Altered Health Status and Promotion in Mental Health Counseling - Essay Example

? Altered Health Status and Promotion in Mental Health Counseling Word Count: 2,516 (10 pages Select a service user with a physical health statusproblems/needs. (500 words) The profile is of a 23-year-old Angolan male named Kwame Abouja (not his real name). He is on a forensic ward. Mr. Abouja has exhibited some very strange behaviours, which have landed him on the forensic ward. It is a psychiatric unit. Mr. Abouja has been diagnosed as a paranoid schizophrenic. As such, he has schizoaffective tendencies, and exhibits all the classical symptoms of the schizoid spectrum disorder family. His unusual behaviours included the following. He entered without a licence and pointed a gun at a shop assistant. He stabbed a friend during an unprovoked argument. Also, he committed the offence of burglary, and his fingerprints were found at the scene of the crime. Mr. Abouja was imprisoned and then later transferred to a forensic ward due to mental illness. While in the forensic unit, Mr. Abouja suffered a cardiac arrest secondary to a bi-lateral massive pulmonary embolism. After having suffered a pulmonary embolism, Mr. Abouja should be assessed for further risk in the near future. “Confirmation of pulmonary embolism (PE) must be followed by risk stratification in order to obtain information on short-term prognosis and determine the need for more aggressive therapy such as thrombolysis or surgical interventional embolectomy” (Konstantinides, pp. 69). The medication Mr. Abouja has been placed on is Warfarin, also commonly known as rat poison. The levels of Warfarin have to be carefully evaluated, to ensure that the patient is not poisoned himself. Basically, Warfarin is most likely going to be used for a lengthier amount of time in order to treat Mr. Abouja’s illness. “A vitamin K antagonist such as warfarin should be considered for long-term treatment” (Stein, 2007, pp. 129). There is a timetable for how long the Warfarin should be used. “Initial treatment [with Warfarin] is usually for a minimum of three to six months” (James, Ortel, & Tapson, 2007, pp. 42). However, the nurse should make sure “In healthy subjects, sildenafil alone or in combination with warfarin or aspirin did not affect bleeding time or prothrombin time. However, in a recent study, a transient prolongation of bleeding time 1 hour after administration of 100 mg of sildenafil was demonstrated” (Broderick, 2005, pp. 215). Therefore, bleeding complications are possible when taking Warfarin. Generally, Warfarin is used in these types of situations such as the one in which Mr. Abouja found himself in. “[Warfarin, also known as Coumadin, is] used to prevent the formation of blood clots in the heart and to prevent stroke in patients with conditions such as atrial fibrillation and atrial flutter…[usage] must be carefully monitored by a [regularly-administered] blood test…” (Cohen, 2010, pp. 196). Mr. Abouja was given Warfarin for the Pulmonary Embolism. He is being given 3 mg of Risperdal (Risperidone) on a daily basis, a commonly-used antipsychotic. Some of the side effects Mr. Abouja is suffering, among others, are muscle weakness and sexual dysfunction. Mr. Abouja’s mother had a history of heart disease or PE; his father refused to be in touch due to his offences. Mr. Abouja was born in Angola. 2. Identify appropriate assessment tool/framework and provide rationale for ?your choice of tool/framework. (200 words) The assessment measures which would be appropriate to use as a framework for care would be: 1) a physical assessment; 2) a psychological assessment; and 3) a emotional assessment. The patient had a physical assessment completed upon him. This physical assessment is rationalised by the fact that he needs to have an intervention for any physical problems that may come up since he has just had a major health issue with the cardiac arrest. Interestingly enough, Mr. Abouja had no pain in his upper left arm, which is recognizant of having heart problems—namely, risk of cardiac arrest. The physical assessment is a very important part of the overall health examination because it targets any issues that will be of premier interest when the doctor is reviewing the patient’s file. Since the patient, Mr. Abouja—is from Africa—and that must be taken into account as part of the diagnosis with his schizophrenia from the standpoint of having to perform a psychological assessment. “Unfortunately, there is as yet no conclusive study that can give a reasonable estimate of the prevalence of schizophrenia in Africa” (Noll, 2007, pp. 11). An emotional assessment will be done to determine the patient’s emotional health. 