Question:
You are a registered nursing assistant working in an acute-inpatient mental health facility.
You will be required to choose a person from the Assessment folder in the NSG3MHI MHI LMS patient handover file.
Please take the time to read all information about your patient.
Following are issues related to their care.1.
Please give us a summary of your diagnosis.2.
Identify the signs, symptoms, and causes of mental illness in patients.3.
Highlight the patient’s legal situation and explain how it affects your patient and the care that you provide.
Any relevant issues should be highlighted.4.
Discuss the medication with your patient.
Discuss dosage and side effects.5.
You should report on the physical condition of your patients.
Highlight any potential future issues.6.
Discuss risk assessments with patients.
Identify any potential issues.7.
Consider the potential stigmatization and discrimination that could affect your patient’s healing process8.
You should report on the condition of your patients’ social security.
Discuss any issues.9.
Discuss the support that you could offer to your patient’s loved ones, or their carer.
Answer to Question: NSG3MHI Mental Health And Illness
Signs and Symptoms for a patient with a diagnosed illness
Dennis Thompson, a researcher, described Schizophrenia to be “a chronic but manageable disease.” Thompson wrote in the Web Med Journal about how Schizophrenia manifests itself in ‘delusions o’ grandeur, where patients have false beliefs about their personal importance.
He might think he’s a famous politician and no amount or reasoning could convince him otherwise.
Citing the US National Institute of Mental Heath (US), the writer stated that others suffer delusions of persecution.
Carolyne Smith displayed some signs of psychotic disorder (Killackey, 2014).
She was restless, paranoid, and aggressive toward others.
The worst was her inability to cooperate with doctors and follow their orders.
Killackey (2014) noted that she was highly irritable, disorganised in her thought and actions.
Her bed was not made and her personal possessions were scattered.
The patient appeared deluded.
In a Mayo Clinic journal article, “Patient Care and Health Information”, schizophrenia symptoms are described as being common in adolescents.
It stated that the majority of schizophrenia-afflicted teens tend to withdraw form their friends and family.
It is common for students to experience a dramatic drop in their class performance.
Many are affected by depression, irritability, or insomnia (Andreasen (2010).
Such children can display suicidal thoughts or behavior in advanced situations.
Carolyne showed most of the symptoms, even though she was not a young child.
The Health Line Newsletter issues containing more information are available.
Timothy J. Legg, PhD edited the paper and described various symptoms of schizophrenia, including disorientation, confusion and the general dysfunctionality of an individual, lack desire to socialise and less self-care. He also discussed dressing and grooming issues and difficulties in thinking and remembering.
Amazingly, Carolyne displayed almost all these symptoms of psychosis.
Other symptoms are often associated with schizophrenia.
According to the Mayo Clinic journal, there are a few symptoms that can occur in patients who use drugs and alcohol.
These include paranoias, hallucinations (Hallucinations), muscle problems, chills or sweating, and reduced inhibitions.
The journal ‘Behave Net’, which was first published in 1995 and then updated in 2017, lists other symptoms that can be identified in patients with schizophrenia.
These symptoms may include incoherence, derailment, or disruption of speech due to disturbed thought patterns, social dysfunction and mood disorders.
Carolyne and I discussed the possibility that Carolyne may have at least ninety percent (Mental Fitness Tips, Canadian Mental Health Association, 2017,).
The journal suggested that doctors ensure that all of the symptoms were present for at least six month.
This helps to rule other disorders.
Carolyne showed signs such as hallucinations, delusions and hallucinations that are positives (Kelly et al. 2008). It was encouraging.
The Journal notes that while positive symptoms may not be real, they activate certain brain functions positively. This is an encouraging response to treatment.
The Patient’s Legal Status & Implications for Provision Of Health Care
According to Victoria Legal Aid, Lawyers and Legal Services, the rights and dignity of patients are essential and medical personnel must respect them when caring for them.
The self-help guide for the Mental Health Act was published in 1989, and it was updated in 2010. It outlines the following basic rights of patients:
No patient should be treated differently.
All individuals are equal before the law.
Everyone should have the right and obligation to live.
It is unacceptable for anyone to be treated inhumanely or with cruel degradation.
A patient can move freely.
Respect for privacy and protection of your reputation.
Freedom of religion.
Enjoyment of security and liberty.
The right to a fair hearing
Except in exceptional cases, no patient should remain detained for more that three months (Nelson and 2009).
