Karen appears to have a very positive attitude about her future. She seems to have realized that the end of her relationship wasn’t about her but was about the lack of commitment on her partner’s part.
Karen’s strengths lie in the fact that she is positive about her future and that she is making plans for that future. She has an optimistic outlook on her dating future and is committing herself to a gym membership. This indicates that she is moving in a forward direction.
Karen could be afraid of the stigma that can be attached to mental illness. She may also feel that it might be considered a sign of weakness to her family. It’s also possible that she doesn’t have a strong family relationship and so she doesn’t feel comfortable sharing with them.
Considering the fact that Michael is thinking about med school, he should more than likely be open to the nurse’s explanation. If he is to go into the medical field, he needs to be open to biological possibilities.
The nurse should make sure to explain to Michael that even if he takes medication, that would only help to regulate the neurotransmitters. The psychotherapy is to help him process and understand his emotions, so that he can change his behavior and how he reacts to stressors.
Environment question: Is there any history of abuse?
Stress question: How has work/home life been? Any work or relationship troubles?
I think with some practice the client will be able to restructure her thinking. The student should probably also work on changing the client’s cognitive distortions so that hearing negative comments won’t trigger her so badly.
She could start by explaining that years of research has shown that certain treatments for certain symptoms are very beneficial. She could explain how this research was most likely conducted and that real people participated in the trials.
One evidence-based practice is cognitive behavioral therapy. Controlled studies have shown a reduction in symptoms of paranoid schizophrenics who did not respond well to antipsychotics (Lehman, Goldman, Dixon & Churchill, 2004). Antipsychotic medications are another evidence-based treatment. The same report shows a high number of patients respond well to medication treatment.
Gerald has the right to know why he is being held involuntarily. He also has the right to refuse treatment if he is mentally capable of making that decision. He has the right to make informed decisions about his treatment as well as the right to privacy and confidentiality.
Gerald is unable to make the decision to leave the hospital because he has been deemed a danger to others, based on his action of setting a fire. The doctors/nurses have a legal and ethical obligation to keep Gerald for observation until it is determined that he will not cause harm to others or to himself.
The nurse can explain to the client that the doctor can at least help her to feel better. She can try explaining that her high temperature could be the cause of her aches and pains, without outright telling her that there is no curse.
I think the only way would be for her to become better by treatment with the doctor. It might be seen as disrespectful to try to convince her that the curse does not exist. The doctor could also suggest that the client speak with her neighbor and attempt to work things out.
Sometimes when people feel depressed they turn back to their religious roots to find purpose and meaning in life. Added to that the social activities will help Marta to find support and form new friendships. Attending the camp will also benefit her by making even more connections and by helping her to focus on more positive things such as new activities.
Since the camp doesn’t begin for another two months, I don’t think it would interfere with her weekly counseling sessions. It would actually be a good amount of time for her to learn coping strategies, especially if she feels anxious or depressed while she is away from home.
A situational factor is a scenario in which behavior is influenced by external factors. That is, a person says or does something out of character because of the situation in which they are placed.
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Non-verbal cues are important because they tend to be a great indication of how a person is feeling. For example, someone can say they are feeling good but non-verbal cues such as a leg shaking or fidgety hands can indicate anxiety.
It’s important because it provides clues as to the person’s past, familial relationships, medical history etc. It’s also important to get the client’s perspective on what they’re dealing with and their symptoms and how they’re affecting his/her life.
They can use the therapeutic techniques of communication in that they use active listening, empathy, humor, self-disclosure etc in order to let the patient know that the nurse is there for them.
That being said, they simply need to keep a certain distance from the patients at the same time so as not to become too emotionally involved with any particular patient. They also need to be aware of whether or not they are becoming too socially and emotionally involved with a patient.
The team will help her because they will coordinate with each other such that her treatment will be organized and will flow smoothly. There will be constant communication between the individual practitioners and her parents which will help keep the lines of communication open.