3. Using the tool/framework, provide a thorough physical assessment of the service user and critically discuss assessment outcomes. Completed ?physical assessment can be included as an appendix. (200 words) There were two general outcomes from the assessment. The first one was that the client had a significantly shorter (but not that much shorter) left leg than the right one. This did not affect the patient’s gait or cause him any pain in any way. However, it was noted on the physical assessment as a formality. The second issue noted on the physical assessment was that the patient admitted to having some shaking in his legs after having been put on the Risperdal awhile ago. Such shaking—which can turn into RLS (restless leg syndrome)—is not uncommon within the population of mental patients who frequently use a variety of antipsychotics. Risperdal (the brand name, also known by its generic name as Risperidone) is a drug which can have several adverse side effects. One of these side effects is a form of shaking that occurs so slightly that the patient himself might not even notice it were he not paying attention. The nurse might make mention of this shaking to the doctor, solely because if the shaking gets significantly worse, the attending psychiatrist may choose to alter—in some way, shape, or form—the patient’s current medications, especially the Risperdal. 4. Identify physical problems/needs and critically discuss nursing care, ?management and health promotion specific to the service user. (616 words) Nursing care, management, and health promotion specific to this user are of premier importance. First of all, nursing care will many times focus upon the day-to-day overall health and well-being of the patient. Nursing care must focus exclusively upon the patient. Management of the client’s issues is going to require medication management, which will be the staple of the nurse’s job to facilitate and preside over, in general. With Mr. Abouja having the risk of pulmonary embolism, it should be ensured that he get the proper nursing care with regards to this malady. Pulmonary Embolism can be fatal, so anticoagulants will be administered to the patient as had been discussed in the previous section. Not only this, but probably Mr. Abouja will have to be put on bed rest so that the embolism doesn’t travel. Also, it depends upon what the size of the embolism is. Doctors may choose to put in an umbrella so the embolism doesn’t break off and travel in various places, including towards the heart—which no one wants to see happen. Someone who is a sufferer of PE will probably want to pare down their physical activities to a bare minimum until the patient is safely out of the risk of danger. At that point, Mr. Abouja will be able to participate in all of his regularly scheduled activities. Nurses are responsible for administering medications and making sure that patients take their medications in accordance with the directions. Medication management is especially important, since Mr. Abouja may have to have his medications adjusted due to the problematic leg-shaking. The shaking in his legs is most likely caused by the Risperdal, and this is a common side-effect of taking such antipsychotic medication. This kind of slight movement is fairly typical. If the shaking should happen to get worse, this should be noted in Mr. Abouja’s patient records and he should have the staff psychiatrist look at him immediately upon the worsening of the condition. The psychiatrist may decide to discontinue, reduce, or eliminate usage of the Risperdal at that point. There are other antipsychotics which might be used in the latter case, which could include tapering off of Risperdal and eventually, ending usage of Risperdal altogether while introducing another antipsychotic such as brand-name drug Lamictal (the generic name being Lamotrigine). Health promotion for the specific user may include, but is not limited to several options. These options include continued counselling, regulation of diet by a licenced nutritionist or dietician, and spiritual direction. Counselling is probably going to be one of the measures that would be enforced whether the patient wants it or not, due to the possibly severe nature of his illness. He will probably be required to participate in group therapy as well as individual therapy—but most likely group therapy only as he is in a forensic ward. Additionally, the patient may be attended to by a dietician, who will be encouraged to see the patient on the insistence of the attending nurse. Last, but not least, the patient will probably be referred to a social service organization of some type—which may or may not have a particular spiritual bent or direction. In this regard, if the patient is Christian, for example, he may be referred to one of several social service organizations which serve Christians and other people who are not necessarily adherents of the faith. In conclusion, there are three major components to Mr. Abouja’s personal health: nursing care; management; and health promotion. It is important that all of these directives be followed in order to ensure the patient’s continuing, ongoing improvement in all of the areas mentioned above. It is thought that Mr. Abouja can improve. 