Table of Contents
The current a study will analyse the case study of Adam Delirante. In doing so, the mental health issues that the current patient is facing will also be discussed along with the contemporary evidence based care options available for the current case. The study will also highlight the consultation and referral for the patient. The associated ethical considerations will also be highlighted in the current study. The major factors that include opportunities and challenges relating to the lived experience of the person will also be discussed.
Considering the case of Adam, it can be stated that presently there is some mild symptoms demonstrated by the patient. However, the medication has helped to reduce the withdrawal symptoms and current the patient is suffering from depressed mood and anhedonia. Adam is a 47 year-old man with long history of alcohol dependence. This patient has been admitted to the inpatient unit due to the presence of the alcohol withdrawal symptoms as the case was complicated with seizure activity. The CIWA-Ar score was 18 which could be considered as s severe withdrawal symptom. Some of the symptoms such as vomiting, nausea, seizures and hypertension have been gradually reduced after the use of diazepam. There is no sensorium or agitation though Adam is in depressed mood with marked anhedonia.
In order to decide upon pharmacological care for the current patient, it is required to ensure if there is any comorbid substance use or any psychiatric disorder are there. As the patient is suffering from moderate to severe AUD symptoms, he can be given naltrexone or acamprosate which will help in having a goal of abstinence or reducing consumption of alcohol. It is also required to identify if there is any renal impairment. If the patient is having a renal impairment, acamprosate is required to be avoided (Safranek et al., 2020).
The non-pharmacological treatment available for the current patient is psychological intervention such as cognitive behavioural interventions are required to be considered. Apart from that Transcutaneous Electrical Nerve Stimulation is another non-pharmacological care that can be provided to the current patient which will help in pain management (De Crescenzo et al., 2017). Acupuncture is another treatment method that can be used in the context of current case which is also helpful in managing pain related symptoms. Physical and Manual Therapies have been evidentially observed to have positive effects upon the symptoms of pain.
Person and family oriented care
Person centred care refers to safe and high quality health care which is respectful towards the patient, responsive to the preference and considers the needs and values of the affected person. As mentioned by Daley et al. (2018), person centred care approach allows the patient to be involved in the care planning and the decision making process focus on the opinion of the patient. Therefore, it is required to understand Adam’s personal preferences. It is also required for the nurses to involve the patient into the decision making. Health direct, (2020) suggests that the based on the current mental state of the patient they are required to be provided with ‘hospital in the home’ services as per the need. General nursing care can be provided through collaborating with family members and involving them in the decision making. It is due to the fact that family members are more aware of the daily routine of the person than the hospital staffs. Additionally, the family members of the patient are also required to be provided with health related information and educate them about the same.
Culturally safe care
Culturally safe practices have been considered as a care standard for the patients to ensure total respect towards the cultural values and identity of the patient. In order to achieve the same, Australian Commission on Safety and Quality in Health Care has suggested that nurses and other healthcare staffs are required to be aware and recognise the values of a patient (Australian Nursing and Midwifery Federation, 2020). In order to develop person centred care plan nurses are required to know about the cultural values that impacts upon the choices of the patients. The clinical governance is required to be integrated and quality improvement systems can be implemented in the current context. For instance, in order to ensure quality of the care delivered to the patient, quality improvement systems are required to be considered to be implemented. For instance, the effectiveness of clinical communication is needed to be monitored regularly. It is also required to implement strategies that will improve clinical communication. Regular reporting on effectiveness of the communication process ios also required to be conducted.
The case study has indicated that the patient is demonstrating symptoms of anhedonia. The healthcare professionals are required to determine if there is both social and physical andedonia is present. In order to escalate the mood of the current patient, the mental disorder causing this issue is required to be treated. Initially, the patient is required to be referred to a mental health professional for ideally treating the depressive symptoms. The symptoms can be treated through pharmacotherapy including antidepressants (Destoop et al., 2019). Apart from that, the social support is required to be enhanced by encouraging the patient to be involved in various social support groups. Additionally, the nurses are required to perform some tasks while planning discharge of the patient. This may include after care planning, where the patient will be supported with adequate information about medication needed to be taken as prescribed, activities to be performed such as staying in quite room, avoiding bright lights and others.
Apart from that, the nurse is also required to provide adequate support for self-care of the patient. If the patient is referred to any psychiatric help, the patient is required to be suggested to continue the same with appropriate rationale.
As suggested by Nursing and Midwifery Board of Australia (2020), there are some codes of ethics that are required to be followed by the nurses while practicing. While caring for the current patient nurse appointed for caring Adam needed to value quality nursing for all the people. The nurse also respected and was kind to the patient understand the current mental condition of the patient. The approach towards making decision about the patient was always informed and the information related to the patient was managed ethically, for instance confidentiality of the information has been maintained.
It can be stated that the nursing practice has followed the legislative considerations incorporated in Health Practitioner Regulation National Law (2009) (ACT Legislation Centre, 2020). As per this legal framework, nurses are bound to follow some principles while caring for a patient. The nurses are required to be accountable for every action. Apart from that, nurses are also expected to engage in therapeutic and professional relationships. Therefore, while caring for Adam, the nurses conducted through examination of the health condition of Adam, safe and responsive quality nursing has also been performed.
