NUR3205 Case Study Analysis: Managing Mental Health and Substance Use in Nursing Practice

ASSESSMENT DETAILS

Clinician: Anna Pulikken

Place: Emergency Department Program: VU

Date: Nil

Time: 2:00 AM

Precipitants

History of current episode & treatment

Change in behaviour Signs and symptoms:

Hallucinations

Abnormal Ideation

Preoccupations

Suicidal Ideation

Aggressive

Homicidal thoughts

Anxiety states

Mood disturbance

Sleep

Appetite

Substance abuse

Other disability IDS/Physical Demographics

Major Illnesses Surgical Interventions Current medical health PRESENTING PROBLEMS (Clients perception of problem)

Due to the relationship breakup with peters partner, there has been changes in his Mood, sleep, appetite and an increase use of substance.

Peter mentioned he feels lethargic and doesnt want to do anything except watch tv and walk a lot. Peter consumes larger amounts of substance compared to his consumption with adequate amounts of food, which lead to weight loss. His substance use of alcohol and smoking has raised advancing from having beer to mixing alcohol and smoking once a day to whenever he feels stressed. He has mentioned smoking relives him and gives him relaxation.

COLLATERAL HISTORY

MEDICAL HISTORY/CURRENT MEDICATIONS

NIL reported

PSYCHIATRIC HISTORY / MHA STATUS

Has previously gone through depression and was mentioned but did not seek help from health professionals.

FAMILY HISTORY (Includes family history of mental illness, quality of relationships, current family issues)

NIL reported

GENOGRAM

Genogram Key

Male Female Unknown Married Defacto Separated Divorce Adoption Death Female

Male

Milestones School

Academic performance Social development Friends at school Childhood interests Hobbies

Current support network Psychosexual development Significant intimate relationships

Cultural Issues Reason for migration

Connection with community Recreational interests

Capacity for independent living PERSONAL HISTORY

Peter doesnt mention any sort of Hobbies in the discussion, but mentions he works for a harvesting company, recently has a relationship breakdown of 5 years. Peters closest relationship is his mother, due to some circumstances with his relationship he had to move out to his moms house as his capacity of living independently is rough ending.

Appearance

Physical

Dress

Grooming Personal hygiene

Behaviour

Guarded

Suspicious

Distracted

Psychomotor retardation

Compulsions

Panic attacks

Catatonic behaviorEye contact

Mannerisms

Degree cooperation

Rapport

Gait

Speech

Rate, volume, tone

Coherence

Spontaneity

Repetition

Thought form

Flight of ideas

Loosening of association

Circumstantiality

Confabulation

Incoherence

Poverty of thought

Neologisms

PerserverationsEcholalia

Clanging MENTAL STATUS EXAMINATION

When peter was admitted in to the emergency department, he was dressed comfortably, was unkept and seemed confused. Peter did struggle to keep eye contact while talking, may due to his consumption with alcohol. Peter kept a good rapport and provided answer when he was given questions but answers given was not clear and were more puzzled and or didnt know.

Peters spoke in a

Thought content

Overvalued ideas

Illogical thinking

Ideas of reference

Paranoid ideation

Thought withdrawal

Thought insertion

Delusions

Anhedonia

Homicidal/suicidal

Disorders of perception

Illusions

Hallucinations

Emotional state Cognitive & biologival Judgment

Level of insight DRUG ALCOHOL SCREENING

Substance Past Use Current Use Quantity Frequency Route Age First Use Last Used Depressants Benzodiazapines Codeine, morph Cannabis Methadone Heroin 1 gm Stimulants Amphetamine (speed, ice) Ecstasy Cocaine Hallucinogens LSD

Mushrooms Inhalants GHB Alcohol Spirits Beer Wine PREVIOUS WITHDRAWAL ATTEMPTS/REHABILITATION

NIL to be reported

INTERACTION BETWEEN SUBSTANCES & SYMPTOMS

FUNCTION OF USE

What the client thinks are good things about use:

Level of concern about use:

