Chapter 11: What Would You Do?

1. Considering Elin’s history of legal incidents and the potential threat to her own safety and others, discuss why court-ordered therapy might be deemed necessary for her case. How do the legal implications of her substance misuse contribute to the decision for involuntary intervention, and, what ethical considerations should be taken into account?

2. Given Elin’s complex needs, provide examples of specific types of court-ordered therapy that could be beneficial in her case. How might inpatient rehabilitation, dual diagnosis treatment, and counseling programs address the multifaceted challenges presented by her severe alcohol use disorder, chronic liver disease, and co-occurring anxiety and depression?

3. What legal criteria and procedures would need to be considered when initiating involuntary court-ordered treatment for Elin? Identify and discuss the steps involved in determining whether she meets the necessary criteria for involuntary intervention.

Alexandra, a thirty-five-year-old female, has presented at the emergency department (ED) seeking assistance for escalating symptoms of severe anxiety and depression. She reports experiencing persistent feelings of hopelessness, insomnia, and a significant loss of interest in daily activities. Alexandra has a history of bipolar disorder and is currently prescribed mood stabilizers. Her medical history also includes a recent hospitalization due to a suicide attempt. In the ED, Alexandra’s vital signs reveal an elevated heart rate of 110 beats per minute, blood pressure of 150/90 mmHg, and shallow breathing. Given her history and the acuity of her symptoms, staff safety is a concern. Alexandra appears agitated, and her affect is labile.

4. Identify three specific mental health issues that Alexandra is currently facing based on her reported symptoms and history. How do these issues contribute to concerns regarding her safety in the emergency department?

5. Outline at least three immediate approaches nurses can employ in the ED to address Alexandra’s safety concerns based on her elevated vital signs and agitated state. How can the physical environment and communication strategies contribute to ensuring her safety during this encounter?

6. Considering Alexandra’s case, what specific challenges might nurses face in ensuring their own safety while providing care? How can interdisciplinary collaboration and clear communication contribute to enhancing staff safety in the context of this emergency situation?

Sunil, a fifty-five-year-old male, has been admitted to the psychiatric unit with a history of bipolar disorder. He presents with symptoms of severe mood swings, impulsivity, and decreased need for sleep. Sunil has a well-documented psychiatric history, including multiple hospitalizations due to manic episodes. Upon admission, his vital signs are stable, with a heart rate of 78 beats per minute, blood pressure of 120/80 mmHg, and normal respiratory rate. Given the recurrent nature of his condition, Sunil has a comprehensive mental health-care plan that includes a power of attorney designating his sister as his legal representative. Additionally, he has a living will specifying preferences for treatment during periods of incapacitation. Sunil has also provided a psychiatric advance directive outlining his preferences for specific psychiatric interventions in various scenarios.

7. Sunil’s psychiatric history includes multiple hospitalizations due to manic episodes. How might the power of attorney designated to his sister play a crucial role in ensuring continuity of care during his hospitalizations? Discuss specific scenarios where the sister’s involvement might be essential.

8. Sunil has a living will specifying treatment preferences during periods of incapacitation. How can the nurse effectively communicate and collaborate with Sunil’s sister to tailor his care to his preferences while balancing the legal and ethical aspects of mental health nursing?

9. Define the role of psychiatric advance directives in mental health care. How might Sunil’s psychiatric advance directive influence decision-making in specific psychiatric interventions, and what challenges could arise in implementing these directives within the clinical setting?

Geraldine, a sixty-eight-year-old female, has been admitted to the hospital with a diagnosis of advanced Alzheimer’s disease. She presents with symptoms of severe cognitive decline, including disorientation, memory loss, and difficulty performing activities of daily living. Geraldine’s medical history includes a gradual deterioration of cognitive function over the past two years, leading to increased dependency on others for basic care. During this admission, her vital signs are within normal ranges, with a heart rate of 80 beats per minute, blood pressure of 130/78 mmHg, and a regular respiratory rate. Due to the progression of her Alzheimer’s disease, concerns have arisen about Geraldine’s ability to make decisions regarding her health care and living situation.

10. Given Geraldine’s advanced Alzheimer’s disease and cognitive decline, how would you define the role of a guardian or conservator in her situation? Consider the specific responsibilities and decision-making authority that a guardian or conservator might have in managing her health care and living arrangements.

11. Outline the step-by-step process for appointing a guardian or conservator for Geraldine, taking into account her advanced Alzheimer’s disease. Consider the legal and procedural aspects involved in initiating and completing this process.

12. In Geraldine’s case, how might the appointment of a guardian or conservator impact her overall well-being, considering not only medical decisions but also aspects of her daily life and personal preferences? Discuss potential benefits and drawbacks of such an appointment.