CASE STUDY; INSTITIONALISATION, HEALTH PROMOTION IN MENTAL HEALTH, STIGMA , ALCOHOL ABUSE, GRIEVING, ECT,EPILEPSY, CHILD ABUSE, MANIA, AGRESSION

 CASE STUDY;

 INSTITUTIONALIZATION, 

HEALTH PROMOTION IN MENTAL HEALTH,

 STIGMA,

 ALCOHOL ABUSE, 

GRIEVING, 

ECT,

EPILEPSY,

 CHILD ABUSE, 

MANIA, 

AGGRESSION

QUESTIONS

QUESTION 1 A

You are the in-charge for E ward and you observe patients are fond of sleeping, doing nothing and seem to lack interest in their surroundings, they lack initiative and appear to be powerless in decision making about issues that concern their lives.

A)    Define institutionalization                            5%

B)     Discuss the causes of institutionalization    25%

C)     As an in-charge of E ward, what measures should put in place to address this problem          20%

 

QUESTION 1B

Edina Moyo, is a schizophrenic patient admitted in chainama hospital for the past 8 years. She is observed to have developed the symptoms of being institutionalized.

A)    Define institutionalization    5%

B)     Explain five (5) features of institutionalization on the patient and how you would manage  them                        25%

C)     Explain five (5) measures you would take to prevent developing symptoms of institutionalization    20%

D)    Describe ten (10) points you would include in the rehabilitation programme for Edina Moyo who is institutionalized            50%

 

 

QUESTION 2

The current ministry of Health Policy focuses on public Health with emphasis on health promotion and disease prevention. You happen to implement the above policy in your community

A)     Explain the three (3) levels of prevention in relation to mental illness to the student nurses                       30%

B)     You are trying to find out the prevalence of mental illness in the community, discuss four (4) data collection techniques                          40%

C)     Explain the importance of follow up visits/home visits in relation to psychiatric patients                      30%

 

QUESTION 3

You are a mental health nurse working at one of the Rural Health Centres in the country. The local volunteers engaged to support people with mental illness within the catchment area informs you that the greatest challenge faced by individuals with mental illness in the community is stigma.

A)    Define the two (2) forms of stigma likely to be experience by people suffering from mental illness                10%

B)     State five (5) factors that contribute to stigma against clients with mental illness 20%

C)     Explain five (5) effects stigma may have on the recovery process from mental illness 20%

D)    Describe the program that you may develop within your catchment area aimed at reducing stigma against people with mental illness                       50%

 

QUESTION 4

Mr Mbuzi phiri male aged 36 years married with 4 children is admitted to Chainama  Hills Hospital with history of alcohol abuse. The wife said her husband sometimes experiences tremor. He has been suspended at work for absenteeism. The wife explains that he has impaired thinking and hallucinations as well. On examination a provisional diagnosis of alcoholism was made.

A)    State six (6) social effects of alcohol abuse                          20%

B)     Discuss how alcohol abuse can be prevented                    30%

C)     Describe in details the management of Mr. Mbuzi                         50%

 

 

 

QUESTION 5

Mrs Nyambe went through various stages of the grieving process after losing her husband 6 months ago and made several attempt to take her life. She is admitted to the acute ward following suicidal attempts

A)    I. Explain three (3) significant loses that may lead to grieving       15%

ii. State five (5) stages of grieving     15%

B)     Explain three (3) types of suicide     15%

C)     What are some of the circumstances that may complicate grieving          35%

D)    Outline the management of a client who has three previous attempts of suicide  while on the ward      20%

 

QUESTION 6

Mr. Mulenga, a 36 year old man is due to undergo Electro-convulsive therapy (ECT). ECT remains controversial for many Psychiatric Practitioners. One of the important ethical aspects of ECT is whether the therapeutic benefits out-weigh the risk. Given that there is no conclusive evidence to identify ECT as the treatment of choice in major depression, each case needs individual assessment.

