Cormac’S Case Study On Mental Health

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Mental Status Assesment

Has withdrawn behavior, he has never had effective cycle of friends since his childhood, and he could not get along with friends at school, he was admitted to psychiatric hospital because of relationship breakdown he avoids eye contact.

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Physical appearance

Cormac has beard, his hair is long, blonde, matted and greasy, his washcloth is on his head, and he has clothes that are crushed and stained. He is very thin Cormac has degree of self-neglect.

Speech

Has monosyllabic pressure of speech and monotonous tone.

Attitude

He is cooperative when interviewed by the nurse, he is hostile and shouts back when asked to take medications.

Mood

He has been agitated and irritable for the past weeks, he even refuses to go for work.

Affect

He has pseudo bulbar affect, he laughs for no apparent reason, he has incongruent affect, he potrays little emotion when listening to a story.

Orientation

Cormac is oriented to time, place and person. Attention and concentrationUnable to remain maintain a long concentration span. He frequently stand up and head to the window to stare out.

Thought process

He has flight of ideas, he thinks taking his medication makes him feels tired all the time, had a dry mouth and had urinary incontinence. Circumstantiality, answers questions but not relevant to what is asked. Thought contentHe has delusions, he spends time scrutinizing videos because he thinks his manager has been recording all his conversations when doing business to catch him making mistakes, that certain brand of equipment’s has recordings of the conversation he held with spy agency, and that he have ability to send and receive messages from God through his recordings. Perception. He has hallucinations. He hears strange voices that are real talking about hi, his lips move silently and even turns his head as if he is speaking to someone. InsightHe is not aware that he’s sick, he tells the parents that there is nothing wrong with him, he refuses to take medications because he thinks he is okay and that the drugs make him terrible.

PS in Mental Health

Biological social Psychological Predisposing

Cormac childhood was unremarkable which contributed to schizophrenia. During his childhood he never had a good network of friends. Environmental factors, his school environment made him to have emotional problems, he couldn’t get along with friends and at home he had conflict with friends. Precipitating Drug abuse. Cormac has been smoking marijuana which contribute to the mental illness. Life events for example he has never had strong network of friends, he dropped out of school because he couldn’t get along with friends and also relationship breakup. Environmental stressors, school work and work environment. perpetuating Drug abuse and non-compliance to medications, parents report that Cormac has not been taking medication and if told to he becomes very hostile. Social network, work and family. He has poor interaction with work mates, customers in place of work and even family. Environmental stressors such as home or social environment, school environment was not favorable for him because he could not get along with friends and his had unremarkable childhood. Protective Medications, they act directly on to biological mechanism that caused his condition, for example monoamine oxidase inhibitors. Training on social skills, social adjustment, and social cognition (Spence, Zubrick, & Lawrence, 2017). Cognitive behavioral therapy and cognition training.

Care Plan

Disturbed sensory perception related to altered chemical alterations, biochemical changes evidenced by altered communication pattern, change in problem solving pattern he drops out of school and refuses to go for work, inappropriate response he shouts back to his parents when asked to take medications, he has hallucinations, Cormac moves his lips silently as if he’s talking to someone else and goes to look at the window, he admits he hears strangers.

Impaired social interactions evidenced by appearing upset, agitated and unable to maintain eye contact. Cormac childhood has never had a strong network of friend at school he couldn’t get along with friends and he didn’t believe the feedback that his tutors deliver about his assessment, he was admitted to a mental hospital when he was 20 years because of relationship breakdown and he has also been behaving strangely with customers at work, he chooses for them the brand of equipment to buy and not to buy.

Interventions

Accept the fact that the voices are real but explain to Cormac that you do not hear and refer as your voices (Rogers, 2012). This makes client to cast doubts. Intervene with one on one or seclusion when necessary. Intervene before anxiety begins, if he is out of control then use of chemical can implemented (Carhuff, 2017). Adhere to easy, basic and reality based topics of conversations. This help him to focus on one idea at a go.

