical orders and administer prescribed medications.

Medications

Lexapro

It is believed to reduce symptoms of anxiety and depression. Nausea, vomiting, dry mouth, insomnia, lethargy, dizziness, increased sweating.

Prozac

It is used to treat eating disorder, panic attacks and sever premenstrual syndrome. Side effects are nausea, drowsiness, insomnia, loss of appetite, sweating or yawning.

Part I

Obsessive-compulsive disorder

Obsessive compulsive disorder is usually stated as OCD in short form. OCD is a mental health condition in which patient suffering from obsessive thoughts and compulsive behavior.

Signs and symptoms

Fear of contamination, persistent sexual thoughts, repeated unwanted ideas, constant checking and counting, repeated cleaning of items, repeated hand washing, continually checking the stove or door locks.

Social impacts

OCD disturbs the routine work by consuming time in compulsive disorder. obsessive and compulsive symptoms leads to uneasy and unsatisfied lifestyle.

Nursing intervention


Encourage and educate to learn stress management


Identify situation that relaxes client and apply


Provide positive reinforcement


Use a relaxed and calm environment

Medication and side effects

Fluvoxamine

It is used to treat OCD by reducing unwanted thoughts and urge to do repeated actions. Nausea, vomiting, loss of appetite, dizziness, drowsiness, insomnia and sweating are the side effects.

Venlafaxine

It is used to treat depression and promote mood and energy level. Side effects are drowsiness, dizziness, dry mouth, insomnia, loss of appetite, constipation, nervousness, unusual sweating.

Part J

Borderline personality disorder

It affects the way of thinking and feeling about yourself and others.

Signs and symptoms

Fear, unbalanced relationships, mood swings, self-harm, feeling of emptiness, explosive anger is the signs and symptoms of borderline personality disorder.

Social impacts

An unstable relationship leads to confusion in relationships. Due to explosive anger some time client has feeling of guilt.

Medication and side effects

Risperidone

It is used to treat some mood disorder rand borderline personality disorder. Side effects are drowsiness, dizziness, dry mouth, constipation, drooling and nausea.

Paroxetine Hcl

It is used to treat depression and manic attacks, OCD and anxiety disorder. Dizziness, constipation, loss of appetite, weakness, and dry mouth is side effects.

Part K

Delirium

It is a disturbance in mental status caused due to confused thinking.

Signs and symptoms

Signs and symptoms are poor memory, disorientation, difficulty in remembering words, trouble in reading and writing, hallucination, restlessness.

Social impacts

Delirium affects the routine work as there is difficulty in remembering words. It leads to school dropout due to hallucination and trouble in reading and writing.

Nursing interventions


Never allow the client to stay alone as the patient is suffering from hallucination and delusion.


Use a relaxed and calm environment


Use friendly approach in nursing care.


Administer prescribed medications.

Medication and side effects

Quetiapine

It is used to treat mood disorder and sudden episodes of mania and depression. Side effects are dizziness, drowsiness, and dry mouth, loss of appetite, constipation, tiredness and blurred vision.

Olanzapine

It is used to treat certain mood condition and it helps in reducing hallucination .some of the side effects are light headedness, dry mouth, constipation, increased appetite.

Question 8

Part - A

Reflect on your role as an EN. What should you be aware of in your communication with Arron on his admission?


Collect all clinical data, signs and symptoms from arron and his family.


Accept and acknowledge while sharing about his health condition.


Since arron is irritated and sensitive, use a neutral way of response, neither agrees nor disagree with thoughts.


Allow client to start the conversation


Encourage arron to express his thoughts and feelings and be a good list


Aware on using ethical principles

Part – B

The Enrolled Nurse is an integral part of the mental health nursing team, working under the direction and supervision of the Registered Nurse to provide support and care for clients. Discuss how you can support Mr Arron Quirk.


Plan and work as a team


Advice not to do self-harm at any circumstances


Encourage and allow a friend to stay with Mr. Arron


Remove all the hazards materials from his environment


Provide emotional and psychological support.


