Psychological Critique of a Clinical PatientRuby C ElliottDes Moines Area Community CollegePsychological

Psychological Critique of a Clinical PatientRuby C. ElliottDes Moines Area Community CollegePsychological Critique of a Clinical PatientIntroThis paper will discuss the care of one specific patient, a 25-year-old female, with a primary diagnosis of Major Depressive Disorder (MDD) and her care. There are many different aspects that go into the care of each individual and their diagnosis this can vary by patient. Specific tools are used to aid in the care of each individual such as a one-on-one assessment and a psychosocial assessment. Many different aspects are taken into consideration when planning care for each individual such as Growth and development, their laboratory diagnostics, and the medications they are taking. Each of these elements plays a role in the care and discharge education to the patient to provide a safe transition from the hospital setting to the patient’s home. Textbook comparison Textbooks and online sources can help us look for signs and symptoms of specific diagnoses but there will be very few diagnoses that have every sign and symptom that is described in the textbook. We will discuss the variations from the text book as well as similarities for the diagnosis of Major Depressive Disorder compared to one specific patient. Major Depressive Disorder according to the American Psychiatric Association is defined as “A common and serious medical illness that can affect how you feel, think, and act.”(CITATIpoon) “Depression causes feeling if sadness and/ or loss of interest in activities that were once enjoyed. It can lead to emotional and physical problems that can decrease the person’s ability to function at work and home.” The feelings this patient exhibited lead to her diagnosis of Major Depressive Disorder. (APA) When taking a look at the symptoms of MDD according to the APA. We will discuss how these were seen in the patient or if they were not exhibited. The signs include: “Feeling sad or having a depressed mood, loss of interest in activities, changes in appetite, trouble sleeping or sleeping too much, loss of energy or increased fatigue, increase in purposeless physical activity or slowed movements and speech, feeling worthless or guilty, difficulty thinking, making decision or concentrating, and thoughts of death or suicide.” These symptoms must last more than two weeks to be diagnosed with depression. APA The symptoms that were seen in my patient were Feeling sad or having a depressed mood, loss of interest in activities, increased fatigue, feeling worthless, difficulty making decisions, change in appetite, and thoughts of suicide. Each of these signs were exhibited when doing a one-on-one assessment. My patient exhibited sadness and a depressive mood upon entering her room. She had a flat affect and kept her head down for the majority of the one-on-one assessment. She had a tendency to spend a lot of time in her room sleeping or laying in her bed saying that she felt tired all the time and she did not want to do anything. Upon assessment, she stated that she felt like she could not do anything right and she was not good at anything. When asked if she wanted to go to group therapy class she was very hesitant and anxious until she made a decision to go. She refused to eat breakfast in the morning saying she was not hungry and did not want to eat. When asked if she was feeling suicidal she said yes, all the time. If I was not here right now I would try and jump off a bridge. She said that she did not have a plan in the hospital. The only symptoms that was not seen in the patient were purposeless physical activity or slowed movements and speech. My patient tended to keep to herself and stay in her room either sleeping or alone. She did not have any delayed movements and her speech was appropriate.Client Care Aspects Different aspects of client care are taken into consideration to allow the best care for each patient and their needs. It is important to look at patient’s laboratory diagnostics, medications, the patient’s environment, and be able to view the patient in a holistic way to provide the best care to each individual. A thorough understanding of this portion of care is important in preventing injury, discharge planning, and providing the best care to the patient. Laboratory Diagnostics The labs that were done for my patient include a Complete Blood Count (CBC) with differential and a Urine Drug Screen upon admission. My patient was voluntarily admitted to the facility and these labs were drawn. When a patient is admitted to the facility with depression lab tests such as a CBC are drawn to test your thyroid function. (MAYO) The patient did have a functioning thyroid and all of her labs were normal except for the following: An elevated red blood cell count, and elevated red blood cell distribution width, an elevated glucose level and an elevated Alkaline phosphate level. She had lowered levels of carbon dioxide in the blood, and a low bilirubin total. This patient had a Urine Drug Screening done upon admission for suspected drug abuse. This is not usually done to diagnose a patient with depression. The results of this test were that this patient tested positive for benzodiazepines. When asked about the medications in her system she stated that she had tried to overdose on her depression medications about a week ago and stated that she had been drinking that night as well. With this knowledge, educating this patent on alcohol use and the adverse effects of medications is essential for her safety. MEDICATIONSMedication use is very common for patients admitted to the behavioral health unit to help treat the symptoms they are experiencing. Since these patients are usually one more than one antipsychotic medication adverse effects are common and medication compliance is a priority. Each shift the patients’ vital signs are taken to help monitor adverse effects such as orthostatic hypotension. This patient was on two antipsychotic medications and three antidepressant medications. The antipsychotic medications were cariprazine and quetiapine fumarate. When entering these medications into Macromedics to check the compatibility of these drugs with the other drugs this client takes it was unsuccessful. Common things to look for in patients taking antipsychotic medications are extrapyramidal signs and symptoms, Neuroleptic syndrome, and tardive dyskinesia. These conditions can be life-threatening and/or permanent.The three antidepressant medications