NRSG262: Clinical Integration: Mental Health Practice- Management Plan Solution

Clinical Integration- Management Plan

Case Studies

You need to choose from one of the two (2) following case studies and provide a 1000 word Medication management plan for the chosen individual.

• The assignment is to be presented in a question/answer format,and not as and essay (i.e. no introduction or conclusion).
• Each answer must be supported with citations.
• You should follow the recommended formatting for academic papers https://students.acu.edu.au/308971
• You will need to reference according to APA referencing.
• Students must provide in-text referencing and a reference list must be provided at the end of the assignment.

A minimum of (6) six academic references and (2) two websites are required for this assessment task

A marking guide has been made available on the unit outline to support your response.

Please include the following areas in your management plan:

• What physical health considerations should be considered before giving this medication to the consumer?
• Provide a rationale for the use of this medication to the consumer.
• What are the side effects / adverse effects of this medication? And how will you manage these effects?
• How is medication management influenced by recovery principles in mental health?

CASE STUDY: Daniel

Daniel is a 31-year-old male who currently lives in a community care residential unit (CCU). Daniel was diagnosed with schizophrenia at the age of 19 years. He had a traumatic first admission to mental health services and was bought into the inpatient ward via police. On admission he was displaying positive signs of schizophrenia, and he was responding to auditory hallucinations. He expressed paranoid delusions that his parents were not his parents but imposters, who were trying to ‘kill him’. He was also suspicious of the neighbours, and as a result had been isolating himself from everyone. He was agitated and distressed on admission and was concerned the admission was unsafe for him.

Since this admission, Daniel has had numerous admissions (10 in total) to acute mental health services, as an involuntary client. For three years after his diagnosis, he was case managed by the Early Psychosis Team. He was then referred to the Mobile Intensive Support Team for 6 months and in the past 7 years, he has had periods of case management with the local Adult Community Mental Health Team.

Daniel has been trialled on various antipsychotic and mood stabilisers to help manage his symptoms. However, on several occasions prior to admission, he had ceased taking his medications. On his last admission to an acute mental health services, the Consultant Psychiatrist and the treating team made a collaborative decision to commence Daniel on a depot medication. He was trialled on oral olanzapine and then commenced on Olanzapine Depot injection. His current dose is 210mg fortnightly. The medication is administered via injection by mental health nurses at the specialist clinic associated with the Mental Health Unit at his local hospital.

Family History:

Daniel’s parents live in the family home and usually have Daniel stay with them on weekends when he is well enough. Daniel is their second child. His older sister Meg is married with two children and lives nearby. She is supportive.

Medical History:

Daniel has asthma and this is managed with Ventolin puffer PRN. Daniel has been diagnosed with schizophrenia and is currently being managed on an antipsychotic medication – Olanzapine Depot – 210mg fortnightly.

Current Mental State Examination

Observation

Appearance & Behaviour:

• Fair complexion, short cropped blonde hair and blue eyes.
• Overweight in appearance, height 172cm
• Scar 5 cm length middle of right cheek fell on branch when a child.
• Slightly dishevelled in appearance, unkempt beard and hair
• Needs encouragement to attend to ADL’s
• Suspicious and paranoid
• Irritable at times
• Unusual gesturing of his arms ( waves in the air)
• Difficult to engage in conversation and difficult to establish rapport
• Fixed eye contact when irritable

Cognition:

• orientated to time, orientated to place and person
• Some deficits noted in recall memory and short term memory

Mood:

• Daniel states he feels unhappy with the injection but does not want to end up in hospital again.

Affect:

• restricted affect

Speech:

• Poverty of speech – at times
• Rate and flow of speech often slow

Form of thought:

• Loosening of associations
• Neologisms
• Thought blocking

Content of thought:

• Disordered thinking
• Paranoid thinking at times
• Continually expresses thoughts about his parents, challenges whether they are really his parents
• Denies any suicidal and homicidal thoughts

Perception:

• Experiences auditory hallucinations of a derogatory nature
• Describes hearing a male and a female voice
• Often seen responding to internal stimuli

Insight:

• Limited insight into his illness.

Judgement:

• Poor judgement

CASE STUDY: Lynda

Lynda is a 28 year old female who has a 10 year history of bipolar disorder. She has a history of non-adherence to her prescribed medication. Lynda was admitted after her parents rang triage team expressing concern that Lynda was relapsing. They reported Lynda has poor concentration, not been sleeping, was spending money excessively and had started to become very impulsive and unpredictable. She had also been verbalising her grandiose delusion of being a member of the royal family.

Family History.

Lynda is an only child; her parents are very supportive and have a good relationship with Lynda. Lynda’s maternal grandmother and her aunt have a diagnosis of bipolar disorder. Lynda’s parents are active members of the carer’s group run by the local Mental Health service. Lynda will be discharged next week, and requires education on her discharge medications.

Medical History

Lynda has a long history of bipolar disorder, first diagnosed at the age of 18, several acute admissions over a 10 year period.

Lynda has been diagnosed with bipolar disorder and is currently being managed on a mood stabiliser – Quilonum SR– 450mg BD.

Current Mental State Examination

Observation

Appearance & Behaviour:

• Olive complexion with shoulder length brown hair styled
• Average height (164 cm) and weight (63kg)
• Dressed appropriate to weather
• Wearing heavy makeup/multiple bracelets, rings, necklaces.
• No distinguishing features (e.g. no scars)
• Very friendly in manner, overfamiliar in conversation and gestures at times

Cognition:

• Orientated to time, place and person
• Able to maintain concentration through interview.

