Complex Nursing Practice I Assignment Sample

• Subject Name : Nursing

Case Study: Bernadette Cook

Write an introduction to the case study and state the focus of your assignment.

Bernadette Cook is old woman of 50 years and is suffering from Bipolar affective disorder (BPAD). She currently lives with her husband. Bernadette was afraid that people trying to kill her. The reason of afraid is that she has stopped her medication for BAPD. As she thinks that, the medication is causing some metabolic syndrome such as high blood pressure, excess fatty, overweight, and mood swings.

The assignment will elaborate the mental and physical health of Bernadette. It will highlight the detailed mental state examination (MSE) components, the potential, actual risk associated with mental state of Bernadette. It will also provide the insight on health care plan required for person suffering with complex health issue. the assignment highlight the interventions associated with the person suffering from BPAD and what rational one should made to safe her/his life. It elaborates the potential key things which need to be take care of by healthcare provider, family member, or registered nurse.

Part 1:

1.a) Using information from the video, describe Bernadette’s mental state by completing the following components of Mental State Examination (MSE).

The Bernadette’s MSE detail are as follow:

Appearance: Dishelved appearance was found whih suggest that person is suffering from BPAD. Unkempt appearance determines depression, psychotics, and mental disorder with unusual characteristic tone

Mood and affect: Bad mood with lesser eye contact, full of depression, anxiety, and fear of society with distressed feeling of moving out

Though content: Bernadette look like anxious, obsessed, with homicidal thoughts

Cognition: Lack of cognitive ability, lack of stability, and consciousness. She also lack orientation of time, person, place and memory.

Insight and judgement

The above MSE examination determines that the physical, mental, and emotional state of Bernadette is affected. This ensures that she is suffering from BPAD. Her dyspathetic, irritable, angry, and apathetic mood determines that she is suffering from depression and shows less emotion altogether. The bipolar depression symptoms include sleep paterns, apetite change, weight gain, less energy, and loss of libido. Other than this, she also shows a sign of low mood, anhedonia, lack or lesser concentration, worthlessness feeling, and mood variations.

Her style also reveals the appearance of comorbidity. This highlights the development of anxiety disorder. This relates with the development of obsessive and compulsive disorder, anxiety, panic, social phobia, psychosis, and rapid cycling of moods.

It can also be seen from video that she feel abnormally and persistently happy sometimes. Her behaviour swings different at different times as if sometimes she is impulsive, angry, angry, abnormal, impulsive, irrational and restlessness.

From the above mental state examination, it can be concluded that she is suffering from BPAD and the behaviour she is showing is because of her diseased condition. BPAD is a complex psychoogic disorder, which severely affect the mood swings of person and ultimately cause the person to enter in the mania state. As discussed above, the symptoms associated with the disease are anorexia, depression, low mood, anxiety, guilt, lack of sleep, decreased appetite, and hopeless, sluggish, and irritable personality. However, Bernadette was also angry because her psychiatrist does not tell her about the risk associated with mediations s they contribute to the metabolic syndrome and thus she quits off her medicine. This quit off result in mood swings and also generate a feeling of loneliness and social phobia as she thinks that her husband or any other Peron nearby will kill her.

Regular medication and diseased condition are responsible for the development of such characteristic. The medicine have the side effects of developing metabolic syndrome and responsible for degraded behaviour. However, with proper healthcare, proper medication and family support, she can come up with makeover. There are various way through which she can develops a good and healthy life ahead. These ways and interventions includes cognitive development, patient-centric training, rehabilitation therapy and family-oriented health.

1.b) Define bipolar affective disorders and describe any three symptoms that were displayed by Bernadette in the case video.

Bipolar affective disorder is a mental health condition, which causes excessive high mood swings (hypomania) and lower mood swings (depression). The disease is also known as manic depression. The symptoms of disease vary from person to person. The mood swings can occur multiple times or rarely per year. The duration of episodes is highly variable between patients and typically depends on the time the patient suffering from disease (McCormik, Murray, McNew, 2015). It is a common and disabling disease is a severe psychiatric disorder. The treatment inputs associated with the disorder includes medical integration, psychological and psychosocial (Ayano, 2016). The disease is equivalently occurs in men and women. It is caused by several biopsychosocial factors such as genetic, neurochemical, and abnormalities (Ayano, 2016). Other than this, the external psychologic factors influence the degree of disease, these includes social, environmental, political, and others.

