Mental Health and Elder Abuse - Essay Example

Presentation: Elder Abuse When discussing care of the elderly and geriatrics, it is pertinent to discuss elder abuse. Elder abuse can originate from a family member or friend of the elderly individual in question. Abuse of the elderly can be defined as any type of physical, emotional or sexual abuse which is directed at an elderly individual. This particular type of abuse can also entail emotional and financial abuse. Elder abuse can even mean neglect or desertion of an elderly person in one’s care. The following outline will assert a presentation aimed at the topic of abuse of the elderly. 1. What is elder abuse A. Specifics of cases of elder abuse B. How the law protects the elderly C. How to prevent elder abuse 2. What elder abuse means from a medical standpoint A. What you as a care giver should do B. The responsibility of the medical professional regarding abuse of the elderly 3. Conclusion: Summary of research and closing statement Scenario: Peter who is 14 Peter is 14 and in high school. He was 11 when his mother passed away and is now raised by his older siblings. His father is always at work and is rarely home. Peter is exhibiting signs of depression and seclusion by spending hours in bed, in his room. Based on his reclusive behavior and self professed sadness, Peter may even be at risk for suicide. Peter is also at risk for substance abuse and other self destructive behaviors. Many types of depression that surface in adolescents can lead to long term psychological disorders which contribute to lifelong mental illness, if left untreated. Peter is obviously displaying signs and symptoms such as decreased energy, decreased interest in activity, sadness and hopelessness. Due to the early death of Peter’s mother, his family dynamics have changed drastically. Peter is without a parent as his father is mostly always at work and Peter is left to the care of his older siblings. It is likely that at the time of Peter’s mother’s death, proper grief counseling intervention did not take place leaving Peter with an overwhelming feeling of loss and grief. Peter is obviously in a situation where he feels alienated and therefore is retreating farther into an antisocial shell which only serves to fuel his depression. In looking at how the Mental Health Act addresses specific cases of depression, namely teen depression, it is clear that individualized care within an individual’s community is provided for. The Mental Health Act is meant to protect those who suffer from mental illness where in many cases, a stigma may exist. Prior to the Mental Health Act of 1983, those who suffered with mental illnesses may have been allowed to fall through the cracks of the system while remaining untreated. The Mental Health Act is meant to change that in order to address mental health cases before they manifest into more serious conditions. In Part II of the Mental Health Act, labeled “Compulsory Admission to Hospital and Guardianship”, detention and assessment of an individual thought to be suffering from a mental illness, is allowed for. Once an individual is detained in a medical or mental health facility, the individual may be assessed and either released or held for a certain period of time. In the case of Peter, such a process would most likely adequately determine his condition to be either treatable on an out patient basis or more serious, requiring a prolonged stay in the hospital. If Peter is displaying warning signs indicative of suicide or other homicidal tendencies, then he will need to be detained for a period determined by the attending physician. The Mental Health Act allows for a detention of an individual for a period of up to 28 days with the prescription of two physicians. Once Peter is assessed, if it is decided that he requires admission and detention, two physicians will need to prescribe an extended stay for up to 28 days within a mental health facility. In devising a care plan for Peter, it is first necessary to consider his circumstances and family history and dynamics. First of all, Peter is dealing with a great emotional hardship in having lost his mother. Due tot his, his father is the primary care giver and is working long hours. Peter is left to the caer of his older siblings. It is clear that the circumstances of Peter’s family are contributing to his state of mind and depression. His care and treatment will have to be addressed not only on a one on one basis with him but also with his immediate family. This means an interactive care plan which includes his father and his siblings. The first element of his care plan will be to look at his immediate symptoms in contrast or comparison to the classic symptoms of clinical depression which are as follows: “Symptoms of depression include a persistent low mood, low self-esteem, inability to concentrate, irritability, irrational feelings of guilt, constant pessimism, insomnia, frequent negative