Mental Health Nursing - Consumer-Oriented Health Care of Bipolar Disorder - Case Study Example

Bipolar disorders Name Institution Date The patient in this case may be suffering from a bipolar disorder. The name bipolar disorder is known to describe a set of conditions involving mood swings, with the most severe condition termed as manic depression. This term “manic depression” is used in the description of exaggerated mood swings, energy, and cognition from both extremities which characterize the illness. Many people who suffer from bipolar disorders experience recurrent scenarios of elevated moods and depression (Kilbourne et al., 2009). They tend to experience both the highs and the lows of these states, and at times a mixture of them or sometimes a switch during the day and end up giving a “mixed up” picture of symptoms. Each individual has a different pattern of mood swings which are also unique. Some people develop episodes of mood swings once a decade while others have these mood swings on a daily basis. Bipolar diseases may commence at an early age and may be common in teens in their early 20s. There are other groups of individuals who develop this disorder in their mid to late adulthood. This is known as the ‘late onset’ (Piterman, Jones and Castle, 2010). Mary is 48 years of age and hence, exist the age bracket of mid to late adulthood. Her psychotic episodes are so high. Hospitalization was thus necessary (Godwin, 2009). She depicts typical symptoms of a person suffering from mania and hypomania. These include; inappropriate behaviors, irritability, positive mood, heightened creativity and mystical experiences. Her husband complained of her elevated levels of activities. She does not stop easily, she has no time to eat enough, and she is extravagant is spending money and buy a lot of unnecessary things, she started taking alcohol and talking too much about sex. These are some of the inappropriate behaviors noticed by her husband. At the hospital, the mental health team is keen to notice her elevated mood levels. An overtone is also noted on her grooming and also the body language depicting sexy looks. She talks loud and whatever she says has no sense at all (Piterman, Jones and Castle, 2010). Her heightened creativity is noted when she participates in the crafting activities. She creatively paints her jeans with some wordings and phrases. She even awards the mental health staff with her collage work. She is so positive about things like she claims that she is fine and would like to go home. The also claims that all she wants is to show love to other people. She shows other inappropriate behaviors while she is still at the hospital like fastening only two buttons on her shirt. All these activities and characters depicted my Mary are characteristic signs and symptoms of bipolar disorders. It is therefore evident that she has a bipolar I disorder and the medication recommended by the mental health team “Olanzapine (Zyprexa) 15mg every single day” and the decision of her staying in the hospital setting till the manic episode lowers and her safety assessment assured serves the best intervention for her care (Piterman, Jones and Castle, 2010). Studies indicate that about 1% of Australians may suffer from bipolar I disorder through their lifetime. Gender presents no significant differences in terms of susceptibility to bipolar I disorder. People who suffer form bipolar diseases have atypical 10 to 20 years interval from the first instance of mood disorder to its diagnosis. The period through which the patient is not yet diagnosed and treated may be accompanied by a considerable amount of damage. Damage may occur to the patients themselves or may affect the people around these patients. Couples may separate for example. People with this disorder have higher chances of engaging in alcohol drinking activities. This group of disorder is ranked sixth among the causes of disability in Australia. The actual prevalence of this disorder is however, not yet known in general practice. According to statistics revealed by Bettering the Evaluation and Care of Health (BEACH) (2008), a total of 36 patients out of 3374 patients under general practice proved to have a history of bipolar disorders (Piterman, Jones and castle, 2010). Inaccuracy of these various data is evident and this may relate to a number of factors. The factors may include; failure to diagnose the disorder, incorrect diagnoses of the disorder to unipolar depression, erratic and poor participation of patients suffering from this disorder and availability of comorbid psychosocial difficulties (Kilbourne et al., 2009). Patients suffering from bipolar disorders tend to opt for alternative correction mechanisms to stabilize their moods or eliminate depression symptoms. This may result in problems related to interpersonal relationships between the caregivers and the patients. Cases where the general practitioner is not patient centered may result in the development of these differences. Patients suffering form these mental illnesses also develop the tendency of searching through web sources with the aim of discovering alternative explanations of their conditions. They also