Nursing and Mental Health A Case Study

Running head: Mental Health Nursing

Mental Health Nursing 3

Mental Health Nursing

Depression is a widespread psychiatric disorder that has been affecting many people. Grief is a natural reaction that gets experienced when one experiences a significant and permanent loss. The loss of a loved one mainly causes it. The client, when she enters the room, looks around and makes eye contact. She appears to be well-composed as she smiles and is happy talking about her family and her dog. She seems not to have any sign of aggression as she sits quietly and observes the room. Expectations are different from reality as I expected to find someone who was aggressive, who had neglected themselves for two years. I found the client wanted the best for herself, had manageable depressive symptoms, and was ready to open up.

The client, Sheila, is a 53-year-old white female from Gilbert, Sc, who is about 112 pounds at the height of 180.34 cm who presented symptoms of depression. She reported that she was a janitor at Roses before she was diagnosed with depression. She is allergic to morphine and amoxicillin. Sheila has gastroesophageal reflux disease, hypertension; she had a Novasure endometrial ablation and has had tubal ligation surgical procedure performed on her; the surgeries are done on her lead to her hospitalization about two times. Sheila says that she got stressed after the death of her mother in 2020. She is a mother to two children, with her son having mental health problems due to substance a, took regular meals, and is part of the Baptist religion. She reported that she has never used drugs or alcohol.

Mental status evaluation

From my interaction with the patient, my findings were that the client seemed to be a well-composed lady, and she gets shy when maintaining eye contact, so she looks around the room, swings her feet, taps her fingers on the table, and shakes her head. She does not display any form of aggression, and she is calm for most of the assessment. Her speech rate was average, and she is happy when she is talking about hanging out with her best friend. Her mood is stable, and she gets thrilled as she talks about her best friend, her pet, until the feelings recur when asked about her mother’s passing; she gets sad about that occurrence. Her psychological integrity was examined, and her function got examined. The client is sexually active, has a gastrointestinal disorder, but she had not neglected herself in any form.

DSM-5 criteria for depression

Depression is a severe, often chronic, and disabling condition that is common in all cultures. Sheila develops adjustment disorder or situational disorder, according to the DSM-5 analysis. The DSM-5 criteria analyses the disease after five or more symptoms have been present for two weeks. When exhibiting major depression disorder, the patient feels depressed most of the day; the client feels sad, empty, and hopeless. A markedly low interest or pleasure is observed in the client’s enjoyable things, weight loss or gain, insomnia, fatigue, or loss of energy (“2017-2018 Treatment of Adult Major Depressive Disorder.pdf”, 2017-2018). Diminished ability to concentrate and think and recurrent thoughts of death is a normal occurrence of stress than a normal after a stressful event, can lead to several issues in your interpersonal relationships, and any mental health disorder does not cause depressive symptoms. The client had psychosocial behaviors such as feeling helplessness, sadness, depressed mood, and tearfulness.

Social,-cultural development perspective

Different cultural groups interpret traumatic events differently, making some vulnerable to the disorders. Erikson has various psychological stages based on persons opposing emotional forces (“Erikson’s psychosocial development theory,” 2019). The eight steps vary depending on the age of a person. With our client being 53 years, she was under the generativity versus the stagnation period. The stage shows the unconditional creativity of parents, and it also extended to other productive activities. The setting is strongly oriented to parenting, and it extends beyond the children. It may be the stigmas related to seeking psychological treatment as she thinks more about her children. The stage is an end to self-interest where the women tend to think about their children only. Stagnation is an extension of intimacy, which turns to self-absorption. The client thinks it’s better to have therapy to take care of herself.

Diagnosis

After analysis using the DSM-5 criteria, the patient was found to have adjustment disorder and major depressive disorder. The client’s symptoms were consistent with the data collected during the nursing assessment of the patient. Adjustment disorders are mainly caused when individuals have difficulty adjusting to life after a significant stressor (Bridley & Daffin, 2020). The client was having difficulty adjusting to her parents’ death, who had passed two years ago, thus leading to a major depressive disorder associated with psychosocial, interpersonal, and workplace disability.

