Patient Situation and Collected Cues
Question:
Discuss about the Monitoring Depression Treatment Outcomes.
Patient situation: The given patient a male, aged 28 years, is expected to take over his family farm which has been affected by drought from a long time. The patient tried intentional self harm by committing suicide through hanging. The vital signs of the patient were normal, and no serious injuries were reported. Therefore, indicating towards physiological well being.
Collected cues: The handover report showed the patient did not go for breakfast yet again. He went to lunch reluctantly, but had almost nothing to eat. He returned to his bed immediately afterwards. The broken skin from injuries due to breakage of rope was covered using non adherent dressing and tape. The patient did not take any interest in either small group or one to one activity. He was reluctant in communicating, did not acknowledge introductories, and turned away to face the wall. The patient shows signs and symptoms of psychological imbalance, and hence administered Venlafaxine, multivitamins, and Vitamin B12 daily.
By looking at the patient information and life background, the psychosocial factors seem to play as disposing factors in attempted suicide. The psychosocial factors contributing to the condition are often incited in response to crisis, when the person is struggling to master the next phase of development in life. Here, the patient is expected to take over the farm, which is in a worrisome condition. This could be the source of stress which led to precipitating factors of feeling of hopelessness, worrying about future, anger towards others, and feeling lonely and unwanted (Theodore, 2014). The patient shows signs of hopelessness, persistent sad and empty mood, loss of interest in any kind of activity, low energy, and loss of appetite. The patient is also socially withdrawn. These signs and symptoms are more likely to be seen in men, and might lead to frustration, discouragement, irritability, anger and at times abusive behavior (National Institute of Mental Health, 2015).
Hence on the basis of the symptoms presented by the patient the following three problems have been recognized:
- Progressive social isolation related to withdrawal into self
- Low levels of self esteem pertaining to feeling of hopelessness and helplessness.
- These symptoms coupled with patient’s previous suicide attempt indicate towards depression.
- Depressive mental state and behavior suggestive of suicidal attempts in the future.
To help the patient overcome the problems identified above the following nursing goals are defined:
|
Goals |
Necessary measures |
Time frame |
|
To avoid any further events of self harm by providing basic human needs of safety and protection. |
All the potentially harmful objects need to be removed from the patient’s vicinity. Although, the patient is socially withdrawn, still the caretakers need to maintain a one to one relationship, and keep the patient under close observation. |
1 week |
|
The patient should be provided with means to satisfy the physical needs of nutrition, rest and appropriate activities. |
The patient needs to be monitored for any changes in weight. The patient needs to be motivated for intake of bulk and roughage in diet, besides sufficient fluids. The patient needs to be motivated to engage in adequate amount of physical exercise and rest. He also needs to be discouraged from sleeping during the day, and assisted with hygiene and personal appearance. |
1 week |
|
The patient needs to be encouraged to express feelings. |
This will help the patient to cope with the feelings of anger, and depression. A pleasant approach could help the patient in cultivating sense of dignity and self worth. However, the caretakers need to support the patient in expressing feelings in his own time. Also, it is necessary to maintain frequent contact. |
2 weeks |
|
To engage patient in socialization activities. |
The patient needs to be encouraged for participating in occupational therapy and activities. The patient needs to be assessed for hobbies or activities of interest. The patient also needs to be encouraged to participate in activities that promote feeling of accomplishment and self esteem. |
3 weeks |
Table 1: Goals for patient centered care (Zerwekh, 2015)
In the light of the above mentioned goals it is imperative for the nursing care to opt the suitable course of action, with a careful consideration of the different alternatives. In case of suicidal patients effective communication is the most important skill, which could help the mental health nurse practice therapeutic interventions. Besides establishing effective communication, having diligent observation is also important. As observation can help reduce the risk of any further attempts (Bowers, Gournay & Duffy, 2002). In context of the present patient, the first course of action is to help patient overcome the depressive state of mind by the means of pharmacotherapy. The patient has been administered Venlafaxine, which is a serotonin and norepinephrine reuptake inhibitor. The administration of Vitamin B12 is also meant to assist the low folate levels in depressied patients, and could help achieve better treatment outcome (Coppen & Bolander-Gouaille., 2005). The medication management should follow proper course, and the patient needs to be monitored for side effects and response time. The nursing care will also consist of behavioral activation, which consist of a review of relationship between activity and mood (Ekers, David, & Gilbody, 2008). The patient’s use of activity planning also needs to be monitored. The nursing strategies will also involve periodic assessment of depression symptom levels, which can be achieved using the Patient Health Questionnaire-9 (Löwe et al., 2004) and any changes will be reviewed.
