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Evaluation of Outcomes
Implementation Plan
“Vulnerability-stress models propose that social stress triggers psychotic episodes in high risk individuals.” It is shown that stress as well as low self esteem can trigger these delusions and hallucination. “As evidence for causal conclusions has not been provided yet, the present study assessed the direct impact of social stress on paranoid beliefs using an experimental design and considered a decrease in self-esteem as a mediator and the proneness to psychosis and paranoia as moderators of the effect" (Kesting, 2012).
Desired Outcomes
Suicide is one that can be prevented with early diagnosis and vigilance. In the case of this patient if it were possible to reach him before he stabbed himself, this harm could have been avoided. However in his current case and with this past history of inflicting self-harm due to these hallucinations and delusions it can be prevented in the future. It is important that the health care provider works collectively with his team to prevent such harm. Unfortunately in certain cases this is difficult and the early warning signs are not seen. “Emphasizing distal preventive interventions, strategies must focus on people and places-and on related interpersonal factors and social contexts--to alter the life trajectories of people before they become suicidal. Attention also must be paid to those in the middle years--the age with the greatest overall burden” (Caine, 2013).
Recovery Model
The 10 fundamental components are:
Mental Health Exam
AXIS I: Bipolar Affective
AXIS II: None
AXIS III: Diabetes type II
AXIS IV: Death of a family member, living alone
AXIS V: Global Assessment of Functioning (GAF) = 21-30
Behavior considerably influenced by delusions or hallucinations OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends) (MacArthur Study, 1992).
Mental Health Exam
Mental Health Exam
Nursing Diagnoses
Nursing Interventions
Caine, E. D. (2013). Forging an Agenda for Suicide Prevention in the United States. American Journal Of Public Health, 103(5), e1-e8. doi:10.2105/AJPH.2012.301078
Levinson, D.F., Umapathy, C. and Musthaq, Mohamado (1999). Treatment of Schizoaffective Disorders and Schizophrenia with Mood Symptoms. American Journal of Psychiatry, 156:1138-1148.
“Lithium.” (2013) Retrieved from Micromedex Application for Android.
MacArthur Study. (1992). Dsm-iii-r axis v: Global assessment of function scale. Retrieved from http://macarthur.virginia.edu/Data/Pdf/gaf.pdf
Kesting, M., Bredenpohl, M., Klenke, J., Westermann, S., Lincoln, T.M. The impact of social stress on self-esteem and paranoid ideation, Journal of Behavior Therapy and Experimental Psychiatry, Volume 44, Issue 1, March 2013, Pages 122-128, ISSN 0005-7916, http://dx.doi.org/10.1016/j.jbtep.2012.07.010. Retrieved from http://www.sciencedirect.com/science/article/pii/S0005791612000699
Mental Health Foundation. (2013). Recovery model. Retrieved from http://www.mentalhealth.org.uk/help-information/mental-health-a-z/R/recovery/
“Navane.” (2013) Retrieved from Micromedex Application for Android.
Recovery model. Mental Health Foundation. http://www.mentalhealth.org.uk/help-information/mental-health-a-z/R/recovery/
Stuart, Gail. Principles and Practice of Psychiatric Nursing, 10th edition. Mosby, 2013.
Swearingen, Pamela L. All-in-One Care Planning Resource, 2nd edition. Mosby, 2008.
Classification
Anti-psychotic
Therapeutic Use
Schizophrenia
Psychotic disorder
Client Education
•Patient should avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness or somnolence
•Instruct patient to rise slowly from a sitting/supine position, as drug may cause orthostatic hypotension
•Drug may impair heat or cold regulation. Advise patient to use caution with activities leading to an increased core temperature, such as strenuous exercise, exposure to extreme heat, or dehydration. Also advise patient to wear appropriate clothing in colder weather
•This drug may cause anticholinergic effects, akathisia, dystonia, extrapyrimidal disease, epithetial keratopathy, retinitis pigmentosa, or nasal congestion
•Tell patient to report signs/symptoms of arrhythmia, myelosuppression, or tardive dyskinesia (jerky muscle movements, tongue thrusting, facial grimacing/ticks, random movements of extremities)
•Patient should take with food to minimize gastric irritation
•Advise patient against sudden discontinuation of drug
•Patient should avoid drinking alcohol while taking this drug.
Possible disturbed body image
Onset: 28 years old on vacation – sudden paranoia
continuous psychiatric evaluations + KROL status
Lost 60 lbs prior to trip in a short amount of time
Prescribed antipsychotic medication
Currently believes there are demons living in his home and feels tormented
Classification
Anti-manic
Therapeutic Use
Bipolar disorder: maintenance therapy
Bipolar disorder: manic episodes
Client Education
•Advise patient to avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness, somnolence, and vision changes.
•Drug may cause diarrhea, nausea, ataxia, hand tremor, muscle irritability or weakness, polyuria, oliguria, dehydration, cardiac arrhythmias, hypotension, seizures, alopecia, or xerostomia.
•Instruct patient to discontinue therapy and immediately report signs/symptoms of toxicity, which may include diarrhea, vomiting, tremor, ataxia, drowsiness, muscle weakness, lack of coordination, giddiness, blurred vision, tinnitus, or large volumes of dilute urine.
•Counsel patient to seek emergency assistance with development of unexplained syncope, lightheadedness, palpitations, or shortness of breath, as these may be symptoms of Brugada syndrome.
•Advise patient to maintain adequate fluid intake, salt intake, and a normal diet, especially during stabilization period.
•Advise patient there are multiple significant drug-drug interactions for this drug. Consult healthcare professional prior to new drug use, including over-the-counter and herbal drugs.
"The accident"