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NUR219 Mental Health Nursing: Andrew`S Clinical Scenario

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Instructions:

Using the following clinical scenario provide a short essay-style response to each of the four questions using 

Four short essay question:

Discuss the key interpersonal skills you will use to engage with Andrew.

The doctor stated that Andrew has symptoms of a psychosis. Using correct clinical terms and the clinical cues in the scenario, discuss three important signs and symptoms that support the doctor's opinion.

Andrew asks you why he has a prescription for medication. Briefly discuss how you would respond.

The GP has requested Andrew is informed and carefully monitored over the next few weeks. Briefly discuss your plan.

Clinical Scenario:

In this scenario you are a new graduate nurse working as part of a small multidisciplinary team in a large metropolitan 24-hour medical clinic. Andrew was referred to the clinic by the local university counseling service. He is a 21-year old university student studying Law. In the referral the Counsellor expresses concern about a noticeable change in his general behaviour and a significant drop in his academic performance during this semester. At the GP's request, you sit in on the appointment interview. During the interview Andrew relates a number of loosely connected and implausible stories about different people in the university being ASIO spies. He also refers to technology such as a transmitter chip that has been inserted into his brain to monitor his thoughts. He goes on to describe other evidence of a conspiracy against him such as different electrical items being moved around in his apartment, and the lights outside his unit being operated to interfere with his thoughts. He also claims that other students have been discussing his activities with the lecturer to make sure he gets into trouble. Throughout the interview Andrew maintains a consistent flat monotone voice and sits calmly in his chair.

While observing and listening to his story, you also notice that he frequently looks around or past you as if looking for something. When you ask, he describes that he can hear them talking about him. There is no-one else in the room. He states that he can clearly hear other people talking about him. He is completely convinced they are real people but doesn't know who they are. The GP conducts a basic health check and concludes by informing Andrew that he is experiencing symptoms of a psychosis. The GP provides a script for risperidone 1 mg nocte. Before Andrew leaves the GP expresses concern that careful monitoring is needed for the next few weeks. The GP asks that you set up the next appointment and ensure Andrew has access to information and support before he leaves the clinic.

Answer:

 

1.

My engagement with Andrew is interpersonal.  Interpersonal communication depicts an interaction between individuals during which they relay their feelings, thoughts, behaviour, and emotions (Patrick & Catherine, 2015).  Its success requires proper skills and active participation of the involved individuals.

Appropriate intonation and gestures are indispensable when engaging psychotic patients (David, 2013).  As such, my skills will be immensely skewed towards these.  The tone will be empathic and be showing care (Patrick & Catherine, 2015).  This will be essential in alluring substantial attention and interest of the patient.  The expression of care in my voice will make him fully express himself both verbally and non-verbally.  Using empathic tone when asking and responding to questions in the conversation will enable me to satisfactorily see things particularly his experiences and behaviour from his psychotic situation or disorder.  For instance, empathize with him associating several loosely linked and implausible stories about diverse people in the university being ASIO spies.  This will enable me to articulate and adequately comprehend his psychotic disorder.

My intonation will express positivity and optimism (Cleary, Hunt, Horsfall, & Deacon, 2012).  In conversing with him, the positive intonation will make him see me as an individual who means well for him especially in alleviating his mental disorder.  This will enable Andrew to fully express himself without holding back both consciously and unknowingly.  This is because he will be feeling safe and appreciated.  Consequently, this way I will understand his condition holistically and comprehensively.  Most importantly, this will have some therapeutic effect in it (Tania, Claude, & Til, 2016).  This implies that it will aid him in recovering by triggering the desire to overcome it within him.

The gestures I will employ, for instance, posture, eye contact, and facial expressions will express encouragement, support and communicate respect (Patrick & Catherine, 2015).  Similarly, the gestures should elicit interest and engagement in the patient (Rebekka, Margret, Peter, Rolf, & Roland, 2011).  This will serve to connect with him and motivate him to voice his experiences and express his conduct without fear.  He will feel encouraged to be strong and persistent in facing the disorder and consequently overcome it.  The support gesture will trigger the will within him to progressively fight the condition.  Additionally, facial expressions and eye contact which vividly communicates respect are going to make him see that I understand his condition and that I can assist him in recovering from it.

2.

`The doctor stated that Andrew has symptoms of psychosis`.  `Using correct clinical terms and the clinical cues in the scenario, discuss three important signs and symptoms that support the doctor`s opinion. (400 words)`

    One of the chief symptoms of psychosis is difficulty in concentration (Heckers, et al., 2013).  From the clinical scenario, it is evident that Andrew is exhibiting hardships in concentrating with what is going on in our conversation.  For instance, as we are conversing he frequently looks around or even past me as if looking for something.  This implies that he does not pay attention to what we are discussing regarding his condition.  As such, it leads one to conclude that indeed he is a psychotic patient who requires rehabilitation and pharmacological intervention.