Identified Problems and Nursing Goals
The nursing support provided to the patients receiving mental health treatment, in adjunct to standard general practitioner treatment is important. The mental health nurse mainly strives to assess depression, monitor the progress, enhancing compliance with treatment, and promote social change and education for both the patients and families. In order to ensure the establishment and practice of cost-effective, innovative, and accountable practices, it is essential for the practice to be evaluated constantly (Wilkinson, 1992). Therefore in the context of present case study the efficacy of actions and outcomes also needs to be assessed. In the wake of aforementioned goals and strategies it is foreseen that the patient will reap both short and long term benefits. The strategies will help the patient in verbalizing the behaviors associated with grief, helping him discharge harmful emotions. The patient will begin to engage in the social activities, and the emotional quotient will improve. Through behavioral activation, the activities could be modulated to suit the mood of the patient, helping to customize the treatment to improve the moods. The appropriate monitoring of the depression symptoms also proves to be a useful strategy in monitoring the improvement, and subsequent discharge of the patient from hospice care to family care. Also, it is highly important for the treatment choices to be competent enough, as a failure of competence could possibly have serious implications on the patient’s autonomy and lead to their subjection to intervention which might be against their wishes (Kerridge, Lowe & Cameron., 2005). Hence, the present strategies were designed to avoid any such complications, and stand the six tests of competence of evidencing, reasoning, choice based on rational outcomes, ability to understand, actual understanding, and appreciation (Elder, Evans & Nizette., 2008).
The given case study has allowed critical evaluation of the cues obtained from the patient’s behavior, medical condition, and family history and background. The task allowed interpretation of the cues to design relevant goals and strategies to assist the patient in the course of treatment. It has been emphasized that constant communication and monitoring is they key for assisting the mental health patients. It is essential to observe the patients so as to avoid their indulgence in any harmful behaviors. The relevant actions in the light of contemplated cues, processes information, and self evaluation allows for designing competent healthcare strategies.
References:
Theodore, D. (2014). Textbook of Mental Health Nursing, Vol-II, Delhi: Elsevier Health Sciences.
National Institute of Mental Health (2015). Depression: What you need to know. Bethesda: Government Printing Office.
Zerwekh, J. (2015). Illustrated study guide for the NCLEX-RN exam. St. Louis, Missouri: Elsevier Health Sciences.
Bowers, L., Gournay, K., & Duffy, D. (2000). Suicide and self?harm in inpatient psychiatric units: a national survey of observation policies. Journal of advanced nursing, 32(2), 437-444.
Coppen, A., & Bolander-Gouaille, C. (2005). Treatment of depression: time to consider folic acid and vitamin B12. Journal of Psychopharmacology, 19(1), 59-65.
Ekers, D., Richards, D., & Gilbody, S. (2008). A meta-analysis of randomized trials of behavioural treatment of depression. Psychological medicine, 38(5), 611-623.
Löwe, B., Unützer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring depression treatment outcomes with the patient health questionnaire-9. Medical care, 42(12), 1194-1201.
Wilkinson, G. (1992). The role of the practice nurse in the management of depression. International Review of Psychiatry, 4(3-4), 311-315.
Elder, R., Evans, K., & Nizette, D. (2008). Psychiatric and mental health nursing. Elsevier Australia.
Kerridge, I., Lowe, M., &Stewart, C. (2103) Ethics and law for the health professions. Federation press.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
