Angela was diagnosed at the age of 54 with paranoid schizophrenia, and was initially admitted to a mental health unit for management. She stayed in the institution for four years. With significant improvements, she was discharged for home and community management…
She was doing well under the care of her daughter, but after two years at home, many of her symptoms recurred including her hallucinations, paranoia, delusions of grandeur; she was also manifesting disorganized speech and thought processes. She was hearing voices and was often heard talking to her hallucinations; she also insisted she was a Queen and must be treated as such; and she was easily distracted and had trouble organizing her thoughts. She was also refusing to take her medications. After appropriate evaluation, she was admitted to the mental health unit. I met the patient after being assigned to her care as a mental health nurse. In evaluating her condition, she has been schizophrenic for six years now with her symptoms being manageable for the better part of four years, but due to an untoward incident – the death of her husband, her symptoms have become unmanageable again. Angela is now 56 years old, has had two grown children, and has been recently widowed. She has worked as a school teacher up to the time when her initial symptoms manifested. She has since opted for early retirement due to her condition. When she was brought home after four years in the mental institution, she has had a limited social history. She has opted to not engage in any social interactions because she felt ashamed of her condition. Her family members have remained supportive of her and they have done their best to maintain social interactions with her. Within the mental health unit, she is a shy and socially awkward person. At times, she can also be gregarious with other people, especially when her delusions of grandeur are manifesting. However, she also tends to be suspicious of everyone including the health staff and the patients. This makes her resistant to interactions and to the medical interventions which the health staff are administering. Long term conditions are those conditions which basically require prolonged medical care (London Health Observatory, 2011). The World Health Organization (Department of Health, 2005) describes that long-term conditions or chronic conditions are health issues which call for continuous care over a period of years or even decades. It includes conditions like cancer, HIV/AIDS, diabetes, hypertension, and mental disorders including schizophrenia, depression, Alzheimer’s disease (London Health Observatory, 2011). The patient’s mental illness is considered a long-term condition because it would require continuous management. In short, it is a life-long disease which would require constant supervision and treatment. The patient would have to take medications for the rest of her life to manage her symptoms and she would have to be monitored in order to ensure that her symptoms would not endanger her life and the life of other people. 2. PLANNING THE CARE a. What interventions were planned – what is the evidence based for this? Interventions which were planned primarily included the administration of antipsychotic medications. The management of schizophrenia most often includes antipsychotic medications (Brown University, 2012). The patient was to be placed on Risperidone (Risperdal) which is an atypical antipsychotic. Risperidone is currently preferred as an antipsychotic because it does not cause agranulocytosis, which is commonly seen in clozapine, another antipsychotic (National Institute of Mental Health, 2012). Risperidone however can increase a patient’s risk to diabetes and hypercholestolemia; as a result, regular monitoring of the ...
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