Nursing Care for Psychiatric Illnesses - Essay Example

Nursing Care Case Study Introduction The case study is about Robert Jones who is thirty three years old and has had several admissions secondary to psychiatric illnesses. This patient has some problems which make him to be at risk in the future. Firstly, the patient has been on management for psychiatric illnesses for fifteen years but still has episodes of the illness, because of the patient’s inability to take medications. Thus, as argued by Blanchard, (2008, p. 17), the nurse is important in trying to establish what the factors are, which are making the patient not to take his medications appropriately. The patient also appears to be an alcoholic which puts him in a danger of getting addicted. When the patient gets addicted, he cannot take medications properly and in addition cannot take care of his health appropriately. The patient is single and does not have a stable family who can take care for him which puts him at risk because he appears to have no other person who is very close to him to share his thoughts with. This can lead complications such as depressive disorder or even committing suicide. As indicated by Blanchard, (2008, p. 20), the role of the nurse here is to counsel the patient so that he understands the need of having a close person who they can share experiences of life with, regardless of whether in a love relationship or not (male or female). This will also make him avoid the risks which come with a person being in an unstable relationship. These include such things as risks of getting sexually transmitted infections because of having multiple partners (Beech, et al. 2007, pp, 121). The parents and other family members do not live with him which puts him at risk of not being taken care of well. The failure to take medications might be as a result of lack of a person who will ensure that he takes medications as required. Considering that he is an alcoholic, he is likely to have very little concern about his health and thus he is supposed to have a close relative who can help him take care of himself. This is the role of the parents or close relatives in the management of the patient. Therefore, the nurse can as a matter of responsibility, give counseling to the patient’s relatives so that they understand the need of the patient staying with someone to take good care of him. The social worker has the responsibility of following the patient up and ensuring that the parents or the other relatives are seriously taking care of the patient (Blanchard, 2008, p. 21). This rehabilitation will help the patient in two ways: firstly, he will be able to get some money from the job he is doing. This will help him acquire the basic needs and thus make him have less stress from lack of finances. He will be able to work and earn some income for his upkeep. He will not also be a burden to the relatives who currently have to supply him with the basic needs. Secondly, getting a job for the patient will also help in the reduction of the free time for the patient. As a result, it will reduce the patient’s time of engaging in alcoholism in his free time. Getting a job is the social worker’s duty and is an essential part of the management of a patient with psychiatric illness. Due to his alcohol addiction, the patient has to sell some of his clothing so that he can get money to buy alcohol. The nurse’s role is to counsel the patient to make him understand that alcoholism is bad. Other people in the management team are the doctors who will also do some counseling. They can advise the patient to avoid going to places where alcohol is sold and changing friends so that they may not influence him. Other people who will help in the management of the alcoholism are people who are in alcoholic support groups such as alcoholic anonymous. According to Blanchard, (2008, p. 22), these people will give the patient moral support and thus the social worker should ensure that the patient joins such a group. Discussion People suffering from mental illnesses are at risk of getting worse if appropriate care is not given to them. For example, this patient has been on management for the illness and still is being hospitalized for the same disease. It means that there are episodes of the disease which will come up once in a while. This is because of the failure to take medication. As a result, he will still get sick again and will be unable to live in good health without the medication. According to Blanchard, (2008, p. 20), Mental illnesses are usually chronic in nature most of the times and the patient is required to be under chronic medications. If the patient disobeys the medication, he can get sick again. This shows that the people who were doing the counseling in the first place did not do it appropriately. They should have talked with the patient about his condition and the need to take the medications well. However, they seem not to have done well as the patient is always coming back to the hospital. In addition, they should have talked with the relatives and ensure that there is an appropriate person who can take care of the patient before he is released (Blanchard, 2008, p. 22). The social workers should have established the people who can live with the patient and ensure that he takes his medications faithfully. Thus, the aspect of the social therapy seems to be lacking in this patient and this needs to be done to ensure that the patient is not getting back to the problem again. Another issue about the management of the patient is the exposure to the alcohol. The mother gives the patient a lot of money and makes no follow up on the same. This makes the patient to have plenty of money which he can use to buy alcohol and take. As a result, the patient has become an alcoholic which may be the reason as to why the patient is constantly getting back to the sickness; this should stop. The patient should also be investigated for sexually transmitted infections. This is because the patient is at risk of contracting sexually transmitted infection because of the alcoholism and the type of partner the patient has. The patient seems to