Encourage simple tasks


Involve family members while caring for arron


Educate and encourage to maintain personal hygiene


Plan and provide nutritious and tasty food

Question 9

Your client has a nursing diagnosis of disturbed thought process related to Alzheimer’s disease. List the possible signs and symptoms that may be present.

Signs and symptoms of Alzheimer’s disease are


Confused while speaking


Difficulty in solving problems


Trouble in choosing apt dress for the weather


Failed attempts in problem solving


Disoriented about time, place.


Insomnia


Short – tempered


Doubting the care giver


Repeating similar statements


Forgetting things

Part B

Discuss the desired outcomes for a client with disturbed thought processes.

Desired outcome of disturbed thought process


Disorientation and problem in communication


Impaired thinking process


Unable to participate in social gathering


Unable to interact


Unable to recognize what others are speaking about

Part C

Discuss the nursing interventions for a client with disturbed thought processes.

Nursing interventions


Assist and co-operate with client and family


Orient the client for place and time


Apply all safety measure and educate the family.


Do not force any action or conversation


Provide nutritious diet


Encourage client to express his/her feelings

Part D

Your client has a nursing diagnosis of self-care deficit: bathing/hygiene related to Alzheimer’s disease. List the possible signs and symptoms that may be present.

Signs and symptoms of self-care deficit are


Strong and unbearable body odor


Unable to dress up


Impairment in bathing and self-grooming


Unable to tolerate warmth of water


Depressed and frustrated

Part E

Discuss the desired outcomes for a client with self-care deficit: bathing/hygiene.

Outcomes of self-care deficit: bathing/hygienic


Oral infection due to poor oral hygiene


Low self-esteem


Skin infection


Unhealthy life style


Separation from family and friends

Part F

Discuss the nursing interventions for a client with self-care deficit: bathing/hygiene.


Encourage and educate about personal hygiene


Change in lifestyle helps in enhanced thinking process


Encourage simple tasks in hygiene


Offer small gifts when tasks are successfully completed

Question 10

Case Study

1. What are your nursing responsibilities? Include in your answer the Mental Health Act and relevant state legislation, organizational policies and procedures and the Nursing and Midwifery Board for Code of Conduct, Code of Ethics and Scope of practice.

Nursing responsibilities


Provide comfortable environment


Monitor for possible suicidal attempt


Evaluate the cause for loss of appetite and resolve it


Providing homely environment may induce sleep.


Encourage positive thoughts




Mental health Act offers right to Mr. Jones with mental condition to make a decision on the treatment and care. It also provides autonomy, justice, respect and dignity to him in treatment. Mrs. Julie needs to be respected and treated with dignity. Mr. Jones can choose a person and nominate him for a better care and support. Mr. Jones can directly complain to mental health commissioner about any issues in hospitalization

2. What information from your conversation with Mr. Jones would you document?

Information need to be documented is Name, Age, marital status, Past-medical history, present medical history, family history, signs and symptoms on admission, what are the medications heis consuming, for how many years.

3. Who would you report your conversation with Mr. Jones to?

All the information’s collected during conversation need to be reported to registered nurse and to hand over nurse.

4. What would be other relevant questions to ask Mr. Jones?


Does he have family history of any psychiatric disorder?


When he is been diagnosed with post-traumatic stress disorder?


What are the medications he is consuming now?


Factors that increases the symptoms

5. Reflect on your own attitudes and values and research and discuss why Mr Jones may feel “embarrassed” about his illness.

Mr. Jones is an ex-service man worked in army. He would be respected by all when he was on service. He might have overcome many physical and psychological injuries in past. Now he is feeling embarrassed, may be because of the comments from family and friends and himself not able to do anything with confidence.

6. Discuss effective communication techniques that you would use to provide care for

Mr Jones

Effective communication techniques are


Listening is the first step in communication


Focus on recovery


Provide proper explanation


Encourage and educate


Ask helpful questions


Allow Mr.Jones to express his thoughts and views

7. List four internal and four external triggers that may trigger flashbacks for Mr Jones

Internal triggers

His memories, disease condition, sleeplessness and thinking are the factors that triggers past

External triggers

Some of the external triggers are his family, friends visiting him in hospital, when health care practitioners enquire about his past and wound and injuries in hospital.

