Question

CASE STUDY

Jerry is a 35-year-old man who is studying horticulture part-time at his local TAFE and working part-time for the government in a forestry role. Jerry has had bipolar disorder since his late teens but was only officially diagnosed three years ago. Recently, Jerry has started staying up longer during the night working on his assignments, and for the past five days he has not slept at all. For the past month, Jerry has only been sporadically taking his prescribed medication. Last week Jerry’s neighbours made a complaint to the body corporate in the unit where Jerry lives after he did some gardening in his courtyard at 3 am, followed by mowing the communal areas at 4.30 am. Jerry thinks his neighbours need to ‘chill’ and that he was actually in the middle of a breakthrough that could result in reversing global warming. Jerry believes that his neighbours should mind their own business and stop interfering with his creativity, and he cannot understand why they are confused by his ideas. Jerry believes he is on the ‘verge’ of a major discovery. While he was writing his latest assignment, his research helped him unearth a discovery that will reverse global warming, resulting in him making millions of dollars. When the morning came, Jerry quit his job. Jerry’s major concern now is what will happen if he accidentally reverses global warming too much and the temperature becomes too cool. While he is worried about this, he believes everything will probably be okay, because it all comes down to the word ‘land’ and it will ‘even out’, but he does want to seek clarification on this. Jerry is reassured because people live in Iceland, Greenland, Ireland and Poland and these are all cold climates. It will all balance out because there are equal numbers of countries in warmer climates that have the word ‘land’ in them, too, such as Swaziland, Thailand, New Zealand and the Falklands. Outcomes being ‘even’ is of great importance to Jerry. Jerry’s father Paul visited him a few days ago for dinner and is worried about him. Despite Paul making dinner, Jerry couldn’t sit still long enough to eat it. Jerry doesn’t want to talk about the possibility that he may be unwell again, because, he says, ‘It’s not like last time, Dad.’ Yesterday, Jerry attended the Polish embassy requesting they work with him on his project. He demanded to see the ‘most senior person here’ because they would be the only one who could understand his discovery. Both the Thai and Irish embassies had refused to return his calls. Jerry became upset when a representative from the Polish embassy exports department would not meet with him. Jerry was talking rapidly and loudly, and staff could not follow the topic of his conversation. Jerry became irritated when staff didn’t provide the information he wanted and eventually security was called. Jerry was taken to his local hospital for assessment and later admitted.

Please let me know below questions regarding above case..(bold = important one!!)

**what risks would you identify?

**Describe these features of the presentation of mania: pressured speech, disinhibition, punning, grandiose delusions, and second person auditory hallucinations.

**Jerry became irritated and security were called, and he was taken to his local hospital for assessment. What is the difference between ‘voluntary’ and ‘involuntary’ treatment in the context of mental health act legislation in your state or territory?

**Treatment for Bipolar Disorder includes antipsychotics, anxiolytics, antidepressants and most commonly mood stabilizers. Investigate the following psychotropic medications known as Mood Stabiliser- Lithium Carbonate, Sodium Valproate, Lamotrigine and Carbamazepine. Consider the importance of effective monitoring, consumer experiences (side effects) and safety factors (e.g. Lithium Toxicity). Discover the other therapeutic use for the last three medications.

**The mental state examination (MSE) is a formal assessment used in both diagnostics and ongoing assessment. How can the principles of a therapeutic relationship facilitate the process of obtaining information through an MSE?

**How can the mental health nurse apply Bandura’s concept of self-efficacy to support consumers in medication self-management?

Answer 1

*jerry is ha bipolar disease few years before, it get progressive as years passed., showing mania and depression. Abuse, mental stress, a “significant loss,” or some other traumatic event may contribute to or trigger bipolar disorder.he have narcasstic feels, if bipolar gets un treates the risk i identied is he will go for alcohol or substance abuse, or suicidal attempts

*pressured speech; loud and rapid speech beacause of anger , its irrevalant cant able to understand listeners...... disinhibition;a temporary loss of inhibition caused by an outside stimulus ......punning; it is the humorous use of a word or phrase with different meanings, grandiose delusions, is a false or unusual belief about one's greatness and second person auditory hallucinations.;feeling of hearing sounds or commands that a normal person cant able to hear

*voluntary treatment means a person itsself going hospital for an illness.. involuntary means another peoples brings him to hospital for management.. here for jerry its involuntary treatment

* Lithium Carbonate; help to reduce the frequency of manic episodes...frequent urination,fine hand tremor,drowsines,weight gain,lightheadedness,lack of awareness,unsteadiness or clumsiness,convulsions or seizures.. inform doctor  if you have heart or kidney disease, an under-active thyroid, or any debilitating medical condition..Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to this medicine..

Carbamazepine is used to prevent and control seizures,Lamotrigine is an anticonvulsant.sodium valporate is uesd for mygraine

*nursing observation is multifaceted • observation and assessment are interrelated • observation is grounded in therapeutic engagement with the person • nurses appreciate how inpatient environments influence behaviour • observations are communicated between colleagues • there is a clear process of documentation that is timely and descriptive.

*Bandura’s concept of self-efficacy -Teach specific learning strategiesfor medication administration,Encourage them  to try medication administration ,Give frequent, focused feedback..