Question

what can you best advocate for tracy?

how can different parts of the healthcare system come together to serve tracy?

what lifestyle changes would you suggest to tracy to incorporate or modify to help mitigate the risk of falling into depressive state again?

Answer 1

1. Advocate is a change agent and someone who educates the community to reduce the stigma and fight for change in the behavioural system. So here as a nurse you serve as an advocate for tracy. So the education will be on-   

A) to convince tracy that as her sister is her own sibling so she will not harm her or take any wrong decision for her.

B) during the previous episode of depression the decision was taken by her own sibling and she was cured from depressive episodes and suicidial ideation.  

C) as u are having difficulties in adjustments during your marriage life so u both divorced and it was good for u because if u both would live together then life would become more worse. So think positive always.

2. The different parts of health care system will include-

A) Medications- Antidepressants are drug of choice mainly the atypical because they cause less extrapyramidal effects.

B) ECT- It is given in severe depression if necessary.

C) Psychosocial Treatment
• Cognitive therapy: It aims at correcting the dep-
ressive negative cognitions like hopelessness,
worthlessness, helplessness and pessimistic
ideas, and replacing them with new cognitive
and behavioral responses.
• Supportive psychotherapy: Various techniques
are employed to support the patient. They are
reassurance, ventilation, occupational the-
rapy, relaxation and other activity therapies.
• Group therapy: Group therapy is useful for
mild cases of depression. In group therapy
negative feelings such as anxiety anger, guilt,
despair are recognized and emotional growth
is improved through expression of their
feelings.
• Family therapy: Family therapy is used to
decrease intrafamilial and interpersonal diffi-
culties and to reduce or modify stressors,
which may help in faster and more complete
recovery.
• Behavior therapy: It includes socialskills train-
ing, problem solving techniques, assertiveness
training, self-control therapy, activity schedu-
ling and decision making techniques.

2.Lifestyle changes includes-

(a) Plan daytime activities according to
the patient's interests, do not allow
him to sit idle.
b) Ensure a quiet and peaceful
environment when the patient
is preparing for sleep.
C) Provide comfort measures
(back rub, tipid bath, warm milk, etc).
D) Do not allow the patient to sleep for long
time during the day.
E) Give p.r.n. sedatives as prescribed.
F) Talk to the patient for a brief period
at bedtime. Do not enter into lengthy conversation.

Among the nutritional changes includes-

a) Closely monitor the client's food and fluid
intake; maintain intake and
output chart.
(b) Record patient's weight regularly.
(c) Find out the likes and dislikes of the person before
he was sick and serve the best preferred food.
(d) Serve small amounts of a light
or liquid diet frequently that is nourishing.
(e) Record the client's pattern of bowel
elimination.
(h) Encourage more fluid intake, roughage diet and green leafy vegetables.

Among the communication process includes-

(a) Observe for non-verbal communication.
The patient may say that he is happy but
looks sad. Point out this discrepancy in
what he is saying and actually feeling.
B) Use short sentences. Ask questions
in such a way that the patient will have to
answer in more than one word.
C) Use silence appropriately without
communicating anxiety or discomfort
in doing so.
D) Introduce the patient to another patient
who is quiet and possibly convalescing
from depression.
E) As he improves, take him to other
patients and see that he is actually included
as part of the group.

To prevent over dependence behaviour-

(a) Allow the patient to take decisions
regarding own care.
B) Ensure that goals are realistic and that
patient is able to identify life
situations that are realistically under his
control.
C) Encourage the patient to verbalize feelings
about areas that are not in his ability to control.

To improve the self esteem-

(a) Be accepting of patient and spend time
with him, even though pessimism and
negativism may seem objectionable.
B) Focus on strengths and accomplishments
and minimize failures.
C) Provide him with simple and easily
achievable activity. Encourage the patient
to perform his activities without
assistance.
D) Encourage patient to recognize areas of
change and provide assistance toward this
effort.
E) Teach assertiveness and coping skills.