Discussion: psycho-social case presentation

Discussion: psycho-social case presentation ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: psycho-social case presentation Please use the attached samples(2) to complete this assignment.. Create a similar paper with the attached information in the zip file. Discussion: psycho-social case presentation nurs_psycholocical_case_presentation__1_.docx psychosocial_assessment.___1_.docx attachments__1_.zip Scholarly Activity Bowie State University May 1, 201 PSYCHOSOCIAL ASSESSMENT AND PSYCHOSOCIAL CASE PRESENTATION Introduction A.A is a 22-year-old African American man, currently unemployed and admitted to the hospital because he assaulted a jail security during his time at the prison. “I’m here because my mother cast a spell on me, she believes I am the bad thing in her life. I believed this worked on me because the moment I rubbed the body lotion she gave me in on my body I landed in jail the following week” Discussion: psycho-social case presentation A.A is a 22-year-old man who has been diagnosed with unspecified schizophrenia spectrum plus other psychotic disorder and substance abuse psychosis. He stated that “I don’t have a problem like the others such as mood swings, hallucination and suicidal thoughts”. “I’m telling you I am here because of what my mother did to me”. According to him he was using and dealing drugs (alcohol, cannabis and cocaine) and the abuse is what lead him to dropping out of high school and ended up in jail. He stated “I want to be a better person for myself and my mother. I miss being out and having real friends”. When asked how he plans to get better he discussed staying out of trouble and using is medications and try to get a green sticker before the end of the month. (A.A is still on Red sticker). Currently A.A. is experiencing an altered sleep pattern. Medications Benztropine (Cogentin) is an Anticholinergic used to treat symptoms of Parkinson disease and tremors. The side effects are Dry mouth, constipation, difficulty urinating. Fluphenazine is an anti-psychotic medicine in a group of drugs called phenothiazines (FEEN-oh-THYE-a-zeens). It works by changing the actions of chemicals in your brain. Fluphenazine is used to treat psychotic disorders such as schizophrenia. A.A takes 50mg IM every 2 weeks. Side effects are Extrapyramidal reactions (e.g., pseudo-parkinsonism, dystonia, dyskinesia, akathisia, oculogyric crises, opisthotonos, and hyperreflexia), drowsiness, lethargy, weight gain. Trazodone is an antidepressant medicine. It affects chemicals in the brain that may be unbalanced in people with depression. Trazodone is used to treat major depressive disorder. A.A take 50mg po every day. Side effect are Blurred vision, confusion, dizziness, lightheadedness, sweating, and unusual tiredness or weakness Biopsychosocial Assessment data Physical Functions Sleep: irregular sleeping pattern, difficulty falling asleep but feels rested after a night’s sleep or nap during the day Appetite and Nutrition: client on regular diet. No food allergies or food intolerance Skin: tattoos on right arm and neck Elimination: normal urinary and bowel movement Activity and exercise: Insufficient exercise, adequate recreation such as playing ping pong Hydration: follows facility’s protocols in partaking of water breaks Self-Care: client performs most activities of daily living such as bathing, laundry, dressing independently and successfully. Sexuality: unable to obtain information Mental Status Examination General appearance: moderately obese, dressed appropriate to the weather and setting, tidy, calm and relaxed. Orientation: client is alert and oriented to place, time, person and situation Behavior Motor: client is calm, sits in place, maintains eye contact, uncrossed arms and legs projecting willingness to engage in conversation, interact with roommates and staffs Speech Language (content and context, or incoherent): Loud and excessive pressured speech, context of speech is intelligible, client has adequate comprehension when students did their evaluation after their group project presentation, content of speech is fluent. Discussion: psycho-social case presentation Mood/Affect: mood is euthymic, client exhibits good humor, shows interest, has a full range of affect in during the process recording interview. Intensity of affect is broad, emotional response is appropriate for the situation with normal stability. Thought process/content: client has connection with words and ideas, ability to get to the point during a conversation, disorganized thought process Perception Intellect: Has a good perception to his environment, his body and identity. Cognition/memory: client has a good attention span and concentration, client has a good recall and short-term memory, moderate recent and remote memory. Sensorium Insight/judgement: client is aware of his thoughts and mental illness. Client has a fair insight Client has poor judgement in making logical decisions about his goals when he gets released. Stress and coping patterns : Client gets worried about being away from his mum who lives in New York and about the loss of his job as a construction worker. Client handles stress and anger by meditating. Discussion: psycho-social case presentation Risk Assessment : Client has no suicidal thoughts, no suicidal behaviors, no suicidal plans, no family history of suicide, no homicidal thoughts, no homicidal behaviors, no aggressive behaviors, no antisocial behavior and no criminal behavior. Functional Status: Current Global Assessment Function is 63 with some difficulty in occupation, school functioning but generally functions well with meaningful interpersonal relationship. Potential Global Assessment Functioning would be 90 with minimal symptoms of schizoaffective disorder and good functioning in all areas Social systems Community resources, cultural and family assessment: client is an African America and both parents were born in Jamaica and have taken him there. Client was raised bilingual and has a fair Jamaica accent. Client has a good family support from his mother, his father is currently not in his life and he is the only child. New phases Incorporation pre-screened patient last year and found him appropriate for community placement in the community (if he maintains good behavior) Spiritual