Nursing Care Plan for Janet Grey - Case Study Example

Nursing Care Plan for Janet Grey Name: Grade Course: Tutor’s Name: 14th September, 2011 Nursing Care Plan for Janet Grey This is a nursing Care plan for Janet Grey. Nursing care will focus on management of depressed mood, suicidal issues, social isolation and alcohol withdrawal. When planning on how to deliver health care services, priority has to be set on the most urgent issues. In the case of Janet, the most urgent issue is her suicidal thought. Suicidal thoughts in her are brought about by her depressed mood among other factors and so depressed mood has to be dealt with, when managing her suicidal condition. In the plan, the first steps identify the causes of suicidal thoughts and how they can be managed. The second step in planning is setting of objectives. The objective of the plan is to ensure that Janet is treated. Her treatment involves handling four issues: social isolation, depressed mood, suicidal thoughts and alcohol withdrawal. The next step is selecting nursing interventions. Under each issue, the plan describes how she will be treated. Lastly, it has the section describing how evaluation will be done to ensure all the objectives are met. There are four sections of this nursing care plan and these are summarized in the table. THE PLAN Nursing Care Plan Summary Assessment Outcomes Nursing Interventions Evaluation Suicidal thoughts 1. Ensure Janet’s Safety 2. Diagnose and treat the fundamental cause of suicidal thoughts [put on mood stabilizers, Check is the set intervention objectives have been met. Determine those that have not been met and ensure they are met in one way or the other. Depressed mood Give antidepressants Enroll for psychotherapy What results were achieved with the antidepressant used? Does it require any change? Any progress in change of way of thinking and behavior? Compare to the aims. Have the aims been accomplished? If no, find out where the problem is and solve it. Alcohol withdrawal 1. Determine the symptoms and treat them 2. Give supportive care and pharmacologic therapy 3. Monitor progress during alcohol withdrawal Are the symptoms reducing over time? Was the aim achieved? If not, what was the cause of the problem? Develop strategy/strategies to solve the problem. Social Isolation 1. Providing appropriate Social Integration Assess the social integrations’ progress in reducing social isolation and loneliness. 1.0 Management of Suicidal Ideation Janet’s problems The assessment showed that Janet had problems with alcoholism and drug abuse, issues with Social isolation and loneliness, and was a danger to herself. These are risk factors to suicide and so should be dealt with first. 1.1 Nursing Interventions To ensuring patient safety To address the fundamental causes of suicidal thoughts 1.2 Rationale Treatment of suicidal patients or patients with suicidal thoughts requires identification of the risk factors and development of a treatment plan. There are two important factors to be considered when treating a suicidal patient. These are; diagnosing and treating the fundamental cause of suicidal ideation or thoughts and ensuring safety (CITRA, 2011, p. 5; Magellan Health Services, 2008, p. 1 and Carrigan & Lynch, 2003). Ensuring Safety Ensure the patient has a safe environment. Janet has confirmed to the interviewer that she thinks of committing suicide sometimes. Although these thoughts are not lethal, since she has no plans to, but admits to think of it, she is not safe in an environment where she cannot be monitored. She feels like a burden to the family and has very little social support. She therefore requires hospitalization to be safe from endangering herself. She drinks not to wake up, with no supervision therefore, she can do anything to harm herself. A patient who lives alone and has little social support but has less frequent thoughts of suicide may require hospitalization, compared to that with frequent suicidal thoughts and a lot of family support (CITRA, 2011, p. 5). Gliatto and Rai (1999) also note that a patient that cannot make a contract for safety has poor social support and poor judgment, and so should be hospitalized. Another reason why Janet should be hospitalized and be monitored is because of the previous experience and actions. She tried to commit suicide and still feels she should not exist. One of the possible explanations to the attempted suicide although Janet was taking antidepressants is the effect of the antidepressants. Antidepressants treat depression but they also present some risks to some people. They may cause people to have thoughts of suicide or even attempt suicide when the patient starts taking the drug and before the drug starts working. This happens mostly on patients who get agitated. Because of such an experience, Janet should be monitored very closely on her progress when taking any antidepressants. Addressing the Fundamental Causes of Suicidal Thoughts Janet will be put on mood stabilizers, antidepressants, antipsychotics and Psychological and psychosocial interventions. Her alcoholism and drug abuse will be addressed as well as her social isolation and loneliness (Psychosocial and psychologic therapeutic approaches to help her cope with her social problems and psychological problems). Janet has a depressed mood and so requires mood stabilizers. Antidepressants help in treatment of some anxiety disorders and