thoughts, the feeling of detachment from reality and the inability to manage simple, everyday tasks. Sufferers of depression may find they also experience other neuroses too” (BBC, 2001). Clearly, Peter’s symptoms are similar to this template of the signs and behaviors of depression. Appropriate treatment is as follows: Psychotherapy, counseling, anti-depressants and deemed necessary by a prescribing physician and possibly ECT. Self Help groups may also be a possibility in Peter’s particular case. In conjunction with these aspects of treatment, educational tools need to be made available to Peter’s immediate family so that he has a support system at home as he recovers from and deals with his depression. It may also be possible to aid Peter’s father in limiting his time at work to effectively juggle bringing in the family income while still being available as the sole guardian of Peter. Documentation of Peter’s behavioral patterns or characteristics in the care plan of this scenario would include noting continued or perpetual signs of withdrawal or antisocial behavior. Charting Peter’s response to questions in therapy such as 1) Rate your mood today as being on a scale of 1-5, one being very sad and 5 being very happy or optimistic. Other questions which should be asked of Peter during each evaluation or therapy session would be what his daily goals are, whether he feels more optimistic about the future or more pessimistic or doubtful. Charting these responses could effectively show a pattern of influences upon Peter’s mood or tone concerning how his home life is going. In other words, isolating direct impacts upon Peter’s state of mind may become possible if a regular assessment is conducted regarding his feelings as a function of his home environment. Certainly, a pattern of continued anti-social behavior and withdrawal from others, will be necessary to maintain a level of alertness of whether Peter is lapsing into a more dangerous state of depression which could lead to self destructive behavior such as substance abuse or suicidal tendencies. Responding to this scenario within the role of an enrolled nurse would entail establishing a care plan conducive to the symptoms and signs displayed by the patient who in this case is Peter. As an enrolled nurse, it is also essential to be aware who is a part of Peter’s care team as well as the hierarchy of that team. The health care team in Peter’s case, would of course be the attending physician(s), mental health and/or medical nurse(s), counselor(s) and therapists and Peter’s immediate family (his father and siblings). The enrolled nurses working on Peter’s case would want to make sure that each member of Peter’s health care team were on the same page with his care, and aware of his progress and goals. It is everyone’s right to participate actively in their own care. This means that each patient (consumer) has a right to be informed of the details of their diagnosis and treatment options. A patient also has the right to decline treatment in most cases with the exception being when individuals suffering from mental illness are admitted to a mental health care facility on a mandatory basis, due to posing a risk to themselves or to others. The actions of an enrolled nurse to support this right of the consumer, is to actively inform the patient not only of their rights but also of their treatment options and detailed diagnosis as per diagnosis by a physician(s). It is important for nurses to work closely with the attending physicians in order to serve as a sort of liaison between the physician and the patient. Nurses may also act to educate the immediate family of the patient in order to assist the family in understanding and responding to their loved one’s condition. In the event that the patient is admitted to a mental health facility on a mandatory basis, the following portions of the Mental Health Act are applicable: “An application for admission for treatment may be made in respect of a patient on the grounds that- (a) he is suffering from mental illness, severe mental impairment, psychopathic disorder or mental impairment and his mental disorder is of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and in the case of psychopathic disorder or mental impairment, such treatment is likely to alleviate or prevent a deterioration of his condition; and (c) it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section”(The Mental Health Act of 1983, UK). In planning, prioritizing and implementing nursing intervention for Peter; the following protocol would be advisable: An assessment of Peter’s risk factor to himself and others should be assessed primarily in order to intervene on a situation where the patient (Peter) may be of harm to himself or to others. The nursing care plan established for Peter should be focused on his individual needs as well as do so in a manner that is positive and collaborative. Peter’s prescribed care may include any