Collaborative Care for a Patient with a Mental Health Disorder vs Patient With a Medical Disorder - Essay Example

The Comparison of Collaborative Care for a Patient With a Mental Health Disorder versus a Patient With a Medical Disorder in the Acute Care Setting Student’s Name Professor’s Name Nursing Essay April 8, 2015 Introduction Healthcare professionals are charged with promoting the health of patients, which may involve the management of mental or medical disorders. In certain instances, it may be necessary to provide both aspects of care to patients. This paper looks at the similarities and differences between the collaborative care for a patient with a mental health disorder versus a patient with a medical disorder in the acute care setting. The medical disorder selected is bipolar disorder while the medical problem is type 2 diabetes mellitus. Part 1 Bipolar disorder (BD) is a psychological health disorder that presents with spontaneous shifts in moods, energy levels, and activities, which in turn impact the ability to perform day to day tasks. The disorder is also referred to as manic-depressive illness. Several factors work together to bring about the disorder. These causes can be anatomical or genetic. Research has shown that certain families are predisposed to having bipolar disorder due to the possession of a certain gene. The anatomic perspective of the development of bipolar disorder shows that there are structural abnormalities in the brain of individuals with bipolar disorders. For instance, similarities have been established through magnetic resonance imaging between the brain development patterns of children with multi-dimensional impairment, bipolar disorder and schizophrenia. These finding implies that the brain plays a substantial role in the development of volatile temperament. The signs of bipolar disorder can be categorized between those associated with manic flare-ups and those related to depressive episodes. Indicators of manic outbreaks include mood alterations such as prolonged periods of excitability and extreme tetchiness. Behavioral changes include rapid speech, impulsive indulgence in risky behavior, restlessness, intense physical activity, having unrealistic expectations, poor sleep and lack of sleep. On the other hand, depressive signs include loss of interest in pleasurable activities, prolonged periods of despair, fatigue, loss of concentration, poor appetite, and suicidal tendencies. Type 2 diabetes mellitus (T2DM) is a metabolic disorder that arises due to the inability of the body to utilize insulin. The condition may be a consequence of insulin resistance or the loss of insulin receptors. It presents with symptoms such as extreme thirst, sudden unexplained loss of weight, fatigue, delayed wound healing and blurred vision. There is a relationship between type 2 diabetes mellitus and BD (Svendal, Fasmer, Engeland, Berk, & Lund, 2012). It has been reported that patients with BD are more likely to develop T2DM than those without BD (Robinson, Luthra, & Vallis, 2013). In addition, T2DM is mainly responsible for cardiovascular complications, which is a leading cause of mortality among patients with BD. The underlying factor is a common pathophysiology connecting the two conditions such as “hypothalamic-pituitary-adrenal and mitochondrial dysfunction, common genetic links, and epigenetic interactions” (Calkin, Gardner, Ransom & Alda, 2013, p. 171). Other possible predisposing factors are the way of life, phenomenology of bipolar signs, and adverse drug reactions. Patients with BD and T2DM have a more difficult sequence of illness and are more noncompliant to therapy. Another link between T2DM and BD is the symptoms and risk factors. BD is associated with symptoms such as depression, which is a risk factor in the development of T2DM (Robinson, Luthra, & Vallis, 2013). On the other hand, certain studies indicate that diabetes has a twofold increase in the risk of depression. The metabolic upshots of diabetes affect the brain, which may trigger depression. The only difference between T2DM and BD is that the former is a metabolic disorder while the latter is a rain or mental disorder. The management of a mental disorder requires more resources than the management of a medical disorder. Mental disorders require the caregiver to be alert and knowledgeable of the emotional changes of the patient, which may at times go unnoticed and can only be discovered when it is too late thereby putting the patient at risk. Caring for a patient with bipolar disorder takes an emotional toll on the caregiver because they have to deal with the volatile moods of the patient. However, when caring for a patient with type 2 diabetes, the caregiver only needs to adhere to the prescribed medication, diet and exercise regimen. In most instances, such measures ensure that the condition is kept under control. Though providing care for any patient is a demanding process, mental disorders are far more demanding than medical disorders. One notable feature of mental health care is the need to restrain