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Psychiatric-Mental Health Nursing

What Should the Nurse Do?

Psychiatric-Mental Health NursingWhat Should the Nurse Do?

What Should the Nurse Do?

Elena is a thirty-two-year-old female who presents to the psychiatric outpatient clinic for a follow-up appointment. Elena has a complex medical and psychiatric history, contributing to her ongoing mental health challenges. She was diagnosed with bipolar disorder at the age of twenty-one and has experienced multiple episodes of both mania and depression since then. Her medical history also includes hypothyroidism, for which she takes levothyroxine. Elena reports a recent exacerbation of depressive symptoms, including persistent low mood, fatigue, and feelings of hopelessness. She mentions difficulty concentrating, changes in appetite with unintended weight loss, and disrupted sleep patterns. During the assessment, she reveals a history of trauma, which she acknowledges has played a role in her mental health struggles. Additionally, Elena has a past history of substance use disorder, particularly alcohol misuse, but reports being in recovery for the past three years. She attends regular Alcoholics Anonymous meetings as part of her ongoing support network.
1 .
Considering Elena’s complex medical and psychiatric history, which case management model(s) might be most suitable for her situation, and why?
2 .
How might the strengths-based case management model (SBCM) be applied to Elena’s case, considering her history of trauma and ongoing mental health challenges?
3 .
Discuss the role of nurses in case management and how it aligns with Elena’s needs.
4 .
Explain how virtual health care would be helpful in the coordination of care for a client like Elena.
5 .
Considering the various models discussed, how might the drawbacks of the intensive case management model (ICM) impact its applicability to clients like Elena?
Sarah is a forty-two-year-old female who arrives at the psychiatric clinic seeking assistance for a complex set of mental health challenges. Sarah’s history reveals a long-standing struggle with bipolar disorder, which was initially diagnosed during her early twenties. Over the years, she has encountered recurrent episodes of both manic and depressive states, impacting her overall quality of life. Recently, Sarah has been grappling with intensified symptoms of depression, including persistent feelings of hopelessness, a diminished interest in activities she once enjoyed, disrupted sleep patterns, and noticeable changes in her appetite leading to unintentional weight loss. In addition to her psychiatric history, Sarah reports a significant life event that triggered this latest episode—a recent divorce after a fifteen-year marriage. The stressors associated with this major life change have exacerbated her bipolar symptoms, leading her to seek professional help. Sarah’s vital signs upon arrival indicate a heightened level of physiological distress, with an increased heart rate of 105 bpm and elevated blood pressure reading at 140/90 mmHg. During the initial assessment, she expresses difficulties in concentrating at work, which has led to a decline in her professional performance and an increasing sense of inadequacy. Sarah also admits to struggling with social isolation, finding it challenging to connect with friends and family members, exacerbating her feelings of loneliness.
6 .
How can the four dimensions of recovery (health, home, purpose, and community) be incorporated into Sarah’s care plan, considering her current mental health challenges and recent major life event? Provide specific examples for each dimension.
7 .
Based on Sarah’s symptoms and history, discuss two rehabilitative treatments that could be beneficial for her, explaining how each treatment addresses specific aspects of her mental health challenges.
8 .
Identify and discuss two rehabilitative resources that could support Sarah in her recovery journey. How might these resources address her specific needs, and what role can nurses play in facilitating access to these resources?
Rodney is a forty-five-year-old male who presents at the psychiatric inpatient unit following a referral from the emergency department due to an acute exacerbation of schizophrenia. Rodney appears disheveled, with poor eye contact and a guarded demeanor. He is oriented to person, place, and time, but is preoccupied with auditory hallucinations, reporting command hallucinations instructing him to harm himself. He exhibits paranoid delusions, expressing a belief that he is being followed and persecuted. Rodney has a complex psychiatric history, dating back to his early twenties when he was initially diagnosed with schizophrenia. He has a history of multiple psychiatric hospitalizations, often precipitated by medication noncompliance. His medical history includes hypertension, for which he takes amlodipine, a medication that has been well-tolerated. In the current episode, Rodney’s family reports a recent decline in his overall functioning. They noticed increased social withdrawal, decreased self-care, and disrupted sleep patterns. He denies any recent substance use or changes in medications. His vital signs on admission are within normal limits, and initial laboratory workup, including a complete blood count and comprehensive metabolic panel, is unremarkable.
9 .
Discuss the key components of a comprehensive discharge plan for Rodney, considering his complex psychiatric history, recent exacerbation of schizophrenia, and the goal of preventing relapse. How can psychiatric-mental health nurses facilitate effective discharge planning?
10 .
Rodney may require a transfer between units or facilities. Outline the procedure for transferring a client with acute exacerbation of schizophrenia, emphasizing legal and ethical considerations, client safety, and staff training. How can nurses ensure a smooth and safe transfer process?
11 .
Rodney’s health information needs to be transferred between health-care facilities while adhering to privacy regulations. Explain the considerations and steps involved in the transfer of psychiatric client health information. How can nurses ensure client confidentiality and informed consent during this process?