Nursing plans interventions

After the assessment is complete, the nurse analyzed the data, determined the priorities, identified the problems, and established a care plan. Performance management, symptom control, drug maintenance, schizo, and psychoanalysis are all common approaches. The nurse manages the medication and takes great care when giving the patient the medicines. The nurse can educate the patient on the different treatment approaches and provide them with questionnaires that help them track symptoms of depression. They are empowered and encouraged to request changes in treatments if they have any side effects. (Unutzer & Park, 2014). The nurse should ensure that the patient comes up for the check-ups weekly after the patient consults the counselor and encourages them to participate in psychosocial treatments such as behavioral activation by offering them a platform to express themselves with no fear of judgment. Maintaining a close relationship with the patient is an important nursing intervention (Berstein, 2006). For treatment to be attained, it is determined by building alliances between the clinician and the client.

Adjustment Disorder and Major Depressive Disorder Treatments

Sheila is treated using a combination of counseling and psychopharmacological treatment. Cognitive behavior therapy is an effective treatment when reducing trauma-related symptoms because it can identify and challenge the traumatic event’s negative cognitions. It replaces them with positive, more adaptive cognitions. The therapy’s goal is to help the patient develop and use problem-solving skills to cope with difficulties (Bridler & Daffin,2020). The counselor educates Sheila on the traumatic event and the emotional responses from the event, relaxation training by teaching her on the various ways she can use her environment to maintain control and use her coping skills that were for her to talk to her best friend and hangout. The counselor encouraged her to find a way of expressing her emotions and fears related to the traumatic event, such as engaging in group therapy.

By manipulating why she felt stressed, Sheila is advised to develop positive thoughts when she had any negative thoughts. The counselor encouraged her to tell the story of losing her mother and included many, then encouraging her to tell small details of the event. As the therapists gain information, she can continue revealing her most distressing moment of her mother’s death(Bridley & Daffin,2020). The therapists involve her family and friends so that Sheila has the most support and sense of security as they are encouraged to practice the coping strategies.

Antidepressant medication will be helpful in her major depressive disorder. The Sertraline taken for 2-4 weeks which is a selective serotonin reuptake inhibitor, is prescribed. She was to take about 25-50mg a day which was to be increased to 200mg a day as the treatment progressed (Berstein,2006). The medication has side effects such as headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, light-headedness, dry mouth, rhinitis, and sweating.

Evaluation of patient

The patient had been diagnosed with adjustment disorder and major depressive disorder. After analyzing, the patient can engage in reality-based interactions within 24 hours; she knows how to express herself safely, express her feelings with direct congruent verbal ways and be free from psychotic symptoms as she continues to receive medication(Schultz & Videcheck,2013). The client was able to comply with knowledge of drugs as time went on and increased the ability to cope with anxiety, stress, verbalize and show the acceptance of loss. She had identified her best friend as her support in the community.

Treatment team goals for discharge

She has two sons; a best friend will help her to find emotional support. Family members and friends take part in a lot of long-term care for the client. Many family members are often invited to assess the patient’s ability to cope at home( Waring et al.,2014). Sheila moved in with her sister to take part in her long-term care and was her support as she attended her outpatient appointments. The sister had to know her rehabilitation plan, her ongoing care needs, and how some therapeutic exercises reduce the depression.

Interacting with Sheila helped me learn to communicate with people. She appeared to be uncomfortable and had a lot of tension. I had to talk about myself and observe her demeanor which was a new experience to me. I had to allow the patient to speak and actively listen to the patient and reflect on some of my statements to not sound insensitive and made her uncomfortable. Being a peoples person helped ease my interaction with Sheila, who felt out of place when she entered the room. It required a lot of patience and understanding to be able to read her expressions and demeanor.