5. Support discussion with accurate and relevant literature. (1000 words) Physical assessment is key for ongoing care. Assessments also have to be observable by outsiders. “Physical assessment findings constitute a second source of information that is used in the assessment phase of the nursing process. Physical assessment findings constitute objective data, or information that is observable and measurable, and can be verified by more than one person” (Estes, 2009, pp. 4). Often included with the assessments are some type of health history. In this particular case, the patient, Mr. Abouja, was identified to have had a mother who suffered from cardiac problems or Pulmonary Embolism(s). In any case, it makes sense to know the patient’s history. In this case, Mr. Abouja’s father did not keep in contact due to his criminal record, which impeded their relationship. Thus, not much is known about his particular health. “A nursing health history can be defined as the systematic collection of subjective data (stated by the client) and objective data (observed by the nurse) used to determine a client’s functional health pattern status…The nurse collects physiologic, psychological, sociocultural, developmental, and spiritual client data” (Weber, 2008, pp. 1). Patient assessment, of course, is another unique element that has come into play in mental health nursing. The importance here of the mental health nurse is to be able to know how to effectively assess patients. “Patient assessment has become a very familiar concept in nursing…Florence Nightingale and many influential nurses since have stressed the importance of accurate observation and recording, to the extent that ‘If you cannot get the habit of observation one way or another, [this is not] your calling…’” (Harris, 2002, pp. 1). Additionally, besides the various assessments that must be completed, it’s very possible that Mr. Abouja might have to have some diagnostic tests done in order to determine if he indeed does have a cardiac condition such as congestive heart failure. “The objective of a diagnostic test is to define the presence or absence of a disease or condition. Diagnosis is then usually used to inform a therapeutic decision” (Van Beek, Buller, & Oudkerk, 2009, pp. 73). Cardiac arrest suggests that Mr. Abouja has a difficult road ahead of him. If he is indeed diagnosed with congestive heart failure—which is highly likely—he may have to take a host of other medications in addition to the warfarin, which would be a substitute for Plavix. He would probably also have to take various other drugs which would assist in thinning his blood—which are anticoagulants. So far, the number of very difficult-to-treat cases of schizophrenia have definitely declined in recent years. “[It was] reported…that the number of ‘catastrophic’ and severe chronic cases had decreased since the beginning of the 20th century” (Weinberger & Harrison, 2011, pp. 105). Obviously, the severity of Mr. Abouja’s illness cannot be underestimated here. He needs the appropriate physical, psychological, and emotional help that will help him live the most fulfilled existence he can while he is still being held in a prison environment. Perhaps, for his physical well-being, there should be a schedule for him in place which would regulate everything he would do. Mr. Abouja should have regular exercise, get up at the same time every day and go to bed at the same time every day as well. In addition to regular exercise, he should probably have some art therapy or music therapy—in addition to some other measures that will reinforce healthy psychology. Psychologically speaking, Mr. Abouja should probably receive some form of counseling. Not only is Mr. Abouja dealing with a lot of stress from physical problems, but his mental health is not exactly the best right now either. He must find some form of relief mentally—so those energies might best be invested in some directive counseling. He might want to talk with a counsellor about how he feels physically, how he feels mentally, and also how he feels emotionally. This is an opportunity for him to talk about his feelings and in general gain a sense of control over his out-of-control life. So, in that sense, he has many different facets which need to be taken care of in one form or another. In addition to all these other problems, he may be facing other difficulties which might be better addressed from another angle. The emotional difficulties that Mr. Abouja will obviously face are many. However, these difficulties that he’s having must be addressed, or he stands to lose much in the face of encountering his own “inner conflicts.” Emotionally, Mr. Abouja may be feeling badly about the crimes he’s committed, knowing