   Hallucinations are also manifested in psychotic patients (Bentall, Wickham, Shevlin, & Varese, 2012).  They describe the process in which an individual sees or hears things which do not exist.  The types of hallucinations vary from one patient to another based on the level of psychosis.  A common hallucination type in patients with a psychotic disorder is an auditory hallucination (Schimmelmann, Walger, & Schultze, 2013).  It normally involves hearing voices which are not present.  For example, when I ask him why he is frequently looking around or past me he says that he can hear people talking about him.  This is a clear indication that he is hallucinating about imaginary individuals who are conversing about him in the room.  This is regardless of the fact that we are just the two of us in the room.  Visual hallucination is also another kind of hallucination that is characteristic of psychotic patients (Schimmelmann, Walger, & Schultze, 2013).  It involves seeing things which do not exist.  For instance, in the scenario, he is entirely convinced that there are other actual people in the room who are talking about him although he does not know who they are.

   Persecutory delusions which depict the feeling that an individual is being subjected to constant surveillance are a manifestation of psychotic condition (Philip & Elaine, 2013).  This is often an expression of false believe that one is being persistently monitored by a third party.  For instance, in the scenario, Andrew describes other evidence of a conspiracy against him like `the lights around the unit he lives in being manipulated to alter his thoughts`.  Additionally, he talks about the various electrical items being moved around in the apartment to keep a close watch over him.  All these according to him, are meant to monitor him in and around his apartment and also alter his thoughts.

3.

`Andrew asks you why he has a prescription for medication.  Briefly, discuss how you would respond.  (400 words)`

     Pharmacological intervention should be done based on the level of the patient`s psychosis (Charles, 2012).  This implies that it is indispensable for the General Practitioners (GP) to first conduct a comprehensive analysis of the degree of severity of the psychosis disorder of the patient to inform him or her on the most suitable pharmacological intervention and rehabilitation measures.  This is because the condition varies from one individual to another.

  One of the paramount principles is that patients showing psychotic symptoms should be treated with antipsychotic medications (Harsh & Kiki, 2012).  As such, I would first explain to him that it is necessary for him to take the risperidone 1mg nocte since it is a basic requirement for individuals experiencing such symptoms like his to be put under the antipsychotic medications.

  I would highlight to him that the prescribed medication is useful in stabilizing his psychotic symptoms (Budson & Barofsky, 2012).  This means that the medication is meant to aid in progressively controlling his hallucinations, difficulty in concentration, delusions, and suspiciousness.  For instance, here I would point out to him how the antipsychotic medication would stabilize his persecutory delusions and hence give him some peace of mind in his apartment.

  Also, I would describe to him that the risperidone 1mg nocte prescription is necessary for lowering his psychotic symptoms such as delusions and hallucinations (Budson & Barofsky, 2012).  This is essential because it is remarkably good news for any other patient facing similar symptoms to hear that the particular prescription for the medication being given to them is going to significantly reduce the disturbing symptoms.  This also includes the possibility of eliminating the symptoms on the condition that the medication is taken strictly according to the GP`s instructions.

  I would point out to him that the prescription for medication also aids in preventing those symptoms from recurring (Budson & Barofsky, 2012).  Here I would explain to Andrew how the antipsychotic medication prescribed by the GP is going to successfully help in averting any possibilities of the present symptoms returning after he heals from them  This will be a certain way to motivate him to accept taking the risperidone 1mg nocte prescription as well as completing the entire dosage.  This is because of he, just like any other patient experiencing the same symptoms can never want or wish to relapse to the initial psychotic symptoms.  As such, this will heighten the chances of him voluntarily accepting to take the medication.

4.

`The GP has requested Andrew is informed and carefully monitored over the next few weeks.  Briefly, discuss your plan.  (400 words)`

  Medication is a chief aspect in monitoring psychotic patients (Robert, Joseph, & Marilyn, 2017).  As such, this factor will noticeably play a critical role in my plan.  This is fundamental because it is the medication that is central to the progressive recovery of Andrew.

  Treatment starts by establishing collaboration with the psychotic patient and providing psychoeducation (with the family and patient) about the disorder and developing the monitoring plan (Robert, Joseph, & Marilyn, 2017).  Based on this, my plan will immensely consider the patient and his immediate family.  This will serve to provide rehabilitation and psychoeducation to aid him to recover speedily.  A patient registry should be employed to monitor the patient`s progress (Robert, Joseph, & Marilyn, 2017).  This implies that the registry will capture all the necessary information regarding the treatment, response and recovery information of the patient.

   Treatment goals should be reinforced and incorporated in the general communication and monitoring plan with the patient (Anna, Jurgen, Wayne, & Kari, 2016).  This is essential in that it enables the identified goals specific to each patient to be in harmony with the overall information and monitoring plan engineered for the patient.  Consequently, the intended treatment goals are central in informing the entire plan for it to be fruitful.