or all of the treatments appropriate for those dealing with depression such as before mentioned. First and foremost, Peter’s needs as an individual should be considered and dealt with accordingly. Part of acting in a collaborative manner with the patient, includes making the patient aware of their condition as well as the variations and side effects in treatment options. It is most likely that Peter will be prescribed antidepressants to treat his depression. They type of antidepressant will depend on his specific needs, family history, allergies and typical reactions to medications. A physician will look at all of these factors when deciding which medication to prescribe for Peter. As an enrolled nurse, the responsibility becomes informing the patient (Peter) of the possible side-effects or adverse reactions associated with the medication(s) prescribed for Peter. Some anti-depressants can cause drowsiness, weight gain or loss, sexual side effects and other uncomfortable conditions. Even though the instance of these side effects is somewhat limited and even rare, it is still very important to make patients aware of their possible occurance, when prescribed and taken. This is all part of implementing a care plan conducive to the individual needs of the patient. One way to make sure that the patient is aware of possible side effects is to ask open ended questions of the patient about their prescribed pharmaceutical regimen. By asking the patient questions like ‘how many times a day has the doctor prescribed your medication for?’ and ‘which of the possible side effects cause you the greatest concern’, the attending nurse can ensure that the patient has retained the information provided tot hem about their health care plan. An enrolled nurse must be able to efficiently identify problem behaviors as well as triggers which insight symptomatic behavior, from the patient. The initial step of gaining family history and dynamics will set the ground work for creating a strategy for trigger identification and problem behavior identification. Peter has most likely not been able to effectively deal with the death of his mother. He is in a position where he has only one parent and that parent is forced to spend most of his time at work. Peter is becoming reclusive but is in a situation where his options are currently limited. The most important thing is to work with Peter and his family at changing the current situation in order to create an atmosphere more conducive to Peter’s mental health and well being. This again, may be a product of the death of peter’s mother which placed Peter’s father in a difficult position where a reasonable amount of time within the home was not an option. During the first phase of Peter’s counseling sessions, identifying things which seem to add to Peter’s feelings of hopelessness and sadness, is integral to hi care. Perhaps the fact that Peter feels isolated at home and feels that he is not useful as the youngest child, contributes to a feeling of hopelessness. It may be ideal to discuss with Peter’s father and siblings, a plan for the family’s daily chores and activities which rely heavily on Peter’s involvement. By allowing Peter a sense of being needed and of being a part of the family dynamics, Peter may more readily respond to his over all care plan. The implementation of de escalation techniques would involve responding to Peter and his family in a positive and calming manner. If Peter presented with agitation or aggression, as is sometimes the case with teens who are suffering from depression, the attending nurse should respond in a manner which essentially serves to diffuse a potentially heated or escalating situation. Remaining calm and speaking in a calm and gentle voice will reassure Peter of his safe environment with his nurse and health care givers. Practicing such negotiating and de escalating techniques with other members of the nursing staff prior to an anticipated encounter, are fundamental for the attending nurse to take part in. Peter may not be used to talking out his problems, feelings, concerns or anger. Teaching Peter techniques for using verbal communication as a vessel to eliminate bad feelings or angry feelings, are an important part of the attending nurse’s job. The following answers apply to a case study involving a 27 year old patient named Ben. Ben is schizophrenic as he was diagnosed 5 years earlier. Ben is seemingly homeless, an avid substance abuser and appears unclean and unkempt. 