Introduction
Schizophrenia is a psychological disorder characterized by disintegration of thought process and emotional responses and a person looses touch with reality (Roofman & Janng, 2009). Mr. Bill is a 37 years old man who lives with his brother in private rentals but the brother recently moved due to bill relapse. Mr. Bill has a two-year history of schizophrenia but he stopped taking his medication since March 2011 and as a result, he became intoxicated. This aggravated his condition and he was unable to neither work nor eat. Consequently, he did not go to work for three weeks and he went hungry for two to three days. Additionally, he experienced auditory hallucination for five days. Upon receiving a call from the case manager about his psychological appointment, he answered with an intoxicated voice and reported that he was sick. As a result, the case manager suggested a voluntary admission in acute care unit of the mental hospital.
History taking
On history taking, Mr. Bill had normal birth and milestone and has neither suffered from any medical condition nor undergone any surgery but he always feels sick with poor appetite. Additionally, he has had two admissions because of a psychiatry condition and the first was in December 2007 due to attempted suicide secondary to distressing auditory hallucination while the second was in June 2009 due to poor medication outcome despite compliance because auditory hallucination worsened. Social history revealed the he left school in 2010; he is not married but has had two significant relationships with female partners in the past five years, he takes alcohol although he recently decrease the amount and he is currently employed as a store man. Finally, family history showed that mother had a mental breakdown twenty-five years ago. The chief complain of Mr. Ben is hallucination, confusion, anxiety, insomnia and anorexia.
Assessment
Assessment of a psychiatry patient usually begins with a physical examination then a mental status examination follows (Aberg, 2008). The physical examination of Mr. Bill showed that he was sick looking and a little anxious. Otherwise, on head to toe examination, there was nothing abnormal detected. The mental status examination performed gave the following results. On appearance and behavior, he was relaxed and he attributed it to the valium that he had taken earlier. Besides, he had a cooperative behavior because he showed willingness to comply with the treatment regimen. He had an alexithymic mood because he was unable to describe his mood state and he reported that he felt nothing. On the other hand, he had a heightened affect because he appeared bright and reactive. Although he was well oriented to time, person and place and had good insight, his speech was slurred, he had auditory hallucination and poor judgment because he consume alcohol yet he is on medication.
The assessment of risk factor for schizophrenia is important in every individual case of schizophrenia and social factor, psychological and biographical data need consideration (Hume, 2010). Biographical assessment entails previous attempt, demographic data and previous perception of illness (Hume, 2010). Social factors involve assessment of social support and isolation, prior functional integration, social status, lack of financial support and family instability (Hume, 2010). Psychological assessment entails the type of schizophrenia, hallucination, course of illness, level of insight, depressive symptoms and substance abuse (Hume, 2010).Under biographical data, the risk factor assessment of Mr. Bill revealed that he had once attempted a highly lethargic suicide. Under social factor, Mr. Bill is a heavy smoker, he abuses alcohol and psychotic drugs and as a result, he is dependent on drugs and experience withdrawal symptoms. Upon psychological assessment, Mr. Bill is currently intoxicated, anxious, agitated and he does not comply with the treatment regimen. Additionally, his mental health problem is deteriorating and he has no insight into inpatients of mental disorders on ability to perform activity of the daily living.
Care plan and nursing intervention
Treatment of schizophrenia is collaborative and it includes medication, psychological treatment, psychosocial treatment and community support (Brunno, Rossaria, &Rocco, 2009). Medication helps in alleviating the signs and symptoms of schizophrenia, psychological treatment help the patient to adapt to his condition, psychosocial treatment assist the patient to cope with other people while community support help other people cope with the patient ( Brunno, Rossaria,& Rocco, 2009 ). The care plan and nursing intervention of Mr. Bill will entail four broad issues that include current problem, social issues, medical issues and discharge planning.
Current problems
The current problem of Mr. Bill is non-compliance with medication and as a result, he is intoxicated. To add on this, he abuses alcohol, he is a heavy smoker, and this has led to deterioration of his mental condition and exacerbation of symptoms like hallucination and apprehension. This is because alcohol and cigarette antagonize psychotic drugs and increase the presentation of psychotic symptoms (Winkel, Hanssen, & Kane, 2009). The goal of nursing intervention to the client is that Mr. Bill will fully recover and be in a position to perform the activities of the daily living on his own. On the other hand, the clinical goal is to have Mr. Bill comply with medication and be free from alcohol and smoking abuse. The intervention therefore includes medication and psychosocial treatment.
The mental health nurse will administer medication and Mr. Bill will receive quetiapine because it aids in titration and this alleviates the intoxication (Winkel, Hanssen,& Kane, 2009). On the other hand, aripirazole is an antipsychotic used to alleviate the negative symptoms of schizophrenia and it will free him from auditory hallucination while diazepam treats anxiety and it will alleviate the apprehension (Winkel, Hanssen, & Kane, 2009). Additionally, the mental health nurse will monitor treatment so that Mr. Bill complies with the treatment regimen because treatment will help him recover and be in a position to perform the activities of the daily living (Winkel, Hanssen, & Kane, 2009).
