Mental Health Nursing

Learning Block 1 Response

Que. 1 Determine the types of observations and questions required for you to perform a Mental

Status Examination and Risk Assessment of Catherine.

As a mental health nurse, there are numerous types of observations and questions that I would require in order to perform a mental status examination and risk assessment of Catherine. For example, I would conduct physical observation of Catherine and record her attitude towards me, facial expression, speech, mood, thought process, thought content affect, and insights. Additionally, I will also observe the level of alertness of Catherine, posture, grooming or any other prominent physical abnormalities, her level of awareness of whether or not she knows why she has been brought to the mental facility. On the other hand, I would ask her husband Greg a number of questions in order to not only establish the severity of the mental disorder, but also the possible causes. For example, I would ask him if Catherine has a history of mental illness or not. Additionally, I will ask him when he started noticing her wife exhibiting abnormal behaviors. Additionally, I would ask him to describe some of the abnormal behaviors that Catherine had been having within the last three weeks. Moreover, I would ask him whether there are some stressful moments that Catherine had experienced in the past, such as death of a loved one.

Que. 2

1. Initial treatment plan for Catherine

The treatment plan for Catherine would be in two folds. Precisely, I would prescribe the use of medicinal treatments as well as counselling (Hunt, 2011, p. 63). The combination of these treatment options would not only help in suppressing the depressive symptoms that Catherine is currently experiencing, as well as empowering her on how to overcome the stressful situations. For example, some of the medicinal treatment options that I can prescribe to Catherine are not limited to the use of lithium, anticonvulsant drugs (such as lamotrigine, carbamazepine, valproate and valproate), and antipsychotics among others. Apparently, counselling is the most effective treatment for mania, especially due to the fact that it will help Catherine to control her behaviors, thinking and emotions especially by altering her thinking patterns.

1. Considerations that I would make in formulating this plan.

In the process of formulating this plan, I would take into considerations a number of aspects. For example, I would consider the side effects of some of the medicines that I would prescribe to Catherine, whether she is expectant or not, age, allergy, as well as her level of being controlled by mood stabilizers.

Que. 3. Possible etiological considerations related to Catherine`s early development with her parents

There are a number of etiological considerations relating to Catherine`s early development with her parents. First, the loss of her father which occurred six months ago could have been the major contributing factor to her condition. In the treatment plan, I would focus on empowering her on how to accept this fact and manage to carry on with her normal life (Healy, 2008, p. 139). She might have been so close and emotionally attached to her father when she was growing up, and his death could mean a big blow to her that she cannot manage to overcome this reality.

Learning Block 2 Responses

Que. 1 A Nursing Care Plan for Catherine

In order to enhance the improvement of Catherine from her depressive disorder, I would embrace and implement an effective treatment plan. For example, I would increase the dosage for Lithium carbonate to 300mgs BD especially due to the fact that the reason as to why she has not shown any signs of improvement is due to the low dosage that is currently being administered (Alevizos et al., 2012). It is worth noting that for an adult suffering from depression, the correct dosage is 900 mgs per day of Lithium Carbonate (Dols, Chan and Shulman, 2017, pp. 57-79). Additionally, I would incorporate counselling as a therapy to this medication. The counselling therapy should extend to her family members as well.

Que. 2 the rationales/considerations taken for the interventions outlined

Counselling would be incorporated in this plan of care since it would help Catherine to change her thinking patterns especially by shunning away from thoughts of losing her father. Additionally, her family members, especially her two children should also be empowered to understand that the reason why her mother has been hospitalized is for the betterment of her health, rather than a punishment. They should be advised to take the situation in a positive way rather than a stressful situation.

Learning Block 3 Responses

Que. 1 Nursing considerations for caring for an individual on lithium carbonate

• Assessing patient`s mental periodically and if possible, initiate suicide preventions (McCormick, Murray and McNew, 2015, pp. 533-534).
• Monitoring intake and output after injecting Lithium Carbonate.
• Ensure that the patient is taking at least 2000-3000 mL daily.
• Taken the weight of the patient after every three months
• Test patient`s glucose levels after regularly.

