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Biological, psychological, social intervention proposed and rationale

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Second assignment

 

Second assignment

 

 

Demographic information – gender: M, age:30

Description of the case - Frank is a 30-year-old man who has been experiencing chronic back pain for the past 6 years following a car accident. He has become addicted to the opiate pain medication regime his General Practitioner has had him on for the past 2 years. The General Practitioner is seeking support to get Frank off the opiates. He has told Frank that there are no structural problems with his back and that he doesn’t need the wheelchair that Frank has recently purchased. Frank feels that he is developing a degenerative condition and no medical practitioner has been able to diagnose why. He has had every investigation and there is no structural or biochemical cause for not being able to walk or continue with his employment. Frank has been on extended sick leave from his work as a building supervisor. Last week Frank went to see a psychiatrist who said that he had developed a somatoform pain disorder. Frank’s partner has recently left and he is finding that he is so anxious he is only leaving the house for medical appointments. His family live interstate and he has no children. The bank has recently contacted and told Frank he needs to appear for an appointment due to the non – payment of his mortgage. The General practitioner has referred Frank to see you as a community mental health clinician.

Setting of treatment – community

 

 

 

 

Over the next 3 months

 

Biological, psychological, social intervention proposed and rationale

 

Expected outcome and evaluation approach

 

Consumer identified goals

The person would complete this section you don’t need to

 

This part does not have to be filled out – it would be completed with the person you don’t to

 

What tools might assist the consumer to evaluate their own goals

 

You do need to identify a self-evaluation tool in this section that can support the person to evaluate their own progress with the treatment provided

 

Two examples of self-report tools where provided in week 1. The BASIS 32, and the INSPIRE tool

Some clinical practice guidelines will recommend specific self-report tools to use

 

 

 

 

Nursing diagnoses identified and goals

  • Pain (NANDA)

Pain assessment

 

Identified Goals:

 

  • Lower pain levels and substitute/eliminate opiates usage to simpler analgesics.

 

 

 

Biological

 

 

Biological intervention

 

  • Patient education

 

  • Patient monitoring

 

  • Administration of SSRI inhibitors. (Jozefowizcz & Smith, 2012)

 

  • Medication administration, minimise and eliminate the use of opiates/ substitute opiates with simpler analgesics. (French et al., 2011)

 

Expected outcome and evaluation tools

 

  • Lower pain levels and substitute/eliminate opiates usage to simpler analgesics.

 

  • May help Frank by restoring serotonin levels in his body.

 

Tools:

 

  • Pain scale use, reduce to at least 4/10. (French et al., 2011)

Nursing diagnoses identified and goals

  • Anxiety

 

  • Post trauma syndrome

 

Hamilton Anxiety Rating Scale (National Institute of Health, 2011)

 

Post traumatic diagnostic Scale (NIH, 2011)

 

Identified goals:

  • Help Frank to cope with anxiety and build up positive attitude towards the treatment.

 

  • Change Frank’s false perspective, thought process to a fact-based information.

 

 

 

    

 

 

 

Psychological

 

  • Cognitive behaviour therapy. (Jozefowicz & Smith, 2012)

 

 

  • Stress coping mechanisms (Abbas et at, 2014)

 

 

 

  • Help Frank cope up with anxiety and the stressors.
  • Help Frank recover from his Post trauma symptoms.

Tools:

 

  • MSE, evaluation marks that Frank has appropriate perspective towards himself and his mental health condition with realistic thought process.
  • Recovery Assessment Scale – Domain and Stages (RAS DS), get an average score of 140/152. (MHISSC, 2015)

 

Nursing diagnoses identified and goals

  •  Impaired social interaction

 

  • Risk of social isolation

    Warwick-Edinburgh Mental Well -Being Scale (WEMWBS)

Identified goals:

  • Social interaction enhancements
  • Reform healthy relationship with family/friends

 

Social

 

 

  • Activate Frank’s contact support with his friends or family to support him.
  • Encourage Frank to participate in group physical therapeutic activities such as yoga classes that can support him physically, psychologically and socially.

Expected outcome and evaluation tools

 

  • Frank starts to engage with his family and friends and asks for support whenever necessary.
  • Frank engages in group activities and enhances his social coping mechanisms.

 

Tools:

 

  • General Health Questionnaire (NIH, 2011)

 

 

Rationale for interventions chosen 

Biological: Traumatic injuries account for more than five million deaths worldwide annually, and account for nine percent of global mortality (NIH. 2011). Survivors are often faced with secondary health issues that may affect their physical, emotional and financial status (NIH, 2011). Likewise, Frank, having been a survivor to a traumatic car accident, has been diagnosed with somatoform disorder secondary to this major event. Jozefowicz and Smith (2012) define somatoform disorder as functional impairment caused by chronic pain without having any underlying biological determinants. Therefore, chronic pain has been established as an important nursing diagnosis relevant to Frank (NANDA).