a patient especially when they display manic symptoms. The restraint serves to protect the wellbeing of the patient as well as the caregivers. Two issues that may arise for the families and patients when taking care of patients with bipolar disorder include physical injury and emotional turmoil. For example, the caregiver may approach the patient during one of the manic episodes when the patient is in a bad mood. The patient is likely to harm themselves or the caregiver due to the high tendencies of impulsive behavior. Relationships particularly marriages bear the brunt of bipolar disorders, which result in the lack of support, sexual dissatisfaction and marital discord. Part 2 Certain aspects complicate the care of a patient with a mental health disorder and a medical disorder. Therefore, there are certain legal and ethical considerations when administering care to these patients. According to the International Covenant of Economic, Social and Cultural Rights, every individual has a right to the best attainable quality of physical and mental health. Therefore, none of these suspects should be neglected. A registered nurse should strive to ensure that this is the case for all patients under their care, which entails promotion of beneficence, self-sufficiency, esteem for individuals, non-malfeasance and enlightening of all individuals especially those who are segregated, stigmatized and victimized. In the case of T2DM and BD, the nurse should practice within his or her scope. A nurse that is proficient in mental health care should only provide care that is within their scope of practice and vice versa. When the patient requires care that is beyond the nurse’s qualifications, the most ethical and legal action that the nurse should take is to refer the patient to the appropriate specialist. Though nursing care aims at providing holistic care to patients, a nurse should not be pressured to offer services that they are not conversant with. Failure to refer the patient to the required specialist may have adverse effects on the wellbeing of the patient because major medical or mental problems may not be addressed. Although patient rights are a perception that all nurses need to be familiar with, they often become challenging when used in patients going through mental therapy. Therefore, the RN should understand the fundamental rights that mental patients are expected to get to help them attain them and ensure that they are upheld (Cady, 2010). Consequently, the nurse needs to ensure that the health facility’s legal and risk handling players are aware of the legal implications. However, these factors vary from state to state. The admission of a mental health patient to the health facility may lead to the suspension of legal rights such as freedom of movement and choosing daily activities. Patients established to be lawfully ineffectual may also lose their right to manage fiscal and legal matters and make crucial decisions. Therefore, patients receiving mental care are put through limitations on day by day activities that patients with other medical conditions are not. However, some of the legal rights that mental health patients retain include the right to converse with an attorney, communicate through mail, receiving visitors, safety, and the basic needs of life. Confinement is perceived as a form of punishment by patients with mental disorders. Therefore, a nurse should address this concern by educating the patient on the importance of this step and its benefit to the wellbeing of the patient. Only then will the patient be willing to be confined to help them get better. One similarity in the ethical and legal implications in the treatment of patients with T2DM and BD is informed consent (Cady, 2010). As in all forms of treatment, patients should receive information regarding the modality of treatment. The RN should inform the patient about the treatment process, the prognosis that accompanies the therapy, potential dangers and adverse effects, potential outcomes of refusing the procedure as well as alternative treatment options. Thereafter, the patient can make their own decision. However, informed consent may be overlooked in an emergency case when seeking the patient’s opinion leads to the loss of life of the patient. Without proper planning and understanding of BD, it is easy to be bogged down in the bipolar symptoms and concentrate on identifying the symptoms instead proactively managing the disorder. Therefore, a registered nurse (RN) can develop a methodical hands-on management strategy as well as educate patients on handling their symptoms and problems. This creates the need for a structured style for handling appointments. The same approach is mandatory in the management of T2DM to ensure that the patient is well-equipped to handle their conditions. Part 3 The management of T2DM and BD in acute care settings requires the cooperation of various healthcare professionals. For example, depression is one of the symptoms in diabetes whose treatment requires the expertise of mental health professionals