Emily is a thirty-two-year-old female who arrives at the psychiatric outpatient clinic for follow-up care after a recent hospitalization for a major depressive episode with suicidal ideation. Emily reports a two-month history of persistent low mood, anhedonia, feelings of hopelessness, and changes in sleep and appetite. During her hospitalization, she was started on a therapeutic dose of sertraline and engaged in individual and group therapy sessions. Emily has a history of recurrent depressive episodes since her early twenties, with intermittent periods of stability. She has a family history of mood disorders, and her past psychiatric treatments have included various antidepressant medications and psychotherapy. Emily’s medical history is notable for hypothyroidism, managed with levothyroxine, and there is no reported history of substance use. During her initial assessment, Emily’s vital signs are within normal limits, and she expresses a commitment to continue with her medication regimen and follow-up appointments.
12 .
Discuss the role of the nurse in facilitating follow-up care for Emily after her recent hospitalization for a major depressive episode. What specific actions can the nurse take to ensure a smooth transition from the hospital to the community, emphasizing medication management, counseling, and involving family and support groups?
13 .
Explain the concept of mental health and psychosocial support (MHPSS) and how it can be applied in the context of Emily’s ongoing care. How can MHPSS interventions, such as counseling, psychoeducation, and community-based activities, contribute to Emily’s overall mental health and recovery?
Aarav, a twenty-eight-year-old nonbinary individual, seeks care at the psychiatric outpatient clinic due to escalating symptoms of anxiety and panic attacks. Aarav provides a comprehensive account of the distress, linking it to heightened stress levels arising from work-related pressures and challenges in personal relationships. Aarav describes the anxiety as pervasive, affecting both day-to-day functioning and overall well-being. The reported symptoms encompass various dimensions. Aarav mentions experiencing disrupted sleep patterns, characterized by frequent awakenings and difficulty falling asleep due to intrusive thoughts. Racing thoughts dominate waking hours, contributing to a heightened sense of unease. Physical manifestations during panic attacks include palpitations, a racing heartbeat, and shortness of breath, further intensifying the emotional distress. A thorough exploration of Aarav’s medical history reveals no significant health issues or prior engagements with mental health services. This marks Aarav’s first encounter with seeking professional support for mental health concerns. The absence of a mental health treatment history prompts the nurse to gather additional information about Aarav’s coping mechanisms, support systems, and any past strategies employed to manage stress. Aarav’s social history unveils a dynamic and supportive network of friends and family. However, recent challenges in personal relationships have strained these support systems, contributing to Aarav’s sense of isolation and exacerbating the anxiety symptoms.
14 .
Given Aarav’s presentation of anxiety and panic attacks, discuss the potential benefits of specific online self-help and therapy options mentioned in the chapter, such as teletherapy, self-guided therapy, and online support groups. How can these options contribute to Aarav’s mental health resilience, considering the reported symptoms and challenges in personal relationships?
15 .
Identify and discuss the special considerations and concerns that PMH nurses need to address when recommending or providing online self-help and therapy options to individuals like Aarav. How can nurses ensure the privacy, confidentiality, and ethical considerations of online mental health platforms while promoting client education and informed consent?
16 .
Explain the role of the PMH nurse in promoting online self-help and therapy for individuals like Aarav. How can nurses provide health education, assess the suitability of online platforms for specific clients, and monitor progress while maintaining ethical standards and addressing potential challenges associated with online mental health services?
Riya is a thirty-five-year-old female, who presents at the mental health clinic reporting persistent symptoms of depression and anxiety. Riya expresses a sense of overwhelming sadness, loss of interest in previously enjoyable activities, and pervasive worry about the future. The nurse notes vital signs, revealing an increased heart rate and slightly elevated blood pressure. Riya’s medical history indicates a previous diagnosis of hypothyroidism, managed with medication. Her psychiatric history unveils that Riya has a history of recurrent depressive episodes, with the current episode marked by increased severity. Riya has engaged in therapy intermittently but has struggled to maintain consistent follow-ups due to various barriers, including financial constraints and limited accessibility to mental health services. Communication challenges emerge as Riya highlights difficulties in expressing her emotions verbally, contributing to a sense of isolation.
17 .
Riya has a history of recurrent depressive episodes, and barriers, such as financial constraints and limited accessibility, hinder consistent therapy follow-ups. Discuss the complexity of providing continuity of care for Riya, considering her recurrent depressive episodes and the identified barriers. How can the nurse address these challenges to ensure Riya receives consistent and comprehensive mental health care?
18 .
Riya faces communication challenges, finding it difficult to express her emotions verbally, contributing to a sense of isolation. How does effective communication play a crucial role in promoting continuity of care for Riya? Discuss specific communication strategies the nurse can employ to overcome Riya’s communication challenges and enhance the overall continuity of care.
19 .
Financial constraints and limited accessibility to mental health services are barriers for Riya. Explain the nurse’s role in removing these barriers to promote continuity of care. What specific interventions can the nurse implement to address financial constraints and improve Riya’s access to mental health services, ensuring a more seamless continuity of care?

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