A)        Discuss the preparation of Mr. Mulenga before he undergoes ECT 25%

B)         Lithium carbonate is usually given to patients with psychiatric depression

(i)         List five (5) side effects of the drug  10%

(ii)        Outline the specific nursing care for the management of the side effects identified in (i)  25%

C)         State five (5) side effects of ECT  15%

D)        Explain five (5) roles of the community psychiatric nurse  towards Mr. Mulenga upon his discharge  25%

 

 

 

 

QUESTION 7

Lukundo is an epileptic patient; married with 3 children has been brought to the ward following a grandmal seizure two days ago. The patient had generalized movement of the body and confusion ensued thereafter. Since then the patient just stares blankly in the environment, withdrawn and has hallucinations and illusion. Patient is also neglecting himself and not eating.

A)        Define epilepsy   5%

B)         Discuss five (5) points why epilepsy is a mental condition  15%

C)         Discuss the management of Lukundo according to the presenting symptoms  40%

D)        You are required to draw a rehabilitation plan for Lukundo, identify five (5) community based structures that you would work with and explain their roles  40%

 

QUESTION 8

The issue of Child Abuse has raised concern among the Government and Stake Holders.

A)        Define the term “Child Abuse”  5%

B)         Outline five (5) factors that contribute to Child Abuse  25%

C)         Discuss five (5) effects of abuse on a Child  25%

D)        Outline the role of the community Mental Health Nurse in preventing and dealing with abuse.  45%

 

QUESTION 9

Mutinta, a young female adolescent is brought to the psychiatric hospital amidst talking and shouting on top of her voice non-stop. The mother had accompanied her saying this was of sudden onset. The daughter cannot sleep claims she is the newly crown queen of England, and feels she has some special powers to save the world. The staff on the ward decides to manage this client accordingly.

A)        Define Mania  5%

B)         State five (5) causes of mania  15%

C)         State five (5) clinical manifestation of mania  15%

D)        Discuss the management of mutinta   50%

E)         State five (5) points you would include in your information education and communication to both mutinta and the relatives on discharge   15%

 

 QUESTION 10

Aggression is one of the common sign that are exhibited by mentally ill patients

A)        Define aggression    5%

B)         Explain five (5) risk factors of aggression  20%

C)         Discuss the nursing intervention during an episode of aggression   50%

D)        Discuss how you would prevent episode of aggression in the ward   25%

 

ANSWERS

 

Question 2

A)

       I.          Primary prevention. This is defined as reducing the incidence of mental illness/ disorders within the population. It mainly targets individuals and the environment and emphasis is twofold: Assisting individuals to increase the abilities to cope with stress within the environment. Targeting and diminishing harmful forces (stressors within the environment).Nursing in primary intervention is fused on targeting groups at risk and the provision of education programs such as teaching physical and psychosocial effects of alcohol and drugs to primary and secondary school children. Teaching techniques of stress management to virtually anyone when desires to learn. Teaching the concepts of mental illness within the community.

     II.          Secondary prevention:  This is accompanied through early identification of problems and prompts initiation of treatment. Nursing in secondary prevention focuses on recognition of symptoms and provision of referrals for treatment for example ongoing assessment of individuals of high risk of mental illness. This is done through home visit, day care, community health centers or any setting where screening of high risk individuals might occur.  Provision of care for individuals in whom illness symptoms have been assessed and the type of care is done through counselling, medication, admission, health education as well as support

 

    III.          Tertiary prevention. This is defined as reducing the residual defects that are associated with severe or chronic mental illness. This is accomplished in two ways: Prevention of complication of illness. Promoting rehabilitation that is directed towards achievements of each individual’s maximum level of functioning. Nursing in tertiary prevention focuses on helping the clients to earn or re-learn socially appropriate behaviors so that they can achieve a satisfying role within the community. E.g. Monitoring effectiveness of after care services through home visits or follow up appointments in community mental health centers .Referring clients for various after care services e.g. supports groups, day treatments programs, psychosocial rehabilitation programs etc. Teaching the clients the daily living skills and encouraging independence to his or her maximum ability.

 

(B ) Use of Available Information

Depending on the type of information that is needed, a researcher can use the already available information. For example, if the researcher needs information on the prevalence of disease from a particular geographical area during a certain period of time, he can simply request for the hospital and health centre record books and retrieve the information. Or if the information is readily available from Management Health Information System, the researcher can simply request for a print out. Another example is the birth registration records kept by the registration office. In order to retrieve the information in its original state, the researcher may need to design a checklist or a compilation sheet or form.

