NURSING

Case Study, Mohr

CHAPTER 1, Introduction to Psychiatric–Mental Health Nursing In completing the case study, students will be addressing the following learning objectives: Explain elements that contribute to mental health.

Review trends, problems, and goals related to the delivery of mental health care and treatment of mental illness.

1. Karen is a 25-year-old white woman who lives alone in an apartment with her dog. Karen has been divorced for 2 years and is taking Prozac prescribed by her psychiatrist for depression.  Karen and her boyfriend had been discussing marriage until he told her that he wanted to end their relationship.  Karen became even more depressed and could not work for a week.  Karen returned to work, refusing to discuss her issues with family, friends, or coworkers. She did, however, make an appointment to see a psychiatric nurse practitioner.  Karen told the nurse that she was making some changes in her life.  Karen said that she and a girlfriend were joining a gym program for workouts and a social group for young men and women.  Karen stated that she realizes that her former boyfriend had not been committed to her, and she anticipates meeting and dating other young men from the adult social group.  Karen also said that she thinks that the gym exercise will be beneficial to her mentally and physically.

Learning Objectives: 1, 4)

  • How will the psychiatric nurse assess if Karen has made progress toward self-realization?
  • Identify strengths that Karen has for progress in personal growth.

Karen has been seeking treatment for her depression. Analyze the factors that might contribute to Karen’s reluctance to discuss her depression with others.

Case Study, Mohr:  CHAPTER 2, Neuroscience: Biology and Behavior

In completing the case study, students will be addressing the following learning objectives:

Discuss neuroplasticity and how this concept relates to mental health and mental illness.

Briefly explain the importance of interaction between genes and environment, the role of endophenotypes, and the stress-diathesis model of psychiatric illness.

1. Michael is a 22-year-old college senior whose GPA has declined with this semester’s grades.  Michael plans to apply to medical school and thinks that the lower GPA may prevent his acceptance to medical school.  For the last 2 weeks, Michael has skipped most classes because he has insomnia and fatigue.  Michael is now very depressed and has been thinking of suicide.  He took a loaded gun from his father’s gun cabinet and then wrote a suicide note to his family.  At the last moment, he telephoned 911 and told them of his suicide plan.  The police came, took the gun away, and then took Michael to the city hospital to be admitted for psychiatric treatment.   In the admission interview with the psychiatric nurse, Michael said that his pastor thought that only weak-willed people experienced depression and that it was a punishment for personal sins and the sins of one’s ancestors.  Michael told the nurse that he must be weak-willed and will never be able to accomplish anything.  The psychiatric nurse explained that multiple factors are the cause of depression.  The nurse told Michael that one theory holds that an imbalance of neurotransmitters, or chemical messengers of the brain, occurs in depression.  Neurotransmitters influence the individual’s emotions, thoughts, and subsequent behavior.  Recent research implies that neurobiology, heredity, as well as Psychological and environmental factors may be involved in the development and progression of depression.

(Learning Objectives: 5, 6)

a. Will Michael think that the psychiatric nurse’s explanation for the cause of depression is more correct than that of his pastor?

b. Michael asks the nurse why he has to have psychotherapy. He states that he only needs to take a couple of pills to get better. How should the nurse respond to Michael’s question and comment?

c. Develop an assessment question for each of the following possible causes of Michael’s    development of depression:

Genetic, Environment and Stress.

Case Study, Mohr

CHAPTER 3, Conceptual Frameworks and Theories:

In completing the case study, students will be addressing the following learning objective:

Give examples of behavioral and cognitive-behavioral interventions.

The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder.  This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room.   The student walked over to the client and used reflective communication by stating, “I see that you have a tense expression and are walking around almost all of the time.  Is there something that we could discuss?”  The client replied that she has talked on the telephone to her mother who was keeping her children while she was in the hospital.  The client said that her mother had told her that she was not a good mother, and then said, “I guess I am a bad mother, but I could never measure up to my mother’s expectations.”  The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression.  The student decided to use a behavioral intervention with the client and asked the client who is a good artist and why the client liked the artist’s works. The student and the client then made a list of activities that the client liked. The student taught the client to engage in one of these activities when an unpleasant experience evoked negative thoughts.  The following day, the student decided that the client needed some cognitive restructuring for her relationship with her mother.  The student taught the client that during discussions with her mother, feelings of incompetence might be experienced when the mother made negative comments.  The client was instructed that if her mother made negative comments about parenting, she was to immediately tell her mother that she was a good parent to her children and terminate the conversation at the first opportunity.

(Learning Objective: 3)

a. Will the client be able to learn cognitive restructuring in her relationship with her mother?

b.    How will engaging in activities help the client with her anxiety?

Case Study, Mohr

CHAPTER 4, Evidence-Based Practice

In completing the case study, students will be addressing the following learning objective:

Define evidence-based care.

1. Jessica, a 17-year-old girl who came with her family from Romania to the United States 10 years ago, is brought to the mental health clinic by her mother.  At the admission psychiatric interview, the mother stated that Jessica has been saying for 6 months that aliens have been conducting experiments on her and will soon take her in a spaceship to their planet.  Jessica is often awake at night and roams the house with a hammer and sharp knife, searching for aliens. Jessica’s mother says that she fears that some night Jessica will harm a family member whom she believes to be an alien.  The mother then said that she did not bring Jessica for psychiatric care earlier because she had heard that much of mental health treatment was quackery and a waste of money. The psychiatric nurse explains to Jessica’s mother that all mental health treatment is based on scientific principles.

(Learning Objective: 3)

a. How would the nurse best explain that the care Jessica will receive at the psychiatric   facility is based on evidence? Give two examples of psychiatric evidence-based care, and explain the scientific evidence that supports your examples.

Case Study, Mohr

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