The symptoms associated displayed by Bernadette in video are as follows:

• Episodes of depression, anxiety, and eating disorder habit

• Mania or Hypomania condition, which causes the mood swings of Bernadette. This further made her impaired judgement, distracted, euphoric, risk-associated behaviour, and pressurised speech

• Psychosis that cause made her unable to think and differentiate fantasy and reality. This causes her to suffer from delusions, hallucinations, temper tantrumps, aggression, and reckless behaviour.

• Other characteristics which are found in her behaviours includes fatigue, difficult remembering, insomnia, hopelessness, pain, sadness, underperformer, different eating patterns, and listlessness

1.c) Identify three actual and/or potential risks associated with Bernadette’s mental state.

The potential risk factors associated with Bernadette’s mental state includes:

• Mental comorbidity: BPAD affects the medical, mental, and psychiatric condition of person. Factors such as genetic, hereditary, environment and socioeconomic-lifestyle of person that is responsible for the development and progression of disease (Rowland, Marwaha, 2018). Comordibity result in development of migraine, obesity, hypertension, head internal injury, trauma, and stigma. Similar, Bernadette is suffering from mental comborditiy as she fears that someone is trying to kill her. This nature of fears is a result of mental depression, loneliness, mental illness and mental comidibility. If the things continue she will develop sever comordibity health issue.

• Manic or Hypomania: Mania or hypomania is some of the mental illness condition, which varies in degree (BPJ). Manic is condition, which describes abnormality, and irritable and severe mood swings. The severity of these ill effects continues and can increase due to medicines, drugs intake, behaviour, and smoking. Hyomania is a condition, which derives similar symptoms of manic but with lesser degree. It is different form mania i context that the patient feel positive and highly productive in hypomania condition than mania condition. Bernadette develop hypermania condition is in high-risk phase to develop full manic episode. She has develop deteriorate mood swings due to her increasing weight and because her psychiatric not informed her about the risk of metabolic syndrome associated with the medicine she is taking.

• Cognitive impairment: Cognitive impairment and dysfunction associated with BPAD patient. The cognitive impairment along with the disease’s remission period determines the process of identifying and treating the disease. The cognitive impairment results in neurocognitive development and dysfunction. It effects the patients psychosocial outcomes and beliefs (Sole et al, 2015). Bernadette is at higher risk of developing cognitive impairment as well. Some of the factors associated for the development of cognition impairment are psychotic symptoms, depressive symptoms, pharmaceuticals treatment, chronicity of disease (BPAD), and bipolar diagnostic subtype. The impairment degree and variability depends on the stage of BPAD. However, the impairment effect can be reduced using cognitive therapies, lifestyle, social activates, and diet plan. These factors not only boost the cognitive development of patient but also add positivity around her.

1.d) Formulate a nursing care plan to support Bernadette achieve her mental health recovery. This care plan needs to reflect your level of knowledge and understand about the care of a person under the Mental Health Act 2014.

Meta analysis recommended that nursing intervention, care, and support act as adjunctive therapy in medical treatment of patient suffering from mental health. The nursing processes determine the systematic, efficient, rigorous, planned, and thorough clinical decision. The decision follow patient centric approach to stimulate and identify the major challenges. In the paper published by Goncalves, Sequeira, & Silva (2019), it was opined the different intervention categories adopted by nurses for the treatment of mental health patient. They adopt surveillance, diagnosis, evaluation, information, implementation, standardised language and objective intervention. The study reveals that with the adoption of this intervention, there is a good nursing care towards psychiatric and mental population health. They also state that with the improvement of nursing informatics system (Goncalves, Sequeira, & Silva, 2019). The ursig care plan incorporated are as follow:

• Check for the mutilating behaviour in Bernadette. Types, frequency, and stressors preceding behaviour also incorporate in the daily plan.

• Explore with Bernadette’s feelings with respect to self-multination. The feelings include is to gain control over others, to fell alive through pain, a feeling of sef-hate or guilt.

• Make her surrounding such that she is able to develop socially appropriate behaviour. This can be achieve by creating safe environment, improve her self-esteem, and meet her physiologic needs.

• Prepare her diet chart with frequent high caorie fluid intake that will prevent the risk of dehydration

• Regular physical exercise as it decrease tension and will give a mental focus to her

• Proper medication that helps in reducing mood swings, depression, and seizures.

