Sarah's Need for Nursing Care - Essay Example

Introduction of Case The aim of the essay is to understand the condition of bipolar disease in context of Sarah case and develop a nursing care plan and develop nursing intervention and rationale behind this. The context of the essay is Australia. The Mental State Examination and the Nursing Care Plan. Are the different strategies that will be discussed in the essay. The World Health Organization has identified health as a condition that can be stated as not merely the absence of disease (“World Health Organization”) but as a state of physical, social and mental well being. The people who have been diagnosed with incurable diseases like HIV, Heart disease (“Horowitz C,2004”) are being treated by professionals from medical field through. Bipolar disorder is a condition or illness that is characterized by frequent changes in the mood. The patients experience conditions in which the mood is elevated or mood is depressed and both these periods will separate by period of mood which will be normal. (Lehne, 2004, p. 321) .The bipolar disorder can be termed as a condition of episodic illness. (http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=671829) Bipolar disorder is a controllable disease that can be treated if diagnosed properly. The bipolar disorder is not gender specific and may display a genetic link. The bipolar disorder has been seen to affect the lives of other family members negatively like spouse and other related members. The bipolar disorder can be seen as maniac depression that can bring forward change in mood, thoughts and behaviour. There has been period of extreme high or mood elation- the phase of mania interspersed with periods of extreme low- depression, and periods of normality. ( http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=671829) In the high period of the disease, it has been found out that the patient may show increased self awareness and self confidence often bordering on grandiosity. The period of the low behaviour has been shown to have diminished energy and increased likelihood of withdrawing from social interactions.( http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=671829) There is a belief that the patient with bi-polar is four times more disabled than a general patient.(“Bipolar mood disorder”).There has been research study reports that has suggested that bipolar disorder mood patients has experienced a breakdown of relationships.( Highet N, McNair B).It has been found out that bipolar disease has been affecting each patient differently. There has been lot of studies that has shown the relation between stress and personality disorders like depression (“Miranda J, 1992”), attitudes that can be termed as dysfunctional (Olinger L, Kuiper N, Shaw B, 1987), low self esteem (Hall L, Kotch J, Browne D, Rayens M, 1996), self complexity (Linville P, 1987), and the thought competence plus a sense of humour (Nezu A, Blisset S, 1988).The bipolar disorder can cause an case of disruption to sleep (Rasmana R, Bebbington P,1995) and hypomania(Malkoff-Schwartz S, Frank E, Anderson B). Nursing care plans are meant for meeting the clinical nursing situation. The nursing care plans are usually organized to meet the nursing process that has happened after the diagnosis has been met. The nursing plans are usually based on the psychiatric disorder ,clinical behaviour and clinical problems. The aim of the essay is to prepare the nursing plan for Sarah. Mental State Examination The Speech factor of Sarah can be accessed through decreased rate of depression, the continuity of the speech, the flight of ideas that Sarah has displayed at the time of conversation.( http://www.scribd.com/doc/10995927/Mental-State-Examination) Sarah should be accessed on the facial expressions, the movements, general appearance and the social interaction and that can be placed under the appearance factor.( http://www.scribd.com/doc/10995927/Mental-State-Examination) The mood of the Sarah should be accessed on the basis of the recurrence of the mood and whether Sarah requires lifetime diagnosis or not. The patient can be accessed on the thought process of committing suicide. The knowledge about the patient about the illness should be understood in detail How would you describe the frequency of mood? It is very important to understand the role of stress in the case of Sarah. When Sarah reached the age of 37, her father passed away. Sarah had been close to her father and could not take death lightly. Sarah had the guilty feeling of not being good to her father or in other terms not a good daughter. Sarah had a period of high energy that lasted for three weeks after the death of her father and she had problems in sleeping. What was the information from the family? Sarah would stay awake all night cleaning the house. Sarah was bright and self confident during this period and Sarah had high sexual energy during these times. Sarah then had a down period that lasted for one week when she complained of a exhaustation and slept for long periods.The periods of high energy followed by low energy and the in between normal periods was occurring near the anniversary of Sarah’s father’s death. Sarah was having extreme mood swings from depression to sadness that can be found related to her approach to her father’s death and elation and excitement that can be said to relate to her high energy level in work and with sexual activity with her husband. There were mild to severe attack in the form of Sarah being confined to bed.