   Specifically, my communication, treatment and monitoring plan for Andrew will include several paramount elements.  Key among them include his health records, psychotic recovery phases, goals, baseline and week one to five.  The health records will capture all his previous and present health information, especially regarding his psychotic condition.  The psychotic recovery phases will be categorized into three categories namely acute phase, stabilization phase, and stable phase respectively.  Each of these phases will have its specific goals that should be monitored whether they have been attained or not.  The baseline will represent the current psychotic state of the patient.  The subsequent weeks will be used in monitoring the recovery progress of the patient against the baseline status.

References

Anna, R., Jurgen, U., Wayne, K., & Kari, S. (2016). Integrated Care: Creating Effective Mental and Primary Health Care Teams. John Wiley & Sons.

Robert, F., Joseph, C., & Marilyn, F. (2017). Integrating Behavioral Health and Primary Care. Oxford University Press.

Anna, R., Jurgen, U., Wayne, K., & Kari, S. (2016). Integrated Care: Creating Effective Mental and Primary Health Care Teams. John Wiley & Sons.

Bentall, P., Wickham, S., Shevlin, M., & Varese, F. (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin, 734-740.

Budson, R., & Barofsky, I. (2012). `The Chronic Psychiatric Patient in the Community: Principles of Treatment`. Springer Science & Business Media.

Charles, S. (2012). Forensic Psychiatry, An Issue of Psychiatric Clinics- E-Book. Elsevier Health Sciences.

Cleary, M., Hunt, E., Horsfall, J., & Deacon, M. (2012). `Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies`. Issues in mental health nursing, 66-79.

David, K. (2013). Schizophrenia: An overview and practical handbook. Springer.

Harsh, T., & Kiki, C. (2012). `Psychopharmacology, An Issue of Child and Adolescent Psychiatric of North America-E-Book`. Elsevier Health Science.

Heckers, S., Barch, M., Bustillo, J., Gaebel, W., Gur, R., Malaspina, D., & Van, J. (2013). Structure of the psychotic disorders classifications in DSM-5. Schizophrenia Research, 11-14.

Patrick, C., & Catherine, G. (2015). Oxford Handbook of Mental Nursing. Oxford University Press.

Philip, H., & Elaine, W. (2013). `Positive and Negative Symptoms in Psychosis: Description, Research, and Future Directions`. Routledge.

Rebekka, L., Margret, H., Peter, W., Rolf, S., & Roland, V. (2011). When Psychopharmacology Is Not Enough: Using Cognitive Behavioural Therapy Techniques for persons with Persistent Psychosis. Hogrefe Publishing.

Robert, F., Joseph, C., & Marilyn, F. (2017). Integrating Behavioral Health and Primary Care. Oxford University Press.

Schimmelmann, G., Walger, P., & Schultze, F. (2013). The significance of at-risk-symptoms for psychosis in children and adolescents. The Canadian journal of Psychiatry, 32-40.

Tania, L., Claude, L., & Til, W. (2016). `Group CBT for Psychosis: A Guidebook for Clinicians`. Oxford University Press.

Cleary, M., Hunt, E., Horsfall, J., & Deacon, M. (2012). Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies. Issues in mental health nursing, 66-79.

David, K. (2013). Schizophrenia: An overview and practical handbook. Springer.

Patrick, C., & Catherine, G. (2015). Oxford Handbook of Mental Nursing. Oxford University Press.

Rebekka, L., Margret, H., Peter, W., Rolf, S., & Roland, V. (2011). When Psychopharmacology Is Not Enough: Using Cognitive Behavioural Therapy Techniques for persons with Persistent Psychosis. Hogrefe Publishing.

Tania, L., Claude, L., & Til, W. (2016). `Group CBT for Psychosis: A Guidebook for Clinicians`. Oxford University Press.

Bentall, P., Wickham, S., Shevlin, M., & Varese, F. (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin, 734-740.

Heckers, S., Barch, M., Bustillo, J., Gaebel, W., Gur, R., Malaspina, D., & Van, J. (2013). Structure of the psychotic disorders classifications in DSM-5. Schizophrenia Research, 11-14.

Philip, H., & Elaine, W. (2013). `Positive and Negative Symptoms in Psychosis: Description, Research, and Future Directions`. Routledge.

Schimmelmann, G., Walger, P., & Schultze, F. (2013). The significance of at-risk-symptoms for psychosis in children and adolescents. The Canadian journal of Psychiatry, 32-40.

Budson, R., & Barofsky, I. (2012). `The Chronic Psychiatric Patient in the Community: Principles of Treatment`. Springer Science & Business Media.

Charles, S. (2012). Forensic Psychiatry, An Issue of Psychiatric Clinics- E-Book. Elsevier Health Sciences.

Harsh, T., & Kiki, C. (2012). `Psychopharmacology, An Issue of Child and Adolescent Psychiatric of North America-E-Book`. Elsevier Health Science.

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