8. Discuss the importance of using the Nursing Process (assessment, nursing diagnosis, planning, implementation and evaluation) for clients who have a mental illness.

Nursing process is used both for physical illness and mental illness. First step is assessment will help us to know the care actually need for the client. Nurse must diagnose the disease condition. She needs to plan nursing care. Planned care need to be implemented. Finally outcome of nursing care is evaluated. Nursing process must be used in mentally illness to provide prompt care.

9.Mr Jones has difficulty has decreased motivation to attend to personal cares. You have noticed that Mr Jones does not attend to oral hygiene. What are some of the most common side effects from medications that may affect oral health?

Some of the common side effects that affect oral health are drooling of saliva, dehydrated mouth, swollen gums, bleeding gums, infected cavities, and oral ulcers.

10. What are the nursing strategies that you could implement to assist Mr Jones with his oral hygiene?


Encourage Mr. .jones to brush his teeth twice daily


Advise him to gargle his mouth after meals


Avoid the substances that can damage oral cavities


Advise him to avoid using sharp materials in oral cavity


Regularly assess his oral cavity for any damage

11. Research and discuss the history, social, political and economic issues that have influence the nursing delivery of mental health care in Australia. Provide a brief review of the delivery of care from a global perspective.

Mental healthcare in Australia is highly influenced by social, political, and economic issues .A person with the history of mental health is prone to get mental illness. Preventive measures need to be taken in such cases. Many psychiatric conditions are occurred due to various social issues. Adults get addicted to drugs due to social issues like broken families Economic issues poverty causes mental illness.

12. The Who Mental Health Care Law: Ten Basic Principles are there

Discuss how The Who Mental Health Care Law: Ten Basic Principles can be

Implemented when caring for Mr Jones


Implement preventive measures for complication caused due to mental disorder.


Take extra care to maintain basic health care


Assess mental health using internationally accepted principles.


Ensure to use less limiting measures.


Help Mr.Jones to overcome self –esteem issues


Provide support to exercise self determination


Ensure availability of review procedure


Encourage regular follow up


Follow the physicians order


Follow all law and Acts related to mental health

13. The principles of recovery-oriented mental health practice ensure that mental health services are delivered in a way that supports the recovery of mental health consumers. List the principles of recovery oriented mental health practice


Treat and care an individual in a unique manner.


All human beings deserve right to choose or refuse Real choices


Maintain positive attitude towards client and nursing care


Practice nursing care with respect towards client and profession.


Use of appropriate communication tools


Evaluate nursing care and health education

14. Mr Jones’s condition deteriorates. He becomes increasingly agitated and speaks of self-harm. He has an involuntary admission. Discuss the key features of the mental health legislation for your State. Include in your answer involuntary admission, consumer rights, involuntary review processes, seclusion and restraint, admission procedures, community treatment orders, the role of the multi-disciplinary team, consent and privacy.

South Australian civil and Administrative tribunal is the legal tribunal which handles custody, involuntary, treatment and community treatment orders. The tribunal hears the petitions about medical orders made by psychiatrist or mental health professionals. Mr.Jones can get help from the legal tribunal for involuntary admission. While using physical restraints staff need to take extra care on clients skin, soft side of the restraint should be fronting the clients skin and there should be one finger moving between the restraint and clients skin. The multi-disciplinary team plays role in taking care of patients’ care plans and their exclusive medical need.

References

1. Wayne, October (2016) Accessed from: https://nurseslabs.com/anxiety/

2. Melissa, (2018) Accessed from: https://www.nursechoice.com/traveler-resources/10-essential-nurse-communication-skills-for-success/

3. Shaheen E Lakhan (2016) Accessed from: http://brainblogger.com/2006/02/15/bps-the-biopsychosocial-model-of-health-illness/

4. Santa (2018) Accessed from: https://mhaustralia.org/

5. AIHW (2018) Accessed from: https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/summary-of-mental-health-services-in-australia

















.