Client's perception of effects of use:

What client would like to do about use:

MANAGEMENT PLAN

RISK SCREEN

STATIC BACKGROUND CURRENT (DYNAMIC)

Suicide Yes No UnkSuicide Yes No UnkComments

Previous Attempts Expressing ideation Family history Plan/intent Major psych. Diagnosis Highly distressed Serious medical condition Hopeless Separated/divorced Substance abuse Loss of job/retired/role loss Recent life event Lack of resources Self-harm Yes No UnkSelf-harm Yes No UnkHistory of self-harm Actual or thoughts Yes No UnkYes No UnkAggression Aggression Previous violence Expressing intent Previous use of weapons Access to means Male Paranoid Criminal history Command hall. Previous ideation Anger, agitation Childhood maladjustment Recent violence Role instability Substance use History of drugs/alcohol Reduced control Yes No UnkYes No UnkVulnerability Vulnerability Intellectual disability Cognitive deficit Previous mental illness Self-neglect Absconding Non-compliant Sexual vulnerability Delusional Predatory behaviours Intrusive Serious medical condition Physical illness L M H Poor memory &/ orientation Level of Risk Disinhibition Suicide Disorganization Self-harm Preoccupation with hospital Aggression Intent on leaving Vulnerability Absconding risk PROTECTIVE FACTORS (factors that reduce the likelihood of negative outcome, e.g. supports)

MANAGEMENT PLAN

left2466975BIOMEDICINE

HEALTH AND

MEDICATION

DIARY

00BIOMEDICINE

HEALTH AND

MEDICATION

DIARY

Name:

Student ID:

The purpose of the VU Nursing and Midwifery student led drug diary is to assist students in their understanding of medication administration and management. Registered Nurses and Midwives are legally obligated, as regulated health professionals, and are accountable to the Nursing and Midwifery Board of Australia (NMBA) https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx . Additionally, the safe and effective use of medications is clinically governed by the National Safety and Quality Standards to support medication management https://www.safetyandquality.gov.au/standards/nsqhs-standards

The fundamental six (6) Rights of medication administration are to be adhered to at all times. Some hospitals may implement to up to 11 rights of medication administration and it is your professional obligation to be aware of the policies of the institution in which you are working and to adhere to their requirements. RIGHT PERSON, RIGHT DRUG, RIGHT DOSE, RIGHT ROUTE, RIGHT TIME, RIGHT DOCUMENTATION

Medications can be grouped by how they affect our bodies so it is important to have an understanding of this. For example analgesics relieve pain, antihypertensives reduce blood pressure, antidepressants assist in reducing depression etc These medications are then further divided by their individual therapeutic actions. For example you may have two different medications classified as antihypertensives however Drug A may work differently to Drug B to reduce this BP. It is important to be aware of how medications work as nurses are accountable for the drugs they administer.

When using this Drug Diary it is advised that you place any drugs that are unfamiliar to you into this diary and take the time consolidate the information you have included. Through this you will then become familiar with the medications you administer. Try to paraphrase which will assist you in understanding the medication in your own words. If you like try grouping drugs together on the same page eg. Analgesics, Anti-Emetics etc

*BE SURE TO USE AUSTRALIAN GENERIC & BRAND NAMES*

Utilising updated Australian text books will assist you with this drug diary:

McKenna, L., & Mirkov, S. (2019). McKennas Drug Handbook for Nursing and Midwifery Australia and New Zealand. Wolters Kluwer is a great little handbook that can be easily carried with you to clinical. This also includes nursing care implications.

Supplementing this is a much larger, in depth text, should you wish to learn more in depth information:

McKenna, L., & Gigi Lim, A. (2020). McKennas Pharmacology for nursing and health professionals (2nd ed revised.). Wolters Kluwer.

Symons, K., & Ermer, J. (2020). Australian injectable drugs handbook (8th ed.). Society of Hospital Pharmacists of Australia is what we refer to as the yellow bible in nursing. This will be found in every acute hospital and access is readily available either electronically (a log in is required) or through hard copy. There is no need to purchase this handbook.