Ensure the patient is taking drugs and even asses if medication have reached therapeutic levels, most of the positive symptoms of schizophrenia will subside with medications which facilitate interactions (Evans, 2017). Since the patient is very withdrawn, a one on one activities with someone should be planned, this will help him learn to feel safe and he may even gradually participate in a group therapy. Engage the client with other clients in social interactions and activities such as games, this will help client to feel part of the group and that he is wanted.

Clinical Handover

Cormac, a 24 years having a diagnosis of schizophrenia, he has withdrawn behavior, he has never had a strong network of friends since childhood and he couldn’t get along with friends at school, he has long, blonde, greasy and matted hair. his clothes are crushed and stained, the patient has monotonous tone and monosyllabic pressure of speech, he is hostile and shouts at parents when he is reminded to take medications, he has agitated and irritable mood for the past weeks, unable to concentrate for long as he is not unable to remain seated for long and often gets up to look at the window. He has flight of ideas, he thinks when he takes medication he feels tired all the time, he has delusion, he believes his boss has been taping all the conversations with the customers to catch him with mistake, he has hallucinations, he hears stranger voices and that the voices are real,he has religious delusions,he believes he can send and receive messages from God through the radio and television.

Therapeutic engagement and clinical interpretation

Therapeutic relationship

Developing a therapeutic relationship with a patient is one of the key elements that contributes greatly to the wellness of a patient (Unhjem, Vatne, & Hem, 2018). It is a key determinant of the positive results for people with mental health disorders irrespective of the kind of therapy used (Sucala et. al, 2012). This is why it is important to develop a therapeutic relationship with Cormac. The patient is the only one who can perfectly describe his experiences since he is the one going through it and a therapeutic relationship will help the nurse to get him describe the experience well. To develop such a relationship with Cormac there are some key factors to consider. First, empathy should be embrace (Erskine, Moursund, & Trautmann, 2013). This is the act of being able to identify with the feelings, thoughts or his emotional state (Edward, Hercelinskyj, & Giandinoto, J2017). Being empathic will enable Cormac to express his and also provide an appropriate environment in which he can feel safe sharing his feelings. I should also engage with him in a genuine manner and be non-judgmental. This means that I should not at any point try to lie to Cormac or judge him in any way, either concerning his feelings or his actions. Judging him may create a negative impact and will even restrain him from opening up more. Another factor to consider is confidentiality (Greenberg, 2014. Cormac should be assured that all that he is going to say will not in any way exposed to other people. This may also involve ensuring that privacy is maintain while engaging in a discussion with him by selecting a place where other people cannot hear the conversation. Probing will also help to guide Cormac examine his feelings. Most importantly, warmth and safety must also be enhanced throughout the conversation (Australian College of Mental Health Nurses, 2010).

Cultural safety

The first step to ensure that that culturally safe health care is delivered to Cormac is ensuring self-awareness by realizing and acknowledging the fact that he differs from the nurse both in beliefs and practices, for example in age, occupation, religion, ethnic origin and even disability (Best, 2014). Cormac state and believes that he receives messages from God through radio and television. This is a clear indication that he believes in God and therefore this must be considered when delivering care to him. The principle to be applied in this scenario is that cultural safety aims to enhance or improve the health of an individual. This is why the interventions stated above was geared towards improving his health status despite the fact that he differs culturally (Usher, Mills, West, & Power, 2017).

Recovery-oriented Nursing Care

It is important to note that health care staff do not possess the key to recovery but instead it is the mental health patients who do (Sini, Munro, Taylor, & Griffiths, 2015). Therefore, considering the interventions aimed at improving Cormac’s mental health status, I only do the facilitation towards achieving recovery. This can only be achieved by learning his disorder and being able to define what can be done with the resources available. Cormac’s recovery is also achieved through therapeutic relationship which enables the nurse to develop a more personal relationship with him. It is through this interaction that the nurse can get to give hope to him to enable him depend on himself with only help from others and not entirely count on others. Recovery may occur and clinical manifestation recur again. Therefore, as a nurse I have to lead Cormac towards achieving personal identity, that is a sense of self that is even past diagnostic label.

15 Jun 2020

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