Commercializing Bio-medical science-Klotho Protein

Klotho is a protein with the anti-aging property. It is in the form of membrane-bound and soluble form. Klotho circulates in the body fluids like blood and cerebrospinal fluid. It was discovered in the year 1997. Studies show that Klotho protein is involved in the aging process of mammals. It also evident that decrease in Klotho protein in the human body influences the aging process. It shows a drastic change in the cognitive perception in elderly people. It is also believed to increase the life span of the mammals. (Hu et al. 2012, 2650-2657) This assignment helps to assist a group of investors who wanted to invest in companies indulged in discovering the medical benefits of Klotho proteins. This assignment provides a clear picture of the Klotho protein and how it is related to aging. It also provides a framework to assess new investment opportunities related to Klotho protein. Task 1 includes the preparation of a target product profile for new medicine prepared from Klotho protein. The new medicine is prepared to treat the kidney disease caused due to aging. Task 2 provides the memo of advice for the investors regarding the preferred field of investment. Task3 offers the Memo of advice regarding the preferred type of product to be developed among the provided klotho protein form.
Target product profile for new medicine made from Klotho

Characteristics of medicine


Medical usage


Product development considerations and assumptions


Indications


For the prevention of kidney diseases due to aging. Age above 60 years can be considered. (Neyra 2017,41-19)

Kidney diseases are common in aging. It begins at the age of 60. Kidneys also turn out to be older when years go by and cause various kidney diseases in human. Kidney disease may lead to renal failure which is considered to be a serious complication in aging. Recent research shows that kidney disease affects more elders than cancer. Kidneys disease accompanies various other diseases like increased blood pressure, Kidney failure followed by heart failure and in many cases it is fatal. Kidney disease is mostly associated with Diabetes and hypertension which is considered to be other age-related diseases. Studies show that prevention of kidney disease in aging may increase the life span of a person. ( Mallappallil et al. 2014,525)

Contra-Indication
As it is a body protein, it can be used for all, above the age of 60. No contraindications recommended.

As klotho protein is the enzyme secreted in our body, no adverse effects or contraindications are observed in the recent researches. Both theoretically and practically klotho protein proves that it is the beneficiary protein. But when used for chronic kidney disease patient two aspects have to be considered. High potassium diet and intake of vitamin D supplement may influence the klotho protein administration(Hu et al. 2010)

Target Population 

Klotho protein has an anti-aging property. It can be used for all the elderly people above the age of 60. Particularly it deals with kidney disease in old age. Since it can be applied to elderly people with kidney disorders.

Kidney disease is always associated with various chronic diseases like diabetes, hypertension and heart disease. Treating or preventing kidney disease will reduce the complications of other chronic diseases due to aging. It also increases the life span and also provides harmony in the process of aging.

Safety precautions
Klotho protein is safe to administer in soluble form.

Klotho protein regulates the metabolism of phosphate, calcium, and potassium. It is a safe and effective way to protect vital organs like the kidney and brain. Studies show that a soluble form of Klotho protein is safe to administer for men and women above the age of 60. But as for other medications, continuous monitoring is recommended. Monitor the levels of calcium, phosphate, and potassium. Vital signs also have to be monitored(Hu et al. 2012, 2650-2657) 

Measures of Efficacy
Various studies show that people with end-stage kidney disease had less Klotho protein in the blood and urine. (Hu et al.2010)

Experimental study on kidney injury shows that absence of Klotho protein leads to ischemia in kidneys. Another study shows that creatinine level in urine is normalized with Klotho protein. Studies also prove that Klotho protein prevents the calcium deposition or calcification in heart, kidney and blood vessels. An experimental study shows that it is an effective way to treat kidney injuries also. Laboratories created an ELISA Kit to measure the level of klotho protein in the blood. On Investigation it has generated higher readings on the fresh blood samples and lower reading in the delayed samples or the stored one. Due to the variable blood result, further research needs to be executed. (Hu et al. 2010)

Dose regimen A single dose is Advisable
Klotho protein is available in the form of soluble form, vaccine form, gene therapy, and molecule drug form. It has to be administered only on the advice of the physician. Since it is related to the metabolism of minerals like calcium, phosphate, and potassium. It also influenced the high potassium diet and intake of vitamin D supplement. 