 

 

 

Observing

When using this technique, the researcher need to systematically select, watch and record the behaviors and characteristics of the people, objects or situations. Observation of human behavior can be done in two ways: Participant observation: This is when the observer takes part in the situation he or she observes. Non-participant observation: This is when the observer watches the situation, openly or concealed, but does not participate. Observations are important because they give additional, more accurate information on behavior of people than interviews or questionnaires. Observations can be used to check on information collected especially on sensitive topics such as alcohol or drug use, or stigmatization of epilepsy, or AIDS patients. Or they may be a primary source of information. Information can be obtained using tools such as scale, thermometer, eyes, tape measures, microscopes etc. Information obtained through observations can be recorded using either a checklist, or compilation sheets. Checklist and data compilation sheets are also called data collection tools.

Interviewing

An interview is a data-collection technique that involves the researcher asking questions to the respondents while the respondent provides answers. Interviewing should be carried out in a conversation manner.

The answer - question session during interviews can be recorded either by writing down the responses or using a tape recorder. Interviews can be conducted with varying degrees of flexibility such as high and low degrees. The degrees of flexibility are outlined below:

High degree of flexibility: These use loosely structured methods of asking questions. There are no restrictions as to what or how the respondent should answer. Data collection tools such as unstructured questionnaires or interview schedules can be used. The interviewer is allowed to ask additional questions to clarify issues. Loosely structured methods are used when there is little knowledge of the problem or situation for example in exploratory studies or in case studies.

Low grade flexibility: This method uses questionnaires that have a fixed list of questions with fixed or pre-categorized answers. The methods are used when the researcher has less knowledge about the expected answers and when the number of participants to be interviewed is large.

 

Administering written questionnaires

  A written questionnaire is a data collection tool that the respondent has to answer by writing in the questionnaire according to the instructions given. A written questionnaire is also called a self-administered questionnaire.  Questionnaire can be sent by mail. Clear instructions should be given to respondent on how to answer and where to post the filled in questionnaire. Respondents can be gathered in one area at the same time. Oral or written instructions are given to them and respondents fill in the questionnaire. The questionnaires are then collected from the respondents. The questionnaires can also be delivered to the respondents by hand and then collected later on. It involves close and open ended questions. Open-ended type of questions allows the respondent to express themselves freely. The kind of data collected from open-ended type of questions is called qualitative data. Open-ended questions allow flexibility in the sense that the respondents are not restricted or the degree of restriction is minimal. Closed-ended questions do not allow the respondent or the interviewer to express themselves or seek clarification respectively. They are used to collect quantitative data. Both types of questions can be used in a questionnaire. Use of both flexible (qualitative methods) and non - flexible (quantitative methods) is helpful in that they complement each other.

(C)     Purpose of home visit

- Home visit is done in order to assess the patient’s response to treatment

- In order to assess the level of drug compliance in cases of defaulters.

- In order to assess the home environment if there are any triggering factors such as family support, stigma and discrimination. The structure of the house can also show the economic status of the patient e.g poverty.

- Assessment of family dynamics

- Assessment of social support system available

- Assessment of coping strategies

- Physical assessment such as nutrition

 

Q. 4. ANSWERS

SIX (6) SOCIAL EFFECTS OF ALCOHOL

 

1.     Disruption of marriages; alcohol can lead to disruption of marriages in that people who take alcohol tend to have impaired judgment which can lead to violence in homes causing disruption of a marriage.

2.     Unemployment. Alcohol leads to poor work performance and absenteeism which leads to loss of jobs.

3.     Poverty; this can occur due to employment loss and because alcoholics tend to use most of their finances on alcoholism leading to poverty.

4.     Road traffic accidents; alcohol leads to impaired judgment which can lead to road traffic accidents.

5.     Serious illnesses; alcohol deteriorates the health status e.g. it causes hypertension, liver cirrhosis, peripheral neuropathy

6.     Increased reckless behaviors;  alcohol increases the libido of someone causing them to be involved in reckless behaviors such as having sex with different ladies which also leads to the development of sexually transmitted diseases.