such as a psychiatrist, psychologist, or clinical social worker. However, professionals need to work closely with the doctor and nurse providing the diabetes care. This is particularly crucial antidepressant drugs are prescribed to ensure that potentially unsafe drug exchanges are circumvented. In certain instances, a mental health expert that focuses in treating patients with depression and accompanying bodily illnesses such as diabetes may be accessible. The acute care of BD entails the management of symptoms such as aggression, functional disability, suicidal tendencies and marital discord. The professional nurse has three main roles in the provision of interprofessional care. One of the roles is educative. The professional nurse needs to enlighten the patients about their conditions and lead them toward healthy living. For the patient with T2DM, the nurse needs to educate them on healthy diets, exercise, and adherent to medication. The professional nurse can educate a patient with BD on the importance of communication and airing their grievances as part of the management of their depressive tendencies. The other two roles are the provision of nursing care and ensuring adherence to treatment modalities. Adherence to medication regimen and follow-up visits is the most crucial aspect in the management of any disorder. A nurse can achieve this for patients with medical and mental disorders in three major ways. The first way is helping patients who tend to forget to take their medications with a simple but effective way to remember. Items such as alarms, pill boxes as well as calendars may be helpful. It may also be beneficial to simplify the dosing of drugs. The second way is to provide the patient’s medication in small doses such that the patient will be required to return to the healthcare facility once they run out of their prescription. The third way of ensuring that the patient adheres to treatment and follow-up is to obtain the patient’s contacts and call them on or before the due date of the appointment. A simple phone call may go a long way in ensuring that a willing but forgetful patient visits the hospital for a follow-up assessment. Another effective way of ensuring adherent to treatment and medication is patient education. A patient who understands their health status and the importance of professional care for their health condition is likely to take the personal initiative to ensure that he or she does not skip a drug dose or miss a hospital appointment. Patient education also involves enlightening the patient on the consequences of missed doses or appointments. The RN can evaluate the efforts of the interprofessional team by assessing the areas of a patient’s need that have improved or retrogressed. This can be achieved during the physical assessment of a patient in a hospital setting. For example, a diabetic patient who displays depressive symptoms even after several visits to a psychologist or psychiatrist is an indication that additional measures or modifications to the patients’ treatment regimen are necessary. In an acute care setting, taking care of a diabetic patient involves the restoration of normal fluid and electrolyte balance as well as blood sugar levels. Hyperglycemia, diabetic ketoacidosis and hyperglycemic hyperosmolar state are the key causes of emergency hospital visits in patients with T2DM (McNaughton, Self, & Slovis, 2011). On the other hand, suicidal tendencies and aggression are the causes of emergency hospital visits in BD. The aim of treatment is to restore the patient’s normal state of mind to avoid accidents, violence, physical injury and incarceration. Conclusion Nursing staff need to understand the similarities and differences between mental and medical disorders, as well as their interrelationships, in order to mount appropriate interventions. Additionally, patients need to cooperate in their treatment by providing their health providers with vital information. For example, diabetic patients who develop depression and patients with BD who develop diabetes need ensure that their health care provider is aware of all their medications. References Cady, R. E. F. (2010). A review of basic patient rights in psychiatric care. JONAs Healthcare Law, Ethics, and Regulation, 12(4) 117-125. Calkin, C. V., Gardner, D. M., Ransom, T., & Alda, M. (2013). The relationship between bipolar disorder and type 2 diabetes: more than just co-morbid disorders. Annals of Medicine, 45(2), 171-181. McNaughton, C. D., Self, W. H., & Slovis, C. (2011). Diabetes in the emergency department: Acute care of diabetes patients. Clinical Diabetes, 29(2), 51-59. Robinson, D. J., Luthra, M., & Vallis, M. (2013). Diabetes and mental health. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Retrieved from http://guidelines.diabetes.ca/browse/Chapter18 Svendal, G., Fasmer, O. B., Engeland, A., Berk, M., & Lund, A. (2012). Co-prescription of medication for bipolar disorder and diabetes mellitus: A nationwide population-based study with focus on gender differences. BMC Medicine, 10,148. Read More