Mental Health Nursing in a variety of Setting
Overview of the Case
The case was about a 21 year old Afro-Caribbean who is suffering from schizophrenia. The patient has been known to have various problems which resulted in considering mental health services. It can be said that this case has so much issues to be given attention.
In this report, the presentation will tackle about the issue of the medicine which is taken by the patient, i.e. OLANZAPINE 15 mgs. In this regard, the paper will give emphasis on OLANZAPINE, its description, how it should be taken, and its possible side effects on the patient. In addition, this paper will also discuss the reason why this issue has been taken and how this enhances my nursing knowledge and practice and the ethico-legal aspects considered to choose this issue.
Description: OLANZAPINE
· Olanzapine also known as Zyprexa belongs to the category of medicines commonly regarded asatypical antipsychotics. This medication is known to be effective for treating various symptoms of illness.
· It belongs to a drug class regarded as atypical antipsychotics (Medicine Net, 2008).
· It is an oral medication and comes as tablets.
· A medication which is used for treating acute manic episodes associated with bipolar I disorder and schizophrenia.
HOW OLANZAPINE WORKS
· This medication works for various illnesses which affect the brain, most especially psychotic disorders such as drug-induced psychosis, first phase psychosis, schizophrenia. These illnesses are caused by the imbalances of certain chemicals in the brain. Such chemical imbalances cal also results in some of the symptoms experience by various individuals.
· Through the help of Olanzapine, the medicine enables the chemical to be balance in specific parts of the brain and those affected by the medication are known as the dopamine and serotonin.
· Olanzapine also helps with symptoms like patient’s hallucinations, racing or disorganized thinking, and unusual mood swings, thinking which is out of touch with reality and other problems.
How Olanzapine should be taken
· It is said that the daily intake of Olanzapine can help the patient control their symptoms and enables them to feel better. With this context, it is very essential to take the doses of Olanzapine in a daily basis even once the symptoms go away or while the patient is feeling better.
· This medication is availabe for oral intake as tablets and may be taken with or without food. The patient must take Olanzapine daily as directed by their physicians.
· In order to gain the benefit of this medicine, the patient must take the exact number of tablets prescribed by the doctor at the right time.
· Olanzapine is a maintenance medicine so, whether the patient feels good or bad, this medicine should be taken and do not stop until the doctor said so.
· This medicine is commonly taken for 10-20 mgs daily (in this case, the patient is taking 15 mgs of Olanzapine), and it’s commonly started low and established up to 10 or 15 mgs initially for one week or two weeks.
Notes: However, older people, teenagers and individuals with any condition that affect their brain are required to take smaller dose of this medicine.
· It is said that if the patient miss their dose of Olanzapine, they are required to take it as soon as possible. However, if it is almost time for the net dose, the patient can skip the missed dose and return to their regular medicine schedule.
· It is not recommended that the patient will take two doses at one period. Take the medicine on their appropriate time with the appropriate dosage and wait until the symptoms improve (which will eventually happen) over the first few weeks of the patient treatment.
· For patient who misses their dose, the most essential thing to do is to follow what the doctor has prescribed you.
· Taking Olanzapine the way the doctor has said it will enable the patients to feel more relieved and also keep them from experiencing the symptoms.
Notes: Since there are patients who have difficulty in remembering the time when they should take their medicine, the following tips are provided.
o First, the patient should set their mind of taking the medication at the same time in a daily basis.
o The patient can also choose a daily event which they can use as a reference to help them remember that they need to take their medication like during mealtime or bedtime.
o The patient can also use some pill container which can hold a weeks worth of Olanzapine tables to remind them the medicines they need to take each day.
o If the patient does not have healthcare provider’s supervision or assistance, they can also use some calendar noting the date and the time after each dose has been take for tracking and record purposes. In addition, a written reminder posted in the mirror or the refrigerator, personal computers and other appliance which you use daily can also be used.
o Further, the patient can also assign one family member to remind the patient that he should take his medicine and if these did not work, you can request the doctor to provide a blister pack to help the patient follow the daily intake of Olanzapine.