 

PREVENTION OF ALCOHOL ABUSE

 

1.     Sensitization of the community on the dangers of alcohol abuse. This can be done through the media, music, drama e.t.c.

2.     Organizing school health services in the community; this involves screening of pupils for substance abuse and educating them on the dangers of substance abuse.

3.     Recreational activities. The community should identify community based programs to occupy the youths and unemployed in order to reduce idleness, hence reducing substance abuse.

4.     Reporting people selling illegal substances to relevant authorities.

5.     Conducting counselling sessions; when patients are cancelled about the dangers of substance abuse, it helps them to understand the effects of substance abuse which helps to prevent substance abuse.

6.     Conducting group therapies within the hospital; this therapy helps the clients to understand more about substance abuse, its effects and how it can be avoided, hence it helps clients prevent substance abuse

MANAGEMENT OF MR NJOBVU WITH ALCOHOL ABUSE

Management of alcohol abuse generally involves immediate intervention, nursing management, pharmacological management, counselling and managing the side effects of drugs

 

IMMEDIATE MANAGEMENT

 

Since the patient is presenting with alcohol withdrawal symptoms, therefore the immediate intervention will involve calming the patient by administering benzodiazepines such as diazepam 10mg iv. If the patient is a danger to self, others or property, will make sure the patient is observed throughout his stay at OPD. Removing any dangerous objects which the patient can use to harm against self or others, will help ensuring safety for the patient and others. A full diazepam detox regime will be prescribed by the clinician. The initial dose of this treatment regime can either be commenced from the filter clinic or on the ward depending on the severity of the condition. Patient shall require to take treatment for five (5) days and the route of administration will depend on the patient’s condition.

 

            TREATMENT REGIME GUIDELINE FOR DIAZEPAM IV (MODERATE – SEVERE

            CONDITION)

Day 1……10mg QID

Day 2……10mg TDS

Day 3……10mg BD

Day 4……5mg BD

Day 5……5mg OD

 

NURSING MANAGEMENT 

 

PATIENTS SAFETY AND ENVIRONMENT

Patient’s safety in the environment is the nursing priority when nursing a patient with alcohol abuse. The environment should be free from any dangerous objects that the patient can use to harm himself as the patient is prone to falls. The patient should be searched in his pockets for dangerous items that he can use to injure himself.  Since, Mr. Mbuzi is experiencing withdrawal symptoms is likely to be anxious, therefore I will orient the patient on the ward environment and I will make sure that the environment is quiet, adequate lighting system  with low stimulation as such environment is favored for alcohol abusers. In addition, monitor the risk of falls and ensure enough night light to reduce perceptual errors which may exacerbate the anxiety levels and psychotic phenomenon.

Detoxification of alcohol is the initial treatment for alcohol abusers who experience alcohol withdrawal symptoms. I will do a full detoxification to Mr. Mbuzi using diazepam for five days as prescribed as it helps to alleviate withdrawal symptoms and separate the patient from alcohol related social and environment stimuli that may increases the risks of relapse.

 

 

THERAPEUTIC COMMUNICATION

 

Communicate to the patient and the family about the nature of severity and duration of the symptoms and the role of medication during the treatment of Mr Mbuzi. Explaining all appropriate intervations to relatives and Mr Mbuzi clearly and in the friendly manner to alley anxiety.

 

OBSERVATIONS AND PHYSICAL EXAMINATION

 

Since Mr Mbuzi is experiencing alcohol withdrawal symptoms, he is likely to have unstable vital signs, therefore I will ensure that the blood pressure, temperature, pulse and respiration are checked regularly to notice any deviation from the normal. Physical examination should also be conducted to rule out certain medical disorders that can occur comorbid with alcoholism which can exacerbate withdrawal symptoms and complicate treatment. I will also observe if the patient is responding well to treatment and monitor the patients eating patterns.

 

NUTRITION

 

Most of the alcoholics exhibit vitamin deficiencies, presumably due to poor diet habits as well as from alcohol induced changes in the digestive tract that impairs the absorption of nutrients into the blood stream. I will give folic acid to Mr Mbuzi for two weeks as it helps in the synthesis of the cells genetic material and maturation of certain blood cells. I will also administer thiamine 100 mg / day orally for 5 days (or longer if required)  as it helps in the metabolism of  sugars for energy  and it prevent the development of thiamine-deficiency syndromes such as Wernicke’s encephalopathy.

