Dementia
Social Activities
Dementia is a health condition that manifests in acquired cognitive impairment, which tends to “cause limitations of memory, self-care, and family, social, and occupational functioning” (Perese, 2012, p. 512). As a result, patients with dementia often experience social isolation. At the same time, there is a distinct relationship between social activities and quality of life in patients with dementia with social isolation having negative impacts and engagement in social activities being beneficial (Giebel, Challis, & Montaldi, 2014). Townsend (2015) suggests that social isolation can be addressed by creating opportunities for inter-patient interactions. Perese (2012) and Townsend (2015) also highlight familial interactions and their grand supportive potential. Both authors also point out the importance of autonomy in patients, which can be promoted through the support of close people: friends and family members. It is noteworthy that Giebel et al. (2014) shows that patients with dementia tend to be rather reluctant to engage in social activities. Therefore, apart from creating opportunities for interaction, nursing professionals need to assess and address patients’ motivation to engage in social activities.
Treatment and Safety Interventions in the Home
Dementia tends to lead to a decrease in the quality of life and threats to the safety of patients. The interventions for patients with dementia can depend on the specifics of the illnesses and the unique characteristics of every patient. For instance, a wandering patient would need a carefully arranged safe place for pacing, and an agitated one would need control of stimuli. These examples also demonstrate that the environment of a patient with dementia is of supreme importance and can be used to improve their safety as well as a treatment intervention (Townsend, 2015, pp. 346-348). Apart from that, medications, including cholinesterase inhibitors that are meant for cognitive function improvement, are typically used to treat some of the symptoms of dementia (Townsend, 2015, 353).
The safety of a patient can be achieved through the improvement of furniture placement and, possibly, the installation of additional equipment like bedrails at the patient’s place (Townsend, 2015). The patient may also need assistance in learning how to use the equipment. Townsend (2015) and Giebel et al. (2014) highlight the importance of helping the patient to preserve and, if possible, regain autonomy in any form; Townsend (2015) suggests that interventions like structured schedules for the activities of daily living and structured environments should enable patients to remain autonomous. Also, Perese (2012) and Townsend (2015) promote family education concerning ensuring patients’ autonomy. Indeed, the family of the patients can also be involved in care, which should improve the quality of life for patients as well as other family members, especially those who live with the patient (Perese, 2012, p. 513).
Safety for Patients with Delirium
Delirium is a cognitive impairment syndrome that is typically relatively brief. It is usually related to impaired attention and awareness, and it can involve hallucinations (Varcarolis, 2016, p. 273). Nursing safety interventions are similar for patients with delirium and dementia, and they involve the provision of a safe environment that lacks stimuli and distractions, which can cause anxiety or increase confusion. Assistance in daily activities can be required because of the specifics of psychomotor activity, including tremors (Townsend, 2015). Finally, the observation of patients is of supreme importance to ensure their safety. As highlighted by Townsend (2015), the education of family members can assist in achieving this aim.
Patrick
Patrick is a 34-year-old man who has been experiencing changes in his state and behavior lately. He has a wife and two sons, and he works as a sales representative. Until recently, he was a competitive employee, but he reports that a loss of an opportunity to get a promotion has led to a gradual decrease in his motivation, which eventually affected not only his work but his family life as well. He is worried that he might lose the job, but he feels tired and depressed, which prevents him from participating in any job- and family-related activities. He also lost appetite, which resulted in a weight loss, and he has been suffering from insomnia, which he attempts to reduce by using heroin. The case also states that he has started to drink scotch; his medical history contains a car crash incident, in which he was involved at the age of 19 after a drinking party with his friends.
Immediate Needs and Therapeutic Management
The immediate needs of Patrick include his feelings of depression and fatigue; also, his anxiety about the possibility of him being fired can be deemed a significant issue upon a more detailed assessment. The case does not explicitly state Patrick’s diagnosis, but the mentioned symptoms seem to indicate major depressive disorder (MDD), the acute treatment phase for which typically involved six-to-eight months of psychotherapy (for instance, cognitive behavioral therapy) and pharmacotherapy (Perese, 2012, p. 397). The specific drug choice depends on the subtype of MDD and may involve antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and some others (Perese, 2012, p. 399).
It is noteworthy that MDD-typical medications often have side effects, which should be controlled. Insomnia can also be treated through pharmacotherapy. Concerning fatigue, Carney, Moss, Lachowski, and Atwood (2013) highlight the fact that this symptom is often misunderstood or overlooked in psychiatry, even though it significantly affects the quality of life of patients. The authors suggest that, among other things, the issue can be addressed through cognitive therapy, which should involve the investigation and reconsideration of the patient’s stereotypes and beliefs about sleep and fatigue that can be maladaptive and harmful for their psychological comfort.
It should also be pointed out that the choice of drugs needs to be considered comprehensively while taking into account Partick’s substance issues. The lack of interest in food, which results in weight loss, should also be taken into consideration as a major need. However, these elements can be classified as a part of the comprehensive assessment.