These circumstances could include the continuation of symptoms, or the threat to social order and peace.
It should be evident that the hospital can handle the patient’s demands.
These restrictions will have an impact on the delivery and quality care that patients receive.
The legal restrictions may be enforced by health professionals who feel that a patient will need more time to receive treatment in a specific facility.
Prescriptions, side effects, dosing, and use
The 2010 journal, Oregon Am Farm Physician, provided useful information.
John Muen, Assistant Professor of Family Medicine, wrote about side effects of antipsychotic medication. (Mental Fitness Tips – Canadian Mental Health Association, 2017).
Side-effects include sedation. Hypotension, cognitive problems. Blurs. Dykinesia. Urinary retention. Dry mouth. Constipation. Seizures.
The following medication was prescribed and given to the patient: Olanzapine.
The dose was increased by 10 mg.
An anxiety attack was treated with Diazepam PrN.
Olanzapine for adults: 10mg was taken twice daily.
This was despite side-effects like increased appetite, weight gain and headaches, dizziness or restlessness, memory issues, and increased appetite.
It was prescribed to relieve anxiety.
For adults, the oral dose was 10 mg twice daily.
Expected side effects included confusion, muscle spasm, muscle twitching, muscle tremors and loss of bladder control.
The Patient’s Physical Well-Being; Potential, Current and Future Concerns
According to Oxford Academic, 2014, people suffering from schizophrenia are more likely to die prematurely or develop heart diseases.
It recommended that patients join support groups that could improve their personal well-being.
They were unhealthy.
The study suggested that increasing physical activity was associated with lower mortality and a better quality of life.
Patients were offered advice by doctors to help them do this.
Carolyne was not a fit person.
A physical exam revealed that excessive weight gain was due to poor diet and insufficient exercise (Castle & Buckley 2011, 2011).. The patient discussed the fact that schizophrenia, which is the cause of the problem, also contributed.
It was necessary to create an action plan to help this patient.
Additional reasons were chronic fatigue, fear of social activities and common illnesses such as lung disease.
The Centre for Addiction and Mental Health Journal provides timely guidance for schizophrenics.
The journal noted that technological and medical advances have allowed for better treatment options and more knowledge.
The Journal pointed out that some schizophrenia patients respond well and can resume normal work or study.
The Journal suggests that they try vocational rehabilitation to improve their skills, and build confidence (Dickerson Sommerville Origoni Ringel, Parente & Parente (2012)).
This would allow them to find alternative occupations that best suit their needs.
Health Central stated that patients are often faced with daily challenges due to schizophrenia treatment.
It listed issues such as abnormal eating patterns and sleep patterns which, in turn, can lead obesity and physical fitness problems.
The document also mentioned other issues that may be faced by individual patients.
Others have to deal slowed movement or unusual postures.
According to the publication, victims are often faced with mental health issues such as anxiety, depression, moodiness, moodiness, and ambivalence.
Other conditions such as schizophrenia can affect victims in other ways. These include their natural senses, thought patterns, and overall behaviour.
The best thing for schizophrenia patients is to take good care of themselves.
Carolyne Smith’s case was successfully handled using the information from this source (“DSM-5”, 2017, p.
The patient shared some childhood experiences that could have led to her current schizophrenia.
Carolyne shared some childhood memories that suggested that she had suffered from impairments of motor function and intermittent verbal deficits.
Assessment of Patient’s Vital Issues and Risk Assessment
The Cochrane Review refers to risk assessment as the process of identifying those most at risk of violence or aggression. (Chung, 2008).
A study that examined some patients admitted to hospitals for aggressive behavior revealed that the majority of them were schizophrenics.
This was based on the Mulidharan report from 2006.
This led to the need to sometimes take extraordinary measures to control violent patients (Lawrie, 2014).
Although some of these measures may not be legal, others are still necessary. Such measures include: placing a patient in a seclusion room, Mechanical ( physical) restrictions, the Physical holding of a patient and involuntary medication(Dickerson, Sommerville, Origoni, Ringel, & Parente, 2010).
Another study, conducted by Philip J. Candilis MD in 2001, came up with similar results.
A scholar found that between 10 and 33% of nurses had been assaulted or threatened by violent patients.
A staggering 90 percent of the violent patients were suicidal.
A person’s childhood and the time of illness onset were both important factors.