assessment: Christian but doesn’t practice as much Occupational/economic status: Client is unemployed/ difficulty with living arrangement. Diagnostic data: (Axis) Axis I: Unspecified schizophrenia spectrum plus other psychotic disorder, alcohol, cannabis and cocaine use disorder Axis II: Deferred Axis III: Hyperlipidemia, obesity with risk for metabolic syndrome, constipation, episodic seizures in the remote past secondary to drug abuse Axis IV: Legal issues, Housing problems (unstable housing) and Occupation problem (unemployment), Economic problem (no income) Axis V: GAF= 63 (current), 90 (potential) Possible nursing diagnosis Altered thought process related to schizophrenia as evidence by delusional thought Imbalanced Nutrition: More Than Body Requirements Impaired social interactions related to Self-concept disturbance as evidence by use of unsuccessful social interaction behaviors Powerlessness related to homelessness as evidence by client verbal expression of having no control over self-care, situation and outcome of housing arrangement. Etiology of diagnosis (Schizophrenia) Schizophrenia refers to a group of severe, disabling psychiatric disorders marked by withdrawal from reality, illogical thinking, possible delusions and hallucinations, and emotional, behavioral, or intellectual disturbance. It’s not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder. Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia (Nordqvist 2015). Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t certain about the significance of these changes, they indicate that schizophrenia is a brain disease. Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It’s uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45. Symptoms of schizophrenia in teenagers are common for typical development during teen years, such as: Withdrawal from friends and family, a drop in performance at school, trouble sleeping, irritability or depressed mood, Lack of motivation, compared with schizophrenia symptoms in adults, teens may be: Less likely to have delusions and more likely to have visual hallucinations(Nordqvist 2015). Article meta-analysis Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes Summary Although antipsychotic medications are used largely to treat depression, the risk factors and benefits have not yet been established. In order to establish the benefits and risks associated with taking atypical antipsychotic medications to treat depression the researchers conducted a systematic review of the effectiveness and safety of the drugs. The drugs that were studied were aripiprazole, olanzapine/fluoxetine combination (OFC), quetiapine, and risperidone (Spielmans, 2013). Method In order to conduct this experiment, the researchers used random trials comparing different antipsychotic medications along with placebo for treatment of depression. The researchers were able to identify 14 short term trials of aripiprazole, olanzapine/fluoxetine combination (OFC), quetiapine, and risperidone when conducting their research. This research was conducted in December of 2011 and updated on December 14, 2012. The researchers tried to use date from manufactures clinical trials done in the US by Food and Drug Administration New Drug Applications rather than using published literature. The study lasted for 4 to 12 weeks and all four drugs tested had statistically significant effects on remission (Spielmans, 2013). Discussion: psycho-social case presentation Finding The researchers found that all for drugs with the exception of OFC also had statistically significant effects on response rates. All four drugs showed statistically significant effects on clinician –rated depression. In terms of quality of life and overall functioning the medications showed either no benefit or very small benefit. Risperidone however, showed a very small to moderate effect on quality of life (Spielmans, 2013). Implications The researchers are unware of any other trials conducted involving psychotherapy or lithium, or other treatment strategies such as switching the antidepressant medication initially used for treatment in comparison to using antipsychotic medication. Further research needs to be conducted in order to completely understand the implications of these medications. Although more research needs to be conducted some evidence has found that there has been some improvement in clinician-assessed depressive symptoms, little evidence of substantial benefit in overall well-being, and abundant evidence of potential treatment-related harm. The researcher’s evaluations have provided useful insight that may be helpful to other researchers (Spielmans, 2013). Conclusion It was found that antipsychotic medications are the more useful when treating depressive symptoms. However, although this found clinicians still need to take precautions due to the fact that there are still only small benefits, there is a lack of benefits in compared to quality of life and overall function, and the large amount of evidence of potential harm (Spielmans, 2013). Case study article A study conducted by Billeke et al. (2015) is based on description of social impairment related to schizophrenia that can affect relation of a person. The reason for selecting this article for review is that this article is based on the description of social impairments related to any type of schizophrenia and the findings of this study can be related with different social impairments presents in the case study. According to the researchers of this study, functional outcomes in people with paranoid schizophrenia are the reasons of social impairments. The researchers tested the hypothesis that impairment in social interaction of these patients is related to their prediction about behavior of others and associated neurobiological processes. This study was carried out through electroencephalography on two group; control group with 25 subjects and 20 patients having any type of schizophrenia. The participants of this study acted as proposers repeatedly in a game and participants thought they were playing with computer or other human being. Wavelet transform was used to obtain potential of oscillatory activity of brain. The risk of offer was trial-by-trial correlated with oscillatory activity of a person. The results of this study revealed that control participants