1. The nurse working with me has asked for a mental health assessment to be done on the patient. The assessment conducted on Ben will consist of me gaining information from Ben as well as by documented observations. Being that Ben is schizophrenic, and is doing poorly as of late, indicates that his mental state is rapidly declining. It would be necessary to investigate the possibility that Ben is a danger to himself or others. If it is discovered that Ben is indeed posing a threa to himself or others, his physician would need to be notified so that a mandatory detention and of Ben within a mental health facility can be arranges. Ben’s physical appearance is also an integral part of the overall scenario of Ben whether he is showing behavioral symptoms of a declining mental state or whether he is showing a lack of ability to undergo the basics of personal hygiene . The fact that Ben presents with tattered clothes and absence of grooming and hygiene, indicates that he is becoming unable to take care of himself. Another aspect of Ben’s assessment is of course his family and social dynamic. Ben is actually homeless which may also suggests that he is not functioning well in society and on his won. Ben is also an active substances abuser. Certainly abuse of substances alone, suggests that Ben is not properly functioning from a psychological standpoint. He has also discontinued his medication which could point to why he is on a downward spiral. 2. The signs and symptoms of schizophrenia which Ben is displaying are as follows: change in mood or behavior, behavior which is sporadic and personality changes. Schizophrenia is also characterized by mental capacity loss and loss of an understanding of reality. Ben is most predominantly behaving in such a way that it is clear that his mental grasp on the present reality is nonexistent. 3. Name the 4 broad classifications of mental illness: The 4 broad classifications of mental illness are detachment from reality and a propensity to mentally “check out” or lose the ability to separate the fictional from the real. Cognitive functions are often impaired as a result of many mental disorders. Signs akin to depression and voluntary isolation are also credited to mental illness. Mental illness may also cause one to behave in varied and constant inappropriate behavior or harmful and destructive behavior towards themselves and towards others. During Ben’s assessment, it will be important to examine through interview, what type of reality awareness he possesses. It may be asked of Ben whether he hears disembodied voices or whether he feels threatened by an individual or group of individuals. Schizophrenia is often characterized by paranoia almost to an extreme and in some cases, beyond the extreme. Ben is self medicating with his use of cannabis and other drugs to achieve a ‘happy’ feeling or euphoria. It would be relevant for the mental health care team to assess whether Ben is using substance to deal with emotional pain or whether he is simply acquiring these drugs in order to self treat his schizophrenia. Ben may simply be caught in a catch 22 where he is suffering from his mental illness but in order to satiate his probable constant confusion, he is attracted to the false comfort of mood altering drugs in clouding alcohol. 4. My role in the treatment of Ben is to assess him, help educate him and his family on not only his condition but his treatment options. It is also my role to practice a de escalating approach in communicating with not only the patient, but his family as well. 5. In implementing Ben’s care team, there would be an order or hierarchy of health care professionals as well as members of Ben’s immediate family. The very top of the hierarchy is of course Ben. When he is assessed and the recipient of a mental health care plan. An attending psychiatrist would be necessary in order to treat Ben’s mental illness and prescribe any necessary medications. Next, Ben should have a physician who is just a general practitioner in order to treat any possible physical illnesses, symptoms or ailments which Ben may have. Below the 2 main physicians on Ben’s case, is the nursing staff assisting the physicians in his care. It is up to the nurses to carry out the orders of the physician in accordance with Ben’s illness. It is also the nursing staff which continually assesses Ben and his progress while educating him on his disease and treatment options. Ben may also have counselors as part of his treatment plan and finally, Ben’s family completes the team actively participating in Ben’s treatment. 6. In the event that hospitalization is required in this case, the severity of Ben’s condition will be determinant of whether or not he is voluntarily admitted or involuntarily admitted. Primarily, if Ben is behaving in self destructive or homicidal ways, he will be forcibly admitted for his well being as well as the well being of others. The fact that he is not functioning at all in society from a financial standpoint or otherwise, Ben may in fact be involuntarily admitted due to the severity of his particular symptoms and due to his substance abuse. It may even be necessary to admit him into a drug and alcohol rehabilitation program before, during or after his hospital admission for mental illness. If however, Ben agrees to an admission to a mental illness facility, he be considered to have voluntarily accepted his treatment and detention. It is not unusual for doctors to tell a patient suffering from mental illnesses which are extreme, that the patient can sign in voluntarily to a hospital but if they do not consent to do so, the physician may then admit the patient regardless on a involuntary basis. 