Side effects of Olanzapine
Like any other medicines, Olanzapine has also their share of possible side effects.
· People who took up Olanzapine may be at risk of some side effects. One of these is the patient who took Olanzapine tends to experience drowsiness and tiredness at first. However, this improves in the first week of the medication as the patient get used to it.
· In addition, some of the side effects of taking Olanzapine are its effect on the muscles like stiffness, shakiness or general restlessness. Such side effects can occur but do not usually happen on this Olanzapine.
· Furthermore, Olanzapine has also low risk of having anticholinergic side effects which include the drying of mouth, the difficulty of the patient to focus on fine print, slightly fast rate of heart and constipation.
Notes: All these side effects are considered as unlikely, temporary and tend to get beet as soon as the patient get use it.
Other Side Effects
· All these antipsychotic medicines (Olanzapine) can also cause a rare condition which is called as tardive dyskinesia. Tardive dyskinesia is known as a muscular condition which is characterised by a small movement which may start around the mouth or face. Although this is rare with Risperidone these side effects may be felt gradually over time and the doctor or healthcare provided must carefully check it.
Notes: If this is the case, the patient must tell it immediately to the healthcare providers to provide immediate response and to stop the use of the medication to prevent further risks (Medline Plus, 2008).
· Other side effects of olanzapine are it can sometimes cause weight gain.
Notes: However, this side effect varies a lot for different patients, and is a bit more likely to occur with people having low or average weight rather than obese or overweight people.
Because of the side effects of gaining weight of this medicine, the manufacturers of olanzapine has been able to provide special information regarding weight management programme which is availabe from the Eli Lilly. In addition, there is also a pamphlet about weight management which is available in the company website.
· Aside from this, there are also some risks of raised blood sugar and an increased risk of development of diabetes, unusual behavior, weakening, constipation, pain in legs, arms, joints and back, sleeping difficulty, walking difficulty, dizziness and restlessness (Zyprexa, 2008).
All in all, it can be said that olanzapine is given for the patient to maintain balance in the brain chemicals and to help the patient manage their behaviour.
Relevance of the Issue with the Nursing Knowledge and Practice
The individual healthcare professional’s ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring that the best is given to patients, specifically for those patients who are experiencing mental health problems like Rick. But professional competence is only part of the picture.
Nursing Knowledge and Practice
The role of the nurse as a vital member of the healthcare team through collaborative professional practice must always give priority through caring its patient and giving all the possible assistance in order to alleviate their sufferings, like in the case of Rick.
The prime responsibility of being a nurse is to assist individuals like Rick in the achievement of an optimal level of wellness. The focus of nursing practice is on specific needs of Rick based on their healthcare choices related to physiological, psychological, socio-cultural, developmental, and spiritual dimensions of individual lifestyles.
Being a nurse and a healthcare professional, it is important that I am able to determine what should be done with a patient having schizophrenia and the medications and treatment that this patient (like in the case above) is needed to alleviate his suffering as well as his families.
It is known that schizophrenia is a severe mental disorder that usually becomes observable in adolescence or in early adulthood (Andreasen, 2001). It is described by partial disorganization of personality functions, developmental regression, and a tendency to withdraw from interpersonal contacts into a subjective internal world of ideas, often coloured by hallucinations and /or delusions.
The illness may begin suddenly or gradually, and its symptoms either improve or become chronic to different degrees. Many patients have better periods with only minor symptoms and worse periods when the symptom is re-aggravated.
Knowing what schizophrenia is, it is equally important that nurses determine the medications or medicines needed to help the patient suffering from this illness.
Reasons for the Identification of the Issue: Olanzapine
The issue of identifying olanzapine as a medicine used for treating schizophrenic person can be considered as a relevant issue because it enables us to determine which medicines are mostly used with these patients and whether this medicine is really helpful for the patient or not.
In addition, as a healthcare professional, nurses must be able to be knowledgeable on the possible side effects of olanzapine.
Since the patient is having difficulty taking his medicine, it is essential that as a nurse practitioner, I am able to know the pros and cons of taking and not taking these medicines for the patient conditions.