Comprehensive Assessment
Patrick’s case requires a comprehensive assessment of his condition, particularly because of his substance issues. Substance abuse can contribute to the development of certain disorders (Townsend, 2015, p. 341). Apart from that, substance use, especially in combination with insomnia, presupposes significant risks of the development of aggressive and self-destructive behaviors, including suicidal ones (Townsend, 2015, p. 277). Finally, substance use can result in substance abuse disorders. The presented information is not enough to diagnose the presence or absence of addiction in Patrick, but the necessary assessments should be made (Townsend, 2015, p. 279). The recovery of a patient requires the recovery from substance addiction if it is present.
Patrick’s weight loss also should be considered in the assessment. For other factors, it can be suggested that the reported socioeconomic status of Patrick does not appear to imply direct complications. Also, no information on the biological parents of Patrick is available, which limits the possibilities of assessments.
Sally
Sally is a 23-year-old woman who is diagnosed with borderline personality disorder (BPD) and has a history of self-harm and anorexia; she has also developed rituals related to cleanness. She was first hospitalized at the age of fourteen; the event made her distance herself from relatives and friends. She reports having been sexually abused by one of her mothers’ boyfriends between the ages of 8 and 11. Currently, she is admitted after her third event of suicidal behavior, which involved lacerations of the wrist and forearm. Sally lives in a shelter, does not have a stable job or relationship, dresses “provocatively,” and appears to take alcohol. She has a third-year-old daughter.
Immediate Needs and Therapeutic Management
Sally’s immediate needs are directly related to BPD and her recent suicidal behavior. The risk of self-harm is of primary importance for the time being. According to Townsend (2015) and Perese (2012), the management of a suicidal client includes the creation of a safe environment and a variety of interventions based on observation (for instance, either regular or irregular checks) and counseling. The latter can include educational interventions (for example, making an inventory of the patient’s resources or discussing coping behaviors). In effect, similar types of interventions are meant for the management of BPD (Townsend, 2015, pp. 683-684). Particular interventions depend on the specifics of Sally’s needs that her nurse will determine. The therapeutic management of BPD also includes medications, the choice of which depends on exhibited symptoms; for instance, mood stabilizers can help to deal with impulsivity while psychotropic medication can help to alleviate anxiety and depression (Bateman & Krawitz, 2013).
Comprehensive Assessment
A comprehensive assessment of Sally’s state and needs should take into account multiple aspects of her current state and situation. Substance use and abuse have been shown to contribute to the development of mental disorders and self-harm behaviors; they are also a risk factor for suicide (Townsend, 2015). As a result, Sally’s substance use needs to be analyzed, in particular, to determine if she has an addiction. Her socioeconomic conditions (being a single mother, living in a shelter, being detached from family and friends) can affect her access to various elements of care and support, limiting her resources (including time). The secondary mental conditions, especially her eating disorders, need to be considered during the assessment as well. All the mentioned factors might have contributed to her current state and the development of suicidal behaviors (Townsend, 2015, p. 278), which makes their introduction into assessment rather critical. Moreover, according to Townsend (2015), various other factors, including religion, ethnicity, and genetics, could also contribute to suicidal behavior and should be considered.
Sally’s Experiences and Personality Development
Sally’s lifetime experiences are likely to have had an impact on her personality, beliefs, and psychological issues. Since Sally was diagnosed with BPD, it can be inferred that she is impulsive and has unstable attitudes towards other people, which can be proved by her reported instability in relationships (Townsend, 2015, p. 675). The latter factor, while characteristic of BPD (Townsend, 2015, p. 675), might also be connected to a similar behavior that Sally used to witness in her mother. Apart from that, early life stress, including that related to sexual abuse and neglect, is known to have destructive effects on the human psyche, and BPD can be caused by this type of trauma (Carr, Martins, Stingel, Lemgruber, & Juruena, 2013, p. 1010). Similarly, eating disorders, distortion in self-image, obsessive-compulsive disorders, and related concerns (in Sally’s case, they are cleanness-related) can all originate from early life trauma (Carr et al., 2013, pp. 1010-1011). These features affect Sally’s personality, behavior, and life choices, and their origin can be traced back to Sally’s early life experiences.
References
Bateman, A., & Krawitz, R. (2013). Borderline personality disorder: An evidence-based guide for generalist mental health professionals. Oxford, UK: OUP Oxford.
Carney, C., Moss, T., Lachowski, A., & Atwood, M. (2013). Understanding mental and physical fatigue complaints in those with depression and insomnia. Behavioral Sleep Medicine, 12(4), 272-289.
Carr, C., Martins, C., Stingel, A., Lemgruber, V., & Juruena, M. (2013). The role of early life stress in adult psychiatric disorders. The Journal Of Nervous And Mental Disease, 201(12), 1007-1020.
Giebel, C., Challis, D., & Montaldi, D. (2014). A revised interview for deterioration in daily living activities in dementia reveals the relationship between social activities and well-being. Dementia, 15(5), 1068-1081.
Perese, E. (2012). Psychiatric advanced practice nursing. Philadelphia, PA: F.A. Davis.
Townsend, M. (2015). Psychiatric mental health nursing (8th ed.). Philadelphia, PA: F.A. Davis Company.
Varcarolis, E. (2016). Essentials of psychiatric mental health nursing (3rd ed.). New York, NY: Elsevier Health Sciences.