Duration of Action
Duration of action differs according to the form of klotho protein administered.

Since Klotho protein is an enzyme the duration of action is limited for few hours only. Duration of action depends on the form of klotho protein used. Duration of action for gene therapy is longer than the other for klotho protein. (Tan et al. 2014, 439-449)

Route of Administration
Oral and Intra-muscular

Klotho protein supplement is available in 20 ug/vial. Gene therapy and vaccine form of klotho protein is administered as injections.

Product storage
Advised to store at 4 degrees C.

Medication has to be stored at 4degree C until the reformation. Once reformation is over medicine need to frozen at – 20 degree for the long term storage.

To provide the details about the Klotho protein this includes the advantages and disadvantages and the scope in the pharmaceutical industry. It also discusses alternative medicines with anti-aging property and healing properties for chronic kidney disease (Mallappallil et al. 2014, 525)

Summary of the task: Klotho protein is the natural form of protein with the anti-aging property. The protein delays the aging and promotes the functions and health of the vital organs like kidneys and brain. Mainly it promotes the health of the kidney and helps the host to recover soon from the kidney injuries. So there is a great demand for the Klotho protein among old age people. Investing in this medicine will bring a revolution in the pharmaceutical industry.

Advice: According to researches done on the klotho protein, it states that Klotho protein is an anti-aging protein full of medical benefits for the old age people. Klotho protein mainly improves the function and health of the vital organs like kidneys and brain. It benefits the kidneys by preventing from aging and kidney failure. But before investing in the klotho protein for the business purpose few points need to be considered. The researches on the klotho protein are limited and proven studies are not available. Observational studies are done only for the small group. An additional difficulty is the lack of tools and standardized method to measure the circulating klotho. The available method of measuring the circulating klotho protein is providing variable results. (Neyra 2017, 41-19)The actual function of Klotho protein in kidney disease is unknown. Exploring alternative anti-aging medicines will provide choices to the investors, which will bring out the best medicine to treat aging and age-related disease conditions like chronic kidney diseases.

Reasons for your advice: Klotho protein is believed to be the benefiter protein. But an Experimental study shows the variable result and readings. Laboratories created an ELISA Kit to measure the level of klotho protein in the blood. On Investigation it has generated higher readings on the fresh blood samples and lower reading in the delayed samples or the stored one. (Neyra 2017, 41-19) The reliable study is not done to prove the function of the klotho protein in kidney disease. Klotho protein has many forms which include circulating klotho, complex klotho, secreted form, a linked form of klotho. The functions and right method to measure the klotho form has to discover. It has been identified as factors like phosphate-rich diet, intake of vitamin D supplementation. (Neyra 2017, 41-19) It also influences certain medication, which is not identified in the observational or experimental studies. Nicotinamide adenine dinucleotide is the alternative medicine suggested to slow down the aging process. Astragals Chinese herbs are two alternative medications suggested to treat the age related disease like chronic kidney disease.. Nicotinamide adenine dinucleotide is the co-factor found in the cells. It has an anti-aging property (Kitada et al. 2013). Various proven studies are available with an accurate research finding. Another option to treat chronic kidney disease due to aging is Astragals, a Chinese herb. (Li et al.2005)Proven studies are available to justify that Astragals has enormous health benefits for the kidneys. Researches show that it prevents the aging of the vital organs. It is also called a ruler drug in the treatment of chronic kidney disease. Studies also prove that it is the safest drug to administer for elderly people.

Advantages and disadvantages of developing a new medicine

• Nicotinamide adenine dinucleotide
• Astragals a Chinese herbs
• Nicotinamide adenine dinucleotide is the co-factor found in the cells with anti-aging property
• Astragal is the Chinese herb with enormous health benefits specifically it treats chronic kidney disease due to aging.
• Nicotinamide adenine dinucleotide therapy costs $200 per month
• Astragal herb is cost effective
• Can be administered as IV infusion
• Astragal Herbs can be administered as food or supplement
• Proven researches are available for its anti-aging property
• Proven research studies are available to support healing properties for the chronic kidney disease
• No side effects are reported
• Less or no side effects are reported
• The right method to measure the accuracy or the range in the blood is reliable
• The right method to measure the accuracy is available
• Not influenced due to intake of any medication or supplement.
• Not influenced by the intake of specific food or medicine.
• It benefits the aged population. It acts as an anti-aging agent whereby it lessens the age of vital organs.
• Astragals herb is an anti-aging herb found in China. It is also called as a ruler drug to treat chronic kidney disease
• The investigation provides the accurate result on measuring Nicotinamide adenine dinucleotide
• Since it is a herbal product, investigation and blood tests are not required to measure the level.