that this patient was on were Duloxetine, Sertraline, and Trazodone. It is important to monitor for signs and symptoms of suicidal tendencies or thoughts for patients taking antidepressants. Since this patient is on multiple antidepressant medications safety is priority for this patient. Program AspectsThe mental health floor of Iowa Lutheran hospital provides structure so that each patient spends time learning how to cope with their emotions and improve social skills. This is accomplished by providing a safe environment and various therapy sessions. My patient went to multiple groups a day focused on coping with their feelings, arts and crafts, and groups focused on coping mechanisms. After each group therapy, she stated that she discovered that some people have had similar experiences to the ones she had gone through and it made her feel like she wasn’t the only one dealing with depression and anxiety.She said that she learned that the first step to help herself and her diagnosis is to focus on herself and what she can change in order to live a healthier life. She went to an arts and craft group and said that It reminded her of when she used to draw and she would like to do that more. While my patient was at group classes she was able to distract herself from her diagnosis and any thoughts of suicide or depressive thoughts. The milieu provided a safe environment for each patient and each nurse was responsible for knowing which patients were at risk for suicide to keep an eye on those patients. GROWTH AND DEVELOPMENTWhen working with patient it is important to know their age and appropriate stage of development in order to set goals, educate the patient, and assess any risks that they may be predisposed to due to age. Sometimes a patient can regress to a different stage of development due to injury or health condition. Growth and DevelopmentDischarge PlanningSince my patient is at a high risk for suicide discharge education and Global ConceptsThe seven global concepts of the Des Moines Area Community College nursing program include: Communication, Safe Practice, Nursing Process, Care Across the Life Span, Professionalism, Culture, and Health Promotion. Each of these concepts help integrate the plan of care for my patient.CommunicationCommunication was the most important part in caring for my patient. Upon entering my patients room, she was very withdrawn and anxious. After actively listening to my patient talk about how she got to the behavioral health unit I was able to assess how she felt about being there, and what she was going through. I asked my patient open ended questions such as how did that make you feel? and can you tell me more about that? This helped create a therapeutic relationship with the patient. Nursing ProcessAfter talking with my patient and noticing that she spent a lot of time in bed and withdrawn from people. My goals for this patient were to attend at least one group therapy class and take a shower before the end of the shift. She was able to meet these goals by attending a coping therapy class and an arts and crafts class. After the group therapy classes, she also took a shower. Care Across the Life SpanAfter reviewing the laboratory test of my patient and noticing that when she was admitted to the hospital she tested positive for. When talking with my patient she stated that days prior to going to the hospital she took a lot of pills and was drinking with her friends. I educated her on the effects of drinking and medications. Some medications mixed with alcohol can have an adverse effect especially benzodiazepines such as sedation or death. ProfessionalismWhen interviewing my patient, I noticed that when I would tap my foot it would make her more anxious. I was able to notice this behavior and actively worked to prevent my foot from tapping. She calmed down noticeably after the foot tapping stopped. Culture When talking with my patient she stated that she lives in a house of seven people including her. She said that this many people and the environment causes her to be extremely anxious and stressed but it is the only support system that she has. Knowing this information allows me to see the patients big picture and see what coping skills may work for her. One coping skill we discussed was going for a walk when feeling stressed to get away from the house a little bit and be alone. Safe practiceThis patient was in for Major depressive disorder so my priority question when talking with her was “Are you feeling suicidal or having suicidal thoughts?” This is extremely important to ask to help ensure her safety. She said no she did not have any suicidal thoughts. Health PromotionWhen assessing my patient, I noticed that she had very greasy hair and looked like she hadn’t showered in a while. I told her that sometimes when people are very depressed they may not notice that they haven’t taken a shower in a few days or haven’t brushed their teeth. I told her that I would like her to take a shower and do some self- care activities such as taking a walk or brushing her hair. ConclusionReference listPsychological Critique of a Clinical PatientRuby C. ElliottDes Moines Area Community CollegePsychological Critique of a Clinical PatientIntroThis paper will discuss the care of one specific patient, a 25-year-old female, with a primary diagnosis of Major Depressive Disorder (MDD) and her care. There are many different aspects that go into the care of each individual and their diagnosis this can vary by patient. Specific tools are used to aid in the care of each individual such as a one-on-one assessment and a psychosocial assessment. Many different aspects are taken into consideration when planning care for each individual such as Growth and development, their laboratory diagnostics, and the medications they are taking. Each of these elements plays a role in the care and discharge education to the patient to provide a safe transition from the hospital setting to the patient’s home. Textbook comparison Textbooks and online sources can help us look for signs and symptoms of specific diagnoses but there will be very few diagnoses that have every sign and symptom that is described in the textbook. We will discuss the variations from the text book as well as similarities for the diagnosis of Major Depressive Disorder compared to one specific patient. Major Depressive Disorder according to the American Psychiatric Association is defined as “A common and serious medical illness that can affect how you feel, think, and act.”