Objectives of the Course
According to the World Health Organization (2018), mental wellness is the capability of every individual to cope up with the stressful situations, working ability that increases his or her productivity and from their work can contribute in the development of their community. Despite this, more than 30 million people around the world is suffering from mental disorders. An article published in the Guardian mentioned that in the United Kingdom, every 1 in four person is suffering from mental disorders, the disorder can range from anxiety to schizophrenia, and people become alcohol dependent or becomes addicted to substance abuse (Johnson et al., 2016). The healthcare facilities carry out client focused study to determine the interventions for such patients.
For this assignment, a clinical ward of memory assessment unit has been considered, which in associated with a multidisciplinary team serving to an allied range of mental health disorder. The services provided are various memory assessment techniques, therapies, rehabilitation, medications. The MDT teams consisted of Psychiatrist, senior nurse practitioner, enrolled nurses (6-8), Neuropsychologist, health support staffs and nutritionist.
In this assignment, the case study of Mathew Hans will be discussed who is 57 years old and is suffering from dementia and anxiety related symptoms. He has 2 daughters who lived around the city 11 km away from their father’s place. Mathew lost his wife 4 years ago and since then he is suffering from anxiety related symptoms. After facing severe anxiety attack, he was admitted to a nearby acute mental healthcare setting where such emergencies are being handled.
Being a military pilot, Mathew’s career has been successful and full of enthusiasm. He had stayed his entire work life away from the family which can be one of the reasons for dis depression at that time. However, the current development occurred after the death of his wife Anna due to pancreatic cancer. His daughter Serena informed the healthcare physicians that antipsychotic medication was prescribed to Mathews by their family physician and he used to take those medicines since four years. However, her daughters observed that those medicines were not improving his condition and his physical and mental health was deteriorating gradually, that increased the burden on their daily life. On the day of admission, Mathews was found on his bed lying inappropriately and he was shivering extensively. At the time of admission he had an accelerated heart rate and was sweating profusely, was having a sensation of smothering, derealisation and depersonalization. Therefore, his daughters and the care giver at their place brought him to the nearest acute mental healthcare center where in the emergency ward, he was admitted. On primary assessment and Based on the self-reported data it was found that Mathew had been feeling restless and keyed up on the edge for the past six months. He was being easily fatigued, had been finding it too difficult to concentrate on anything. His irritability had increased considerably and continuous sleep disorder. This recurrent panic attacks causes extensive disturbances that reaches the peak within a minute and hence require psychiatric care.
Case Study of Mathew Hans
As Jack et al. (2013) mentions, dementia is a group of symptoms that is associated with loss in memory and increases their sensitivity as per the environment. Damage to the specific brain cells can lead to dementia and anxiety disorder. There are several reasons for dementia has been mentioned by the researchers Dubois et al. (2014) such as excessive tension, depression, excessive use of alcohol, thyroid related issue, vitamin deficiencies and so on. The pathophysiology of the diagnosis of dementia disorder depends on the metal functional impairment that affects the daily living on the patient such as impairment related to language skills, problem solving and reasoning ability, attention paying ability and finally the visual perception (Galvin & Sadowsky, 2012). In case of Mathews, the pathophysiology of the diagnosis included steps such as determination of past medical history, complete physical examination with lab reports, his behavior, thinking pattern and his ability to perform day to day functions. However, with the help of these, the healthcare physician will be able to determine the presence and level of dementia and the type of dementia will remain undiagnosed (Jack et al., 2016). It should be mentioned that due to the emotional shock after the death of Anna, it might be possible that the amygdala, section of the responsible for environmental stimuli and stores emotional memories gets affected and hence, the brain signaling structures ruptured leading to dementia as well as anxiety disorder. (Dubois et al., 2014).
As per the NICE guidelines, a nurse should be able to assess any information about the patient that would help her out in the final diagnosis. This should be followed by a proper care plan. The initial diagnosis would enable the nurse to carry out the treatment in a problem solving manner, involving both the patient and the family in a shared decision making. This would help the nurse to develop a set of goals. A multidisciplinary approach should be taken to plan the care and implement them. Finally the outcome can be evaluated by patient’s follow up.
The nursing assessment framework is a conceptual model, which is prepared with a combination of meaningful practices and theoretical assumptions. In the case of Mathews, this framework was implemented from the admission process, as the nursing professionals included in the care process were concern about the cultural preference, personal values and the need of the patient (Dubois et al., 2014).