depression. In Janet’s case, the antidepressants will be for her depression. The patient’s problem with Effexor will be determined before giving another type of antidepressant. It is considered one of the safe antidepressants when dealing with suicidal patients compared to the tricyclic antidepressants that have high lethal potential (Gliatto & Rai, 1999). Antipsychotics will help in the management of her slight visual hallucinations. Monitoring the Patient during Treatment Suicidal depressed patients are normally at risk of harming themselves especially during the transitional period of treatment, and so Janet is not an exception. She will be monitored during treatment for any feelings of sadness, low self esteem, hopelessness/unworthiness and feelings of being a burden to the family, at the time when improvements are seen in symptoms like motivation and low energy (Gliatto & Rai, 1999). 1.3 Evaluation This sub plan has the aim of eliminating the risks factors to suicide that Janet experiences and to ensure her safety. Evaluation will therefore determine if such aims have been achieved. She was to be hospitalized and any measures necessary for her safety should be in place. Evaluation will assess the methods used to treat her depression, her progress and any problems arising due to such medication. The same will be done with other treatments and management approaches. Any problems or lack of achievement of aims will be addressed by fresh planning based on the findings. 2.0 Management and Treatment of Depression 2.1 Interventions Janet will be treated for depression and actions include; pharmacologic medication and psychotherapy. 2.2 Rationale Pharmacologic medication involves the use of depressants and this has been explained above. Apart from the antidepressants, she will be put under psychotherapy. This will aim at developing new habits and way of thinking so that her thoughts do not lead to depression. It will help her understand herself, her family and work through the relationship between them. One of the contributing factors to Janet’s depression is the inability to take care of her children and being a burden to her family. Psychotherapy will help her through this among others. Drugs alone cannot help her deal with the thoughts of her real life situation; she needs more than that. She will receive psychological treatment alongside medication and can be assigned a clinical psychologist (NIMH, 2011). 2.3 Evaluation Evaluation will be conducted considering two issues; the patient health status and the effectiveness of the interventions. Evaluation of the patient will help determine if there are any improvements or not, if there are complications and if the patient needs any further care or should be discharged. It will require normal procedures of assessment which will produce the current status compared to the initial health condition before interventions. Any complications developed will be noted and nursing interventions implemented. Assessment will focus on safety, symptoms of depression and daily functioning (Beck, 2011). Evaluation of the effectiveness of the interventions will focus on depressed mood management interventions. 3.0 Management of Alcoholism in the Patient 3.1 Interventions This depends on the symptoms shown by Janet. The goals of this treatment are; to prevent complications, to treat the alcohol withdrawal symptoms and to get the patient to stop drinking. The patient will be under close monitoring for identification of hallucinations or any delirium tremen signs. Alcohol withdrawal symptoms can lead to death especially if delirium tremens occurs (PubMed Health, 2011 and Australian Government, 2011). Treatments include; Supportive Care: This is all about providing a quiet environment for the patient. It could be a quiet environment with precautions against falls and constant supervision; it could include provision of IV fluids in case of dehydration or it could be daily administration of thiamine or multivitamin (Hartsell, Drost, Wilkens & Budavari, 2007 and Myrick & Anton, 1998). Pharmacologic Therapy: This focuses on treatment of alcohol withdrawal using alcohol cross tolerant medications. Examples include Lorazepam, benzodiazepines, Oxazepam and diazepam (Hartsell, Drost, Wilkens & Budavari, 2007 and Kosten & O'Connor, 2003). Plan after Hospitalization: To ensure effective treatment, a proper follow up plan will be developed to ensure self restraint from alcohol even after leaving the hospital. Counseling services should also be included and if necessary, psychiatry consultation if the patient is resistant to treatment (Hartsell, Drost, Wilkens & Budavari, 2007). The patient has to be monitored for medication compliance and for any changes or problems with medication. 3.2 Rationale This is one of the problems that have to be dealt with to ensure Janet’s safety and well being. It forms part of her treatment. She will have to stop taking alcohol and Marijuana that she was used to taking immediately. This is sudden and so symptoms of withdrawal will be expected. Because alcohol is a risk factor to Janet’s safety, she has to stop immediately. Any sudden stop of taking alcohol to an individual who was used to taking it leads to certain symptoms. These symptoms are collectively known as alcohol withdrawal and this has to be managed. Janet takes alcohol every day; she is expected to experience such symptoms. Janet is already at high risk of suffering from alcohol withdrawal and so her treatments should include alcohol withdrawal interventions. Assessment of Janet to find out the signs and symptoms of alcohol withdrawal will be done during the nursing care process. 