7. Ben certainly has rights but in the case of involuntary treatment, Ben is not able to refuse treatment. He may do so on a voluntary basis, but if and when Ben is admitted to a mental health facility by two physicians, he is not able to reject treatment until his release. 8. Ben has the right to privacy and autonomy. Ben’s privacy is protected in that no one may gain access to his medical conditions or treatments including those of a psychological nature, without his written consent. His right to autonomy defines him as a human being entitled to dignity and care by the medical community. He is an individual like every one else and is entitled to be treated accordingly. 9. The key words which sum up the spirit of the Mental Health Act are assessment treatment and collaboration. 10. The term deinstitutionalized means to release a patient from their involuntary hospital detention. 11. The difference between sadness and depression are as follows: Sadness is more temporary than depression and usually comes and goes depending on the trigger of the emotion. Depression is usually a constant and long trm feeling of hopelessness, contemplation of suicide or cessation of necessary duties. Sadness is normal and is simply a response to circumstances where depression is a mental illness. 12. When planning Ben’s care; Ben and his family will certainly be involved as well as his attending physicians, nursing staff and counselors. 13. Ben has been prescribed medication by the doctor upon an exam, it is most likely an antipsychotic medication such as Seroquil XR. 14. Some of the side effects for this medication and other antipsychotic are as follows: dry mouth, constipation, dizziness and grogginess. 15. The three types of drug administration within a mental illness setting are as follows: oral administration via a nurse, injection of medication by a nurse and rectaly. 16. A therapeutic environment is one with positive stimulus and minimal stress. This type of environment also possesses a great deal of structure and routine for the patients. 17. Ben’s behavior may be indicative of contemplation of suicide if he begins discussing death more often or if he begins to behave in an extremely paranoid manner. If Ben begins to demonize all the things which are normal to most, he may react to his overwhelming feeling of paranoia by inducing his won death. Another sign to watch for is a sudden and drastic increase in Ben’s mood. 18. In the event that Ben becomes verbally aggressive during a dialogue between myself and he, I would first do my best to calm Ben down whilst engaging in de escalating techniques. 19. If the next nurse who is relieving me at the end of my shift, asks how I am feeling and engages in debriefing me, it is important for me to answer honestly to ensure that I am not internalizing poor progress of Ben or that I am not becoming angry or hostile towards Ben due to his verbal mistreatment of me. 20. The basic functions of the nervous system are to maintain survival by allowing us senses in order to regulate homeostasis as well as to alert us to danger. The nervous system allows nerves to tell us when something is dangerous or a threat. We have all placed a toe in bath water to check the temperature before entering. If our bodies did not utilize the nervous system to tell us that the bath water was too hot and may burn us or too cold which may decrease our body temperature, we would be in constant self destruct mode. This section addresses the patient who has just received an appendectomy and is soon returning from recovery. 1. In making up the patient’s room, I will want to ensure that the bed is outfitted with fresh sheets and blankets, that the room is free of clutter impeding the incoming wheelchair equipped with the patient. I may also want to make sure that the toilet seat is down thus preventing Jill from sitting down into the actual water of the toilet possibly harming herself post operatively. 2. Observations of Jill post operatively should include a regular reading of vital signs, routine check for possible beginnings of infection, pain level fluctuations, need and ability to urinate or evacuate bowels. Overall, surgery is always risky as well as hard on the human body. Immediately following surgery, close observation of patients is critical to ensure adverse reactions or post operative infections do not manifest. 