To provide details on the different form of the klotho protein available and choose one method of administration of klotho protein. Rationalize how chronic kidney disease can be treated using the chosen form of klotho protein


Summary of the task: Klotho is the anti-aging protein bound in the human body. It has various medical benefits which increase the life span of the human. It also increases the life span of the vital organs like the kidney and brain. Klotho protein benefits the old age people to overcome chronic kidney disease. An investor group is interested to invest in the companies involved in the invention of new medicine using klotho protein. Four different forms of klotho protein are exhibited to the investor to choose the right one for the benefit of mankind. This memo advice helps the investors to acquire details about the advantages and disadvantages of developing new medicine for the treatment of an age-related disease based on four Klotho-related mechanisms.


Advice: Klotho protein can be used as an anti-aging supplement. Administering medication to elderly people is like administering to pediatric patients. The medication has to undergo various studies and accurate results need to derive before administering to the elderly people. So Klotho protein has to administer in the form that is favorable for the elderly people. Klotho protein is available in various forms for the administration. Soluble Klotho protein is the biological product which can be administered as a protein drug. A small molecule drug base is another form of klotho drug which is yet to pass through the lead optimization process. Gene therapy product is the one form of klotho protein that induces the body to produce more Klotho protein. It is also available in the form of the vaccine. Administration of soluble Klotho protein is considered to be the best method to treat age-related disease.


Reasons for your advice: Administration of klotho protein in the soluble form is the best method to treat the age-related diseases in elderly people. (Neyra 2017, 41-19) Various age-related diseases like diabetes, a cognitive disorder due to aging, kidney diseases can be treated using klotho protein gene therapy. It also increases the life span of humans. Chronic kidney disease can be easily treated using soluble Klotho protein. Gene therapy is beneficial for elderly people suffering from cognitive disorders. But it is not a suitable method for people suffering from chronic kidney disease. Even though it is a cost-effective method, it is the one time therapy which is contraindicated for chronic kidney disease patients. Because chronic kidney disease patient may also have cardiac problems. High potassium diet is recommended for cardiac patients who may influence the klotho protein. Elderly woman’s undergone menopause is usually prescribed with vitamin D supplement. Vitamin D supplement influences the function of the klotho protein. So elderly women’s on vitamin D supplement can’t choose the gene therapy method for klotho protein administration. A soluble form of klotho protein is the human-friendly. Presence of any adverse effects can be treated easily. Many Research studies support the administration of soluble Klotho protein for elderly people suffering from chronic kidney disease. As a soluble form of klotho protein is the natural one, less or no side effects are reported. Regular monitoring under the specialized physician is possible on the administration of the klotho protein in the soluble form (Hu et al. 2010).

Advantages and disadvantages of available klotho protein products

• Soluble Klotho protein
• Other klotho protein products
• It is the natural form of klotho protein ( found in the circulating blood stream)
• Other products are mostly unnatural
• It has less or no side effects reported. But it may influenced by the intake of high potassium diet and Vitamin D supplement.
• Side effects are expected as it is an unnatural form. May influenced by the intake of high potassium diet and Vitamin D supplement.
• It is human-friendly and easy to administer
• Administration need more procedure to be followed
• Suitable for elderly people with chronic kidney disease.
• Not a suitable method for elderly people with chronic kidney disease.
• Blood investigation on the Post-administration of medication provides an accurate result
• Blood investigation on the Post-administration of medication results are inaccurate
• Monitoring the patient on the medication administration is simple and painless
• Monitoring the patient on the medication administration has complex procedures
• Continuous monitoring is not recommended
• Continuous monitoring is recommended

