NURSING 3004 Mental Health Nursing

Question:

A young woman has just presented. You notice that she is dressed in T-shirt and jeans with her hair neatly pulled back. Her jeans look scuffed and unwashed. She sits in the waiting room looking as if she might be softly muttering to herself. At times when you look at her she is looking at the ceiling frowning. When you ask her to fill in the intake form she gets up and quietly takes the form and proceeds to fill it in.

When it comes to his appointment time, the duty doctor asks you to sit in and assist him with the interview.

The young woman gives her name as Amelia.
Amelia is attentive and cooperative. She keeps good eye contact although fidgets with her hair and cloths while talking. She describes to the doctor about becoming increasingly nervous about cameras watching her at home. Asked what she does in response to the cameras, she says she no longer goes home and instead lives in her car. When you encourage her to talk more about the cameras she gives you a lot of detail about â€œspying and also mentions that voices tell her they are watching her because she is a bad person.

She says she is scared and that her friend persuaded her to come and talk to the doctor and get some medication. Following a basic physical check-up and questions about her general health, the doctor He is provided with a script for 5mg olanzapine nocte for symptoms of a psychosis. He expressed concern about her well-being and asks you to talk to her before leaving the clinic to ensure she has adequate support. He made an appointment to see Amelia the next day.

Four short essay questions
1. Describe the key interpersonal skills you would have used in this interview to engage with Amelia.
2. The doctor stated that Amelia has symptoms of a psychosis. Using correct clinical terms, describe three important signs and symptoms from the scenario that you agree would support the doctorâ€™s clinical opinion.
3. The doctor prescribed 5mg olanzapine nocte` for Amelia. Describe the education you will need to provide to her before she leaves the clinic.
4. Explain why you would need to ensure â€œadequate supportâ€ for Amelia before she leaves the clinic.

Answer:

1. Nurse requires effective interpersonal skills for communication with the patients. These interpersonal skills comprises of listening, communication, patience, personal stress management and sense of humor. Nurse should be a good listener while interviewing Amelia. Nurse should listen carefully to Amelia and make interpretations about her. Nurse should not stop her from talking because nurse should allow her to express herself. Nurse possesses required skills to understand condition of Amelia and nurse can explain it to doctor in correct medical terminologies. Nurse can observe important clues about her mental health and psychological status through listening to her. This can be helpful in making correct diagnosis for Amelia. Listening to Amelia by nurse, would give her feeling of dignity and she would tell everything about her. Nurse should have effective verbal and written communication, so that it can be collected form Amelia and can be conveyed to doctor and other healthcare professionals. Good communication can give Amelia feeling of respect and she would be ready to cooperate in interview. Written communication would be helpful in case of medical terminologies and conditions, which are difficult to understand for Amelia. Nurse can explain it to her by writing and drawing pictures. By virtue of this, she would get more interest in interview. Patience is very important skill required by nurse while interviewing Amelia. Nurse should remain calm in all the situations during interview. Nurse should not be impatient for non-cooperation by Amelia and allow her to take time to explain about herself (Stein-Parbury, 2013). Nurse should not demand more information forcibly from Amelia, however she should extract it from Amelia through very positive approach.

Personal stress management is required by nurse while interviewing Amelia because nurse should not be influenced by her medical and psychological condition. Nurse should remain strong and should not become emotional. By virtue of this, there would not be distraction for Amelia at the time of interview process. Nurse should maintain healthy atmosphere during interview session. For this purpose nurse should possesses quality of humor. This quality of humor would relieve Amelia from stress and she would feel more comfortable in interview. This atmosphere also gives Amelia feeling of freedom and she would share everything about her. Humor during interview process also makes Amelia to forget about her painful experience. Due to this she would discuss with nurse about her condition without any burden of illness (Sellman and Snelling, 2014).

2. Amelia is having delusions that her family members are spying her. Delusions are false perceptions and false beliefs of psychosis patients. In most of the cases, these delusions are contradicted from reality. However, patients consider it as true. Delusion symptoms are true for the patients, however in reality these feeling of patients are extremely unlikely. Reasons behind it are that, patients develop this negative feeling about their family members and loved ones. In reality these delusions are highly possible events because delusions are not generally impractical or supernatural. However, these delusions are highly irrational. These delusions don’t have any evidence. There are different types of delusions like paranoia, grandiose delusions and somatic delusions. In this case, Amelia is suffering through paranoia. Patients of paranoia might have feeling or impression that they are being followed continuously by others. In reality, this is not the case (Sikich, 2013).

Another prominent symptom observed in Amelia is hallucination. Hallucination is defined as a sensory perception by a person. These sensory perceptions are present in the absence of external stimuli. Patients with hallucination have feeling of seeing, smelling, feeling and hearing without its existence. People with hallucination might feel that somebody is talking to them when they are alone in the room. In case of Amelia also she is having hallucination that she is hearing sounds like her family members are watching her because she is a bad person. Hallucinated voices can talk about a person or talk to the person. In case of Amelia, these voices are talking to her. Moreover, these hallucinated voices are not always negative. These can be positive also. However, in case of Amelia these voices are negative for Amelia. Another psychosis symptom observed in Amelia is lack of insight. People with psychotic disorders are often having feeling that their delusions and hallucinations are true. In reality, it is not the truth. Due to this, these people develop negative thought process and they are afraid of most of things. In this case, Amelia expressed that she is scared. She is scared because she developed strong feeling of existence of non-existing things. They are frightened to small things and distressed due to confused state of mind. Due to this lack of insight, people with psychosis are not able to make proper decisions (Harvey and Walker, 2013).