end up seeking alternative remedies. These patients are, in most cases victims of negative attitude and fail to undertake motivational discussions during consultations. They also fail to apply the principles of slow behavioral change. Consequently they end up being alienated from the general practice and thus compromise the continued process of delivering care (Piterman, Jones and Castle, 2010). Consumer oriented health care can be viewed in various dimensions. These dimensions may include; preferences, values and believes of the patients. It is also about customizing delivery of care to the patient and ensuring that the process of care giving is culturally effective. Recognition of the patients` preferences tends to change with time with regard to clinical shifts and other conditions. This type of health care delivery can be implemented under various steps which are adhered to with utmost professionalism (McIntyre, Danilewitz and Liauw, 2010). This type of health care focuses on the coordination and integration of health care. Continuity of services is ensured from one clinical setting to the other. Exchange of information is timely and accurate. Effective communication between the general practitioners is a necessity. Patients are also supposed to be educated based on the clinical presentations. Educating patients may involve provision of accurate information which can be understood by the patient easily. This information may focus on the diagnosis of patients, prognosis, better treatment procedures or options. The delivery of this treatment procedures as depicted in the shared information should be at the patient`s consent and preferences as well (Sacristan, 2013). Consumer oriented mental health care also ensures that the patients` physical comfort is observed throughout management of symptoms by experts. This will help patients receives treatment interventions that are pain free and do not cause any form of suffering. In order to achieve this, the mental healthcare staff may offer emotional support to patients. The aim of emotional support in most cases is to help patients ease their fears regarding their mental state, their anxiety through paying attention to the experiences of loneliness, uncertainty, negative financial impacts due to their illness and resulting disabilities. This kind of treatment also accommodates the patients` family and relatives (Marshall, Oades and Crowe, 2010). They are given a chance to take part in the decision making process, giving care, recognition of the patients` needs, potential contributions, and offering them a warm welcome to the health care environment to levels desired by the patient. Successful observation of these objectives is related to healing relationships through which high quality technical skills and interpersonal interactions that are very sensitive occur in way directed the preferences of the patient. These preferences may be in terms of desired levels of participation in decision making processes. Ultimately, consumer oriented mental health care delivery system requires care customization in order to meet the needs the patients rather than the opposite (Sacristan, 2013). Olanzapine (Zypera) is the medication that is commonly administered to patients suffering from bipolar I disorder. The dosage is 10 or 15 mg tablets once per day for adult like Mary. Olanzapine is an antipsychotic drug and has demonstrated broad efficacy in the treatment of manic episodes. Double blind researches have proved that there is a rapid onset of action of the drug in acute bipolar mania. This rate of action has been significantly greater in terms of response when compared with placebo, and a rate of remission of 83.3% in an open label study that lasted for 49 weeks (McIntyre, Danilewitz and Liauw, 2010). This medication is associated with a number of side effects. For instance a patient may experience any of the following side effects; difficulties in swallowing or speaking, stiffening of muscles, tremors, high fever, confusion, sweating, uneven heartbeats, urinating less, fever, body aches, flu symptoms, chills, sore throat, hand swells, unusual thoughts, changes on personality, hallucinations, raised levels of blood sugar, appetite loss, nausea, vomiting, dry skin, upper stomach pains and weight gain. Nursing management of side effects associated with olanzapine (zyprexa) is very important for the patient`s health. This will help in monitoring and minimization of side effects related to this drug. Occasionally, patients are supposed to cancel all their appointments while on medication. Patients are supposed to discuss with nurses symptoms that bother most, the type of medications they used before, the side effects they experience with the previous medication, the current medications, if pregnant, breastfeeding or if planning to get pregnant, if the patient suffers from breast cancer of any of his or her relatives suffers from breast cancer. The nurses should also inquire about the patient`s thoughts. For example, if he or she has thoughts about committing suicide in the future. Patients are advised to avoid smoking, taking illegal drugs or drinking alcohol, exposure to the sun. They should