3. Refer to picture of appendix and its anatomical location within the body. 4. The pathophysiology of appendicitis is as follows: The appendix becomes infected when it becomes somehow perforated allowing intestinal bacteria to take up residence within the appendix itself. This reduces the appendix blood supply resulting in a great deal of pain. The appendix fills with infection and then can rupture, spreading bacteria and pus into the body’s core. 5. Peritonitis is a serious medical condition because it is the swelling of the peritoneum which is the outer intestinal wall. If this wall ruptures due to pressure and swelling, it releases the toxic contents of the bowels resulting in infection of the blood. Treatment for this disease may include IV fluids along with antibiotics. In severe cases, surgery is required. 6. If it is notices that Jill’s fluid bag is nearly empty when I am switching a line, I must consult the doctor’s orders on the chart to see if another bag is to be administered. If this is unclear, the doctor may then be notified. 7. The two most commonly used IV solutions are dextrose and sodium chloride. The decision to use one over the other has to do with the patient’s electrolyte level s and immediate dietary and medical needs. 8. The physician is responsible for ordering IV fluids. 9. If it is noticed that an additive is required in Jill’s IV bag as per doctor’s orders, I would do so prior to replacing the bag while ensuring that the additive has been given in appropriate intervals thus far. 10. If Jill begins to complain of nausea a few days post operatively, I would contact the attending physician to make him aware in order to take the appropriate steps in the event of a complication. 11. One common antimetic is reglan which reduces acid reflux and stomach upset. 12. Since Jill does not have a catheter, it is necessary to measure her urine output and record this in order to establish if her kidneys are properly functioning. 13. If Jill is unable to pass urine after 6 hours, I would consult with the physician and see if eating and drinking was acceptable at this time for Jill, I would recommend doing both to her if approved by the physician. Otherwise, helping Jill urinate by running water for her or suggesting she imagine water, are just a few ways I can help Jill speed up the process of passing urine. 14. Routine post operative exercises including moving the legs and arms back and forth for a small period of time every so often, would be advisable in Jill’s case. 15-18. The term DVT stands for deep vein thrombosis and is essentially a blood clot within a blood vessel. Coagulation can take place heavily post operatively resulting in a DVT. DVTs may break lose and travel to the brain or the heart causing cardiac arrest or a stroke. DVT’s can be treated with anticoagulants such as cumadin. 19-20. Jill’s wound will need to be observed and redressed regularly to avoid and look for infection. Every 4 hours, a wound check is recommended. 21. Some wounds are expected to drain as they heal due to an existing infection. The allowance for drainage of an existing infection from a wound allows the body to naturally flush out what it can of the pathogen. 22. If blood is noticed in Jill’s surgical site, notifying the doctor is important as well as showing the doctor the amount of blood present. This would be documented in the patient’s daily chart. 23. The function of the gallbladder is to assist in the metabolism of fat. 24. Signs and symptoms of a liver which is not working properly is yellowing around the whites of the eyes and of the skin. This is called jaundice. The liver is a filter organ and when it is not working properly, the body becomes full of substances which are ordinarily supposed to be filtered out and released by way of the liver. 25. Checking the location of the nasogastric tube allows for certainty that the tube is placed down into the esophagus instead of the lungs! 26. Insertion of a nasogastric tube must be done in conjunction with the patient. As the tube passes the throat and into the esophagus, it is important to have the patient swallow. Knowing a depth for how far the tube is to be placed, is essential also. 27. The two types of preparations administered most commonly by the nasogastric tube are liquids and pureed foods. 28. In the event that Jill is to receive IV antibiotics at 2000 hours but has not received them and it is now 2020 hours, it is necessary to simply skip this does and make sure that Jill receives the medication at the next allotted dosing time. 29. Four ways to be an advocate for my patient are as follows: I would make sure that any expression of pain was immediately addressed by being presented to the attending physician. I would make sure that my patient was fully aware of their diagnosis and treatment. I would make sure that my patient was aware of their care upon leaving the hospital and of the details of their follow up care. I would lastly protect my patient’s privacy to the fullest. Works Cited: British Broadcasting Network, (1991) “Mental Health”, retrieved from website at: http://www.bbc.co.uk/dna/h2g2/A646148 ----------------, “The Mental Health Act“, (1983) retrieved from website at: http://www.bbc.co.uk/dna/h2g2/A646148 Read More