adapted offers while playing that shows normal bargaining and learning approaches and on contrary to this, schizophrenic people showed significantly negative behavior in both games( with computer and human). The difference of patient while playing with computer or other human being has demonstrated impairments in social impairment. The concluding remarks of this study showed that impairment in social interaction of the schizophrenic patients is due to emotional maladjustment and while facing any social event. Such change is related to different psychotic symptoms and this study is important as understanding these factors can provide guidance about other therapies that can be used to bring improvement in social functioning and performance of patients (Billeke et al. 2015). These articles apply to A.A because his diagnoses are unspecific but he is at risk for depression and paranoid schizophrenia. Each article assesses different treatment types that may be effective for a patient with some sort of schizophrenia. Based on all the article one can assume that medication is the best treatment. Collaborative care helps the patient but its effects do not continue for a long period of time. If one was do use collaborative care on its own it would only have a beneficial effect for 6 months. Combining it with medications and other therapeutic interventions would be the best option for A.A. Nursing Diagnosis #1: Disturbed Thought Process related to schizophrenia as evidence by delusional thought Goal: Patient will verbalize recognition of delusional thoughts if they persist. Discussion: psycho-social case presentation Expected Client Outcome “Client will. . Patient will develop trust in at least one staff member within 1 week by the end of my shift at 3pm on 04/27/18 By time of discharge from treatment, client’s verbalizations will reflect reality-based thinking with no evidence of delusional or distorted ideation Patient will be free from delusions or demonstrate the ability to function without responding to persistent delusional thoughts. Prioritized Interventions and rationales: Explain the procedures and try to be sure the client understands the procedures before carrying them out. Rationale: When the client has full knowledge of procedures, he or she is less likely to feel tricked by the staff (Townsend, 2011). Nurse will reinforce and focus on reality. Talk about real events and real people. Rationale: Use real situations and events to divert client away from long, purposeless, repetitive verbalizations of false ideas (Townsend, 2011). Nurse will give positive reinforcement as client is able to differentiate between reality-based and non–reality-based thinking. Rationale: Positive reinforcement enhances self-esteem and encourages Repetition of desirable behaviors (Ralph & Taylor, 2014). Nurse will show empathy regarding the client’s feelings; reassure the client of your presence and acceptance. Rationale: The client’s delusion can be distressing. Empathy conveys your caring, interest and acceptance of the client. (Townsend, 2011). Evaluation of Client Outcomes Patient was able to cooperate with nurse since trust was developed as all procedures were understood By the end of my shift, A.A thinking processes reflects accurate interpretation of the environment A is able to recognize negative or irrational thoughts and intervene to “stop” their progression. Nursing Diagnosis #2 : Imbalanced Nutrition: More Than Body Requirements Related to Food intake that exceeds body needs as evidenced by: excess body fat by skinfold, BMI of 32. Goal: client will demonstrate change in eating patterns and involvement in individual exercise program by end of shift Discussion: psycho-social case presentation Expected Client Outcome “Client will . . Client will verbalize food proportions using Myplate pyramid of how much he can eat. Client will express feelings regarding dietary regimen and current weight Client will plan to monitor weight and sustain target weight. Prioritized Interventions and rationales: Carry out and review daily food diary (caloric intake, types and amounts of food, eating habits). (Ralph & Taylor 2013) Rationale: Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. (Ralph & Taylor 2013) Formulate an eating plan with the patient, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, energy, and nutrient requirements. (Ralph & Taylor 2013) Rationale: – A good reducing diet should contain foods from all basic food groups with a focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. (Ralph & Taylor 2013) Weigh periodically as individually indicated, and obtain appropriate body measurements. (Ralph & Taylor 2013) Rationale: Provides information about effectiveness of therapeutic regimen and visual evidence of success of patient’s efforts (Ralph & Taylor 2013) Evaluation of Client Outcomes Goals were met. Client did name three nutrients on the Myplate chart and the amount of food to eat per meal. Goals were met. Client did collaborate with nurse about an eating plan, verbalized age, gender and nutrient requirements Goals were met. Client did weigh himself monthly on a measuring weight scale References Billeke, P., Armijo, A., Castillo, D., López, T., Zamorano, F., Cosmelli, D., & Aboitiz, F. (2015). Paradoxical expectation: oscillatory brain activity reveals social interaction impairment in schizophrenia. Biological psychiatry, 78(6), 421-431. Drugs.com. (n.d.) TrazodoneUses, Dosage & Side Effects. Retrieved from https://www.drugs.com/sfx/trazodone-side-effects.html Nordqvist, C. (2015). Schizophrenia: Causes, Symptoms and Treatments. Medical News Today. Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. ( 2013). Fundamentals of Nursing ( 8 Ed ). St Louis: Elsevier Mosby. Ralph, S. S., & Taylor, C. M. (2014). Sparks & Taylor’s nursing diagnosis pocket guide. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. Spielmans, G. I., Berman, M. I., Linardatos, E., Rosenlicht, N. Z., Perry, A., & Tsai, A. C. (2013, March 12). Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes. Retrieved from http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1001403 Townsend, M. C. (2011). Nursing Diagnosis in Psychiatris Nursing: Care Plans and Psychotropic Medication. Philadelphia : F.A Davis Company. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10