HYDRATION AND COLLECTION OF ELECTROLYTE IMBALANCE

Mr NJOBVU is at risk of being dehydrated as he might start sweating and fever due to hyperactivity of autonomic nervous system induced by alcohol, I will ensure that he takes enough fluids as they are essential for the performance of the physiological processes and to maintain the function of the vital organs such as the heart and the kidney. I will also collect electrolyte imbalances by administering magnesium, phosphate and sodium as they help in the metabolism in order to prevent life threatening metabolic disorders.  Magnesium supplements also helps to reduce the occurrence of seizures.

MEDICATION

Other medications, such as  low dosages of antipsychotics  can be given to mr Mbuzi with cautions when psychotic features are present as antipsychotics have the tendence of lowering seizure thresh hold and can induce alcohol withdrawal seizures. Antiemetics such as promethazine can be prescribed if the patient is having nausea nad vomiting . Acomprosate is used to augment treatment, and is then carried on into long term use to reduce the risk of relaps.. Acomprosate 600 mg
(2 tabs) tds is indicated especially when susceptible to drinking cues or drinking triggered by withdrawal symptoms . It lowers potential for drug addictions and need normal renal function. Side effects include diarrhoea, headache, nausea.  After  Mr. Mbuzi has stabilized, I will prepare him for interventions that aim at long term alcoholism management (rehabilitation)

INFORMATION, EDUCATION AND COMMUNICATION

Ø  As the patient stabilizes, I will explain about the importance of staying away from alcohol as this will help on a good prognosis and prevent relapse cases.

Ø  Patient’s family shall be counseled on Mr Mbuzi’s condition. This will ensure the family to take appropriate care and support necessarily

Ø  Mr Mbuzi will be canceled on the dangers of alcohol abuse and the social and health effects that alcohol can cause.

Ø  The patient will be advised to be staying away from the influence of alcohol especially his old associates in order to prevent alcohol relapse cases.

Ø  Prior to discharge, Mr. mbuzi will advised to undergo rehabilitation. This will help him cope with his new life style. Rehabilitation will involve skills such as problem solving skills, anger management skills, etc.

Ø   

 

 

 

ANSWER

QUESTION 3

3 A) Self-stigma is where the client is self-stigmatised due to mental illness from the public. The other form of stigma is Public stigma is where the public stigmatises people with mental illness. They are considered to be of no value to the society.

 

B)

ü  One of the factors that contribute to stigma against people with mental illness is the lack of knowledge about cause of mental illness. They believe that mental illness is caused by supernatural powers or evil spirits hence this makes them stigmatise people with mental illness.

ü  The other factor that contribute to stigma is the side effects of  medication that they are given to treat their condition, people usually experiences severe side effects that are unusual know that they are suffering from mental disorder hence they stop medication.

ü  Course and duration of mental illness condition is also the cause of stigma for they believe that mental illness cannot be healed hence when one suffer from a mental disorder he is considered to be a permanent patient.

ü  Relapse are at fault of causing stigma among people with mental illness when these patient are not compliant to medication regimen, they tend to relapse hence causing stigma.

ü  The myth that people have towards mental illness.

C)

ü  Stigma has a greater effects on the recovery process of mental illness in that people are reluctant to seek medical help at early stage of the illness and this makes it difficult for the illness to be completely treated because it has already progressed.

ü  People stopped going to psychiatric hospitals to collect medication and this has really reduced the rate of people attending psychiatric clinics and hospital hence increase in the number of relapse.

ü  Patients because of stigma they loss employment as they are considered to be non-functional once they suffer from mental illness.

