CNA256 Mental Health

Question: After Mrs. B’s delirium had cleared and the symptoms of her major depressive disorder with psychotic features continued to improve; cognitive and functional assessment revealed only mild deficits in short and long-term memory and instrumental activities of daily living. Mrs B’s ability to bathe, dress, use the toilet and eat meals remained steady at the level of requiring some assistance with planning and organising (motivating?) while able to complete the fine and gross motor tasks (praxis) without physical assistance. Mrs B. is planning to go home to the hostel (“low care aged care facility”) section of the retirement community where she had previously had an assisted living apartment. Her constipation, dehydration and poor nutrition resolved in hospital. Her cognition improved now scoring 26/30 on the MMSE with mild deficits in short term recall, orientation for date and a couple of minor errors in the language tests. Her hypothyroidism was corrected. Her BP was stable in hospital, so her antihypertensive was ceased (she hadn’t been taking it regularly when she was unwell at home). She responded well to anti-psychotic and anti-depressant medication. Over time Mrs B gradually became more responsive and more engaged with recreational pursuits with some encouragement. She expressed no more thoughts of dying and was perplexed (embarrassed?) when asked about her previous expression of these thoughts. Her appetite and sleep stabilised. Episodes of anxiety were less frequent. 1.Using the ISBAR format, what information should be communicated to the Aged Care Facility prior to discharge and include any information that might help them manage Mrs B in the future (for example, Mrs B’s mental health relapse indicators). 2.Describe the indication, clinical use, adverse effects, potential interactions and nursing implications of one psychoactive medications for the older person. Consider one of Mrs B’s medications from the case study: Quetiapine, Sodium Valproate, Sertraline, Venlafaxine, Aripiprazole or Lorazepam. 3.Discuss briefly a personal model of successful ageing incorporating at least 2 theories of aging from the readings or text. In your answer explain the potential changing roles of a person as they reach old age and potential associated life problems. Answer: Introduction: Mrs. B is planning to home to the low care aged care facility and will be discharged shortly in this regard. The following SBAR format clearly illustrates her condition. 1. Situation After a thorough treatment of Mrs. B, the issue regarding delirium has been resolved and also the symptoms of her major depressive disorder with some psychotic features has been improved a lot and she is recovering. The state of physical wellbeing of Mrs. B has also been improved. Apart from that, she sleeps and her appetite is also in stabilized condition. Her response to the anti-depressant as well as anti-psychotic medication was extremely good. She was facing difficulties regarding constipation, nutrition as well as dehydration, which was solved after the treatment. Without any kind of physical assistance, she is able to complete the fine and gross motor tasks. The issue she was facing due to hypothyroidisim, has also been corrected after medication. From the analysis of the cognitive function, it has been revealed that it scores 26/30 on MMSE and her BP is also stable in hospital. She is ready to be discharged with new medication regime as well as recommendation from the physician team who treated Mrs. B. Background Mrs. B was brought to the hospital with delirium and symptoms of major depressive disorder. The depression caused many serious health consequences including disability associated with medical as well as cognitive disorders. She faced some episodes of anxiety and persistent and recurrent fear of certain objects that were apparently not found, which can be termed as a sort of illusion or hallucination. She was not well at home and was suffering from hypothyroidism and sleeping disturbances, constipation as well. Also, when she was brought to the acute mental health unit, she was dehydrated and malnourished. Assessment Her response to the anti-psychotic as well as anti-depressant helped to improve the delirium and other psychotic features that included anxiety and depression. In order to improve her cognitive and functional physical condition, changes in the medication worked well. However, she requires some assistance in planning and organizing. A routine follow-up from any general practitioner or any psychiatrist is needed in her case. Her condition might relapse after returning back to the home and so a scheduled scrutiny of her physical and mental state is required. All the current medication will be enlisted with the discharge document. Recommendation: In order to maintain her nutritional status, a proper diet chart is highly recommended. A regular review of medication regime and assistance to her daily activities is also recommended for Mrs. B. Patients who used anti-depressants should be under observation and a bowel chart assessment and a fluid balance chart, in order to assess the hydration condition is required for her. Mild and regular exercise is also recommended in this regard (Cvecka et al., 2015). An engagement to social and