KEY TERMS/ABBREVIATIONS

MEANING

Pharmacokinetics the absorption, distribution, metabolism and excretion of drugs

Pharmacodynamics the scientific interactions between the chemistry of the living systems and the foreign chemicals that have been introduced to those systems

Loading Dose some medications need an initial higher dose to obtain the desired effect in a timely manner

Half Life the time it takes for a medication to reduce to half of its peak level

Peak Level highest concentration of the medication in the bloodstream

Generic Name the original medication name that receives approval for use (eg. PARACETAMOL)

Brand Name the name given to the generic medication by the company making it (eg. PANADOL, PANAMAX, DYMADON)

Daily Once a day, at the same time each day

Mane In the morning

Nocte At night

Bd Twice a day, usually 12 hours apart

TdsThree times a day, usually eight hours (8/24) apart

QID Four times a day, usually six (6/24) apart

PRN When necessary or as required

SR Slow or sustained release

IR Immediate release

KEY TERMS/ABBREVIATIONS

MEANING

PO Per oral (by mouth)

PR Per Rectum

NEB Nebuliser

MDI Metered Dose Inhaler

TOP Topical (on the skin)

BE Both Eyes

S/L Sub Lingual (under the tongue)

Buccal Between the cheek and gums

S/C: Sub cutaneous

IM Intramuscular

IV Intravenous

NG Nasogastric

PEG Percutaneous Endoscopic Gastrostomy tube

Please refer to the Recommendations for terminology, abbreviations and symbols used in medicines documentation:

https://www.safetyandquality.gov.au/sites/default/files/migrated/Recommendations-for-terminology-abbreviations-and-symbols-used-in-medicines-December-2016.pdfANALGESICS GENERIC MEDICATION NAME ( and brand names) & DRUG CLASS (include drug schedule) ACTIONS (link to patho) & INDICATIONS ADVERSE REACTIONS (most common) and INTERACTIONS (including drug interactions if any) METHODS OF ADMINISTRATION. IS THERE AN ANTIDOTE? NURSING CONSIDERATIONS/PATIENT EDUCATION

eg. PARACETAMOL (Panadol, Panamax, Dymadon) Analgesia & Antipyretic (S4)

Used for mild pain and fever. Blocks pain impulses: it prevents prostaglandin synthesis in CNS or other substances that sensitise the pain receptors. Reduces fever by acting on the hypothalamus Liver damage with toxic doses.

Increases anticoagulation if on warfarin, alcohol may increase the risk of liver damage, caffeine may increase analgesic response, barbiturates/carbamazepine/ hydantoins/ rifampicin/ sulfinpyrazone: may therapeutic effect & liver toxicity with high doses or long term use: DO NOT USE TOGETHER PO (tablets, capsules, syrup, elixir, chewable, soluable, IV, PR

N-Acetylcycteine (NAC) can be used in overdose Be careful if liver disease, be careful of other medications that contain paracetamol, for short term use only, seek dr advice if being used for high temps

ANTI EMETICS GENERIC MEDICATION NAME ( and brand names) & DRUG CLASS (include drug schedule) ACTIONS (link to patho) & INDICATIONS ADVERSE REACTIONS (most common) and INTERACTIONS (including drug interactions if any) METHODS OF ADMINISTRATION. IS THERE AN ANTIDOTE? NURSING CONSIDERATIONS/PATIENT EDUCATION

eg. ONDANSETRON (Zofran, Onsetron)

5-HT -receptor blocker (S4)

GENERIC MEDICATION NAME ( and brand names) & DRUG CLASS (include drug schedule) ACTIONS (link to patho) & INDICATIONS ADVERSE REACTIONS (most common) and INTERACTIONS (including drug interactions if any) METHODS OF ADMINISTRATION. IS THERE AN ANTIDOTE? NURSING CONSIDERATIONS/PATIENT EDUCATION

REFERENCES