In a clinical scenario, nurses play vital role towards formulating an appropriate pain management regime for their patients (Brown et al., 2015). Furthermore, critical monitoring tasks are needed when addictive agents, such as opiates, are in use. Drug dependence is a major issue towards use of high risked opiates (Bryant & Knights, 2014). Frank was prescribed opiate medication by his general practitioner to manage his pain, however, overuse of this opiate has resulted Frank to be dependent on the prescribed opiate to carry out normal functioning. Bryant and Knights suggest that, the best way to get off a person from drug dependence is to administer lower doses, lower frequency and substitution with simpler analgesics by the nurse collaborating with participating practitioner and consumer. This procedure would be carried out slowly, with close patient monitoring and with collaborative information sharing to enhance nurse-consumer participation in recovery. Pain scale would be used to measure pain and collect data on patient recovery status. 

Jozefowicz and Smith (2012) suggest that administration of SSRIs may have positive outcome on patients with somatoform disorder. The researchers suggest that SSRIs may help balance the neurological chemical serotonin levels in the body and promote recovery. SSRIs may also help consumers faced with somatoform disorder to cope with comorbid psychological effects such as anxiety and Post-Traumatic Stress Syndromes (PTSD). 

Psychological: American Psychiatric Association (2013), believe that somatoform disorders are disorders that are symptomatic to medically un-diagnosable conditions that are accompanied by several mental distresses. For instance, Frank was diagnosed with somatoform disorder and has been complaining about severe chronic back pain without any clinical rationale. Additionally, Frank presents with comorbid psychological disturbances such as anxiety and post-traumatic stress syndrome that has impacted on his daily lifestyle activities. Anxiety and Post-Traumatic Stress syndrome are nursing diagnosis that will be elaborated in this section of paper (NANDA).

Bjorn et al., believe that patients with somatoform disorder often lack ability to recognise emotions and epithetical deficits that may lead to stress related mental disorders such as anxiety. Anxiety generally causes people to have enhanced concerns about specific situations that may result in harming ideations and actions (Barsky, 2013). Frank has been anxious about his health condition regardless of several tests run to rule out any degenerative or any medical conditions applicable. This may be a result of anxiety where Frank’s thought process has been disturbed. Collaterally, Post- Traumatic Stress Syndrome is another major issue that commonly occurs side by side with somatoform disorders, which contributes to increased levels of anxiety (Bjorn et al., 2012). Having been through a major traumatic incident, it is inevitable that Frank has concerns and anxiety towards his health status. Management of PTSD is therefore, critical towards Frank’s journey to recovery. Psychotherapy such as Cognitive Behaviour Therapy (CBT), has been found to be effective in management of anxiety and PTSD (Abbass et al., 2014). There are several exercises that may help Frank to cope with mental stressors. For instance, deep breathing, mindful meditation, focusing on single objects of the room, etc. can help manage stress (Gerace, 2018). Self-assessment tools will be used to measure anxiety levels and recovery. These tools are HAM and RAS DS respectively. Furthermore, MSE can also be used to keep track of recovery and psychological disorder management.

 

 

References

 

Brown, D., Edwards, H., Swaton, L., et al. (2015). Lewis’s medical-surgical nursing (4th ed.). Sydney: Elsevier

 

Bryant, B. & Knights, K. (2014).  Pharmacology for health professionals. Sydney: Elsevier

 

 

 

 

 

Over the next 3 months

 

Biological, psychological, social intervention proposed and rationale

 

Expected outcome and evaluation approach

 

Consumer identified goals

The person would complete this section you don’t need to

 

This part does not have to be filled out – it would be completed with the person you don’t to

 

What tools might assist the consumer to evaluate their own goals

 

You do need to identify a self-evaluation tool in this section that can support the person to evaluate their own progress with the treatment provided

 

Two examples of self-report tools where provided in week 1. The BASIS 32, and the INSPIRE tool

Some clinical practice guidelines will recommend specific self-report tools to use

 

 

 

 

Nursing diagnoses identified and goals

  • Pain (NANDA)

Pain assessment

 

Identified Goals:

 

  • Lower pain levels and substitute/eliminate opiates usage to simpler analgesics.

 

 

 

Biological

 

 

Biological intervention

 

  • Patient education

 

  • Patient monitoring

 

  • Administration of SSRI inhibitors. (Jozefowizcz & Smith, 2012)

 

  • Medication administration, minimise and eliminate the use of opiates/ substitute opiates with simpler analgesics. (French et al., 2011)

 

Expected outcome and evaluation tools

 

  • Lower pain levels and substitute/eliminate opiates usage to simpler analgesics.

 

  • May help Frank by restoring serotonin levels in his body.

 

Tools:

 

  • Pain scale use, reduce to at least 4/10. (French et al., 2011)

Nursing diagnoses identified and goals

  • Anxiety

 

  • Post trauma syndrome

 

Hamilton Anxiety Rating Scale (National Institute of Health, 2011)

 

Post traumatic diagnostic Scale (NIH, 2011)

 

Identified goals:

  • Help Frank to cope with anxiety and build up positive attitude towards the treatment.

 

  • Change Frank’s false perspective, thought process to a fact-based information.