The Impact of Stigmatization and Discrimination on Patients’ Recovery
The British Journal of Psychiatry (2007) published a study of stigmatizing psychotic patients.
The research was done by Tanzanian researchers.
It defined stigma to be “problems or ignorance, behaviour, or attitudes (Weinberger, Harrison 2010, 2010).”
Perceived stigmatization (stigma originating directly from the patient or other people)
Individual stigma (attitudes to stigmatised people)
Self-stigma is an opinion that the patient has expressed.
Attitudes toward helping (which can affect the patient’s ability to seek help)
Carolyne experienced stigma in her family, at work, and in her local community (“DSM-5”, 2017).
It is especially distressing to witness the lack of empathy and understanding between family members.
She felt discriminated when workers were considered for a salary increase.
“The Schizophrenia Bulletin” (2010) published an article about this.
Faith B. Dickerson published an article entitled, “Experiences in Stigma among Schizophrenia Outpatients”. She listed the following situations: Denial of treatment because of lack of insurance coverage; Exclusion from volunteer or social activities; Unsupportive coworkers and supervisors; and Turn-down for health insurance.
Social Welfare for Patients and Other Significant Issues
According to the Journal (2016), “the Conversation-Africa Pilot”, Schizophrenia can have a significant impact on the lives of people.
A journal revealed that schizophrenia patients are very concerned about finding work.
Kevin Andrews (Minister for Social Welfare) stated that ‘work is best’ and that he believed that such patients could be assisted to find work.
According to the paper, it is vital that patients are able achieve economic independence and social functionality.
Similar results were reported in “The Psychiatric services” Journal Volume 51, No. 2, 2000.
It described government support as a “good safety net” and pointed out that half of the patients studied were socially isolated with a third having lost their jobs (Mueser and Jeste, 2011,).
The paper concluded that many patients with psychiatric disorders could be successfully integrated into their community if the proper support was provided.
Carolyne was self sufficient, but she would need assistance in navigating the employment landscape.Support To Patient And Family- 515
Samantha Gluck, researcher (2016) provided suggestions on how families affected by illness could be helped.
The practical suggestions would help Carolyne and her loved ones to deal with her illness.
Ms. Gluck mentioned that caregivers need to give patients some freedom in their daily lives.
This would mean that caregivers should cease performing all patient tasks.
She suggested that the patient will feel more confident and dignity if given some freedom (Crane & McDonough (2014)).
According to the researcher (Tsuang Faraone and Glatt (2011)), caregivers should not attempt rationalization for paranoias, hallucinations, delusions or other mental disorders.
Instead, caregivers should look for other ways to help patients.
They should also learn to forgive others when they make mistakes. (Nodgvist 2017, 2017).
They should also learn how to forgive others who make the same mistakes as them (Nodgvist 2017).
This was crucial because it would enable them to care for the patient lovingly, even when the disease symptoms are distressing (Ando Clement Barley & Thornicroft 2011).
They would be unable to bear the disease, but they would love their patient.
Ms. Gluck suggested that caregivers should not feel ashamed of having a patient with schizophrenia at home.
Instead, caregivers need to accept the illness and see it as a normal part of life.
Another publication, Self-Help Tools and Tips of Patients, offers practical suggestions (Mahoney 2011).
It recommends that patients participate actively in the treatment regimen as described by doctors (Nodgvist 2017.
The patient should be able to find out more about her condition, treatment, warning signs, and other pertinent information that can help her recover quickly.
She should have a mutually trusting relationship with her doctor and therapist (Ando Clement Barley & Thornicroft 2011).
The patient should be instructed to comply with the prescribed dosage requirements.
It is important that patients keep a list of reminders on the medication schedule to ensure they are able to succeed in difficult times (Szasz (2010)).
This could be a digital reminder system or computer-based.
Patients suffering from drug and alcohol problems should seek assistance to get off the drugs.
Walsh (2011) says that caregivers need to recognize warning signs for schizophrenics.
The journal, Schizophrenia, is finally available.
Com offers caregivers more assistance.
It urges family members to look after their patients in order to have better results.
It warns against self-neglect (Alanen (2010)
The Journal suggests that in some cases, the patient’s care needs might not always be prioritized above the caregiver’s.
The Journal suggests that caregivers who are responsible for caring for a patient with a history of violent episodes should put in place safety measures to protect their own safety.
Humour is a great antidote to difficult situations like caring for the chronically sick.
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