When answering the question, the ADPIE should be from the case scenario and 3b and 3c should be like 11/2 pages and if any referencing used should be APA format. any questions don’t hesitate to contact me thanks
Case Study Assignment
Due: on or before February 22, 2022 at 0830
- Write a paper, following in APA format, to include the following:
- A nursing care plan for this patient situation (use ADPIE rationale)
- Explaining 2 actual problems
- Explaining 2 potential problems
- Describe how the social determinants of health influence this patient’s health experience
- What does “recovery” mean in the context of severe mental illness?
- A nursing care plan for this patient situation (use ADPIE rationale)
APA – double spaced, Times New Roman font # 12, proper intext citations throughout, title page and reference page. Refer to the resources available on Brightspace.
CASE STUDY #1
CASE STUDY #2
Valerie is a 50 year old woman who was diagnosed with schizophrenia when she was 29. Prior to her diagnosis, Valerie had completed her BSc at the University of Toronto and began graduate school at The University of Guelph. During university, Valerie was convinced that someone was poisoning her, and made frequent trips to student health. Valerie became fascinated with organic foods and chemicals and was certain that growth hormones in meat were created to poison humans. While she did not have a large circle of friends, Valerie did have a boyfriend, Henry, throughout her undergraduate degree. As she became increasingly delusional, she isolated herself from her friends, and her relationship with Henry broke down. After starting her graduate degree, Valerie became more obsessed with food and would only allow herself to eat bread and bananas.
She began to use marijuana. Now Valerie would spend her days in a smoke-filled room scared to go out for fear of coming in contact with contaminated food. During this time she continued to see her doctor for stomach symptoms. One day, while traveling back from a doctor’s appointment, Valerie ran into Henry. Their relationship was soon rekindled, and Valerie stopped using marijuana. Valerie’s stress was substantially decreased now that she and Henry were spending so much time together, and gradually, Valerie became less and less worried about her food being contaminated, and her stomach symptoms ceased.
Within 2 years, Valerie & Henry were married. After 4 years of marriage, however, Valerie’s stomach problems started to come back. She began to make multiple appointments with her family physician, who could not discover any problems with her health. Valerie and Henry were not getting along, and Valerie became worried that he was injecting her food with poison and contaminating the milk she was drinking with deadly bacteria. Valerie & Henry were active members of their church; however, during this time, Valerie began to believe that there were members of the church who had infiltrated and were trying to destroy their faith community.
When Valerie told Henry about her concerns, Henry and Valerie’s pastor became worried about her, and consulted with Valerie’s physician. Henry and Valerie’s family physician informed Valerie that he was admitting her to hospital. Valerie was relieved that someone saw what was really going on; however, on admission, she realized she was on the psychiatric floor and was convinced the government was plotting against her. After 6 months in a psychiatric facility, Valerie felt better and was discharged. She received a diagnosis of schizophrenia, and was prescribed medication. Valerie took her medication and was able to settle into an apartment.
Valerie and Henry got back together for a short time. After 6 months, the side effects of the medication were so severe, she stopped taking them and she and Henry divorced. Two months later, she realized that Henry was spying on her through her apartment window, and she decided to escape by hitchhiking to Vancouver Island. In Comox – a small town on Vancouver Island, she got a job as a receptionist in a saw mill. Valerie continued to experience paranoia about the food around her and now started to feel that her co-workers in the office were plotting against her. She would see them huddled together before and after work and felt they were mapping out their plan against her. Valerie had contact with a community mental health team and the occupational therapist was working with her to support her at home and work. The OT had met with Valerie’s employer and discussed the difficulty Valerie had been having with her medication and maintaining her focus and attention. Shortly after this meeting, Valerie was fired and she stopped seeing her mental health team. This created a downward spiral for Valerie who continued to live in Comox for another 2 years, taking odd jobs, and living in squalor.
Isolation and despair drove her to leave BC and move back to Toronto. In Toronto, without money, Valerie lived between an abandoned car and local shelters. She went to soup kitchens, but was hungry and had little human contact. Somehow, she found a job taking out the garbage at a local restaurant and was able to find an apartment in a run down building in Toronto. With a little money, she began to drink heavily, alternating between cheap liquor and homemade beer.
