B760 Mental Health Nursing

Amanda is having is having a history of bipolar disorder and tends to have a manic episode at the beginning of the year which gradually decreased at the end of the year. This had become a regular pattern for Amanda since the death of her 5-year-old daughter named Molly, about 20 years ago due to renal tubular acidosis. Amanda lives with her son Jamie since last 6 weeks because she is frightened to stay alone at home.  Amanda is worried about her cats which had to be rehomed as Amanda will not be present to look after him. She is having a high tendency of self-harm and had also tried to commit suicide 3 month ago by consuming excess sleeping pills. Recently she had also tried to take 50 tablets of Co-codamol at a go, but eventually was forced to vomit it out on taking her to the hospital. Her past medical history shows neurological disorders causing gait disturbances. She also suffered from frequent stomach disturbances like diarrhea. She had a past history of substance abuse, such as cannabis and amphetamines, although according to her, she had not taken them over a year. She was a chain smoker during the early years and hopefully continues to take them. On assessing the vital signs, Amanda’s respiratory rate, heart rate, rhythm and rhythmic output volume has been found to be normal. No cases of tremors or icterus had been identified.

She had been admitted to hospitals for as number of times, where she never cooperated with the caregivers and also showed agitation on forcing her. She does not want to undergo any therapies that might be useful of treating her disorder. Amanda has been found to suffer from nocturnal wakening, sleep-onset insomnia and had also lost weight considerably for the past few months and has reported poor appetite and thereby mostly lives on sandwiches. She suffers from extremities of moods, as she describes feelings of intense anger, whereas she feels depressed sometime. Amanda reported that most of the time she is either low or frightened as she always finds her mind to be overburdened with anxiety and depression. She is too de-motivated to do any constructive tasks.

She had been prescribed quetriapine for her disorder. Amanda is currently on two mood stabilizers, Sodium valproate and Lithium.  Amanda has a positive family history of mood disorders, which can be linked to her current symptoms.

Amanda is now under electroconvulsive therapy and is on the medication of Quetiapine and Temazepam (which was later replaced with Trifluoperazine).

The rationale for choosing this topic is that it a case study analysis of bipolar disorder would increase the knowledge regarding the various signs and the symptoms of bipolar disorder. This topic would help to assist the students to develop critical thinking skills regarding the signs and the symptoms of bipolar disorder and the different approaches to treat them. This topic would also give an in-depth knowledge about the different pharmaceutical and the non pharmaceutical interventions to be taken in case of mood disorders (Harrison et al. 2017). This would facilitate critical analysis of the symptoms of individual patients that would facilitate active learning. This would further enhance the clinical trouble shooting and practicing evidence based nursing. The effective nursing plan of action made for the patient would help to understand the nursing rationale for each of the treatment and can be used for countering similar cases in the future. The case study reveals that Amanda, the patient had been suffering from suicidal tendency due to the peaks and the troughs of the , and therefore it is challenging for a nurse to deal with such patients as they are too vulnerable to harm others and herself and therefore should be kept under constant surveillance. This practice would further help the nurses to develop interprofessional skills in caring for people with mood disorders.

2.Signs and symptoms of mood disorders related to the case study

The bipolar disorder is a type an affective disorders also known as the mood disorders. The symptoms of this type of disorders vary from person to person and can range from mild to severe. Bipolar disorder is a type that is having a series of depression and mania (Chambers 2017). Mania generally happens when a person feel tremendously active.  Person suffering from mania makes them feel short-tempered, aggressive, reckless and delusional, as seen in case of Amanda (Depp et al. 2015) .There are many types of bipolar disorders. They’re being differentiated according to the severity depression and mania. The case study reveals that Amanda still could not completely recover from the shocks of her daughter’s death and continuously broods over it.  It can also be discriminated by how quick the change in the mood occurs. The symptoms of affective disorders are sadness for long time, anxiety, lack of energy, feelings of guilt and suicidal thoughts (Chambers 2017). This can be easily linked with the suicidal episodes such as self hurting by consuming sleeping pills or self cutting by a knife. As told earlier that people with bipolar disorder often have nocturnal awakenings, which can again be related to Amanda’s sleeping disorders. Substance abuse can exacerbate the symptoms of mood disorders (Fortinash and Worret 2014). Amanda had a past history of drugs and alcohol which can be linked to her current health status.