ü  Poor funding by the government

D)

 

The programmes that can be developed in the community to reduce stigma include the following:

-        Sensitizing the community on the causes of mental illness

-        Use of mass media will reduce stigma

-        Educating the community on substances  like alcohol and others as they are at high risk of causing mental illness

-        Provide employment to the people who have recovered from mental disorder

-        Offer housing to people with mental illness, because patients with no accommodation move anyhow

-        Social network  between the mentally ill patients and the general public  

-          Implement and advocating for mental health act to be enacted in parliament 

 

 

 

QUESTION 6

ELECTROCONVULSIVE THERAPY (ECT)

 Electroconvulsive therapy is the artificial induction of a grandma seizure through the application of electrical current to the brain. The stimulus is applied through electrodes that are placed either bilaterally in the front-temporal region, or unilaterally on the non-dominant side

Parameters of electrical current applied

Standard dose according to American psychiatric Association, 1978

• Voltage- 70-120 volts
• Duration- 0.7-1.5seconds

Types of ECT

Direct ECT- in this, ECT is given in the absence of anesthesia and muscular relaxation. This is not a commonly used method now.

Modified ECT: here ECT is modified by drug-induced muscular relaxation and general anesthesia.

Indications

A)    Major depression, especially with suicidal risk

B)     Severe catatonia

C)     Severe psychosis (F20 or mania)

D)    Organic mental disorders

Contraindications                       

(A) absolute:

Raised ICP (intracranial pressure)

(B) Relative

-cerebral aneurysm

-cerebral hemorrhage

-brain tumor

-acute myocardial infarction

-retinal detachment

SIDE EFFECTS OF ECT

-Memory impairment

-Drowsiness, confusion and restlessness-

-Poor concentration, anxiety

-Headache, weakness/fatigue, backache, muscle aches

-Dryness of the mouth, palpitations, nausea, vomiting

-Unsteady gait

-Tongue bite and incontinence

ROLE OF THE NURSE

Pre-treatment evaluation

- detailed medical and psychiatric history, including history of allergies

- An informed consent should be taken. Allay any unfounded fears and anxieties regarding the procedure.

- Patient should be on empty stomach for 4-6hrs prior to ECT.

- Withhold night doses of drugs, which increase seizure threshold like diazepam, barbiturates and anticonvulsants.

-Withhold oral medications in the morning

- Head shampooing in the morning since oil cause impedance of passage of electricity to brain.

- Any jewellery, prosthesis, dentures, contact lens, metallic objects and tight clothing should be removed from the patients body.

- Empty bladder and bowel just before ECT

- Administer of 0.6mg atropine IM 30minutes before ECT or IV just before ECT

 

Intra-procedure care

-Place the patient comfortably on the ECT table in supine position

-Assist in administering the anesthetic agent (thiopental sodium) and muscle relaxant –succinylcholine

-Since the muscle relaxant paralyzes all muscles including respiratory muscles, patient airway should be ensured and ventilator support should be started.

-Mouth gag should be inserted to prevent possible tongue bite.

-The place (s) of electrode placement should be cleaned with normal saline or 25% bicarbonate solution, or a conducting gel applied

-Monitor voltage, intensity and duration of electrical stimulus given

-100% oxygen should be administered

-Monitor vital signs during seizure , ECG, oxygen saturation EEG etc

-Record the findings and medicines given in the patient chart.

Post-procedure care

-Monitor vital signs

-Continue oxygenation till spontaneous respiration starts

-Assess for post-ictal confussion and restlessness

-Take safety precautions to prevent injury (side-lying position and suctioning to prevent aspiration of secretions, use of side rails to prevent falls)

-If there is severe post-ictal confussion and restlessness, IV diazepam may be administered

-Reorient the patient after recovery and stay with the patient until fully oriented.

-Document any findings as relevant in the patients record

 

 

 

 

 

QUESTION 7

1. Def
2.  

-        Behavioral disturbances associated with the seizure:

-        Psychiatric and cognitive disorder associated with the underlying cause

-        Pre-ictal: prodromal states and mood disturbances

-        Ictal: complex partial seizures cause affective disturbances, hallucinations, experiential phenomena, automatisms, absence seizure cause altered awareness

-         Post-ictal: impaired consciousness, delirium, psychosis.