• Develop trust with Bernadette and maintain safe environment around her, make her to feel as calm and comfort demeanour.

Part 2:

2.a) Using the information from the video, identify the actual and potential physical health issues that is associated with Bernadette. Provide a rationale for each of the physical health issue you have identified.

• She suffers develop unusual activities such as sleep loss, impaired concentration, talkative, irresponsible behaviour, lesser social connect, shy, and impaired concentration.

1. Rationale - these symptoms are normal and many people develop these kind of symptoms who are suffering from mental disability. For sleep loss, sleeping pills are provided so that she can have proper sleep. Moreover, to develop physical and mental strong, I made her to have psycho-education trainee. The psychological trainee help her to attain trust and self-confidence.

• Obesity: she gained too much weight, has gain excess fat around her waist and high triglycerides content in body. Her weight was over the weight recorded as per BMI calculator.

1. Rational – the weight gain is a result of the drugs intake. Drugs such as clozapine, olaaine , and other are associated with body weight gain (Bernateins, Rabideau, Gigler, Nierenberg, Deckersbach, & Sylvia, 2016). To overcome the weight problem, I recommend her to take regular physical exercise under the supervision of healthcare provider. The weight can also be reduce through good diet intake. Make a proper diet plan with excess fluid and nutrition intake.

• Psychosocial issue: she develop some psychosocial issues as if she thinks that her psychiatrist is trying to kill her, she had also started thinking that people surrounds her is trying to kill her including her husband.

1. Rational- the psychosocial disorder develops due to the pharmacological treatments, which cause the neurobiological change and develop the mental illness (Subodh, Sharma, Shah, 2018). The psychosocial characteristics can be reduced using effective healthcare management training including group therapies, family therapies, and other rehabilitation therapies. Over the time, these efforts help to reduce the psychosocial symptoms.

• Mood swings: Severe mood swing is one of the physical health issue faced by Bernadette, as she has stopped her medicine four weeks before. She was experiencing an intense mood swing that interferes with her daily life and her health.

1. Rational – I will recommend her to have a healthy sleep and eating habits, which help her to stabilise her mood. I will also teach her to monitor her own mood so that she can herself stop the problem before initiation. The proper sleeping pattern, proper nutrition intake , and regular comprehensive mental health evaluation helped her to reduce her moods swing and behave normally

• Metabolic syndrome: she develop many metabolic syndrome characteristics such as weight gain, cardiovascular problem, hypertension, hypertriglyceridemia, and is at risk of developing type two diabetes. Metabolic syndrome is one of the major causes of mortality and morbidity in patient suffering from BPAH (Kartas, Bahceci, Akturk, & Alkus, 2019). The symptoms increased due to side effects of medicine.

1. Rational – the ill effects of metabolic syndrome can be preventing by taking care f her good health. This can be achieved by proper diet, proper rest (sleep), regular medicine without missed and physical activity. Moreover, she must regularly evaluated for weight and metabolic parameters under supportive therapies; this will ensure the check on the metabolic symptoms reduction. Her diet must carry complex unrefined carbohydrates with emphasis of fibre, high-unsaturated fatty acids and low added sugars. The diet and regular checkups help to reduce the metabolic syndrome.

2.b) List the nursing interventions that you would use to conduct a comprehensive physical health assessment of Bernadette. Provide a rationale each of your choice of intervention.

• Meet physiologic needs: i will make sure that environmental stimulation does not intrude with the client relaxation. Thus, I will make sure to provide her with peaceful environment without noise, television, other distraction.

• Simple and proper language: Bernadette have short attention span, so I recommend other nurse to use simple, clear, and easy understand words in front of her. As she face difficulty in grasping the things, so I will break the lot of information into simpler and easy to understand sentences.

• Proper medication management – check for periodic serum lithium levels in sample. This help to monitor Bernadette’s safety towards drug intake, as the drug prescribed can increase the serum lithium level in body. This increase can be fatal too if not maintained regularly. Also, observe the sign of lithium toxicity that can cause vomiting, diarrhoea, tremor, drowsiness, blurred vision, and nausea (Yatham, 2018).

• Promoting motor activities – I will instruct her to mobile herself through walking or exercise, as this will help her to attain confidence and develop positivity around her. The mobility should perform in presence of invigilator or under healthcare practitioner.