some recreational activities On the disclosing of her personal information, a written consent from her will be obtained and clearly documented in the discharge summary. Some additional pamphlets and ISBAR format will be provided to the carer of Mrs. B and if any kind of further information is required, then it is recommended to immediately contact the team. 2. Indication Depression, anxiety disorder, and sleeping disturbances that is termed as insomnia. Clinical Use Venlafaxine is an anti-depressant drug that can be utilized to treat depression, anxiety and other psychotic disorder. Adverse Effects Venlafaxine is used to treat major depressive disorder as well as generalised anxiety disorder. It is taken around the same time every day. Depressive patients who are experiencing agitation, thoughts of suicide, especially at the beginning stage of treatment procedure, are treated with this medication. Studies have revealed that the improver as well as excessive use of the medicine can result in various adverse effects (Riediger et al., 2017). Due to overdose, patient might feel headache, blurred vision, drowsiness, loss of appetites and others. Apart from that, pregnant women and breastfeeding patients should strictly avoid using this medicine. Even, the patients, who experienced seizures, should not intake Venlafaxine. Patients with high blood pressure and allergy are not prescribed to use this medicine. Missing proper dose or excessive use of this medicine can change the natural heart-beat process and also take the patient to coma which is life-threatening (Ensrud et al., 2015). Potential Interactions This is a tablet and can be taken two or three times a day as per the direction of the physicians. Patients with kidney as well as liver problems should have a lower dose than others. Before taking the medicine, patients should discuss their medical history to the doctors. Nursing Implications The patients under the age of 18 years should never use this medicine. Data shows that long-term use of venlafaxine can lead to nausea and vomiting (Friedrich-Cuntz, . Again, people who are planning to stop venlafaxine, should consult their physicians to monitor the blood pressure and other vital signs because, sudden withdrawal of the medicine can cause negative symptoms (Razavi et al., 2014). It should be considered for long-term treatment and excessive dosage must be avoided to reduce the risks in elderly patients (Fava, Mulroy, Alpert,2014) Nierenberg, & Rosenbaum, 1997). 3. According to literature, the three main components of successful ageing are active engagement with life, low probability of disease and disease related disability, high-cognitive and physical functional capacity (Rowe & Kahn, 1997). All the three terms are relative to each other. According to the well-known disengagement theory, successful ageing is regarded as the desires as well as the ability of all the older people to disengage from the active and social life, in order prepare them for death. Again, according to the activity theory, successful ageing is interpreted as continuous adherence to the activities in order to maintain the positive sense of oneself. Gerontology theory claims that life expectancy increase with the proper use of medicine, diet as well as social aspects. Another important model of successful ageing is the life span model of Selective Optimization with Compensation Model which is termed as SOC- Model, states that ageing is characterized as a heterogeneous process with different pathways and outcomes and it becomes important during aging to maintain a positive balance between the gains and losses (Ouwehand, de Ridder & Bensing, 2007). References: Cvecka, J., Tirpakova, V., Sedliak, M., Kern, H., Mayr, W., & Hamar, D. (2015). Physical activity in elderly. European journal of translational myology, 25(4), 249. Ensrud, K. E., Guthrie, K. A., Hohensee, C., Caan, B., Carpenter, J. S., Freeman, E. W., … & Otte, J. (2015). Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes. Sleep, 38(1), 97-108. Fava, M., Mulroy, R., Alpert, J., Nierenberg, A. A., & Rosenbaum, J. F. (1997). Emergence of adverse events following discontinuation of treatment with extended-release venlafaxine. American Journal of Psychiatry, 154(12), 1760-1762. Friedrich-Cuntz, A. G. (2014). Nurses as Teachers: A Case for Interpersonal Relationship Skill Training (Doctoral dissertation, Walden University). Retrieved from https://www.kcl.ac.uk/ioppn/depts/hspr/research/ciemh/mhn/projects/talking.pdf Ouwehand, C., de Ridder, D. T., & Bensing, J. M. (2007). A review of successful aging models: Proposing proactive coping as an important additional strategy. Clinical psychology review, 27(8), 873-884. Razavi, S. M., Negahban, Z., Pirhosseinloo, M., Razavi, M. S., Hadjati, G., & Salamati, P. (2014). Sulfur mustard effects on mental health and quality-of-life: a review. Iranian journal of psychiatry and behavioral sciences, 8(3), 11. Riediger, C., Schuster, T., Barlinn, K., Maier, S., Weitz, J., & Siepmann, T. (2017). adverse effects of antidepressants for chronic Pain: a systematic review and Meta-analysis. Frontiers in neurology, 8, 307. Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The gerontologist, 37(4), 433-440.

CNA256 Mental Health

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