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
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