use sunscreens with at least SPF 15 and put on colored clothing with a hat to offer protection to the head and face. Some of the side effects can be minimized by gradually increasing the prescribed dosage. Prescription of drugs like Benadryl (diphenhydramine) may be necessary in the reduction or elimination of muscle stiffness and tremors. Concurrent application of benzodiazepines including (diazepam) Valium with olanzapine may result in lowering of blood pressure or dizziness. Weight gain may be minimized by a lot of exercising and healthy eating such as a balanced diet (McIntyre, 2009). Mary in her mental condition may largely depend on her relatives and other care givers in order to live a normal life. Mary may however, have difficulties in maintaining her marriage because of her inappropriate behaviors which tend to annoy her husband. The risk factors associated with Mary`s mental health state may include; weight gain, smoking, drinking alcohol (which she is already doing) metabolic syndrome, development of diabetes, hypertension and destructive sleep apnea (Fiedorowicz and Palagummi, 2008; Young and Grunze, 2013). The comorbid metabolic syndrome may impact Mary`s presentation of her mental illness and also the response to treatment interventions. Her illness presentation may turn complex with poor response towards treatment. Mary`s baseline weight and BMI should be measured. Laboratory screens on diabetes, thyroid abnormalities and lipid abnormalities should be performed to monitor her physical health. Other evaluations should involve; inquiries on exercise habits, caffeine usage, her eating habits smoking and alcohol drinking. To manage her weight, the mental health team will offer counseling with regard to the type of diet she should consume and the type of exercise that best suits her. The best meals for would be fat (cholesterol) free meals like a lot of vegetables and white meat. She can also consume whole grain meals including wheat. Regarding exercises, aerobics would be best for her. She can also participate in morning jogs which will enhance her blood circulation and heartbeat. Behavior therapies will also serve to maintain her weigh regime. If her weight gain will be related to the drug, alternative medication regime like lowering the dosage would be opted for. Care should be taken so that Mary does not fall a victim of smoking. Otherwise, if she happens to smoke, provision of smoking cessation support, pharmacologic treatment whenever appropriate and counseling will be warranted. Mary`s state of mental health may be associated with an elevated rate of psychiatric comorbidity. According to reports evidenced by her husband and mental health staff, it is likely that she has developed substance use disorders, eating disorders and personality disorders. Assessment of Mary`s mental health state may require knowledge of good psychiatric nursing. An evidence based approach would serve the best intervention in this clinical case. Assessment of the risk factors is very vital. These risk factors may trigger further assessment like the family bipolar history (Youngstrom, Jenkins, Doss and Youngstrom, 2010). The risk associate with mania can be prioritized. These include; the excessive spending of money, excessive consumption of alcohol, disinhibited characters including uncharacteristic sexual behaviors. At a depressed phase Mary may be vulnerable to the following risks for example; substance misuse, she may start smoking, self injury like suicidal attempts, poor self care including taking inappropriate diets; poor hygiene, poor adherence to treatment, disruption of close relationships (she may destroy her marriage) and fears that other people around her may be subjected to a terrible fate. In the event to save her people, homicide may occur. These risk factors warrant assessment of risks of self injury with special attention to suicidal attempts (Youngstrom, Jenkins, Doss and Youngstrom, 2012). During examination, it is important for the mental health staff to inquire on the patients thoughts. Mary may be asked to confess if any suicidal or homicidal thoughts have ever crossed her mind. She can also be assessed on her capacity of making her own judgments as well as decisions. Other factors that may be associated with Mary`s suicidal risk are severity of the disorder and comorbid disorders like excessive alcohol consumption. Managing suicidal Mary`s suicidal attempts may require that the mental health staff ensure she is never left alone, make her make statements involving her to confess that she will stay alive until the next meeting, ask for her opinions on why she should stay alive and comment on the same and give her a vivid explanation of her thoughts. Assessing her physical health related risks may require that nurses check with her eating habits, weight gain and exercises. Mary has poor eating habits, she misses meals, and this might increase the number of side effects related to Olanzapine (Zypera). Her eating habits should be monitored such that she eats a well balanced diet thus avoiding development of diabetes and other cardiovascular diseases that may arise as side effects (Bassett, 2010). Mary may be a