The first goal would be to change his way of thinking in the sense that one bad grade does not equate to being a loser. A second goal would be to change his behavior towards his homework. If he does it right away, it will be done and he can enjoy his leisure time. A third goal would be to change strategies for his homework which can tie in to his behavior towards it. If he sees a tutor he can get help with his homework and complete it with the tutor’s help and then his homework is finished and he has help in understanding the class.
CBT can be successful for Frank because he seems to want to change how he’s doing and he appears to feel positively towards it. If he can change his attitude towards Spanish class, then he can change his behavior which can improve his grade which will then become a positive cycle.
It benefits those with a diagnosis because the other members of the group can act as a support system. They are able to give different perspectives and thus different ideas on ways of coping and ways of improving a given situation. They also tend to be diverse and so there are many different ways of looking at things that the client may not have thought of.
She can start by introducing herself and giving a brief background on her experience. She can then ask the rest of the group members to introduce themselves and begin a discussion about the ground rules and what is expected from the members themselves. Discussions about the reason for being there can then begin to take place.
The family is considered an emotional unit and that a person can’t be understood if they’re in isolation from one another. The assumption is that a family and their method of communication can have a profound impact on individuals in that family.
It is most likely the antipsychotic causing the side effects. The client appears to be suffering from either tardive dyskinesia or acute dystonia, which is usually cause specifically by antipsychotics.
The nurse could decrease the dosage of the medication and then perhaps switch to an atypical antipsychotic in the case of tardive dyskinesia. If it’s acute dystonia, then the nurse could administer a dose of Benadryl
These medications cause changes in the way the brain functions so it is entirely possible that some people will experience side effects. Some side effects will be more severe in others depending on how their body and brain reacts. Because of this, it can take a few trials with new medications before finding the one that helps treat the problem without severe side effects.
She could use meditation to help ease her symptoms of anxiety and depression. Yoga is another alternative that people use as this could help with lowering blood pressure and heart rate to allow her to remain calm.
One alternative medication that may interfere with her current medication is that of Kava. Although generally safe, it has not been tested for use in conjunction with tricyclic antidepressants or SSRIs (Kava, 2016).
I would explain to Mr. Abrams that ECT is generally used as a treatment for those with depression who have not responded to traditional treatments. I would explain that it sends small electrical currents through the brain which seems to cause certain changes in brain chemistry which can help reverse symptoms of some mental illnesses including major depression.
As a nurse, my responsibilities would start by educating Julie and her family about the procedure and answering any questions they have. The next part includes the pre-treatment assessment, followed by monitoring the procedure and then caring for the patient after treatment, including patient response.
Acute short-term inpatient care, where the person is psychologically unstable. Partial inpatient care where the person is stable but needs daily assessment. Intensive outpatient care where the person is stable but frequent visits to the person are required. Finally, outpatient care where the person is completely stable and needs minimal contact with practitioners. At this point, I would suggest short-term inpatient care.
The nurse could use therapeutic communication techniques to help Robert understand the need to take his medication regularly. She could also discuss with him the implications of taking his meds in regards to his future and the positive outcomes.
Primary prevention could involve getting together with Jim and his mother in order to discuss coping strategies for Jim. This could also involve offering Jim the social support he might need to reconnect with his peers. Secondary prevention may include counseling for Jim to address what appears to be depression because of his father’s suicide. This would help prevent an illness from getting worse should we find that he does indeed already have some depression. Finally, tertiary prevention could include methods to help Jim restore some his lost functions such as his focus on schoolwork, being withdrawn etc.
She could tell them that the forensic nurse is there to use their medical training to help assess and treat criminal offenders and their victims and to aid in the rehabilitation of those offenders.
The differences include the way the ward can be locked down in cases of violence. There is also most likely a difference in the crisis plans and de-escalation procedures.
It’s quite possible that the anxiety he was experiencing over his schoolwork contributed to his insomnia. The insomnia then caused him to feel sleep-deprived which then led to him being late for school. After learning of the learning disorder, that may have also increased his stress. Once he went to the sleep clinic however, and got onto a proper schedule that could have reduced any anxieties which then led to him being able to sleep well again.