References1. Hu, Ming Chang, Makoto Kuro-o, and Orson W. Moe. "The emerging role of Klotho in clinical nephrology." Nephrology Dialysis Transplantation 27, no. 7 (2012): 2650-2657. https://academic.oup.com/ndt/article/27/7/2650/1850334


2. Hu, Ming-Chang, Makoto Kuro-o, and Orson W. Moe. "Klotho and kidney disease." Journal of Nephrology 23, no. Suppl 16 (2010): S136. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227531/


3. Yang, Haichun, and Agnes B. Fogo. "Cell senescence in the aging kidney." Journal of the American Society of Nephrology 21, no. 9 (2010): 1436-1439. https://jasn.asnjournals.org/content/21/9/1436.short


4. Mallappallil, Mary, Eli A. Friedman, Barbara G. Delano, Samy I. McFarlane, and Moro O. Salifu. "Chronic kidney disease in the elderly: evaluation and management." Clinical practice (London, England) 11, no. 5 (2014): 525. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291282/


5. Tan, Sven‐Jean, Edward R. Smith, Tim D. Hewitson, Stephen G. Holt, and Nigel D. Toussaint. "The importance of klotho in phosphate metabolism and kidney disease." Nephrology 19, no. 8 (2014): 439-449. https://onlinelibrary.wiley.com/doi/pdf/10.1111/nep.12268


6. Kuro-o, Makoto. "Phosphate and klotho." Kidney International 79 (2011): S20-S23. https://www.sciencedirect.com/science/article/pii/S0085253815547728


7. Tonelli, Marcello, and Miguel Riella. "Chronic kidney disease and the aging population." (2014): F469-F472. https://www.physiology.org/doi/full/10.1152/ajprenal.00063.2014


8. Neyra, Javier A., and Ming-Chang Hu. "Potential application of klotho in human chronic kidney disease." Bone 100 (2017): 41-49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474175/


9. Zhong, Yifei, Yueyi Deng, Yiping Chen, Peter Y. Chuang, and John Cijiang He. "Therapeutic use of traditional Chinese herbal medications for chronic kidney diseases." Kidney international 84, no. 6 (2013): 1108-1118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812398/


10. Peng, A., Y. Gu, and S. Y. Lin. "Herbal treatment for renal diseases." Ann Acad Med Singapore 34, no. 1 (2005): 44-51. https://www.ncbi.nlm.nih.gov/pubmed/15726219


11. Wakino, Shu, Kazuhiro Hasegawa, and Hiroshi Itoh. "Sirtuin and metabolic kidney disease." Kidney international 88, no. 4 (2015): 691-698. https://www.sciencedirect.com/science/article/pii/S2157171615322425


12. Yoshino, Jun, and Shin-ichiro Imai. "Accurate measurement of nicotinamide adenine dinucleotide (NAD+) with high-performance liquid chromatography." In Sirtuins, pp. 203-215. Humana Press, Totowa, NJ, 2013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935825/


13. Li, Xiaomei, and Haiyan Wang. "Chinese herbal medicine in the treatment of chronic kidney disease." Advances in chronic kidney disease 12, no. 3 (2005): 276-281. https://www.sciencedirect.com/science/article/pii/S154855950500073X


14. Zhang, Hong Wei, Zhi Xiu Lin, Chuanshan Xu, Connie Leung, and Lai Sum Chan. "Astragalus (a traditional Chinese medicine) for treating chronic kidney disease." Cochrane Database of Systematic Reviews 10 (2014https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008369.pub2/abstract


15. Hao, Chuan-Ming, and Volker H. Haase. "Sirtuins and their relevance to the kidney." Journal of the American Society of Nephrology 21, no. 10 (2010): 1620-1627. https://jasn.asnjournals.org/content/21/10/1620.short


16. Kitada, Munehiro, Shinji Kume, Ai Takeda-Watanabe, Keizo Kanasaki, and Daisuke Koya. "Sirtuins and renal diseases: relationship with aging and diabetic nephropathy." Clinical science 124, no. 3 (2013): 153-164. http://www.clinsci.org/content/124/3/153.abstract