Valerie’s paranoia and delusions shifted and she became convinced that aliens were inhabiting the people around her. She became increasingly distraught and one day was picked up by police and brought to the hospital. Valerie’s second hospital stay was longer than the first, but by the end, the voices had left and she was feeling like she would be able to manage on her own. Her psychiatrist set up regular appointments with her, and she was assigned to an Assertive Community Treatment (ACT) team who would visit her in the community. The occupational therapist talked to Valerie about activities that were meaningful to her, and she began to focus on music and writing (a passion from early university days). Valerie was prescribed new medications. At discharge, Valerie said that she could begin to see hope and wanted to make sure that she kept taking her medications. On discharge, she had plans to rebuild her life. After just 1 month, Valerie gave up her medications after experiencing strong side effects. Once off her meds, she started missing her psychiatry appointments and moved to a different apartment building. The ACT team lost contact with her.
Valerie had purchased a used guitar at Goodwill – she was now convinced that the music was taking over her mind, and she smashed it against the wall. Valerie withdrew from her small social circle she had begun to develop, was fired from her job, and with no money, was evicted from her apartment. Valerie returned to the streets. Thinking that aliens were going to infiltrate her body, she tried to jump from an overpass. Her shirt got caught on the fence and the police once again took her to the hospital. Valerie was admitted to the same unit as her previous hospital admission. She was re-prescribed medications; however, was adamant about not wanting to be on medications because of the side effects. Valerie refused meds, and her parents were contacted to act as her substitute decision makers. Valerie had not seen her parents in 5 years and was very agitated during their visit. After a lengthy team meeting, her parents signed consent for electroshock therapy (ECT). Once stabilized, Valerie was once again discharged into the community with the support of the Assertive Community Treatment (ACT) team. With the community treatment order, Valerie reluctantly took her medication: Abilify 400mg IM q4 weeks, Haloperidol 1mg po q8h, and Olanzapine 5mg po daily. Her new medication had fewer side effects than her previous meds. Shortly after taking her new medication, Valerie began to feel that she was in control of her body and mind.
With the occupational therapist on the ACT team, Valerie made plans to focus again on music and writing. She started to create a story of her life, on audiotape, with the hope of educating others about schizophrenia. The audiotape found its way into the library, and Valerie was contacted to speak about her personal experience with schizophrenia. Five years later, Valerie continues to take her medication and now speaks to approximately 50-60 groups a year about her experience of schizophrenia. Valerie has a cat, and a small, comfortable apartment, and has made a few close friends in her neighborhood.
Valerie’s case is about her journey of being diagnosed with schizophrenia and being treated for recovery. According to the case scenario, she developed the condition while in college. She began by having fears that there was a person who had plans to poison her and that this was a reason for her regular stomach problems. Due to that fear, she avoids prepared food and only eats bread and bananas. She also has issues with relationships. She only has a small social circle caused by her mistrust and her people. She has a boyfriend with whom she severally breaks up, believing he plans to poison her. This paper will analyze various health issues that affected Valerie.
- Two actual problems
Valerie had two main problems. One of the two actual problems is schizophrenia. Schizophrenia is a mental disorder whereby a person misinterprets reality for a negative response. According to Harvey et al. (2019), the condition is associated with delusions, hallucinations, and extremely disordered thinking and behaviors that largely impair a person’s daily functioning.
At the assessment level, the patient is experiencing delusions, interpreting reality negatively. The patient has fears that someone is trying to poison her even when there is nobody against her. The patient has strained relationships with her workmates, neighbors, parents, and partner. The patient also has false symptoms of stomach problems; whenever she goes to the hospital, there are no stomach issues found.
The beliefs of being harmed by another person or people within the area are linked with schizophrenia. The patient is also having strained relationships in college and marriage. According to Harvey et al. (2019), schizophrenia causes strained relationships due to the fear of harming other people.