3.Assessment, Evaluation and nursing interventions

According to McCormick (2015), Bipolar Disorder has considerable lifetime predominance in the populace at 4%. The peaks and the troughs of BD can relapse from time to time; the condition is related with critical weight to the patient, parental figures, and the community. According to Tsu (2016), Bipolar disorder is an interminable disease that causes intermittent moves in state of mind through scenes of dysthymia, discouragement, hypomania, and agitation (Chambers 2017). There are two noteworthy kinds of bipolar issue: bipolar I issue, which is described by the nearness of no less than one intense hyper scene, and bipolar II issue, which is exemplified by hypomania and longer depressive scenes and is now and again misdiagnosed as real depressive issue. Pharmaco-therapeutic alternatives incorporate lithium, anticonvulsants, antipsychotics, and antidepressants (Baker et al. 2014). Drug specialists assume a part in guaranteeing legitimate dosing regimens, checking for sedate connections, and observing for potential medication lethality. When directing the patients, drug specialists should survey time of the administration and potential reactions for verifying that the patient has an extensive comprehension of the ways to oversee side effects. Bipolar disorders are challenging to identify and are mainly characterised by high levels of aggression, agitation and dysregulation. Patients with bipolar disease are often associated with cyclothymia, having numerous phases of depressive and hypo-maniac symptoms (Hirschfeld 2014). This can be easily linked with the symptoms shown by Amanda. Further assessment diagnosis of mood disorders involve elevated and expansive mood,  increased irritability and inflated grandiosity and self esteem, racing anxiety in mind, decreased need of sleep.  It is necessary to analyse the type of disorder the patient is suffering from. Nursing interventions include pharmacological, non pharmacological and psychopharmacological interventions.  Therapies can be administered such as psycho-education, family interventions, cognitive behavioural therapy, Interpersonal and Social Rhythm therapy (IPSRT) and schema focused therapy. Other alternative treatments can be applied such as light therapy, electro-convulsive therapy and repeated Transcranial Magnetic stimulation (Harrison et al. 2017).  

According to Lee (2016), family intercessions have been accentuated in the treatment of bipolar issue (BPD) due to the bidirectional and caught connections amongst patients and the family framework, and have benefits for patients’ indications and wellbeing; in any case, the impacts of family mediations on family capacity and guardians’ wellbeing related results have not been very much examined. This randomized, controlled trial with 47 hospitalized patients with BPD/family parental figure dyads at a medicinal focus in northern Taiwan thought about the impacts of a concise family-focused care (BFCC) program with treatment of course (TAU). The greater part of the family parental figures in two gatherings were welcome to go to a normal 60-min family talk amass about savagery and suicide counteractive action (Reinares et al 2016). The TAU aggregate without particular family meet for patient and family parental figure dyad. In the BFCC gathering, four 90-min BFCC program sessions were furthermore given twice seven days to each hospitalized family dyad. We speculated that, to begin with, family parental figures in the BFCC gathering could build their family capacity, and second, enhance apparent wellbeing status and lessen guardian’s weights contrasted with the TAU. The outcomes demonstrated that family parental figures in the BFCC aggregate huge connection impacts in general family work (P = 0.03) and subscale struggle (P = 0.04), correspondence (P = 0.01), and critical thinking (P = 0.04), yet there were no huge cooperation consequences for the guardians’ apparent wellbeing status and guardians’ weights. Our discoveries bolster both the attainability of utilizing the BFCC program for inpatients and its particular advantages for family work. A concentrated family intercession amid hospitalization has been proposed in mental practice to help patients with BPD and family guardians (Lee, Chen and Chiang 2013).

4.Role of the mental health nurse

Mental health nurses provides medical care and nursing care to people in hospital, at home or in a residential care setting of patients suffering from mental health problems (Norman and Ryrie  2013) . Mental health nurses work as member of a multidisciplinary team consisting of professional and medical staff including social workers, doctors, therapists and psychiatrists (Lee et al. 2013).

