Question

Case Study

Leonie lives alone in the community. She used to work as a teacher prior to giving up work 10 years ago to care for her husband who was diagnosed with cancer. She cared for him at home for two years, until his death. Leonie was a keen gardener, artist, and enjoyed going to the movies until the past few years. Over the past six months Leonie has been spending less time outdoors and more time at home. She states that she no longer has interest in her painting, gardening or going to the movies with her friends, which were activities that once gave her a lot of joy. She reports being tired and tends to sleep more during the day. She used to walk for half an hour in the morning three days a week for exercise however, over the past 6 months she has not been going for her daily walks and has been sleeping in. She also stopped driving 6 months ago. Leonie has been admitted to an acute medical ward. You obtain the following information from Leonie’s notes: Leonie is 73 years of age, 160cm tall and weighs 105kgs. Leonie arrived at the emergency department via ambulance after presenting at her local shops confused and agitated. She was found to be febrile and hypertensive on initial assessment. Leonie was diagnosed with a urinary tract infection and has been commenced on antibiotics. On transfer to the ward her vital signs are within normal limits, but she still appears confused. Leonie’s medical history includes a decubitus ulcer on the shin of her left leg (0.5 cm long), arthritis in her knees, hypertension and urinary urgency. Leonie has no children but does have has two sisters, both older than her, who live nearby. Both sisters have expressed concerns that Leonie may not coping at home and are concerned that she may need more support to manage tasks such as cooking and selfcare. They report that Leonie has been buying microwave meals for the past 6 months rather than preparing fresh food. She previously cooked a lot of her vegetables from the garden; but the garden has been unkept for the last 12 months. Leonie's sisters also report that her personal care has declined and she has become quite unkempt over this time. They also report that she has gained approximately 6-10kg in the past 6 months. In hospital Leonie has been using a walking frame to assist with her mobility. She appears to be in discomfort when standing up from a seated position and when walking. She needs supervision for transfers, and can attend to her selfcare activities when set up by nursing staff. Leonie has some difficulties planning tasks needed to get dressed. Leonie is very keen to return home and cooperate with interventions. She is, however, reluctant to access home support services, fearing this could lead to her being placed in a nursing home and she has insisted that she wants to remain living at home. Instructions: You may use a a report style for assignment (brief introduction, body and brief conclusion; you may use headings). The report must be all your own work as per your plagiarism agreement. The report should address the following criteria: Criterion 1 - Succinctly discuss three (3) of Leonie’s behavioural health risk factors (i.e. not diagnoses such as anxiety or depression), with reference to current peer reviewed literature. Criterion 2 - Critically evaluate three (3) best-practice assessment tools used by nurses that are appropriate to the risk factors identified, with reference to current peer reviewed literature. Criterion 3 - Discuss at least two (2) interventions that will support Leonie via a person-centred approach and justify these with reference to peer reviewed literature. Criterion 4 - Critically analyse how your chosen interventions relate to your obligations as a Registered Nurse with reference to peer reviewed literature. Criterion 5 - Write in a clear and succinct manner, with correct use of grammar, terminology and Harvard referencing style.

Answer 1

Succinctly discuss three (3) of Leonie’s behavioural health risk factors (i.e. not diagnoses such as anxiety or depression), with reference to current peer reviewed literature

symptoms of depressions are

• Trouble concentrating, remembering details, and making decisions
• Fatigue
• Feelings of guilt, worthlessness, and helplessness
• Pessimism and hopelessness
• Insomnia, early-morning wakefulness, or sleeping too much
• Irritability
• Restlessness
• Loss of interest in things once pleasurable, including sex
• Overeating, or appetite loss
• Aches, pains, headaches, or cramps that won't go away
• Digestive problems that don't get better, even with treatment
• Persistent sad, anxious, or "empty" feelings
• Suicidal thoughts or attempts

symptoms of anxiety includes

• Excessive Worrying
• Feeling Agitated
• Restlessness
• Fatigue
• Difficulty Concentrating
• Irritability
• Tense Muscles
• Trouble Falling or Staying Asleep
• Panic Attacks
• Avoiding Social Situations
• Irrational Fears

Over the past six months Leonie has been spending less time outdoors and more time at home. She states that she no longer has interest in her painting, gardening or going to the movies with her friends, which were activities that once gave her a lot of joy.She reports being tired and tends to sleep more during the day. She used to walk for half an hour in the morning three days a week for exercise however, over the past 6 months she has not been going for her daily walks and has been sleeping in. She also stopped driving 6 months ago. as these symptoms suggest she is suffering from anxiety and depression.

Criterion 2 - Critically evaluate three (3) best-practice assessment tools used by nurses that are appropriate to the risk factors identified, with reference to current peer reviewed literature.

Depression screening tools

Beck Depression Inventory (BDI)

Patient Health Questionnaire (PHQ)

Hospital Anxiety and Depression Scale (HADS)

Criterion 3 - Discuss at least two (2) interventions that will support Leonie via a person-centred approach and justify these with reference to peer reviewed literature.

nursing care plan and interventions for depression

care plan

1. Risk For Self-Directed Violence
2. Impaired Social Interaction
3. Spiritual Distress
4. Chronic Low Self-Esteem
5. Disturbed Thought Processes
6. Self-Care Deficit
7. Grieving
8. Hopelessness
9. Deficient Knowledge

intervention

1. identify the level of suicide precautions needed. If there is a high-risk, does a hospitalization requires? Or if there is a low risk, will the client be safe to go home with supervision from a family member or a friend? For example, does client

• Admit previous suicide attempts.
• Abuse any substances.
• Have no peers/friends

1. Check for the availability of required supply of medications needed.
2. Encourage clients to express feelings (anger, sadness, guilt) and come up with alternative ways to handle feelings of anger and frustration.
3. Contact the family, arrange for crisis counseling. Activate links to self-help groups.
4. If, hospitalized, follow unit protocols.
5. Implement a written no-suicide contract

nursing care plan and intervention for anxiety

care plan

1. Anxiety
2. Fear
3. Ineffective Coping
4. Powerlessness
5. Social Isolation
6. Self-Care Deficit
7. Deficient Knowledge

intervention

1. Maintain a calm, non threatening manner while working with the client.
2. Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions directly, offering unconditional acceptance; being available and respecting the client’s use of personal space.
3. Remain with the client at all times when levels of anxiety are high (severe or panic); reassure client of his or her safety and security.
4. Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.)
5. Maintain calmness in your approach to the client.
6. Provide reassurance and comfort measures.
7. Educate the patient and/or SO that anxiety disorders are treatable.
8. Maintain awareness of your own feelings and level of discomfort.
9. Stay with the patient during panic attacks. Use short, simple directions.
10. Avoid asking or forcing the client to make choices
11. Observe for increasing anxiety. Assume a calm manner, decrease environmental stimulation, and provide temporary isolation as indicated.
12. PRN medications may be indicated for high levels of anxiety. Watch out for adverse side effects.
13. Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth.
14. Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep- breathing exercises, physical exercises, brisk walks, jogging, meditation).

Critically analyse how your chosen interventions relate to your obligations as a Registered Nurse with reference to peer reviewed literature.

Leonie is an old lady staying alone without anyone to care who is suffering from depression and anxiety. Leonie is suffering from mental difficulties rather than her physical problems.it is imortant to take interventions to treat the behavioural disorders such as depression and anxiety. it is important for achieving the overall well being of her health.so the chosen intervention is relating to the obligation as a nurse.