Role of stigma
The stigmatisation associated with Alcohol use may delay the recovery process. Due to the stigma associated with this disorder, 10% of the people affected from Alcohol use disorder have experienced co-morbid mental health issues such as depression (National Institute of Drug Abuse, 2020). This increases the chance of being affected by depression, anxiety and mood disorders. Discriminatory approach towards the affected people may lead them to social withdrawal which delays the recovery. The public stigma associated with alcohol abuse disorder may lead to prejudice due to which the required social support may not be available to the patient. The care seeking tendency of the patient is likely to increase among people with mental illness (Mosquera & Steele, 2017).
Biomedical model vs. Recovery oriented
As proposed by the contemporary addiction researchers addiction is a disease of brain. The biomedical model emphasises that the brain have predispositions to addiction or genetic impressions that actually interacts with the social factors such as social drinking and others. The recovery oriented model suggests four dimensions through which a person with alcohol use disorder may recover effectively (Substance Abuse and Mental Health Services Administration, 2020). Healthy choices are required to be made in order to manage the symptoms for achieving emotional wellbeing. Having a secure place to live and purposeful life along with meaningful relationship with community members are required to be considered.
Trauma informed care
In the trauma informed care, hospital or healthcare organisations develop administrative commitment to trauma related care by establishing a internal trauma team and provides training to the team members to address the different health related aspects that are contributing to trauma. The patient is required to be encouraged to acknowledge the trauma related reactions and is required to inform the reactions will disappear eventually (Andrade et al., 2019). A safe environment is required to be provided to the patient so that the patient does not undergo trauma related reaction due to fear or anxiety. Here, the family oriented care will play a significant role in comforting the patient with trauma related symptoms. Family members are needed to be educated about how the home environment will affect the patient and which strategies can be adopted for reducing chances of being affected by trauma.
Harm minimisation approach
In the current case, harm minimisation process that can be used include reducing harm so that the substance do not physically harm the patient. For instance, through methadone maintenance and brief interventions and others this can be achieved (Department of Health, (2020). The product and supply of alcohol is also required to be prevented. The reduced production and supply of the alcohol may reduce the chance of being affected from the same. The harmful use and uptake of alcohol is also required to be prevented. This can be achieved through encouraging the individual towards health life style (Van Gelderen, Nijdam & Vermetten, 2018). Along with this, the patient is required to be treated in a manner for instance, through community development projects and others so that the demand for alcohol can be reduced.
In conclusion, it can be stated that the present patient namely Adam as been facing severe alcohol withdrawal symptom due to which he was taken into hospital care. However, after diazepam treatment the symptoms were absent. However, the study has proposed some methods through which the current symptoms such as depressive mood and anhedonia can be treated and mood can be escalated. Nursing standards suggested by Nursing and Midwifery Board Australia has been implemented while planning care for the current patient. Additionally, requirements for quality care have also been included in the study. The factors affecting his recovery and referral options have also been described in this context. Additionally, trauma related care planning has also been performed in the current context.
ACT Legislation Centre, (2020). Health Practitioner Regulation National Law (ACT). https://www.legislation.act.gov.au/a/db_39269/
Australian Nursing and Midwifery Federation, (2020). Professional. https://anmf.org.au/pages/professional-july-2013#:~:text=There%20are%20two%20forms%20of,)%20%E2%80%93%20this%20is%20statutory%20regulation.
Daley, D. C., Smith, E., Balogh, D., & Toscaloni, J. (2018). Forgotten but not gone: The impact of the opioid epidemic and other substance use disorders on families and children. Commonwealth, 20(2-3). https://tupjournals.temple.edu/index.php/commonwealth/article/download/189/277
De Crescenzo, F., Cortese, S., Adamo, N., & Janiri, L. (2017). Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review. Evidence-Based Mental Health, 20(1), 4-11. https://ebmh.bmj.com/content/ebmental/20/1/4.full.pdf
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National Institute of Drug Abuse, (2020), Addressing Stigma that Surrounds Addiction. https://www.drugabuse.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction
Safranek, H., Frausto, M., King, A., & Madison, S. (2020). Non-pharmacological Interventions for Alcohol, Marijuana, and Opioid Use During Pregnancy: A Systematic Review. https://ideaexchange.uakron.edu/cgi/viewcontent.cgi?article=2053&context=honors_research_projects
Substance Abuse and Mental Health Services Administration, (2020), Recovery and Recovery Support. https://www.samhsa.gov/find-help/recovery
Health Direct, (2020). Community nursing. https://www.healthdirect.gov.au/community-nursing
Andrade, R. J., Chalasani, N., Björnsson, E. S., Suzuki, A., Kullak-Ublick, G. A., Watkins, P. B., ... & Aithal, G. P. (2019). Drug-induced liver injury. Nature Reviews Disease Primers, 5(1), 1-22. https://www.zora.uzh.ch/id/eprint/180564/1/NRDP-18-063_Drug-induced_liver_injury_ZORA.pdf
Van Gelderen, M. J., Nijdam, M. J., & Vermetten, E. (2018). An innovative framework for delivering psychotherapy to patients with treatment-resistant Posttraumatic Stress Disorder: rationale for interactive motion-assisted therapy. Frontiers in psychiatry, 9, 176. https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00176/full
Mosquera, D., & Steele, K. (2017). Complex trauma, dissociation and Borderline Personality Disorder: Working with integration failures. European Journal of Trauma & Dissociation, 1(1), 63-71. https://www.kathy-steele.com/s/Complex-trauma-and-BPD-Working-with-integrative-failures-EJTD-2017.pdf
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