• Psychoeducation – With the help of interdisciplinary team, will encourage and activate her to participate in decision-making. Psychoeducation is a long-term observative approach, which enrich the patient care, and make her to fight stigma, guilt self-esteem shielding, and relapses (Velentza, Grampsa, E., Basiliadi, E., 2018). From the paper it was opined that psychoeducation help many patients to improve their social behaviour, prevent them from self-destruction, improve their interpersonal and social functionality, were adhere to the treatment (Velentza, Grampsa, E., Basiliadi, E., 2018).

• Medication Therapy – As a registered nurse, one should review the medication therapy on regular basis. This is to ascertain that whether the discontinuation of medicine required or not (Warrens, 2017). This is one of the most important intervention need to be implement for the patient suffering from BPAD. This addresses the importance of adherence to medication and help to emphasise any potential drug-drug interaction.

2.c) Define metabolic syndrome and identify and discuss any three health promotion strategies that you would use to support Bernadette achieve a better physical health.

Metabolic syndrome is clusters of metabolic abnormalities, which are result of medication; or genetic and acquired circumstances. The symptoms or abnormalities associated with disease include abnormal obesity, elevated blood pressure, dyslipidemia, inflammation, diabetes, atherosclerosis, non- atherosclerosis, and hypertension (Rochlani, Pothineni, Kovelamudi, and Mehta 2017). The metabolic syndrome symptoms can treat by reducing weight and becoming more active. The Mediterranean diet needs to adopt including fruit, vegetables, cereals, whole grains, and nuts.

The diet will help to lower the weight, lower bad cholesterol, blood pressure, and also improve insulin resistance (Nishizawa, & Shimomura, 2019). In the case study, Bernadette, was suffering from BPAD and the medications used in the BAPD treatment causes the weight gain and metabolic disturbances. This is causing her to develop a premature mortality and other risk factors such as endocrine disturbances, deregulations of sympathetic nervous system, and worse behaviour patterns. The key health promotion strategies to achieve physical health support are:

• Physical exercise and psychological trainee: Bernadette suffers from BAPD disorder, and is more likely to develop co morbid physical health condition. To make her physical active, regular review of her physical health is implemented. Cognitive behavioural therapy is implemented which help her to learn to change the negative and harmful patterns and behaviour. Along with this, Psycho-education is done which help and tech her about the illness and the treatment associated with it. The pshycoeducation is done in groups so that the patient is socially is also interacted with other ill patient and help themselves to attain good health and corporate with the treatment procedure (The National Institute of Mental Health).

• Proper and regular medication – Regular medication is provided to Bernedette, which would improve her disease symptoms. The medications for sleep, mood swings, antidepressant, and anti psychotics prescribed to patient suffering from BPAD. These medicines help her to stabilize her mood and take proper sleep, as these will help her in mentally stable state.

• Diet and nutrition intake – Nutrition play a critical role in maintaing mental and physical health of patient. Poor diet effect the cognitive impairment and result in weight gain, cardiovascular risk, hypertension, and other ill symptoms. One study also revealed that proper diet help to restore psychological benefits to patients (Bonnin, et al, 2019). I will recommend her to take a good diet as it will improve the symptoms. She should intake beans, nuts, yoghurt, fruits, tofu, fish, and redwine in her diet. Diet has direct role on influencing symptom severity and thus has a causative role i n treating the disorder. Self-medication, sugary food should also include as they help in reducing the stress-induced cortical level (Lopresti & Jacka, 2015).

Summary and conclusion Provide a summary of the key findings from your case study. In other words, effectively summarise the main points of your assignment. It is not necessary to support the conclusion with references as these are your own inferences or interpretations of the key aspects of your assignment.

From the Bernaddette’s case study, it can concluded that BPAD affecting person suffers a great feeling of consciousness. The person suffering from BPAD develope sign of anxiety, depression, decreased concentration, decrease appetite level, loneliness, self-harm, lower self-esteem, and lower self-confidence. BPD is a long-term condition with episodes of mood swings and other depressive symptoms. Moreover, the treatment associated with the BPAD also led the development of various other metabolic symptoms such as hypertension, diabetes, weight gain, and drug toxicity.