Mood:

• Mood appears slightly elevated,
• Describes herself as happy, “never been better”

Affect:

• Bright and reactive. Incongruent at times when discussing events leading to admission.

Speech:

• Pressured at times, but able to be interrupted
• Expansive in conversation
• Loud at times

Form of thought:

• Logical and sequential , occasionally tangential
• Not grossly thought disordered

Content of thought:

• Grandiosity in theme, Lynda keen to inform people that she is a member of the royal family.

Perception:

• No perceptual disturbances elicited

Insight:

• Some insight into illness, states she knows she has Bipolar and will reluctantly take medication if it means she can be discharged home and not be in hospital.

Judgement:

• Poor judgement

Medication Management Plan for Bipolar Disorder

The case study that I have chosen for the medication management plan is that of Lynda, she is a 28 year old female who had been diagnosed with Bipolar disorder when she was 10 years of age. The patient has a family history of Bipolar disorder. Her grandmother and her aunt have had a diagnosis for the same condition previously. The patient gives a history of non adherence to the prescribed medication along with lack of concentration, inability to sleep, impulsive behaviour and unpredictability. The patient has been also having delusions of being a member of the Royal family. Lynda has been prescribed QuilonumSR– 450mg BD.

What is Quilonum SR?

Quilonum SR is the brand name for the group of lithium carbonate that is used for the treatment of mania for patients who are suffering from Bipolar disorder that is also known as manic depressive disorder. It belongs to the class of antimatic agents that act for reducing the amount of abnormal activity of the brain that takes place in this disorder ("Treating bipolar depression - recommendations for research", 1994).

What is the importance of education for medication management?

It is very essential that Lynda is educated so that she can effectively manage the medication that has been provided to her to take at home. Only if the patient is provided with all the important education it becomes simpler for the patient to adhere to the medication program that has been prescribed and at the same time manage their medication in a safe manner. Arming the patient with knowledge about the medications that they need to consume is directly proportional to their adherence towards the medication plan (Stanley & Laugharne, 2011). The patient should have all the knowledge about the generic name of the drugs that have been given, the interactions of the drug, the side effects that the drug causes and the adverse effects that the drug can have on the patient as well. Lynda should be educated on what needs to be done in case she misses out on a dosage and how the medication should be stored in a place that is cool and dry. She also needs to be made aware of the duration of the drug therapy that needs to be followed. Care needs to be taken that Lynda’s current health status is kept in mind hence a medication plan can be designed that helps her to manage her medication easily.

What physical health considerations should be considered before giving Quilonum SR to Lynda?

Patients who are suffering from mental illnesses tend to have a poor health status, which makes it very imperative to conduct a complete physical health check up so that the patient can be provided with a medication plan keeping in mind the physical concerns. The incidence of the irritable bowel syndrome is found to be higher in patients suffering from mental illness hence the patient should be diagnosed for the same, consumption of tobacco; dental health of patients with bipolar disorder is found to be poor and should be checked as well (Stahl, 2013). The patient should be checked for any allergies towards foods, dyes and medicines. Also if the patient has a condition of the Brugada syndrome or family history for the same needs to be reported (Burt & Rasgon, 2004). The doctor needs to be aware if the patient is consuming other medications especially those that have an impact on the urine output and lower the blood pressure.

Rationale for prescribing Quilonum SR to Lynda

Lynda has been prescribed Quilonum SR 450 Mg twice in day. The drug belongs to the antimatics class of drugs that are mood stabilizers. The patient has given a history of being depressed, inability to sleep, delusions, lack of concentration, over familiarity while conversing with people, poor judgement skills, elevated moods and unpredictable behaviour (Woods, 2011). The drug is the first line of medication that is prescribed to treat the above mentioned symptoms for bipolar disorder as Quilonum SR acts to reduce the abnormal activity of the brain and prevent depression and mood swings. Studies have stated that Lithium acts to alter the transportation system of sodium in the cells of the nerves and muscles (Bowden, 2009). It has an impact on the intra-neuronal metabolism of the catecholamine’s that control the biochemical mechanism alterations that are seen in manic depression.

Side effects and adverse effects of Quilonum SR

The most common side effects that are observed in patients who have been prescribed Quilonum SR is an increase in weight which can be managed by constant monitory along with the chances of toxicity that could take place due to the sodium balance changes that can be caused either because of the hot weather, bouts of vomiting and diarrhoea (Australianprescriber.com, 2016). Tremors and an increase in thirst are also seen which are indicative of a change in the thyroid function. Polyuria and GI imitation are indicative of renal toxicity. Consequently making it imperative to conduct thyroid function tests and renal function tests on a periodically for checking the renal functions. Lithium therapy has also been associated with nephrogenic diabetes and such patients need to be managed so that issues of dehydration can be avoided that can result in toxicity and retention of lithium. It is a condition that can be revered when the consumption of lithium is discontinued (Blackdoginstitute.org.au, 2016).

How is medication management influenced by recovery principles in mental health?

The 6 recovery principles in mental health include the following:

1. Uniqueness of the individual
2. Real choices
3. Attitudes and rights
4. Dignity and respect
5. Partnership and communication
6. Evaluating recovery

The recovery principles in mental health is recovery oriented where it is imperative to understand that recovery is not limited to curing the patient but at the same time providing the patient with opportunities so that she can have a life that is meaningful and purposeful. The patient should feel valued and a part of the community (Arango, 2009). The management of medication needs to be based on the personal choices of the individual so that they can pay attention to social inclusion and at the same time strive to enhance the quality of life of the patient and empower them to make them understand that they are a pivotal part of the care that they are receiving.