Que. 2 the rationales for prescribing a benzodiazepine as an adjunct to lithium therapy.

The rationale of prescribing a benzodiazepine as an adjunct to lithium therapy is to supplement the effectiveness of the latter especially when it comes to stabilizing moods and irritability among patients suffering from mental health illnesses (Disord, 2015).

Que. 3 Other medications are now added to the treatment alternatives for episodes of mania or bipolar Affective Disorder?

Besides the currently medications, anticonvulsants such as lamotrigine, carbamazepine and valproic acid can as well be used (Walkup et al., 2015, pp. 1008-1019). In addition, antipsychotic medications such as haloperidol, loxapine and risperidone can also be used. These medications serve the same purpose as Lithium Carbonate only that they are not as effective as the latter (Chen et al., 2017, p. 46).

Learning Block 4 Responses

Que. 1

1. Key issues in day 7 & 9

The major aspects that are occurring to Catherine during day 7 and 9 is that Catherine is undergoing self-denial while Greg has started to feel stressed due to the financial situation of his family. Catherine seems to be improving tremendously especially due to the recent medications that she had been taking.

1. House to manage the issues identified

The ultimate way of managing the aforementioned issues is holding counselling sessions for the couple. Catherine needs to be empowered on how she can accept herself as well as to change her thinking patterns to the better. Greg as well needs to be advised concerning the importance of focusing on his wife`s health more than the financial situation.

Que. 2. Advice/support might be provided to Greg and other members of the family to

Assist them when Catherine is reintegrated home following an inpatient admission.

Greg and other family members ought to keep Catherine engaged with positive thoughts and activities such as listening to music or taking some exercises. It is worth noting that listening to music as well as embracing physical exercises are some of the best ways of coping with stress (Mailanchi and Kumar, 2015, p. 61). Greg and the other family members should avoid situations of blaming Catherine especially on the financial issues that has currently affected the family. Additionally, Greg and the other family members should avoid mentioning or revisiting issues relating to the death of her father.

References

Alevizos B., Alevizos E., Leonardou A., and Zervas I., (2012). Low dosage lithium augmentation in venlafaxine resistant depression: an open-label study. Psychiatriki. 2012 Apr-Jun;23(2):143-8.

Chen, P., Dols, A., Rej, S. and Sajatovic, M., 2017. Update on the epidemiology, diagnosis, and treatment of mania in older-age bipolar disorder. Current psychiatry reports, 19(8), p.46.

Disord J., (2015). Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar I or II disorder: Results from the Bipolar CHOICE trial. Published online 2014 Mar 13. doi: 10.1016/j.jad.2014.02.046

Dols, A., Chan, M.Y. and Shulman, K., 2017. Clinical Management of Older Age Bipolar Disorder. In Bipolar Disorder in Older Age Patients (pp. 57-81). Springer, Cham.

Healy, D. (2008). Mania: a short history of bipolar disorder. Baltimore, Johns Hopkins University Press.

Hunt, N. (2011). Bipolar Disorder E-book: Your Questions Answered. Internet Resource.

Mailanchi, A.A. and Kumar, S.V., 2015. Stress Management through Music Therapy: Efficacy of Sufi Music. Journal of Social Welfare and Management, 7(2), p.61.

McCormick, U., Murray, B. and McNew, B., 2015. Diagnosis and treatment of patients with bipolar disorder: a review for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 27(9), pp.530-542.

Walkup, J.T., Wagner, K.D., Miller, L., Yenokyan, G., Luby, J.L., Joshi, P.T., Axelson, D.A., Robb, A., Salpekar, J.A., Wolf, D. and Sanyal, A., 2015. Treatment of early-age mania: outcomes for partial and nonresponders to initial treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54(12), pp.1008-1019.