(“ The Facts: What Is Bipolar Mood Disorder?”)There has been report that the disease is attributed equally to environmental and genetic factors when it comes to bipolar and Sarah case points out to environmental factors. What was the knowledge about the disease by the Patient or what was the answer to the question “What was worrying Sarah”? The common trigger that can be found here in Sarah case is the family problem and that too of the death of her father. The case with Sarah was that she was unable to identify the factors that may have been responsible for triggering the illness. That can be found out by the fact that Sarah had been showing the behaviour when she was under stress at work or near to the anniversary time of her father’s death. That can be termed as the period of relapse of illness in the case of Sarah. What was the role of the family once disease has been diagnosed? The role of the community to the case of bipolar disorder has to be understood well .The real case here is the role of husband to the cause of Sarah’s illness or relapse. Sarah initially had trouble in assessing her condition and with pressure from her husband she was willing to seek medication. There have been many false starts and fighting before the medication stabilized the condition of Sarah. The role has been supportive from the point of husband to Sarah, though there was some indifference when it came to taking her medicine. The moment Sarah was able to understand the effect of bipolar disorders, she had a stabilizing role as she took the medicines correctly and she was moderately successful in what can be termed as her comeback. Sarah was missing the highs and the lows of her disease but adjusted well. The understanding of the illness should be followed by the need for taking medication and in this case of Sarah, she had been reluctant on accepting or acknowledging her state of disease and even when she understood it, she had been initially reluctant in taking medication. The Nursing Care Plan should be working out strategy of what will be the ideal solution for Sarah. The Nursing Care Plan should be working out a method by which Sarah would understand more of the disease .It can be from any reference journal or medical publication. Sarah’s basic needs have to be protected and in this case she has been protected economically as she has got her job back. Sarah has to be protected from hyperactive behaviour that had led to stress in the job area and that had led to the dismissal of the Sarah and turmoil in the family relationship with the husband. The role of husband in supporting Sarah has to be developed and in this case it has been seen that the husband was taking the initiative to take Sarah to the doctor. Once medication was started, the husband forced Sarah to take it on regular basis though she started with false starts. The supporting facility has to be taken forward in the case of Sarah. The balance between rest and activity has to be addressed in the case of Sarah. Sarah ,when she had illness where she had high peak of energy and less amount of sleep and in the low energy level period she had more sleep. This has to be addressed in the plan as Sarah should be taking enough rest after activity. The process of Nursing care plan The Nursing Care plans will be developed based on assessment of coping, self care activities, self esteem and suicidal tendencies. The care implementation plans will focus on addressing each of these issues based on the specific needs of each person.( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) The NCP plans will broadly include( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Provide a safe environment for the client with a focus on ensuring physical safety of the client and addressing the risk of self inflicted damage( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Assess the potential for suicide. Clients with bipolar disorder may swing between depressive and manic episodes and it is possible that suicidal tendencies flare up during the periods of depression. Mood elevation, on the other hand, may lead to feelings of grandiosity and invincibility and increase the risk for self damage. ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Reorient clients to person, place and time through repeated reinforcements. ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Restrict rumination and encourage interactions with the clients to be rooted in reality. ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Spend time with the client( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Try to limit new contacts by having the same personnel interact with the client. Besides introducing familiarity and trust, this will address the inability of the client to respond to many new people. The number of people interacting can and should be increased once the client improves so that dependency is reduced. ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Interact with the client in moderately cheerful voice; not too loud or silent. ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Observe and record the clients food and fluid intake ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Provide adequate nutritional supplementation Provide the client with their own grooming material like clothes and encourage clients to groom and be presentable. Maintain a routine for grooming, dressing and hygiene. Encourage physical activities but provide adequate time for rest. Provide a nighttime routine Do not let the client spend most time in bed during the day Encourage the client to spend time with staff Give the client positive feedback for interactions Stress that the client should do things to feel better rather than wait to become better before doing things Provide simple activities that can be finished easily and quickly Provide honest praise for accomplishing tasks even if they appear small tasks Check the client at frequent, irregular intervals. Nursing Intervention and Rationale behind it ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) Intervention Rationale Safe Environment The patient has to be provided safe environment as the risk of self inflicted damage is high Reduce the suicidal tendency The patient may be showing suicidal tendencies during the change in the mood and can cause self damage. Limit the new contacts This is done to ensure that client will have more trust and familarity.This can be changed the moment the condition of the client improves. Give positive feedback Encouraging the client for small tasks may help the client to improve his or her condition. The client will be encouraged to spend time with feel good about things they can do Not allowing the patient to spend more time in bed Can increase the physical activity of the client Provide a night time routine The patient Sarah was having trouble in sleeping during the high time depression. That should be changed as fast as possible. ( Lippincott"s Manual of Psychiatric Nursing care plans by JUDITH M SCHULTZ AND SHEILA L VIDEBECK,pp.203) The Process of Queensland Plan for Mental Health The fact that mental disorders have been the largest cause of disability in Australia has to be understood and the figure has reached the 30% of the non –fatal disease.( “Queensland plan for Mental Health 2007-2017") The vision of the Queensland Plan for Mental Health (2007-2017) is that it will facilitate the access to a comprehensive mental health system that will be in recovery mode and the aim will be in providing a range of services that the mental health and well being is promoted. Steps will be taken to prevent mental illness and health problems that can be identified as mental. The impact of mental illness on the family, community and the person will be reduced under this plan. The recovery and resilience will be provided in such a way that people can participate meaningfully in a society. .( “Queensland plan for Mental Health 2007-2017") The mental health plan has to be developed in such a way that the supportive role of consumers and family members will be encouraged and this has to be carried forward to consumers, family members in such a way that the specific need of the patient is understood and mental health care is taken forward.( “Queensland plan for Mental Health 2007-2017") The recovery oriented services is crucial under this plan and that has serious implications in the life of the mental patient and in the family of the mental patient. Here, in this case study that involves Sarah and her husband, Sarah should have improved capacity to lead a life that is not dominated by illness. It is a case of helping Sarah function in higher levels despite her mental illness. Sarah will be able to come to terms with her illness and she will be moving forward with it in confident manner. The potential for growth within the individual has to be focussed upon and individuals with mental illness are part or active participants of recovery process. The ability of Sarah to access employment opportunities has to be seen from this context and forming of social relationships. Sarah had a job at the car dealership and that was lost when the disease was at its peak. Sarah had got back the job once she started medication and she was moderately successful or can be considered as average. The improvement was that she had been going through phases of high level of energy to low level of energy due to her illness. (“Queensland plan for Mental Health 2007-2017",) To reduce the mental health problems and mental illness, the role of sectors of economy like the housing, education and training, the role of the community in supporting it and the police is very crucial. (“ Queensland plan for Mental Health 2007-2017",)The role and responsibility of every sector in promoting the mental health of the whole population is very crucial.(“Queensland plan for Mental Health 2007-2017",) Six principles of Queensland plan in short form. Everyone participating together, with the path of recovery, with the social inclusion, with the partnerships, with the promotion of preventing early and intervening early and evidence based. .( “Queensland plan for Mental Health 2007-2017",) Conclusion The case of Sarah would have not become complicated if it was found early. Sarah had problems of depression at the age of 35 and had if that was treated early Sarah would have faced the situation her father’s death in a new perspective. The absence of that meant Sarah had to take medication by carrying the disease for five years. 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Queensland Goverment,2008,“The Facts: What Is Bipolar Mood Disorder?”,Viewed on May 13,2009,retrived from http://www.health.qld.gov.au/mentalhealth/abt_mental/facts_bipolar.asp 2008,"Queensland plan for Mental Health 2007-2017",viewed on May 13,2009,retrived from http://www.health.qld.gov.au/mentalhealth/abt_us/qpfmh/08132_qpfmh07.pdf Read More