3.3 Evaluation The last section has to evaluate the intervention to determine its effectiveness in achieving the aim of treating alcohol withdrawal. The patient has to be assessed to determine if there are any improvements or not and if there is need for change of nursing care intervention. Evaluation of the effectiveness of the interventions will focus on alcohol withdrawal management interventions used above. 4.0 Management of Social Isolation 4.1Interventions There are several interventions that can be used to manage loneliness or social isolation among patients. The interventions depend on patient settings, health problems and type of isolation. In Janet’s case, she will be hospitalized for some period of time. During the time of hospitalization, social isolation interventions to be used on her will be from specialists group, for example, involvement with support group for people with depression (Tidy, 2009). When out of hospital, she can be encouraged to participate in community activities with the support of the family. The most important social support needed by Janet now if from her family. As indicated earlier, an individual can be lonely even when in contact with other people. The type of social support must go with the type of social support needed by the patient (CITRA, 2011, p. 5). She and the family will need education on how to deal with her condition to help her improve. 4.2 Rationale Social isolation is feeling lonely or isolated. Or objectively, it could be defined as lacking social contacts or living alone. Janet’s social isolation is due to feeling isolated and lonely. Loneliness can be experienced even if one is in contact with others (CITRA, 2011, p. 5 and Graham, 1995, p. 120). She is the only one in the family who has failed them, she has children that she does not take care of and feels not part of the family. Bringing in the family will be the most important step to helping Janet come out of her loneliness. This combined with psychotherapy will help her accept her family and herself as she is, or have a different view about herself and the family. 4.3 Evaluation Evaluation will be conducted considering two issues; the patient health status and the effectiveness of the interventions. Evaluation of the patient will help determine if there are any improvements or not considering her isolation and if the remedy provided for dealing with her isolation is the right one. It will require normal procedures of assessment which will produce the current status compared to the initial health condition before interventions. Evaluation of the effectiveness of the interventions will focus social isolation’s progress in reducing social isolation and loneliness. References Australian Government, 2011, Guidelines to the Treatment of Alcohol Problems: Chapter 5. Alcohol Withdrawal Management. Retrieved from: http://www.health.gov.au/internet/alcohol/publishing.nsf/Content/33F1F1299AD53EA3CA257693001776BE/$File/tre5.pdf. Beck, J., 2011, Nursing Process in Psychiatric Nursing, Retrieved from: http://www.nursingplanet.com/pn/nursing_process_psychiatric_nursing.html. Carrigan, C. G. and Lynch, D. J., 2003, Managing Suicide Attempts: Guidelines for the Primary Care Physician, Journal of Clinical Psychiatry, 5(4), pp. 169–174. Cornell Institute of Translational Research on Aging (CITRA), 2011, Social Isolation Strategies for Connecting and Engaging Older People. Retrieved from: http://www.citra.org/Assets/documents/Social%20Isolation.pdf. Gliatto, M. F. and Rai, A. K., 1999, Evaluation and Treatment of Patients with Suicidal Ideation, The American Family Physician, Retrieved from: http://www.aafp.org/afp/990315ap/1500.html Graham, K. M., 1995, Addictions Treatment For Older Adults: Evaluation Of An Innovative Client-Centered Approach, London: Routledge. Hartsell, Z., Drost, J., Wilkens, J. A. and Budavari, A. I., 2007, Managing Alcohol Withdrawal In Hospitalized Patients, Journal of the American Academy of Physician Assistants, Retrieved from: http://www.jaapa.com/managing-alcohol-withdrawal-in-hospitalized-patients/article/131004/ Kosten, T. R. and O'Connor, P. G, 2003, Management of Drug and Alcohol Withdrawal, The New England of Journal Medicine, 348, pp. 1786-1795. Magellan Health Services, 2008, Assessing and Managing the Suicidal Patient: Keeping the Patient Safe Adapted from: Magellan Behavioral Health Practice Guideline for Assessing and Managing the Suicidal Patient. Retrieved from: http://www.bcbsnc.com/assets/providers/public/pdfs/SuicideTipsheet.pdf. Myrick, H. and Anton, R. F., 1998, Treatment of Alcohol Withdrawal, Alcohol Health & Research World, 22 (1), pp. 38-43. Retrieved from: http://pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf. National Institute of Mental Health (NIMH), 2011, Depression. Retrieved from: http://www.nimh.nih.gov/health/publications/depression-easy-to-read/index.shtml#treatment. PubMed Health, 2011, Alcohol withdrawal, Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001769/ Tidy, C., 2009, Social Isolation - How to Help Patients be Less Lonely, EMIS. Retrieved from: http://www.patient.co.uk/doctor/Social-Isolation-How-to-Help-Patients-be-Less-Lonely.htm. Read More