Chapter 13: What Would You Do?

1. How might the bodies of nursing standards, such as the American Nurses Association (ANA), be relevant to Jeff’s case, considering his recent onset of symptoms?

2. How might the State Board of Nursing contribute to Jeff’s care plan, considering his current distress and the need for a multidimensional approach?

3. How might federal entities, such as the Centers for Medicare and Medicaid Services, influence the provision of care for a client like Jeff?

Ji-Yeon, a twenty-eight-year-old female, has presented to the mental health clinic seeking assistance for recent distressing symptoms. She reports a persistent low mood, loss of interest in activities she once enjoyed, and disrupted sleep patterns, experiencing difficulty falling asleep and staying asleep. Ji-Yeon’s medical history indicates no known physical health issues, and she is not currently taking any medications. She discloses a family history of depression, with her mother and maternal aunt both diagnosed with the condition. During the assessment, Ji-Yeon describes feeling overwhelmed by her emotions, often on the verge of tears for no apparent reason. She reports a noticeable decrease in energy, leading to difficulties in completing daily tasks and maintaining focus at work. Vital signs, including blood pressure, heart rate, and respiratory rate, fall within normal ranges.

4. How has the history of the DSM, from its initial publication in 1952 to the current DSM-5-TR, influenced the understanding and diagnosis of mental disorders, particularly in Ji-Yeon’s case?

5. Discuss how the DSM-5-TR criteria can guide clinicians in Ji-Yeon’s assessment and diagnosis.

6. In light of the advantages and disadvantages of using the DSM-5 system for categorizing mental disorders, how might these factors impact Ji-Yeon’s experience with the diagnostic process?

Lin, a thirty-five-year-old male, has sought help at the psychiatric clinic, expressing apprehensions about his mental well-being. In his detailed self-report, Lin describes a persistent and overwhelming sense of sadness that has lingered for the past six months. He discloses a profound loss of interest in activities that once brought him joy, such as spending time with friends and engaging in hobbies. Additionally, he notes a noticeable decline in concentration at work, impacting his overall performance and contributing to heightened stress levels. Exploring Lin’s medical history reveals a noteworthy diagnosis of hypertension, established in the preceding year. Currently managed with antihypertensive medications, this condition adds a layer of complexity to his overall health. The psychiatric evaluation, however, uncovers that Lin has no documented history of mental health diagnoses or prior therapeutic interventions. During the assessment, Lin’s physical appearance is marked by signs of fatigue, with noticeable dark circles under his eyes. Despite this, his vital signs, including blood pressure and heart rate, fall within the normal range. As the nursing team delves into Lin’s history, they inquire about lifestyle factors, sleep patterns, and any recent life changes that may contribute to his emotional distress.

7. How does a comprehensive assessment contribute to client-centered care, especially considering Lin’s case?

8. How can tools like the mental status exam (MSE) and assessment instruments (e.g., PHQ-9, GAD-7) aid in gathering relevant information for Lin’s care plan?

9. How might the nurse prioritize problems for Lin, considering his symptoms and coexisting conditions like hypertension?

10. How does the nurse collaborate with the client and the health-care team to individualize the care plan, considering Lin’s unique circumstances?

11. How can the nurse effectively implement interventions for Lin, balancing safety, individualized care, and cultural competence?

12. How can ongoing evaluation contribute to optimizing Lin’s wellness and quality of life?

Mei, a twenty-eight-year-old female, has presented to the psychiatric outpatient clinic seeking support for her mental health. Mei reports experiencing symptoms of persistent anxiety, accompanied by intrusive thoughts and difficulty sleeping. Her medical history includes a past diagnosis of asthma, which is currently managed with inhalers. Psychiatrically, Mei discloses a history of recurrent depressive episodes that have been episodically managed with medication and therapy. During the assessment, Mei exhibits signs of restlessness, frequently tapping her foot, and appears tense. Her vital signs, including blood pressure, heart rate, and respiratory rate, fall within normal ranges. Mei communicates a desire for a more active role in her treatment and expresses interest in exploring approaches that go beyond symptom management.

13. Define the recovery model in psychiatric nursing and how it relates to Mei’s case. How does the recovery model differ from traditional approaches to mental health care, and what aspects of Mei’s experience align with the principles of recovery-oriented care?

14. Explain the role of the psychiatric nurse in promoting recovery, specifically in Mei’s case. How can the nurse foster a recovery-oriented approach, considering Mei’s expressed desire for an active role?

Donny, a forty-five-year-old male, has presented to the mental health clinic with symptoms of severe anxiety and emotional distress. He reports a recent loss of employment due to ongoing panic attacks, and his medical history reveals a diagnosis of hypertension managed with antihypertensive medications. Psychiatrically, Donny has a history of generalized anxiety disorder, for which he has been prescribed anxiolytic medication in the past. During the assessment, Donny exhibits signs of restlessness, increased heart rate, and difficulty maintaining eye contact. His vital signs, including blood pressure and respiratory rate, show an elevation from his baseline. Donny expresses concerns about the impact of his mental health on his daily functioning and relationships.

15. Discuss special considerations within the nursing scope of practice in mental health nursing, considering Donny’s case. How might the unique aspects of mental health care, such as the therapeutic milieu and psychopharmacology, influence the nursing scope of practice in this scenario?

16. How do challenges in mental health nursing, such as diagnostic overshadowing, relate to the importance of professional boundaries and ethical considerations? How can nurses address these challenges while maintaining a therapeutic relationship with clients like Donny?