 

 

 

    

 

 

 

Psychological

 

  • Cognitive behaviour therapy. (Jozefowicz & Smith, 2012)

 

 

  • Stress coping mechanisms (Abbas et at, 2014)

 

 

 

  • Help Frank cope up with anxiety and the stressors.
  • Help Frank recover from his Post trauma symptoms.

Tools:

 

  • MSE, evaluation marks that Frank has appropriate perspective towards himself and his mental health condition with realistic thought process.
  • Recovery Assessment Scale – Domain and Stages (RAS DS), get an average score of 140/152. (MHISSC, 2015)

 

Nursing diagnoses identified and goals

  •  Impaired social interaction

 

  • Risk of social isolation

    Warwick-Edinburgh Mental Well -Being Scale (WEMWBS)

Identified goals:

  • Social interaction enhancements
  • Reform healthy relationship with family/friends

 

Social

 

 

  • Activate Frank’s contact support with his friends or family to support him.
  • Encourage Frank to participate in group physical therapeutic activities such as yoga classes that can support him physically, psychologically and socially.

Expected outcome and evaluation tools

 

  • Frank starts to engage with his family and friends and asks for support whenever necessary.
  • Frank engages in group activities and enhances his social coping mechanisms.

 

Tools:

 

  • General Health Questionnaire (NIH, 2011)

 

 

Rationale for interventions chosen 

Biological: Traumatic injuries account for more than five million deaths worldwide annually, and account for nine percent of global mortality (NIH. 2011). Survivors are often faced with secondary health issues that may affect their physical, emotional and financial status (NIH, 2011). Likewise, Frank, having been a survivor to a traumatic car accident, has been diagnosed with somatoform disorder secondary to this major event. Jozefowicz and Smith (2012) define somatoform disorder as functional impairment caused by chronic pain without having any underlying biological determinants. Therefore, chronic pain has been established as an important nursing diagnosis relevant to Frank (NANDA).

In a clinical scenario, nurses play vital role towards formulating an appropriate pain management regime for their patients (Brown et al., 2015). Furthermore, critical monitoring tasks are needed when addictive agents, such as opiates, are in use. Drug dependence is a major issue towards use of high risked opiates (Bryant & Knights, 2014). Frank was prescribed opiate medication by his general practitioner to manage his pain, however, overuse of this opiate has resulted Frank to be dependent on the prescribed opiate to carry out normal functioning. Bryant and Knights suggest that, the best way to get off a person from drug dependence is to administer lower doses, lower frequency and substitution with simpler analgesics by the nurse collaborating with participating practitioner and consumer. This procedure would be carried out slowly, with close patient monitoring and with collaborative information sharing to enhance nurse-consumer participation in recovery. Pain scale would be used to measure pain and collect data on patient recovery status. 

Jozefowicz and Smith (2012) suggest that administration of SSRIs may have positive outcome on patients with somatoform disorder. The researchers suggest that SSRIs may help balance the neurological chemical serotonin levels in the body and promote recovery. SSRIs may also help consumers faced with somatoform disorder to cope with comorbid psychological effects such as anxiety and Post-Traumatic Stress Syndromes (PTSD). 

Psychological: American Psychiatric Association (2013), believe that somatoform disorders are disorders that are symptomatic to medically un-diagnosable conditions that are accompanied by several mental distresses. For instance, Frank was diagnosed with somatoform disorder and has been complaining about severe chronic back pain without any clinical rationale. Additionally, Frank presents with comorbid psychological disturbances such as anxiety and post-traumatic stress syndrome that has impacted on his daily lifestyle activities. Anxiety and Post-Traumatic Stress syndrome are nursing diagnosis that will be elaborated in this section of paper (NANDA).

Bjorn et al., believe that patients with somatoform disorder often lack ability to recognise emotions and epithetical deficits that may lead to stress related mental disorders such as anxiety. Anxiety generally causes people to have enhanced concerns about specific situations that may result in harming ideations and actions (Barsky, 2013). Frank has been anxious about his health condition regardless of several tests run to rule out any degenerative or any medical conditions applicable. This may be a result of anxiety where Frank’s thought process has been disturbed. Collaterally, Post- Traumatic Stress Syndrome is another major issue that commonly occurs side by side with somatoform disorders, which contributes to increased levels of anxiety (Bjorn et al., 2012). Having been through a major traumatic incident, it is inevitable that Frank has concerns and anxiety towards his health status. Management of PTSD is therefore, critical towards Frank’s journey to recovery. Psychotherapy such as Cognitive Behaviour Therapy (CBT), has been found to be effective in management of anxiety and PTSD (Abbass et al., 2014). There are several exercises that may help Frank to cope with mental stressors. For instance, deep breathing, mindful meditation, focusing on single objects of the room, etc. can help manage stress (Gerace, 2018). Self-assessment tools will be used to measure anxiety levels and recovery. These tools are HAM and RAS DS respectively. Furthermore, MSE can also be used to keep track of recovery and psychological disorder management.

 

 

References

 

Brown, D., Edwards, H., Swaton, L., et al. (2015). Lewis’s medical-surgical nursing (4th ed.). Sydney: Elsevier

 

Bryant, B. & Knights, K. (2014).  Pharmacology for health professionals. Sydney: Elsevier

 

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