The patient’s treatment plan was to incorporate medications for mental disorders and undergo psychotherapy. There should be a collaboration with a psychiatrist for the psychiatric treatment process. The patient was taken to a psychiatrist.
The patient was diagnosed with schizophrenia and given medications meant for schizophrenic conditions. The suppression of the schizophrenic behaviors by the medications proves that the patient was suffering from schizophrenia. Olanzapine is an intervention medication for schizophrenia that helps in suppressing schizophrenic behaviors. The patient showed improvement on high adherence to the medications. The patient also underwent psychiatric programs that helped her cope with the problem. Medication and psychiatric services are key interventions in improving schizophrenic symptoms. Medication adherence should be followed during the treatment process, and thus the nurses should do close monitoring.
The evaluation for the wellbeing of the patient is tied to the frequency and strength of the schizophrenic symptoms. The patient should be evaluated on the level of suppression against the symptoms. The patient should be evaluated on the levels of delusions and fear. The ability to maintain positive relationships should be evaluated.
The patient is regularly experiencing false stomach pains and other stomach issues. On reaching out to the healthcare providers, no issues with her stomach are detected.
She experiences false stomach pains due to the belief that she is ill and poisoned. According to Tundo et al. (2017), 20% of schizophrenia patients experience hypochondriasis. The condition is characterized by being worried about being sick or thinking that one is sick or infected.
Collaboration with a psychiatrist and other mental healthcare providers should be done. For effective treatment, the patient should be critically evaluated on the relationship between hypochondriasis and schizophrenia.
The nurses should ensure adherence to the prescribed medication and make follow-up treatments with the psychiatrist to ensure continued suppression of the disorder.
The patient should be evaluated on the level of hypochondriasis symptoms, such as thinking that she is unwell or that she is infected.
- Two potential Problems
Substance Use Dependency
The patient has been living in anxiety, fearing being poisoned by people around him. After being distressed, Valerie started smoking marijuana at a very high level in her isolated room. She stopped after suppressing the schizophrenic symptoms. She also started drinking alcohol heavily after becoming unemployed in Toronto.
The ‘schizophrenic behaviors keep people far from them and thus drive their desperation towards substance use. According to Khokhar et al. (2018), there is a 40% risk of substance use disorder for patients with schizophrenic symptoms. Hunt et al. (2018) conducted a systematic review to establish the prevalence of substance addiction among patients with schizophrenia. The studies showed that the prevalence of substance use disorder among patients with schizophrenia was 41.7% which is high. Smoking of cannabis among schizophrenic patients was 26.2%, illicit drugs (27.5%), alcohol (24.3%), and stimulants (7.3%) (Hunt et al., 2018). The study results indicated the aggression for substance use increased with an increase in schizophrenic behaviors. This indicates that uncontrolled schizophrenia creates a potential risk of developing substance use disorders for hard drugs such as marijuana, cocaine, alcohol, and other illegal drugs.
Coordinated care with psychiatric healthcare providers is essential to control the risk of being dependent on substances such as marijuana. The patient should also be encouraged to avoid conditions that may lead to substance use and dependency by developing healthy relationships and working on healthy mental activities.
The patient should adhere to the psychiatric sessions and probable medications for controlling substance dependence. Regular monitoring should ensure that the patient is positively responding to the treatment procedures.
The evaluation is done on the rate of marijuana consumption and their intention to stop consuming the addictive substance.
The patient lived in an abandoned car after being sacked from a job in Toronto. She relied on casual jobs, being unable to afford house rent.
Homelessness is caused by low income to enable them to comfortably rent or purchase homes for safer living. The patient was pushed to live in unsafe abandoned care due to financial constraints.
The social support programs that would help the homeless with housing would create a favorable and safe place for the homeless. Financial support groups should also be engaged in supporting the homeless. Supporting the jobless by offering them jobs improves their level of income, thus taking them out of homelessness.
High levels of joblessness and stagnated pay increase homelessness rates (Holm et al., 2020). The main goal is to reduce the patient’s risk of being homeless by improving her financial stability and acquiring a safer place. Engaging with the community support groups advances the social and economic wellbeing of the patient. Thus, healthcare providers will engage with support groups for financial or social assistance. She can also be assisted in getting and maintaining employment.