However, with proper medication and patient-centric health care, help the patient to attain their desired health outcomes. As in this case, of Berneddette, with the proper health and care, she become physically active and recovers her from diseased state. Moreover, many therapies implement to provide healthy and positive environment around the patient. These therapies include physioeducation, family-focus therapy, cognitive health therapy, and other routine physical mobility. The adoption of these therapies helps mental or ill patients to know about the disease and allow them to participate in social gathering. The therapies help them to develop interpersonal, trust worth skill, communication, and other psychiatric development.

Similar, with the adoption of management therapies, diet, and proper medication made health practitioner to help Bernatede to resolve her health issues. She will come up with the new and healthy life, which would be devoid of social phobia, mood swings, and depression.

References

Ayano, G. (2016). Bipolar disorder: A concise overview of etiology, epidemiology diagnosis and management: review of literatures, SOJ Psychology, 3, 1-8.

Bonnin, C., Reinares, M., Aran, A. M., Jimenez, E., Moreno, J. S., Sole, B., Montejo, L., Vieta, E. (2019). Improving functioning, quality of life, and well-being with atients with bipolar disorder. International Journal of Neuropsychopharmacology, 22, 467-477. doi: 10.1093/ijnp/pyz018

Bernstein, E. E., Rabideau, D. J., Gigler, M. E., Nierenberg, A. A., Deckersbach, T., Lousia, G. S. (2016). Patient perceptions of physical health and bipolr symptoms: the intersaction of mental and physical health. Journal of Affected Disorder, 189, 203-206

Biomedical and Pharmacology Journal (BPJ) (n.d.). Bipolar disorder: identifying and supporting patients in primary care. Retrieved from: https://www.mentalhealth.org.nz/assets/Uploads/Bipolar-disorder-Identifying-and-supporting-patients-in-primary-care-BPJ-2014.pdf

Goncalves, P. D. B., Sequeira, C. A. C., & Silva, M. A. T. C. (2019).Nursing interventions in mental health and psychiatry: ontent analysis of records from nursing information system in use in Portugal. Journal of Psychiatric and Mental Health Nursing, 1-13.DOI: 10.1111/jpm.12536

Karatas, K. S., Bahceci, B., Akturk, H., & Alkus, F. (2019). Metabolic syndrome in patients with schizophrenia and bipolar disorder in a community of mental health center. Southern Clinics of Istanbul Eurasia, 30, 266-271. DOI: 10.14744/scie.2019.05924

Lopresti, A. l., Jacka, F. N. (2015). Diet and bipolar disorder: A review of its relationship and potential therapeutic mechanism of action. The Journal of Alternative and Complementary Medicine, 0, 1-7.

McCORMIK, U., Murray, B., McNew, B. (2015). Diagnoses and treatment of patients with bipolar disorder: A review for advanced practice nurses. Journal of American Association of Nurse Practitioner, Journal of American Association of Nurse Practitioners, 27, 530-542.

Nishizawa, H. & Shimomura, I. (2019). Population approaches targeting metabolic syndrome focussing on Japanese trials. Nutrients, 11, 1-11.

Rochlani, Y. Pothineni, N. V., Kovelamudi, S. and Mehta, J. L. (2017). Metabolic syndrome : pathophysiology, management, and modulation by natural compounds. Therapeutics Advances in Cardiovascular Disease, 11, 215-225

Rowland, T. A., & Marwaha, S. (2018). Epidermioogy and risk fators for bipolar disorder. Therapeutic Advances in Psychopharmacology 8, 251-269. DOI: 10.1177/ 2045125318769235

Subodh, B. N., Sharma, N., Shah R. (2018). Psychosocial interventions in patients with dual diagnosis. Indian Journal of Psychiatry, 60, 494-500.

The National Institute of Mental Health, (n.d.). Retreived from: https://education.ucsb.edu/sites/default/files/hosford_clinic/docs/Bipolar.pdf

Velentza, O. Grampsa, E., Basiliadi, E. (2018). Psychoeducational interventions in bipolar disorder. American Journal of Nursing Science, 7, 51-56.

Warren B. J. (2019). Moods disorder: management of moods and suicidal behaviour. Reetreived from http://downloads.lww.com/wolterskluwer_vitalstream_com/sample-content/9780781791694_Boyd/Boydch20.pdf

Yatham, L.N. et al. (2018). Canadian network for mood and anxiety treatments and international society for bipolar disorder 2018 guidelines for the management of patients with bipolar disorder. Willey, 20, 97-170

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