A mental attendant begins her work with a patient by meeting her and surveying the new patient to take in her manifestations, history, diseases and everyday living propensities (Brunero et al. 2015). A mental medical caretaker will more often deal with patients having anxiety issues, for example, freeze assaults, fears, mood issue, including bipolar turmoil and despondency (Chambers 2017). They also deal with Substance mishandle, for example, medications and liquor. A mental health nurse has wide spread application in dealing with geriatric Alzheimer’s cases and different types of dementia (Board et al. 2014).

A mental medical caretaker works intimately with her treatment group to build up an individualized arrangement to give the patient the aggregate care and consideration they have to carry on with a profitable life (Happell et al. 2014). The medical attendant will give singular directing to the patient and also the family so they have a superior comprehension of the ailment. The attendant may likewise help the patient to dress, prep and to take their medicines legitimately. Mental medical attendants work in numerous situations, such as Regular healing facilities, Psychiatric healing facilities, Home medicinal services associations, Prisons and correctional facilities, Outpatient psychological wellness associations (Depp et al. 2015). Mental health nurses are faced with many ethical dilemmas while dealing with patients having mood disorders. During the trough period of the mood disorders, patient often becomes violent which compels the nurses to apply restraints by contradicting the codes of ethics of nurses that believed in giving autonomy to patients (Fortinash and Worret 2014).

Thus it can be concluded that Amanda was diagnosed with Bipolar Disorder, from the day when her daughter had died. In Amanda’s case the condition had been caused mainly from the environmental factors, such her family history and the sudden death of her daughter Molly. (McIntosh et al. 2016). The most effective approach for treating Amanda is probably going to contain both mental and pharmacological methodologies. Specifically, Amanda is probably going to benefit by family-engaged treatment that may address her depression and her denial of her diagnosis. Cognitive-behavioural treatment is additionally prone to give Amanda adapting instruments for when her insights are impacted by the maniac periods (Whitton, Treadway and Pizzagalli 2015). The overall rationale of treatment needs to be focussing on providing a holistic care of approach to Amanda.

Introduction:

The profession of nursing can be defined as a profession which is interactive and is used to deliver the appropriate patient care. The individual care for a patient is done to make sure that the patient is treated as a person with some certain conditions. The holistic type of nursing can be defined as the process of treating the patients according to the symptoms of the disease but the treatment is done as a whole including physical, mental, spiritual, emotional, social, contextual, cultural and environmental needs (Board et al. 2014). This assignment is done to focus on a case study of a patient to explore the interventions of nursing along with the assessment of the care of the patient.

References:

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Board, I.A., Kumar, S.T.D. and Council, I.N., 2014. Psychiatric Nursing. Indian Journal of Psychiatric Nursing, 7, p.1.

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Chambers, M. ed., 2017. Psychiatric and mental health nursing: the craft of caring. CRC Press.

Depp, C.A., Ceglowski, J., Wang, V.C., Yaghouti, F., Mausbach, B.T., Thompson, W.K. and Granholm, E.L., 2015. Augmenting psychoeducation with a mobile intervention for bipolar disorder: a randomized controlled trial. Journal of affective disorders, 174, pp.23-30.

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Hirschfeld, R.M., 2014. Differential diagnosis of bipolar disorder and major depressive disorder. Journal of affective disorders, 169, pp.S12-S16.

Hsu, C.C., Hsu, Y.C., Chang, K.H., Lee, C.Y., Chong, L.W., Wang, Y.C., Hsu, C.Y. and Kao, C.H., 2016. Increased risk of fracture in patients with bipolar disorder: a nationwide cohort study. Social psychiatry and psychiatric epidemiology, 51(9), pp.1331-1338.

Lee, H.J., Lin, E.C.L., Chen, M.B., Su, T.P. and Chiang, L.C., 2016. Randomized, controlled trial of a brief family?centred care programme for hospitalized patients with bipolar disorder and their family caregivers. International journal of mental health nursing.

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Reinares, M., Bonnín, C.M., Hidalgo-Mazzei, D., Sánchez-Moreno, J., Colom, F. and Vieta, E., 2016. The role of family interventions in bipolar disorder: A systematic review. Clinical psychology review, 43, pp.47-57..

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Whitton, A.E., Treadway, M.T. and Pizzagalli, D.A., 2015. Reward processing dysfunction in major depression, bipolar disorder and schizophrenia. Current opinion in psychiatry, 28(1), p.7.