The improvement of homelessness can be evaluated by achieving the goal of securing a safe and healthy living place. Having a job is a more secure way of ensuring she has a stable income to sustain house renting costs.
- B) Social determinants of Health Influence
The social determinants include the conditions at which people are born, grow, work or age. The patient experienced various social issues that influenced the patient’s health experience. One of the social determinants is economic stability. The patient never got stable employment due to her schizophrenic symptoms, fearing being poisoned, which increased her income nightmares. She ended up being homeless due to financial instability. The second social determinant is neighborhood. The patient’s neighborhood was fairly understanding and willing to help her regain a normal life. Employers and police assisted the patient in attaining quality care, and thus this factor helped improve the symptoms. When Valerie becomes over-affected by the schizophrenic symptoms, she believes that the people around her want to harm her and thus disassociates with them. Even though they try to make a follow-up with her health issue, her isolation makes it hard for the neighboring people and family to fully help her as it should be. Having a strained relationship with the neighbors and family contributed to her poor adherence to medications and backsliding of the health issue. The healthcare system determinant is important in providing the patient with medical and psychiatric care. In the case scenario, the patient regularly visits the healthcare centers for a medical checkup, and she receives quality care from the healthcare providers. This indicates that the healthcare system is strong in the area. The patient’s abstinence from the medications after experiencing adverse effects indicates a gap in the healthcare system for making follow-up care on the effectiveness of the medications. The social determinants contributed to delayed levels of health response of the patient in achieving the quality health goals.
- C) Recovery
Recovery in mental illness refers to improved behavioral symptoms whereby the people with severe mental illness live autonomously with a satisfying life within the community by having enough control of the persisting symptoms. Mental conditions such as schizophrenia cannot be eliminated, and thus, even after-treatment process, the patients are susceptible to some persistent symptoms. The ability to control and suppress the schizophrenic symptoms even when they happen is when the patient is recovering. The recovery helps the patient live a fairly normal life within a broad community.
The patient has various health concerns whose evaluation can indicate whether the patient is recovering or not. One of the issues to consider in defining a patient to be recovering is the progress the patient is experiencing. The patient has negative beliefs about the people close to her that they are planning to poison or threaten her life in one way or another. Reduced delusions and fears of being poisoned or harmed by other people indicate recovery. When the patient has the least symptoms of fear against the people around her, she would be referred to as recovered. Another symptom that should improve towards recovery is the hypochondriasis symptom. The patient should have a reduced level of abnormal fear for illness or having beliefs that she is sick. These symptoms may disrupt the emotional and mental stability of the patient. The patient should also maintain positive and healthy relationships that can mark her improvement in recovery. One of her issues is maintaining personal and workplace relationships that are important in building a strong social and economic environment. Her ability to maintain quality relationships with her family, friends, and work colleagues would indicate improvement in her health.
Harvey, P. D., Strassnig, M. T., & Silberstein, J. (2019). Prediction of disability in schizophrenia: Symptoms, cognition, and self-assessment. Journal of Experimental Psychopathology, 10(3), 2043808719865693.
Holm, M., Taipale, H., Tanskanen, A., Tiihonen, J., & Mitterdorfer‐Rutz, E. (2020). Employment among people with schizophrenia or bipolar disorder: A population‐based study using nationwide registers. Acta Psychiatrica Scandinavica, 143(1), 61–71. https://doi.org/10.1111/acps.13254
Hunt, G. E., Large, M. M., Cleary, M., Lai, H. M. X., & Saunders, J. B. (2018). Prevalence of comorbid substance use in schizophrenia spectrum disorders in the community and clinical settings, 1990–2017: Systematic review and meta-analysis. Drug and alcohol dependence, 191, 234-258.
Tundo, A., Proietti, L., & de Filippis, R. (2017). Treatment of hypochondriasis in two schizophrenia patients using clozapine. Case Reports in Psychiatry, 2017.