doubt about the faithfulness of the girlfriend and this poses a significant risk to the health of the patient. The patient should be advised to use protection whenever having sex with the girlfriend so that she will not contract the infections easily. Nursing Care Plan Activity Rationale Time Psychological Therapy To ensure there is adherence and avoid relapse. In addition, to ensure the patient takes appropriate nutrition. From the first time the patient presents with psychiatric illness Social Therapy To ensure that the society takes care of the patient the patient, avoid stigma. At the initial time when the patient presents with the illness Biological Therapy To act pharmacologically on the disorder ion the brain to bring about the normal functioning of the brain From the time of diagnosis to the expected time of recovery or throughout life if it’s a chronic illness. It has been reported by Blanchard, (2008, p. 23) that the management of the psychiatric patients involves three forms of treatment. These include biological, psychological and social treatment. The biologic treatment is the one which involves the use of drugs for treatment of the diseases. These drugs include clozapine and olanzapine (Steele, et al., 1990, pp. 1050). They are chosen depending on whether they are effective in the treatment of the presenting complaints or not; the dose should also be appropriate so that the patient does not get an under or an over dose. According to Street, et al (2000, pp. 972), psychological treatment involves the counseling of the person who is affected so that he or she can easily come back to normal life. The patient is counseled about his or her condition and how to take care of it. In addition any other psychological problem the patient has is identified and the therapist seeks a solution for it. Psychological treatment is an important part of the management of these patients since it solves any other problem in the patient and also ensures that the disease does not present again as the patient is taught how to take care of himself (Morrison, et al., 1990, pp. 34). Social treatment involves the society the patient lives in. in social treatment, the relatives of the patient are made to understand the problems which the patients is going through and thus manage him or her better. If there was a stressor which was on the patient from the society, it is removed so that the patient will not be in that state again. The relatives to take care of the patient are educated on how to manage the patient at home, and the use of drugs and nutrition of the patient. They are also advised on what to do when the patient presents with same symptoms. The social therapy is very useful to use for the long term management of the psychiatric disorders. In relation to the literature obtained, these guidelines were not followed. It is not stated as to whether the psychological therapy was carried out appropriately. From the way the patient is behaving, there is a high possibility that the patient was not adequately counseled and thus was not aware of what should be done to avoid the disease. In addition, the patient still is taking alcohol which might be the one making the patient to always get the psychotic illness. Social therapy also seems to be lacking. The patient does not seem to have a close relative who ensures that he takes medications appropriately. This has resulted in the patient failing to take drugs and thus resulting into a relapse. There is poor adherence to medications which could have been solved by the social therapy and thus good compliance (Blanchard, 2008: 21). Reflection This case study is a good example on how the patients with psychiatric illnesses can be managed. It provides a good learning experience to the students so that they can be able to manage the patient well. Some of the issues here are the use of the psychological and social treatment. These are very important in the care of patients who have some psychiatric illnesses. The duty of the social worker is also considered; he plays a very significant role in the long-term follow-up of the patient. In the case study, the patient was not followed up to ensure that he has a job and that he takes medications. Some of the challenges faced in the management of this patient include the alcohol use and the failure to take medications appropriately by the patient. The patient takes a lot of alcohol which might be a trigger to the psychotic episode. Patients with psychotic diseases are supposed to avoid taking of alcohol so that they do not go back to the same situation they were in. As mentioned earlier, adherence to medications in the psychotic illnesses is important in ensuring that the patient does not get sick again (Gudeman, et al., 1993, pp. 953). Some of the insights got in this case include the learning of the proper care of the patient. The case study has helped in the understanding of how a mentally ill patient should be cared for and treated. Bibliographies List Beech, P., Regn, I., IAN J. & NORMA, B. (2007). Patients' perceptions of the quality of psychiatric nursing care: findings from a small-scale descriptive study. Journal of Clinical Nursing, 4, (2), pp. 117–123. Blanchard, R. 2008, Mental Illnesses: Aspects of Management. Journal of psychiatry: 66, (7), pp. 19-27. Gudeman, E. Shore, F. M., & Dickey, B. (1993). Day Hospitalization and an Inn Instead of Inpatient Care for Psychiatric Patients. N English Journal of Medicine 1983; 308 (13) pp. 749-753 Morrison, E. F. (1990). The Tradition of Toughness: A Study of Nonprofessional Nursing Care in Psychiatric Settings. Journal of Nursing Scholarship, 22, (1), pp. 32–38. Steele, C., Rovner, B., Chase, G. A., and Folstein, M. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. Journal of Psychiatry; 147, (8) pp. 1049-1051. Street, J. S. , Clark WS, Gannon KS, Cummings JL, Bymaster FP, Tamura RN, Mitan SJ, Kadam DL, Sanger TM, Feldman PD, Tollefson GD, & Breier A. (2000). Olanzapine Treatment of Psychotic and Behavioral Symptoms in Patients With Alzheimer Disease in Nursing Care Facilities. Journal of General Psychiatry, 57, (10). pp. 968-976. Read More