Nursing Practice and Decision Making 1 – Depression & Anxiety Scenar

Questions: Mary is 56 and has a diagnosis of severe depression and anxiety Present situation: Mary is currently in hospital informally. Mary is very low in mood, spends most of hertime standing in the ward corridor and speaking in hushed tones. She is refusing to eat and complaining of constipation. During the shift she regularly comes to the office saying she cant breathe and her chest hurts. The husband visits daily, bringing fresh clothes, her favourite foods and puzzle books in the hope these will help. Personal and social history: Mary is retired medical secretary. She retired on medical grounds following an extended admission to hospital 5 years ago. She is married with no children. Her husband, Clive, is very supportive and continues to work as a part time school teacher. Mary has always considered herself to be the depressive type and said she was always unhappy even as a child. She found work a useful coping strategy and rarely required more support than what the GP offered. Medical and Psychiatric History Mary was first diagnosed with depression in her 20s. This will be the 4th admission since retiring. Ulcerative Colitis Medication: Antidepressants under review due to constipation Zopiclone 7.5mg PRN nocte Senna PRN Briefly describe the purpose of the assignment with clearly stated aims and objectives. o Explain how these aims/objectives will be addressed o A brief background to include; o Brief discussion of the theory of decision making. o Explain the significance and importance of this topic to nursing practice and/or your development as a student nurse (rationale) o Set the scene for the case-study and offer a rationale offering evidence regarding the significance of the chosen case-study. o Present a short summary highlighting the important points of the case study (if choosing a patient from practice, include more detailed information as an appendix. Remember to maintain patient confidentiality and remove any identifiable information throughout). o The main body of the work should demonstrate an understanding of clinical reasoning and decision making processes applied to the following themes; Answers: IDENTIFIED NEEDS ACTION 1 Mary is experiencing low mood 1 Mary to manage low mood and develop skills to manage her mood 2 Mary is anxious 2 Enable Mary to remain stress free and less anxious 3 Her retirement from work has increased the episodes of depression 3 Encourage Mary to indulge in things that keep her busy and away from the negative thoughts 4 Marys husband Clive needs support to understand her state of mind so that he could assist Mary to reduce stress and develop coping strategies 4 Clive to have resources with which he can support Mary and help in strengthening her resilience. 5 Mary is hopeless about her getting well 5 Make Mary understand that her condition can be improved if she increases her will power 6 Mary is suffering from chest pain 6 Know the medical history of cardiac related problems and other health problems and proceed for ST elevation. 7 Mary is suffering from constipation 7 To prescribe medicine to Mary that will help in regulating the motion and ensure a change in her diet 8 Mary has ulcerative colitis and an abdominal mass has also been diagnosed. 8 To confirm the presence of abdominal mass through ultrasound and prescribe drugs and medications to dissolve the mass. Ulcerative colitis can also lead to cancer and therefore its correct diagnosis followed by management is to be sought. Problem statement Ineffective coping related to the present condition of the patient i.e. depression and feeling of hopelessness such that the patient has started feeling depressed and is unsure about the future, whether she will live or not (Ghazaleh, R. 2004). Objective Goals Short Term Goals- Remission of the patient and not confusing remission with substantial but incomplete improvement, conserving remission state and preventing relapse Long term goals- Protecting the patient against the recurring episodes of depression (MHC 2012) Intervention and rationale The intervention of inducing remission (acute phase), followed by preservation of remission (Continuation phase) and then protection of the patient from the recurring episodes of depression (maintenance phase). The most effective therapeutic approach is the use of medication in form of antidepressants. Rationale: The role of anti depressants in treating depression is positive. Although they have certain side effects associated with them, still their use helps in relieving stress and anxiety to a considerable level (MHC 2012). Evaluation The evaluation will be done after conclusion of every phase of treatment. Acute phase: Follow up should be scheduled within 2 weeks of initiating the treatment and the follow up should be continued every 2 weeks till some improvement is seen Continuation Phase: Medications to be continued till 16-20th week Maintenance phase: Should be done in case of no improvement even after continuation phase (MHC 2012). Essay Plan Introduction The essay will define depression, its prevalence and relation with anxiety and stress. Description A short but detailed description of the case study, highlighting the physical, behavioral and emotional features of the patient Main Body This section will deal with the practice of clinical decision making and assessment of the clinical condition of the patient. The needs of the patient will be identified and a proper action will be recommended based on the guidelines set by NICE and the corresponding rationale will be provided. The second paragraph will deal with the interpretation of the and response to the assessment including appropriate symptom management and a plan of on-going care. You must consider any signs of actual or potential deterioration of physical and/or mental health. Conclusion This last section will highlight the patients critical clinical condition, the prescribed treatments and recommendations followed by the evaluation of the case study. References Ghazaleh, R. 2004, Major Depression, Depression care plan guidelines, Peters institute of Pharmaceutical care. Mental Health Commission (MHC), 2012, Guidance Document on Individual Care Planning Mental Health Services.