Sleep patterns change as we grow and develop because when we are young we need more sleep in order to help our bodies grow. Very young children need multiple naps throughout the day. Older children seem to need a little less sleep but as we develop into teenagers and our bodies begin to change we need more sleep to rest our muscles and reset. As we get older we need less sleep even though we tend to do more as adults.
An anxiety disorder is a disorder that involves feelings of fear and panic in response to certain stimuli. In this case, I would say Amy has developed general anxiety disorder. She has a fear of something bad happening that is unfounded and is fatigued a lot.
Another diagnosis to consider is depression with general anxiety since she has also lost interest in keeping house and cooking meals.
A somatoform disorder is a disorder in which the person believes there is a physical problem but there is no physical cause, thus the symptoms appear to have psychological causes. The types of this disorder are conversion disorder, somatization disorder, pain disorder, hypochondriasis and body dysmorphic disorder.
Based on his current familial situation it’s quite possible that Roger suffers from depression. Since he appears to have no support system it could be his way of seeking out attention he desires. He most likely doesn’t realize that he is doing this and believes he really is experiencing these symptoms.
For this disorder, group CBT is the most likely course of treatment. We could also use a short term antidepressant for his situation.
ASPD is a disorder in which the person has an impairment to form positive relationships with others and tend to engage in behaviours that go against basic social norms. Symptoms include lying or attempting to con others for personal pleasure, committing violent offences, poor control of impulses, low tolerance for frustration, thrill-seeking behavior, easily bored and restless.
Most people with ASPD don’t believe they need treatment but often times they will comply to avoid jail or other consequences. Usually psychotherapy is the preferred treatment which tends to focus on helping the patient gain control over their anger and impulsivity. This includes recognizing triggers and finding new ways to cope.
Anna most likely has obsessive-compulsive disorder. She is very orderly and considers herself a perfectionist. OCD tends to be comorbid with eating disorders.
Anna has the restricting type of anorexia nervosa. She refuses to intake food and doesn’t purge what she does take in.
The biological theory says that genetic abnormalities can alter a person’s neurobiology, causing these disorders to occur. Neurotransmitters could be dysregulated or there could be abnormalities in the brain. Behavioral theories posit that depression arises as a reaction to stressful events such as the break up of a relationship. There is a decline in positive reinforcers and an increase in aversive events which lead to depression. Cognitive theories posit that depressed people have a negative belief system about themselves, the world and the future, created by distorted thinking. Psychodynamic theory believes that they are punishing themselves unconsciously because they feel abandoned by someone but can’t punish that person. Finally, interpersonal theory states that depressed people simply have poor relationships with others which in turn causes their depression.
Depending on the theory one goes with, there are a number of treatments, but what seems to work best is CBT. Supplemented by an antidepressant, CBT would be most effective for Sarah by changing her thought patterns which would then alter her behaviour and allow her to deal with her symptoms more effectively.
Bipolar disorders are characterized by bouts of mania that tend to involve reckless behavior, racing and/or jumbled thoughts, irritable mood, inflated self-esteem, a decrease in need for sleep and flight of ideas. These manic bouts tend to be followed by bouts of depressive episodes which involve the same symptoms of depression. Norma has bipolar I which can involve the depressive episodes but they are not always as severe as in bipolar II.
The first step in the process would be to assess whether or not Norma is a danger to herself or others. Next would be to assess the need for hospitalization. Her medical status would need to be assessed as well and to be aware of any other medical conditions or things that require special intervention such as drug abuse. Finally, it’s necessary to assess her understanding of the disorder, knowledge of medications and of support groups and organizations that can help Norma and her family.
Schizophrenia is characterized by acute symptoms of hallucinations, delusions, disorganized thought, speech, and behavior, as well as negative symptoms such as loss of affect, avolition and alogia.
Disorganized schizophrenia involves incoherence in speech, cognition, and behavior as well as flat or inappropriate affect.