3. Nurse should advise Amelia that she should not consume Olanzapine if she has diabetes. Olanzapine interfers with the glycemic control in diabetes patients. She should periodically perform glucose test. Amelia should perform periodic liver function tests because olanzapine induces hepatotoxicity. These liver function tests includes estimation of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). She should consult with doctor about other medicines she is consuming. Other medicines should not induce any type of hepatotoxicity. Nurse should advise her to monitor heart rate and blood pressure on regular basis. She should monitor her temperature under exercise and stressful conditions. She should not consume olanzapine along with other anticholinergic drugs. Nurse should advise her not to involve in high risk activities because regular consumption of this drug induces hypotension and cognitive impairment (Burchum and Rosenthal, 2014).

Olanzapine changes thinking in a person hence she should not perform activities like driving and any other activities where alertness requirement is more. Nurse should advise to keep her away from alcohol consumption and she should take medications under supervision of doctor only. Nurse should advise to keep her away from hot environment and she should always keep her hydrated. Nurse should advise her to monitor back and chest pain, joint pain, edema in extremities. Nurse should advise her to give more attention to psychological indications after consumption of olanzapine. She should inform to doctor if she has dizziness, headache, insomania, nervousness, amnesia and bipolar disorder. She should inform to doctor if she has gastrointestinal symptoms like GI tract pain, raised salivation, increased appetite, dry mouth, nausea and vomiting. Nurse should inform doctor if she has dyspnea and cough. Nurse should advise her to take medicine with food once daily. She should take more care while standing up from sleep because this dug induces dizziness in the patient. She should be more careful is standing form lying position in initial period of her treatment. Amelia should consult to doctor, in case if she is not feeling improvement from this medicine. For better effect from this drug, she should consume it on regular basis. If she wishes to discontinue this drug she should consult doctor. Olanzapine may induce weight gain and raised levels of lipids and cholesterol. Hence, she should monitor these parameters on regular basis (Keltner and Steele, 2014).

4. Support to psychiatric patients is required to prevent readmission to the department. Adequate support is very important for psychiatric patient before discharge to maintain achievements obtained during the hospital treatment. Lack of support prior to discharge can lead to the disturbance in the Amelia’s condition and can lead to the prominent disturbance in establishment of stable recovery of Amelia. Amelia may seek assistance from self-help groups, mental health services and relapse prevention groups. Nurse should make arrangements for these groups for Amelia. Nurse should also make arrangements for continuing counseling to Amelia because she might require it for maintaining her condition stable. Nurse should make all these arrangements after discussion with Amelia and it should be based on the requirements of Amelia. Nurse should identify the community groups which supports Amelia’s needs and which can maintain benefits achieved during hospitalization. During hospitalization, Amelia was under the supervision of different doctors for different indications. Nurse should make sure that there would be establishment of personal and specific linkage among doctors, Amelia and post-discharge care provider. Nurse should make sure that referral of Amelia to outpatient caregiver should be based on functioning of Amelia and her accessibility (Alghzawi, 2012).

Nurse should also consider her house, employment and income while providing outpatient caregiver facility. Nurse should involve Amelia in discharge plan, hence she would accept it easily. It is evident from the literature that, patient’s who were not incorporated in the discharge plan were resistant to aftercare. Nurse should make arrangements for aftercare in such a way that there would be improvement in the existing symptoms and also it would reduce chances of readmission to the psychiatric department. Nurse should incorporate and should give special emphasis for the improvement in the daily activities of Amelia post discharge. Nurse should also give attention to make suitable living arrangements for her. There may be possibility of no contribution from Amelia in discharge planning. In such scenario, nurse should follow evidence based practice and incorporate community based stakeholders in preparation of discharge plan. Nurse should consider social, cultural and environmental factors for Amelia while making arrangements of aftercare. It is evident from the literature that these factors significantly affect recovery of the patients. Nurse should incorporate family involvement, psychosocial rehabilitation, choice of correct medication and psycho education in her post discharge care. As all these factors would give speedy and sustainable recovery of Amelia, she would need adequate support in these areas (Damon et al., 2012).

References:

Alghzawi, H.M. Psychiatric Discharge Process. (2012). ISRN Psychiatry. 2012. https://dx.doi.org/10.5402/2012/638943.

Burchum, J., and Rosenthal, L. (2014). Lehne’s Pharmacology for Nursing Care. Elsevier Health Sciences.

Damon, L., Matthew, J., and Sheehan, J. (2012). Inpatient Psychiatric Nursing: Clinical Strategies & Practical Interventions. Springer Publishing Company.

Harvey, P. D., and Walker, E. (2013). Positive and Negative Symptoms in Psychosis: Description, Research, and Future Directions. Routledge.

Keltner, N.L., and Steele, D. (2014). Psychiatric Nursing. Elsevier Health Sciences.

Sellman, D., and Snelling, P. (2014). Becoming a Nurse: A Textbook for Professional Practice. Routledge.

Sikich, L. (2013). Diagnosis and evaluation of hallucinations and other psychotic symptoms in children and adolescents. Child & Adolescent Psychiatric Clinics of North America, 22(4), 655-73.

Stein-Parbury, J. (2013). Patient and Person: Interpersonal Skills in Nursing. Elsevier Health Sciences.

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NURSING 3004 Mental Health Nursing

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