Psychosocial treatment of the current problem involves psycho education, cognitive behavioral therapy, group activities and counseling (Wolfson & Jeanie, 2010). Under Psycho education, the mental health nurse will empower Mr. Bill with information about his illness and the treatment options (Wolfson & Jeanie, 2010). This will help him understand his illness and the reason as to why he should comply with the treatment regimen (Wolfson & Jeanie, 2010). On the other hand, cognitive behavioral therapy of Mr. Bill involves the mental health nurse assisting him to change his behavior by informing him on new ways of socialization and stress coping mechanisms (Turner, 2009). If Mr. Bill learn new ways of socialization like watching a football match, his dependence on alcohol and cigarette smoking will reduce because he will spend most of his time watching rather than smoking. Additionally, new ways of coping with stress will reduce his drinking and smoking habits because people usually smoke or take alcohol to relieve stress (Turner, 2009). The mental health nurse will ensure that Mr. Bill is involved in-group activities because it will not only help him in recovery but also change his behavior (Turner, 2009). This is because group activities involve mingling with other people who have schizophrenia and this will help him learn a lot (Wolfson & Jeanie, 2010). For instance, if a schizophrenic person narrates how defaulting from medication almost caused his death, Mr. Bill may be threatened by this situation and as a result, he will focus on taking his medication so that the same does not happen to him. Finally, the mental health nurse should counsel Mr. Bill because he needs counseling on the importance of adhering to medication plan and the need to avoid substance abuse. Additionally, counseling will give him a chance to air out things that distress him and this airing out of a problem is a cure because a problem shared is a problem solved and as a result, it promotes quick recovery from schizophrenia (Turner, 2009).
Social issues
The social issues affecting Mr. Bill is accommodation problem because he cannot afford to rent a house. Besides, he is worried that he might lose his employment and end up lacking finances. The goal of nursing intervention to the client is that Mr. Bill will get accommodation and retain his employment. On the other hand, the clinical goal is to allay anxiety because Mr. Bill is so much worried and this can even lead to suicidal attempts. Therefore, the interventions include family psycho education, vocational and social rehabilitation, and crisis support (Pract, 2010).
Family psycho education involves the mental health nurse working collaboratively with family members so that they support the patient (Wirshing & Barisford, 2008). In this case, a dialogue with Mr. Bill’s brother and mother about the accommodation issue is important because it will not only help Mr. Bill get accommodation but also reduce his anxiety. Vocational and social rehabilitation focuses on person strength and this makes someone feel validated with a purpose in life (Wirshing & Barisford, 2008). In this situation, the mental health nurse should help Mr. Bill realize that he has the ability to perform other tasks even if he loses his current employment. Mr. Bill has a crisis about accommodation, finances and employment and as a result, the mental health nurse should link him to a clinical support that will help him solve his problem. An example of a crisis support is social worker who can support Mr. Bill financially (Wirshing & Barisford, 2008).
Medical issues
The medical issue that Mr. Bill has is nutritional because he always feels sick with poor appetite. The goal of nursing intervention to the client is that Mr. Bill will have a good appetite and feel strong. On the other hand, the clinical goal is that Mr. Bill will have a normal nutrition. Therefore, the mental health nurse should intervene by providing medication and nutritional counseling. Medication involves the use of multivitamin because it boosts appetite and this will make Mr. Bill have an increase in oral intake (Ramin & Bruce, 2009). On the other hand, Nutritional counseling will help Mr. Bill know the type of diet to take and this will help in the maintenance of normal nutrition (Ramin & Bruce, 2009).
Discharge Planning
Discharge planning involves evaluation, education and the follow up (Pract, 2010). The evaluation will involve interview method and physical assessment (Pract, 2010). Interview will help to determine if Mr. Bill has fully recovered and is well oriented to time, place and persons. On the other hand, physical assessment will determine if he is physically stable and fit for discharge to the community. Education will empower both Mr. Bill and the community including his family members who will receive education about schizophrenia and its management in the community. Additionally, the mental health nurse should link Mr. Bill to social work for support. Finally, the mental health nurse can refer Mr. Bill to case manager or junction continuing care team for follow up.
Mental Health act (VIC) 1986
Voluntary admission occurs upon a patient’s request while involuntary admission occurs if a patient cannot consent and in this case, a close relative consents on behalf of the person (Megan, 2009). Upon admission, treatment commence after examination of the patient (Neal, 2010). Besides, the patients have the right to printed statement and the right to information about hospitalization (Megan, 2009). For instance, the patient can have copies of all documents of treatment plan and besides, the patient need to know his treatment regimen (Megan, 2009). On the other hand, the patient does not have a right to refuse treatment because he lacks insight (Neal, 2010). The case of Mr. Bill was a voluntary admission because he consented to it by accepting the admission after the case manager suggested. Additionally, his treatment began after a physical, mental and risk assessment. The mental health nurse considered Mr. Bills rights by explaining the treatment regimen to him. Moreover, he had access to some of his documents like the treatment plan. On the other hand, Mr. Bill’s did not have the right to refuse treatment because the mental health nurse ensured that he took all his medication by monitoring him. It is evident that the act facilitated Mr. Bill’s treatment plan because it directed the actions of the mental health nurse.
Conclusion
Schizophrenia is a condition that requires collaborative management so that the patient recovers easily (Meram, 2008). Besides, the management is holistic and it entails social, emotional, spiritual and physical aspect of the patient s life (Meram, 2008). In this situation, the management of Mr. Bill was comprehensive and it started by history taking, assessment, planning, intervention, discharge and follow up. It is evident that the management of schizophrenic patients does not end in the hospital but it extends to the community.
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