Paranoid type involves delusions and hallucinations that can include themes of persecution and grandiosity
Catatonic type involves almost total unresponsiveness to the environment as well as motor and verbal abnormalities
Undifferentiated type involves schizophrenic symptoms but the person doesn’t meet the criteria for paranoid, disorganized or catatonic type
Finally, residual type involves a history of at least one episode of positive symptoms but no current positive symptoms.
The staff can educate John about alcohol use and that it is also a drug. It’s important to inform him that if he wants to get off drugs completely, then that also includes alcohol. They could then teach him other strategies to deal with his anxiety such as mindfulness or distraction techniques
I think John could also be diagnosed with an anxiety disorder and maybe even a mild depression.
The impairments include memory deficits, language impairments, inability to plan and organize and inability to identify or recognize common objects.
His Alzheimer’s could have been caused by vascular disease ie. stroke, head injury, or other conditions such as Parkinson’s, Huntington’s, etc.
The nurse could have used active listening and empathy. She could also have used paraphrasing and summarizing so that Frances knew that she was listening and understood. I also think in this case self-disclosure could have helped form a connection with Frances followed by confrontation.
First of all, she could be scared. Her other disorders could also be the cause of her anger. Lack of proper medication is a possibility as well and she may not be used to having rules to follow.
The effects of maltreatment can include cognitive defects in that they learn bad behaviors from caregivers and won’t function properly in society. Nita is afraid to form close relationships for fear of being hurt. It could result in abandonment issues and separation anxiety as adults and generally greatly interfere with everyday functioning and relationship development in social situations.
This model looks at four levels of violent development: Individual, relationship, social and community factors. In Nita’s case, at an individual level she experienced maltreatment herself by her step-mother. Socially though, she improved dramatically when she went to live with her aunt who was very nurturing, although she still has some issues when it comes to forming close relationships.
Some warning signs include giving away possessions, no longer talking about the future, withdrawing from family and friends, talking about suicide, purchasing weapons, talking about being a burden, talking about their pain and talking about feeling hopeless.
Factors included being in a new place without support of friends, losing her job, threats of bankruptcy, being off her antidepressants and overall feeling like she had no hope
Maturational crises are events that naturally occur during a person’s development. Situational crises are unexpected events such as job loss, or death of a loved one. Adventitious crises are major disaster such as earthquake, flood or war that can cause an upheaval of a person’s life. Frances is experiencing a situational crisis.
First would be an assessment to identify the type of crisis and to identify current coping skills. Analysis and planning follows in which we explore options to solve the problem. This is followed by implementation in which we attempt to change the situation and to provide support as well as help the patient develop possible solutions
There are biological factors in which parts of the brain are not completed formed or are not formed properly. There are social factors in which frequent changes in the family dynamic are present, such as frequent moves or divorce. And there are cognitive factors such as seeing certain behaviors from parents or other social interactions.
Once again, in Jeremy’s case, CBT would be most effective. Since his issues seem to stem from sexual abuse and from possible hereditary factors, this would be the most helpful for him to learn ways to cope. Short-term medication may also be of benefit.
She should use active listening to hear what the client is saying and to reiterate that she understands using empathy. She should definitely provide information to Molly about diagnostics. She should also paraphrase and ask questions.
Some people might just think it’s a natural part of getting older. Others feel that depression is a result of physical ailments or combinations of medications. Still, other people may believe that it’s a ploy to gain attention.
One major factor is his schizophrenia. On top of that, because of his inability to hold a job, he cannot afford to get the medication he needs to improve his functioning. This becomes a cycle. The other major factor is his drug abuse. Without being treated for that it would be impossible to successfully treat his disorder.
If he can’t remember where to go it would be very hard for him to get treatment at all. Another barrier is his inability to pay for his medication. He should maybe be referred to a shelter to help with his housing issue or admitted to the hospital so that he can get the treatment he needs and the medication.
A major one would be head trauma of any kind. This can lead to personality disorders and changes in brain function. Endocrine disease can also present with psychotic symptoms. Infections are another.
Nursing implications would include assessing how severe her depression and anxiety are and to also assess her cardiac condition.
