Mental Health Nursing II (NSG 221)

Hartley S, Raphael J, Lovell K, Berry K. Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. Int J Nurs Stud. 2020 Feb;102:103490. doi: 10.1016/j.ijnurstu.2019.103490. Epub 2019 Nov 23. PMID: 31862531; PMCID: PMC7026691.

Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. 

From this journal and article can you Describe basic concepts of mental health nursing including delivery of patient care, critical thinking, health education/promotion, nursing process and current issues in psychiatric nursing.

What is Venflafaxine Classification and purpose of use 

What is Lorazepan classification and purpose of use 

David Carter, a 28-year-old male, was admitted 2 hours ago after he became violent with his mother and threw a table at her when she asked him to take his medications. She then called the police, who brought him to the emergency room on an involuntary emergency detention.

David Carter was diagnosed with schizophrenia 10 years ago, and he was stable on his medications until he recently stopped taking them. He had a depressive episode 5 years ago that was successfully treated with venlafaxine. His mother reports that recently he has been talking about his food being poisoned. His mother also reports that he has become more isolated, not going out and always sitting at his computer. She shares that he has been  posting some “weird” updates online. She suspects that he has stopped taking his medications, probably because he believes they are responsible for his weight gain. The medications he has been prescribed for the last year include olanzapine 10 mg and venlafaxine XR 75 mg daily. During his admission, he was alternately agitated and withdrawn, but he did answer questions, although at times inappropriately. He appears to have paranoid delusions, evidenced by stating that he believes people are listening to his thoughts. He has auditory hallucinations telling him that he should not eat the hospital food because it is poisoned. His speech  has loose associations with some evidence of neologisms, and it is difficult to carry on a conversation with him. The patient’s behavior indicates a moderate risk of violence. Preventative measures should be taken. He is malodorous and appears disheveled. He has refused to take a shower.

What is the client & family perception of the illness/admission? 

What evidence indicates that family life has changed?

How do family members seem to be coping? 

What supportive behaviors from family/significant others are evident? 

David Carter, a 28-year-old male, was admitted 2 hours ago after he became violent with his mother and threw a table at her when she asked him to take his medications. She then called the police, who brought him to the emergency room on an involuntary emergency detention.

David Carter was diagnosed with schizophrenia 10 years ago, and he was stable on his medications until he recently stopped taking them. He had a depressive episode 5 years ago that was successfully treated with venlafaxine. His mother reports that recently he has been talking about his food being poisoned. His mother also reports that he has become more isolated, not going out and always sitting at his computer. She shares that he has been  posting some “weird” updates online. She suspects that he has stopped taking his medications, probably because he believes they are responsible for his weight gain. The medications he has been prescribed for the last year include olanzapine 10 mg and venlafaxine XR 75 mg daily. During his admission, he was alternately agitated and withdrawn, but he did answer questions, although at times inappropriately. He appears to have paranoid delusions, evidenced by stating that he believes people are listening to his thoughts. He has auditory hallucinations telling him that he should not eat the hospital food because it is poisoned. His speech  has loose associations with some evidence of neologisms, and it is difficult to carry on a conversation with him. The patient’s behavior indicates a moderate risk of violence. Preventative measures should be taken. He is malodorous and appears disheveled. He has refused to take a shower.
 

How have previous life experiences effected the David Carter’s  perception of the current health problem?

How has life change because of the current health problem

Describe any signs or symptoms that may indicate actual /potential physical/emotional abuse of David carter. 

Henry lawless is a 12 year old African American male who is in 7th grade and lives with his parents and seven year old sister. He was referred to outpatient child and adolescent and family center.

Chief Complaint:

According to the mother," My son's aggressive behavior is out of control."

History of Chief Complaint:

The parents report that Henry has been a good student but in the last six months his mood has been irritable and angry at home, and he has been having physical shoving matches with his sister that end in her crying and the patient being disciplined. He has been easily annoyed by anything his parents say to him, causing arguments with his parents and blaming them for annoying him. His teachers report that he seems more argumentative and disruptive in class. He had one episode at school where he became verbally aggressive with a student in class.

Past Psychiatric History:

Henry's mother reports that her son's behavior was somewhat a problem during early kindergarten. He did not like going to school, would protest, and then become aggressive with the other children, taking their toys, shoving and hitting them if they did not respond to his request.

His mother also indicated that during this time he would be " mean" to the small dog that they adopted and kicked the dog when he walked past him. He would sit in timeout for at least 15 minutes, which would work sometimes but other times he would go back and try to kick the dog. The pattern of behavior became so bad that the parents had to go for counseling to deal with their anger towards Henry. A child psychiatrist diagnosed Henry with attention deficit/hyperactivity disorder (ADHD) and recommended that he be started on a psychostimulant at age 7. His parents were worried that he would become addicted and since his report cards were good they did not start the medicine.

What would be a possible plan of care for Henry should he become aggressive?

What is nursing diagnosis for respiratory and circulation ?