(CITATIpoon) “Depression causes feeling if sadness and/ or loss of interest in activities that were once enjoyed. It can lead to emotional and physical problems that can decrease the person’s ability to function at work and home.” The feelings this patient exhibited lead to her diagnosis of Major Depressive Disorder. (APA) When taking a look at the symptoms of MDD according to the APA. We will discuss how these were seen in the patient or if they were not exhibited. The signs include: “Feeling sad or having a depressed mood, loss of interest in activities, changes in appetite, trouble sleeping or sleeping too much, loss of energy or increased fatigue, increase in purposeless physical activity or slowed movements and speech, feeling worthless or guilty, difficulty thinking, making decision or concentrating, and thoughts of death or suicide.” These symptoms must last more than two weeks to be diagnosed with depression. APA The symptoms that were seen in my patient were Feeling sad or having a depressed mood, loss of interest in activities, increased fatigue, feeling worthless, difficulty making decisions, change in appetite, and thoughts of suicide. Each of these signs were exhibited when doing a one-on-one assessment. My patient exhibited sadness and a depressive mood upon entering her room. She had a flat affect and kept her head down for the majority of the one-on-one assessment. She had a tendency to spend a lot of time in her room sleeping or laying in her bed saying that she felt tired all the time and she did not want to do anything. Upon assessment, she stated that she felt like she could not do anything right and she was not good at anything. When asked if she wanted to go to group therapy class she was very hesitant and anxious until she made a decision to go. She refused to eat breakfast in the morning saying she was not hungry and did not want to eat. When asked if she was feeling suicidal she said yes, all the time. If I was not here right now I would try and jump off a bridge. She said that she did not have a plan in the hospital. The only symptoms that was not seen in the patient were purposeless physical activity or slowed movements and speech. My patient tended to keep to herself and stay in her room either sleeping or alone. She did not have any delayed movements and her speech was appropriate.Client Care Aspects Different aspects of client care are taken into consideration to allow the best care for each patient and their needs. It is important to look at patient’s laboratory diagnostics, medications, the patient’s environment, and be able to view the patient in a holistic way to provide the best care to each individual. A thorough understanding of this portion of care is important in preventing injury, discharge planning, and providing the best care to the patient. Laboratory Diagnostics The labs that were done for my patient include a Complete Blood Count (CBC) with differential and a Urine Drug Screen upon admission. My patient was voluntarily admitted to the facility and these labs were drawn. When a patient is admitted to the facility with depression lab tests such as a CBC are drawn to test your thyroid function. (MAYO) The patient did have a functioning thyroid and all of her labs were normal except for the following: An elevated red blood cell count, and elevated red blood cell distribution width, an elevated glucose level and an elevated Alkaline phosphate level. She had lowered levels of carbon dioxide in the blood, and a low bilirubin total. This patient had a Urine Drug Screening done upon admission for suspected drug abuse. This is not usually done to diagnose a patient with depression. The results of this test were that this patient tested positive for benzodiazepines. When asked about the medications in her system she stated that she had tried to overdose on her depression medications about a week ago and stated that she had been drinking that night as well. With this knowledge, educating this patent on alcohol use and the adverse effects of medications is essential for her safety. MEDICATIONSMedication use is very common for patients admitted to the behavioral health unit to help treat the symptoms they are experiencing. Since these patients are usually one more than one antipsychotic medication adverse effects are common and medication compliance is a priority. Each shift the patients’ vital signs are taken to help monitor adverse effects such as orthostatic hypotension. This patient was on two antipsychotic medications and three antidepressant medications. The antipsychotic medications were cariprazine and quetiapine fumarate. When entering these medications into Macromedics to check the compatibility of these drugs with the other drugs this client takes it was unsuccessful. Common things to look for in patients taking antipsychotic medications are extrapyramidal signs and symptoms, Neuroleptic syndrome, and tardive dyskinesia. These conditions can be life-threatening and/or permanent.The three antidepressant medications that this patient was on were Duloxetine, Sertraline, and Trazodone. It is important to monitor for signs and symptoms of suicidal tendencies or thoughts for patients taking antidepressants. Since this patient is on multiple antidepressant medications safety is priority for this patient. Program AspectsThe mental health floor of Iowa Lutheran hospital provides structure so that each patient spends time learning how to cope with their emotions and improve social skills. This is accomplished by providing a safe environment and various therapy sessions. My patient went to multiple groups a day focused on coping with their feelings, arts and crafts, and groups focused on coping mechanisms. After each group therapy, she stated that she discovered that some people have had similar experiences to the ones she had gone through and it made her feel like she wasn’t the only one dealing with depression and anxiety.She said that she learned that the first step to help herself and her diagnosis is to focus on herself and what she can change in order to live a healthier life. She went to an arts and craft group and said that It reminded her of when she used to draw and she would like to do that more. While my patient was at group classes she was able to distract herself from her diagnosis and any thoughts of suicide or depressive thoughts. The milieu provided a safe environment for each patient and each nurse was responsible for knowing which patients were at risk for suicide to keep an eye on those patients.

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