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nsb023 clinical case

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by

Anastasia Jane

on 16 October 2014

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Transcript of nsb023 clinical case

Shirley
37 year old married woman with two children. She has reluctantly agreed to be admitted to the psychiatric unit. Shirley is experiencing an episode of mania.
clinical
formulation

Shirley's
needs

Two Priorities
Safety

Physiological
Nursing
care

Mental Status Examination
nsb023 clinical case
anastasia, klara, tania & zubayr

APPEARANCE & behavior
Mid-30'S, Caucasian, slim, long brown disheveled Hair
Flamboyant
Hyperactive
Grandiose
Rude and judgemental towards strangers
Highly opinionated and invasive of others space
Speech Form & Speech Content
Mildly pressured
loud and lively
Theatrical
Verbose
Repetitive
Egocentric
Erratic and tangential
Mood & Affect
Mood:
Euphoric
Elevated
Cheerful
Irritated
Frustrated and hostile towards strangers
Affect
Range is expansive: characterised by hyperactivity, sleeplessness, euphoria and grandiosity
Inappropriate
Form & Content of Thought
Flight of ideas
Rapid thinking
Extravagant
Easily distracted
Condescending
Delusions
Believes shes a cat walk model
Believes people recognise her from magazines
Perception, Sensorium and cognition
Visual hallucinations
Nil- depersonalisation, derealisation
Alert and orientated
Decreased attention and concentration
Impaired memory
Presenting
Verbally abusive towards son and close friends
Elevated mood, associated with suspected mania
Hyperactive, impatient and displays tangential thinking
At times Shirley's speech is incoherent
Speech is pressured and displays critical thinking of others
Maslow's Hierarchy
1st Intervention:
Basic needs
2nd Intervention: Safety
Short term goal:

Appearance - encourage appropriate clothing within 24 hours
Medium term goal:

Decrease restlessness,
hyperactivity and agitation
within 24–48 hours
Recovery Model
HOPE
Active sense of self
Discovery
Personal
Responsibility
Connectedness
Summary...

any Questions


Precipitating
On set of mania
Absence of husband
Poor medication adherence for (at least 2 weeks)
Erratic and uncharacteristic behaviors
Predisposing
No detailed history
Suspected history of MH
Likely to be diagnosed with bipolar
Husband working away from home (possible onset)
Perpetuating
Lack of insight and poor judgement
Alcohol and smoking abuse
No history of substance abuse
Not slept in over 2 days (Shirley thinks this is normal)
Pharmacological relief may be met with refusal or resistance
Protective
Strong relationship with family, friends and husband
Active member of the community
Volunteer at social clubs
Personal recovery goals through her protective factors
Insight & Judgement
Invariably impaired
Unaware of inappropriate behaviors
Unaware of behavioral changes
Complete denial of illness
Uncharacteristically drinking and smoking
Risk Assessment
Potential for harm to others
Potential for absconding
Potential to cause harm to others through verbal tirades
Potential to self harm- unintentionally
Basic Needs
Dehydrated
Malnourished- low food intake
Sleep deprived
Fluid volume deficit
Considering mind set and behavior
The therapeutic Relationship
Introductory phase of a therapeutic relationship
Introduction
Finding common ground
Dealing with concerns, issues, questions
Structuring boundaries
Building and Maintaining a Therapeutic Relationship
Active listening
Understanding empathy
Individualistic care
Providing support
Being there/ being available
Promoting equality
Demonstrating respect and clear boundaries
Phases of a therapeutic relationship
CULTURAL
SAFTEY

(Happell et al, 2008)
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