-        Inter-ictal disorder: cognitive changes, personality changes, sexual behavior, depression and other emotional disorders, suicide and deliberate self-harm, crime and other antisocial behavior

i) Behavioral and cognitive disturbances associated with seizures

Increasing tension, irritability and depression are sometimes apparent as prodromata for several days before a seizure. Transient confusional states, hallucinations, affective disturbances, automatisms and other abnormal behaviors may occur during seizures (particularly complex partial seizures), and after seizures (usually those involving generalized convulsions, and complex partial seizures)

ii) Psychiatric and cognitive disorders associated with the underlying cause

The underlying cause of epilepsy may contribute to intellectual impairment or personality problems, especially if there is extensive brain damage. For example, epilepsy is more common in the mentally retarded, than among people with normal intelligence.

iii) inter-ictal disorders

Personality disturbance: Epileptic personality is said to be characterized by egocentricity, irritability, religiosity and quarrelsomeness. When such personality changes occur, social factors probably play an important role in etiology, such as the social limitations imposed on them, their own embarrassment, and reactions of the other people. Also, brain damage can contribute to the development of personality disorder.

Iv) Inter-ictal psychosis

Some patients with temporal lobe epilepsy may develop a psychosis that resembles schizophre

v) Depression and other emotion disorders

Depression and certain other emotional disorders are more common in people with epilepsy than in the general population.

 

3. I) Providing safe environment

- Restrict environmental stimuli, keep unit calm and well illuminated

- As the patient is responding to a terrifying unrealistic world of hallucinatory and illusions, continuous observation and care is needed to protect him from himself and others

ii) Alleviating patients fear and anxiety

-        Remove any object in the room that seem to be a source of misinterpreted perception

-        There should always be somebody at the patient’s bedside reassuring and supporting; as much as possible have the same person all the time by the patient’s bedside

iii) Meeting the physical needs of the patient

-        Maintain intake and output chart

-        Hygienic needs should be taken care of

-        Monitor vital signs

-        Use appropriate nursing measures to reduce high fever, if present

Iv) Facilitate orientation

-        Have a calendar in the room, repeatedly explain to the patient where he is and what date, day and time it is

-        Introduce people with name even if the patient misidentifies the people

 

 

D

I)                 Teachers

·       Educator role- creating awareness in the community about mental health and mental illness with special focus on vulnerable groups

·       Educate pupils about the condition thereby reducing stigma

ii) Community mental health nurses

·       Clinician role- providing direct nursing care to the patient in the community

·       Domiciliary care- services are provided to the client by visiting their homes. Services like administering of medication, assessment of the level of functioning and improvement of patients

·       Bridging the gap between the client and the hospital, client and the employers and also by networking in the community for resource development

·       Train- training of paraprofessionals, community leaders, school teachers and other care giving professionals in the community

 

 

iii) Parents (community) .

·       Monitoring of side effects of drugs, knowing the warning signs

·       Understand the condition and know how to manage

·       Management of resources, planning and coordination (e.g  review dates ,drugs )

 

 

iv) Counselors

·       Counseling of patients and family members at the clients home setting

·       Educator role- creating awareness in the community about mental health and mental illness with special focus on vulnerable groups

·        

v) Social / psych social workers

·       Consultative role- this means giving advice to other professionals in the community about the type and level of nursing care required for a given client group

·       Educate patients and family members of the service agencies available

·       Networking in the community for resource development

·       Follow-up care with special emphasis on medication regimen, improvement made, side effects and patient’s occupational function.

·       Identification of patients in the community

 

 

QUESTION 10

A

 

B i)

 

C  Nursing intervention

·       Be aware of factors that increases the likelihood of violent behavior or that signify a build-up of agitation

·       Talk with the client in a low, calm voice, use simple, clear, direct speech; repeat if necessary

·       Approach the client in a calm, matter-of-fact manner

·       Always maintain control of yourself and the situation; remain calm, if you do not feel competent in dealing with the situation, obtain assistance as soon as possible.

·       Decrease environmental stimulation by turning stereo or TV of or lowering the volume; lowering the lights; asking other clients, visitors or others to leav the area.

·       Try to help the client express these feelings, verbally or physically, in nondestructive ways (remain with the client and listen, use communication technique

·       Do not use physical restraints or techniques without sufficient reason

·       Be aware of PRN medication and procedures for obtaining seclution or restraint orders