Herein, the knowledge of the olanzapine could help me know how this could help the patient with his current condition.
Notes: Nurse practitioners are increasingly being identified as legitimate
providers of health services throughout the world. The emergence of the role of nurse practitioners has tended to occur where a clear need arises. This may be because there are no other providers of timely health services or because health consumers are seeking alternatives to their customary health service providers. In this regard, nurses must be able to have enough and sufficient knowledge about their responsibilities especially in managing and caring patients suffering from schizophrenia and other mental illness.
Ethico-legal principles
In the field of nursing, there can be seen different ethico-legal principles in which the professional nurses can use in order to promote quality care among patients as well as provides respect on their autonomy.
One of the ethico-legal principles that can be considered in this issue is the concern of the rights and interest of the patient.
It can be said that the primary role of the professional nurses is to protect the rights and interest of its patients. Here, the professional nurses must be able to recognize the rights of the patients undermined by their institutional practices and unequal power structures just in the case of Rick.
Moreover, the professional nurses must be able to do its duty to empower patients, (Varcoe, 1997) both directly by supporting and respecting patient autonomy and indirectly by working to changes of practice to disempowering the patients.
In this case, it can be said that healthcare providers have a duty to respect the right of Rick because, if the patient would be given enough space to know everything about his situation, it can be argued that it can be helpful for the treatment process.
The principle of patient’s autonomy expresses that professionals have a job to treat the patient according to the patient’s desire, within the limits of accepted treatment and to protect the patient’s confidentiality and privacy. Under which, the nurses has the core responsibility to let the patients be involved in treatment decisions in a meaningful way.
Hence, in order for Rick to understand his situation, it is important that the healthcare providers must take into consideration the patient’s feelings, desires, and needs.
Given the perception that patients have regularly been as uninformed as they are powerless in health care, the basic prescription has been to inform them and alter that power structure.
The insistence on truth telling is added to this prescription in recognition of both patients’ need for information and insight as to whether there are decisions to be made, and the alleged widespread presence of deception within health care.
Note: In sum, in any clinical encounter between competent patients and their health care providers, the essential details of the recommended intervention must be presented to the patient, the patient’s consent must be obtained before proceeding, the patient has the right to refuse the intervention without prejudice, and any such interaction must proceed honestly without the presence of lies, deception, or coercion (Wear, 2002)
Conclusion
In order to avoid professional issues, especially in this case, the healthcare professional, specifically the nurse must provide patient-centered care based on the demands and needs of the patients.
With this, the nurse must be able to provide services which composed of every level of care in a diversified system throughout the lifespan of the patients regardless of their health, status, race, gender, culture, and religion.
It is the role of the healthcare professionals to deliver high quality competent, effective, efficient, and collaborative care according to the established standards of nursing knowledge and practice.
All in all, it can be said that the nurse handling the case of Rick Martin must be knowledgeable enough to consider every details of the patient to know what kind of treatment can be used not only with his illness but the way he interact with the healthcare providers and his family.
Reference
Andreasen, N.C. (2001) Brave new brain. Conquering mental illness in the era of the Genome. New York: Oxford University Press, Inc.
Gordon, D. et al (2000). A Self-directed Learning Module. 3rd Edition. UW Hospital and clinics Authority Board.
Olanzapine 2008. Online available at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601213.html. retrieve June 20, 2008
Varcoe, C. (1997). The Revolution never Ends: Challenges of Praxis for Nursing Education, in Nursing Praxis: Knowledge and Action in Thorne S.E. and Hayes, V. E., Sage Publications, Thousand Oaks, California, p. 181.
Wear, S. (2002). “Informed Consent: Patients Autonomy and Clinician eneficence within Health Care.” Georgetown University Press: Washington, DC.
Zyprexa 2008. Online available at http://www.zyprexa.com/index.jsp. retrieve June 20, 2008
Olanzapine, 2008. Online available at mhttp://www.medicinenet.com/olanzapine/article.htm. Retrieve June 20, 2008.
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