victim of a number of health and well being problems which may require critical intervention by the mental health staff to help her live happily. It is evident no interest in seeking medical help. This is common to individuals suffering from bipolar disorders. She has begun a life style of drinking. This raises the chances of being addicted to alcohol and she might as well begin smoking or using other illegal drugs. Alcohol consumption and cigarettes smoking, according to various researches, are linked to the development of metabolic syndrome in bipolar disorder patients (Fagiolini, Chengappa, Soreca and Chang, 2008). Mary may not be exceptional to this and as such she may develop this complication. Alcohol consumption linked to pancreatitis may increase the risk of development of diabetes. Alcohol consumption may also facilitate the development of suicidal thoughts. This is a serious threat to her life and relatives` too. Efforts must be made to ensure she does not get access to alcohol and she should also be monitored at all times so the does not attempt take alcohol or any act of homicide. She has also developed inappropriate behaviors which are a threat to her marriage. She spends more than enough on unnecessary things and also her sexy expressions are exaggerated. This may compromise her marriage and she may become a victim of isolation (Kilbourne et al., 2009). There are other problems which are associated with the type of medication she will receive. These are side effects which may present a lot of difficulties with regard to her health. These risks are a threat to her physical health since they are negative side effects. Apart form being alcoholic and diabetic, she may able become obese as a result of taking Olanzapine (Fiedorowicz, Palagummi & Forman-Hoffman, 2008). The effective nursing practice regarding medication would be to ensure that Mary receives the right medication (Olanzapine (Zyprexa) 15mg every single day) as stated earlier. She is not supposed to skip medication or receive an over dose. Side effects should also be monitored with a lot of care to ensure that she successfully completes her medication until she recovers (Fagiolini, Chengappa, Soreca and Chang, 2008). References Bassett., D.L. (2010). Risk Assessment and Management in Bipolar Disorders. MJA 193(4): S21–S23. Bettering the Evaluation and Care of Health (BEACH) program (2008). Australian GP Statistics and Classification Centre SAND abstract: Schizophrenia and Bipolar disorder in general practice patients. Sydney: University of Sydney and Australian Institute of Health and Welfare. Accessed form http://www.fmrc.org.au/Beach/Abstracts/116Schizophrenia_and_bipolar_disorder.pdf on June 2010. Fagiolini, A., Chengappa, K.N.R., Soreca, I., & Chang, J. (2008). Bipolar Disorder and the Metabolic Syndrome: Casual Factors, Psychiatric Outcomes and Economic Burden. CNS Drugs 22(8): 655-669. Fiedorowicz, J.G., Palagummi, N.M., & Forman-Hoffman, V.L. (2008). Elevated Prevalence of Obesity, Metabolic Syndrome, and Cardiovascular Risk Factors in Bipolar Disorder. Ann Clin Psychiatry. 20(3):131-137 Godwin, G.M. (2009). Evidence-Based Guidelines for Treating Bipolar Disorder: Revised Second Edition-Recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 23(4): 346-388. Kilbourne, A.M., Perron, B.R., Mezuk, B., Welsh, D., Ilgen, M., & Bauer, M.S. (2009). Co-occurring Conditions and Health-Related Quality of Life in Patients with Bipolar Disorder. Psychosomatic Medicine, 71:894-900. Marshall, S.L., Oades, L.G & Crowe, T.P. (2010). Australian Mental Health Consumers` Contribution to the Evaluation and Improvement of Recovery-oriented Service Provision. Israel Journal of Psychiatry and Related Sciences 47(3): 198-205. McIntyre, R.S. (2009). Overview of Managing Medical Comorbidities in Patients with Severe Mental Illness. J Clin Psychiatry 70(6):17-22 McIntyre, R.S., Danilewitz, M., & Liauw, S.S. (2010).Bipolar Disorder and Metabolic Syndrome: An international Perspective. J Affect Disord. 126(3):366-387 Murray, G., Suto, M., Hole, R., Hale, S., Amari, E., & Michalak, E.E. (2010). Self-Management Strategies Used by ‘High Functioning’ Individuals with Bipolar Disorder: From Research to Clinical Practice. Clinical Psychology and Psychotherapy DOI: 10.1002/cpp. Retrieved from http://osot.ubc.ca/files/2010/10/Self-Management-Strategies-Bipolar-Disorder2.pdf on 10/8/2013 Newcomer, J.W. (2009). Comparing the Safety and Efficacy of Atypical Antipsychotics in Psychiatric Patients with Comorbid Medical Illnesses. J Clin Psychiatry 70(3):30-36. Piterman, L., Jones, K.M., & castle, D.J. (2010). Bipolar Disorder in General Practice: Challenges and Opportunities. MJA 193(4): S14-S17. Sacristan, J.A. (2013). Patient-Centered Medicine and Patient-Oriented Research: Improving Health Outcomes for individual Patients. BMC Medical Informatics and Decision Making 13(6): 1-8. Young, A.H & Grunze, H. (2013). Physical Health of Patients with Bipolar Disorder. Acta Psychiatr Scand Suppl (442):3-10. Youngstrom, E.A., Jenkins, M.M., Doss, A.J., Youngstrom, J.K. (2012). Evidence-Based Assessment Strategies for Pediatric Bipolar Disorder. Isr J Psychiatry Relat Sci.  49(1):15-27. Read More