vaguely—as a schizophrenic patient—that he has done some things that are very wrong or bad. However, he may not have the mental capacity to full process those actions and their consequences since he is a mentally ill person. Indeed, depending upon the severity of his illness, he may not have known exactly what he had done when he committed these atrocious acts of violence. However, that does not mean that Mr. Abouja can’t be held accountable for his actions. Mr. Abouja does need to be held accountable. In conclusion, basically, Mr. Abouja has got to undergo three assessments: physical, psychological, and emotional. He must be stabilized to the point where he can be reintroduced into society—whether it be the prison society or within the normal community outside. However, it will probably take months and weeks—if not years—of treatment before he will be healed to the extent that he is deemed safe again to be able to be released into the general community. That day may never happen, depending upon how his offences have been judged in a court of law. In that vein, it is important to realize that Mr. Abouja’s salvation lies in rehabilitation. Even though he does have significant challenges and problems to face, there are several people who lead full and long lives having had to confront issues with mental illness, especially schizophrenia. Mr. Abouja definitely has to confront these problems. BIBLIOGRAPHY Broderick GA (2005). Oral pharmacotherapy for male sexual dysfunction. US: Humana Press. Cohen TJ (2010). A patient’s guide to heart rhythm problems. US: JHU Press. Estes MEZ (Ed.) (2009). Health assessment and physical Examination, 4th ed. New York: Delmar & Thomson Learning. ?? Harris R (2002). Physical assessment of patients: the Byron physical assessment framework. London: Whurr. James AH, Ortel TL, & Tapson VF (2007). 100 questions and answers about deep vein thrombosis and pulmonary embolism. US: Jones & Bartlett Learning. Konstantinides S (2007). Management of acute pulmonary embolism. US: Humana Press. Noll R (2007). The encyclopedia of schizophrenia and other psychotic disorders. US: Infobase Publications. Physical assessment form. (2011). [Online Form]. Available: . Stein PD (2007). Pulmonary embolism. US: Wiley-Blackwell. Van Beek EJR, Buller HR, & Oudkerk M (2009). Deep vein thrombosis and pulmonary embolism. US: Wiley. Weber J (2008). Nurse’s handbook of health assessment, 6th ed. Philadelphia: Lippincott, Williams and Wilkins. Weinberger DR & Harrison P (2011). Schizophrenia. US: John Wiley & Sons. APPENDIX PHYSICAL ASSESSMENT FORM (Physical Assessment Form, 2011, pp. 1-3). Date: 25/03/11 Client name: Kwame Abouja (fake name) Contra-indications: Bleeding risk due to Warfarin; potential to go psychotic w/o Risperdal Details: Patient is on Warfarin and Risperidone Current objectives: Minimize risk of bleeding and prevent psychotic episode(s). Height (m) ___2__Weight (kg) _86___ BMI _25.7% kg/m^2__ Body fat (%) __13.6___ Comments: Weight is normal. Body circumferences (cm): Chest ___ Waist _34__ Hips ___ Upper Arm L _30__ R _30__ Upper Leg L _35__ R _35__ Lower Leg L _30__ R _30__ WHR: _47.2_____ Comments: Good body shape. Body type: Ectomorph ___ Mesomorph ___ Endomorph _X__ Comments: POSTURAL ASSESSMENT/BODY ALIGNMENTS HEAD/NECK: Tilted left ___ Tilted right ___ Rotated left ___ Rotated right ___ Forward ___ Flat Lordotic curve ___ Excessive Lordotic curve ___ Other: EYES: Level __X_ Other: EARS: Level _X__ Other: MUSCULATURE: Normal Comments: Good SHOULDERS: Level _X__ Right high ___ Left high ___ Rounded ___ Other: SCAPULAE: Even _X__ Adducted ___ Abducted ___ Winged ___ Rotated ___ Other: CLAVICLES: Level _X__ Other: MUSCULATURE: Normal Comments: Good UPPER EXTREMITIES: Hang evenly _X__ Rotated ___ Other: ELBOWS: Even _X__ Cubitus Varus ___ Cubitus Valgus ___ Cubitus Recurvatus ___ Other: WRISTS: Even _X__ Other: FINGERS: Even __X_ Other: MUSCULATURE: Normal Comments: Good SPINE: Normal ___ Kyphosis ___ Lordosis ___ Flat back ___ Scoliosis ___ Other: MUSCULATURE: Even __X_ Other: Comments: Good/Normal HIPS: Even _X__ Pelvic tilt ___ Coxa Vara ___ Coxa Valga ___ Other: Client’s legs shake and move intermittently. MUSCULATURE: Even _X__ Other: Comments: Other than the intermittent shaking (probably RLS, restless leg syndrome, brought on by Risperdal), the patient is relatively normal. Should keep tabs on patient to make sure shaking does not become permanent; doctor may choose to switch antipsychotic meds. KNEES: Even _X__ Genu Valgus ___ Genu Varus ___ Genu recurvatum ___ Patella squint ___ Excess Q Angle ___ Reduced Q Angle ___ Other: MUSCULATURE: Even __X_ Other: Comments: ANKLE/FOOT/TOES: Even __X_ Tibial torsion ___ Varus heels ___ Valgus heels ___ Pes Planus ___ Pes Cavus ___ Hyper Pronation ___ Hallux Valgus ___ Plantar-flexed first ray ___ Splay foot ___ Hammer-toes ___ Other: MUSCULATURE: Even _X__ Other: Comments: Good/Normal LEG LENGTH: Even ___ Discrepancy _X__ True ___ Apparent ___ Comments: Left leg is slightly longer than the other but does not affect the client’s mobility or gait. Client signature: Kwame Abouja Date: 25/03/11 Therapist signature: Attending Nurse Date: 25/03/11 RANGE OF MOVEMENT ASSESSMENTS (DEGREES OR CM) CERVICAL: Flexion ____ Hyperextension ____ Left Rotation ____ Right Rotation ____ Left Lateral Flexion ____ Right Lateral Flexion ____ Comments: N/A, patient is male THORACIC/LUMBAR: Flexion ____ Hyperextension ____ Left Rotation ____ Right Rotation ____ Left Lateral Flexion ____ Right Lateral Flexion ____ Comments: Normal SHOULDER: Left Flexion ____ Right Flexion ____ Left Hyperextension ____ Right Hyperextension ____ Left Abduction ____ Right Abduction ____ Left Medial Rotation ____ Right Medial Rotation ____ Left Lateral Rotation ____ Right Lateral Rotation ____ Left Horizontal Abduction ____ Right Horizontal Abduction ____ Left Horizontal Adduction ____ Right Horizontal Adduction ____ Comments: Normal ELBOW/FOREARM: Left Flexion ____ Right Flexion ____ Left Extension ____ Right Extension ____ Left Pronation ____ Right Pronation ____ Left Supination ____ Right Supination ____ Comments: Normal HIP: Left Flexion ____ Right Flexion ____ Left Hyperextension ____ Right Hyperextension ____ Left Abduction ____ Right Abduction ____ Left Adduction ____ Right Adduction ____ Left Medial Rotation ____ Right Medial Rotation ____ Left Lateral Rotation ____ Right Lateral Rotation ____ Comments: Normal KNEE: Left Flexion ____ Right Flexion ____ Left Hyperextension ____ Right Hyperextension ____ Comments: Normal ANKLE: Left Dorsiflexion ____ Right Dorsiflexion ____ Left Plantarflexion ____ Right Plantarflexion ____ Left Inversion ____ Right Inversion ____ Left Eversion ____ Right Eversion ____ Comments: Normal Client signature: Kwame Abouja Date: 25/03/11 Therapist signature: Attending Nurse Date: 25/03/11 GAIT ASSESSMENT HEAD: Upright _X_ Forward flexed ___ Deviated laterally ___ Other: Comments: Normal TRUNK: Upright _X__ Forward flexed ___ Deviated laterally ___ Other: Comments: Normal SHOULDERS: Free and even movement during stance and swing _X_ Other: Comments: Normal ARMS: Reciprocal swing ___ Even motion ___ Other: Comments: Normal HIPS: Free and even movement during stance and swing ___ Other: Comments: Normal LEGS: Free and even movement during stance and swing ___ Other: Comments: Uneven legs (one longer than the other) and slight shaking reported KNEES: Free and even movement during stance and swing ___ Other: Comments: Normal ANKLES/FEET: Heel strike ___ Propulsion ___ Excess pronation ___ Excess supination ___ Foot slap ___ Excess dorsiflexion ___ Other: Comments: Normal GENERAL GAIT PATTERN: Step length even _X___ Normal Stride width __X__ Normal Foot Angle _X___ Pain-free gait __X__ Steady gait __X__ Normal cadence __X__ Other: Comments: Good gait, normal although patient’s left leg is a big longer than the other ANALYSIS OF MOVEMENT PARAMETERS In general, the patient has some difficulty with oncoming symptoms of RLS (restless leg syndrome)—most likely due to the antipsychotic meds. The patient’s left leg is longer than his right. This does not, however, affect his movement. REVIEWED OBJECTIVES X Present a short profile of the service user/client. ? X Use an appropriate assessment framework to assess the service user/client’s physical health. ? X Critically discuss assessment outcomes in relation to the service user/client’s altered health status. ? X Critically discuss the management of the physical health needs/problems of the service user/client ? X Critically discuss health promotion strategies appropriate to the service user/client’s altered health status. ? X Use of accurate and relevant literature to support discussion in an unbiased manner. Harvard referencing system should be adhered to. Structure and presentation should be clear and logical with attention to grammar and spelling. Adhere to the Faculty Policy on word counts. ? X Confidentiality and anonymity must be maintained at all times to protect the identity of the service user(s)/client(s), careers, families, professionals involved and healthcare settings. Any breach of confidentiality will result in an automatic fail. RECOMMENDATIONS It is recommended that Mr. Abouja (the anonymized patient) should continue on his current course of treatment as recommended by the forensic ward psychiatrist until further notice. He should be continually evaluated each day by ward staff and make daily reports of his activities. Any kind of surgery should be avoided. If the client has surgery for any prevailing condition, he will have to discontinue Warfarin about a week before said surgery in order to prevent excessive bleeding caused by its anticoagulant nature. Client signature: Kwame Abouja Date: 25/03/11 Therapist signature: Attending Nurse Date: 25/03/11 Read More