Overview of Dementia and Anxiety Disorder
After the patient has been admitted in to the hospital, the initial assessment started with jotting down the medical history of Mathews. Initially a physical examination was carried out by the nurses for checking out any underlying factor of the anxiety attack. With the increasing number of the older people in the general population, anxieties will soon to become a wide spread problem in the later life. Late life anxiety assessment can be measured by the self-report measures. It has to be remembered that anxiety and depression share a common component of the general distress and with age the anxiety, depression and the co morbidity seems to increase and hence anxiety can be confused with some of the aspects of the normal ageing process as well as with the other mental disorders and comorbidities(Balsamo et al., 2018). There are many physical conditions that like heart diseases, hyperthyroidism, respiratory disease and pulmonary complexities that can make involve the anxiety symptoms. It can occur due to the side effects of the medications (Therrien&Hunsley, 2012).The assessment was necessary to identify the main cause of the panic attack or to nullify the chance of occurrence of anxiety due to some other disease. A Geriatric mental examination can be performed in order to understand the underlying cause of the patient’s panic attack (Balsamo et al., 2018). The GMSE is a semi- structured clinical interview that has been designed for the mental health assessment (Bystritsky et al.,2015). Further, the nursing professional uses the Watson’s Philosophy and Science of Caring, which has four primary aspects such as human, health, society and nursing interventions. According to Watson, the core idea of nursing is protection, enhancement and preservation of human dignity. Aligning with the theory it can be said that the patient was elderly, and the main aim was to restore the functional status of the patient and to bring him back to the normal pace of life. The healthcare professionals used this theory so that Mathews can connect to the environmental around him and improve his dementia and depression related condition. Further, it also helped to determine Mathew’s level of communication, his hygiene level, his mobility and nurses helped him to promote his health improvement (Alligood, 2017). As this nursing theory contains strong and accessible nursing intervention assessment for patient evaluation, the care plan was properly scrutinized using this theory. All the information and the predisposing factors were presented to the consultant, which was written in the final diagnosis.
Nursing Assessment and Care Planning
The assessment period is followed by the diagnosis, which allows the health care professionals to make determinations about the individuals and come to an opinion (Kitson et al., 2014). A psychological evaluation was done to understand the symptoms, fears or conditions of the patient, like how her daughter found her shaking and exhibiting delusional behavior, how he had been found to be disturbed for the past few days.
Planning involves establishment of SMART goals for achieving a desired outcome. A multidisciplinary team of four members were appointed for this case-, the nurse, the psychiatrist and a nutritionist to chalk out the plan for the treatment of Mathews.
Short term goals
- To reduce the anxiety and the depression of the patient and restore the functional status of the body, ongoing tremors, irritability, reducing the sense of depersonalization or derealisation and other psychological problems related to dementia.
- The nurse should be preparing a proper discharge plan and should be able to visit the patient for a follow up. The purpose of a discharge planning is to ensure a continuity of care between the community and the hospital(Altfeld et al., 2012).
Smart goals
The patient’s goal should be measurable, specific and reliable.
- A home care has to be arranged for Mathew to help him out in his daily chores and maintenance of personal hygiene, in absence of his daughters. The carer should also be expert in taking care of Mathew’s medicine so that they can be given timely. The carer would also be able to monitor the dietary intake fluid intake of Mathews.
- Another goal is to provide education to Mathew’s family. Mathew’s family should be educated regarding the triggering factors to Mathew’s depression. According to Radfar et al., (2014), nurses can lessen the burden of providing care to the patient suffering from depression and anxiety by improving their knowledge about how to communicate with the patient and enhance the emotional and spiritual supportive resources to the patient and the family (Cuijpers et al., 2015). It is evident from the case study that Mathew’s children live far away from him. Her daughters can be asked to spend quality time with their father or Mathew can be directed to spend more time with his grandchildren in order to remain distracted.
- The next goal is to reduce the physical discomfort of the patient. Physical discomfort of the patient can be treated by the use of the antidepressant medications. The sensory stimulus can be lessened by keeping a quiet and a peaceful environment (Klainin-Yobas et al., 2013). For the reinforcement of the personal reactions, Mathews should be allowed to talk about the anxious feelings, which would help to determine the anxiety provoking situations (DeJean et al., 2013).
- On successful application of the nursing strategies the patient would be able to verbalize the triggering agents of anxiety; the patient should be able to adhere to the treatment regimen and should be able to cope up with excessive stress (Archer et al., 2013). Finally, The patient should be able to socialize and set aside the negative feelings on proper application of the coping up strategies.
Implementation
In compliance with the initial goal, a referral was made to appoint a 24 hours home carer who would be able to take care of Mathew. Furthermore a community nurse would visit Mathew’s place for a two weeks follow up. Psycho-education was provided to both the patient and the family, about the elements of the personal recovery and about how connectedness to the world, socialization and determining his strengths can pacify the person. In order to self-manage the depressions, it is important for the patient to explore the probable stressors and the life style changes to deal with the anxiety attacks (Gonçalves& Byrne, 2012) As per the NICE guidelines it is necessary to identify the psychological needs of the personal caregivers of the family members who are in distress (National Institute for care and excellence,2016). Application of cognitive behavioral therapy has helped the nurses to understand the triggering factors as well as the probable protective factors (Archer et al., 2013).. According to Gonçalves & Byrne, (2012), anxiety can intensify in to a panic state due to excessive noise or talking. Next step involves the reinforcement of the personal reaction of Mathews, to the expression of discomfort or threats of wellbeing. In order to reduce the physical discomfort of the patient lessening of the sensory stimulus was necessary, Mathew was given Antidepressant medicines like benzodiazepines.
Conclusion
In conclusion it can be said that it is the loneliness, social inclusion and health issues that are the main triggering factors of his anxiety attacks. GMSE can be considered as an essential tool to assess the anxiety in older adults. However, proper assessment and a recovery care plan can be useful in helping the patient, coping up with the physical and the emotional burden of anxiety disorder. A proper recognition of the factors leading to or reducing the anxious feelings can be important in developing the alternate response. Finally psychosocial interventions like CBT and talk therapy accompanied by antidepressants can be used ideally for patients like Mathews.
Importance of Multidisciplinary Approach
References
Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book, 9th edition, Volume 1, Elsevier Health Sciences.
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