NURS 3325 Module 3 Discussion Mental Health

NURS 3325 Module 3 Discussion Mental Health

NURS 3325 Module 3 Discussion Mental Health

This discussion focuses on Mrs. Gomez’s history which is relevant to her insomnia. It includes chief complaint, HPI, social, family, and past medical history that are essential to know.

Patient Initials: MG

Subjective Data: MG presents with an ongoing problem of feeling extremely tired and inability to sleep properly for the past six months. The patient is in grief following the recent death of her husband. She reports fatigue, weight gain, and loss of interest in activities she once enjoyed such as going to church and reading. She says that she has lost focus and can read the same page continuously. She denies suicide ideation or self-injury.

Chief Complaint: A 65-year-old Mrs. Gomez claims to be extremely tired lately and has trouble sleeping

HPI: The patient presents with complaints of insomnia for the last six months. She says that she only manages to sleep for a few hours every night.

            Onset: Six months ago

            Location: General

            Duration: She reports sleeping a few hours every night

            Characteristics: Loss of focus, extremely tired

            Aggravating factors: Watching TV at night

            Relieving Factors: None

            Treatment: MG is on Tylenol PM and Zapote Blanco, a Mexican herbal tea

            Severity: Rigorous alteration in sleep pattern, which compromises her routine functioning.

PMH: Type 2 diabetes, Hypertension, Hypercholesterolemia

Social: MG is staying with her daughter and son-in-law following the death of her husband of 30 years. She denies smoking and taking alcohol.

Surgical history: MG has undergone Cholecystectomy, Hysterectomy

Medications: MG has been placed on Glyburide 10 mg daily and Metformin 1,000 mg bid for the management of diabetes, Methyldopa 250 mg bid and Lisinopril 10 mg daily for the management of HTN, Atorvastatin 80 mg daily for the management of hypercholesterolemia, Aspirin 81 mg daily for the management of CHD prophylaxis, and Calcium citrate with vitamin D 600mg/400 IU bid for prevention of osteoarthritis prevention. MG also uses zapote tea and Diphenhydramine.

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Pain: None

Respiration: No apnea, shortness of breath, CTA, snoring

Head, eyes, ears, nose, and throat (HEENT): Denies adenopathy, thyromegaly, or masses

Cardiac: No chest pains, edema, palpitations

Constitutional: No fevers or dizziness

Significant labs: MG’s final hemoglobin A1c has elevated to 8.7%

Endocrinologic: Denies polydipsia or polyuria

Gastrointestinal: No nausea, hematochezia, alterations in bowel habits,

Neurologic: Normal gait, no serious neurologic changes, no confusion, no tremors

Urologic: MG usually urinates once or twice at night without any difficulty

Vital signs: BP 128/78 mm Hg, HT 64 in, WT: 186 pounds, HR 60 beats/minute, and regular

The Physical Exam, Diagnostic Tools, and Recommended Additional Information

MG’s hemoglobin A1c elevated to 8.7%, which is an indication of uncontrolled blood glucose. It is recommended to conduct laboratory tests such as thyroid stimulating hormone (TSH), complete blood count (CBC), and complete metabolic panel (CMP). These tests are crucial in ruling out other potential causes of insomnia, depression, and fatigue. They will assess conditions such as vitamin deficiencies, electrolyte imbalance, anemia, and renal or hepatic problems. The additional information I would seek from this patient is the amount of Zapote tea she consumes daily. This tea contains glucoside which reduces blood pressure. It can also act as an arthritic pain reliever and sedative when consumed in higher doses.

Differential Diagnoses for Mrs. Gomez

The first differential diagnosis is hypothyroidism. The majority of people globally are affected by thyroid problems, which disproportionally affect women compared to men. Hypothyroidism can make a person feel fatigued, alter mood and behavior, and feel apathetic (Wilson et al., 2021). The second differential diagnosis is dementia. However, this diagnosis was ruled out after MG scored normal range in the Mini-Cog exam. The final diagnosis was depression. An episode of depression entails at least five symptoms such as depressed mood, unintended changes in weight, impaired concentration, recurrent suicide ideation, significant changes in sleep pattern, and feeling worthless (Paykel, 2022).  MG presents at least five of the symptoms that confirm depression.

Plan of Care for Mrs. Gomez at Visit, Patient Education, and Follow-up

The main treatment plan of choice for MG includes diet, Sertraline, cognitive-behavioral therapy (CBT), and exercise.  MG should be placed on sertraline to manage depression. This medication is well-tolerated and accessible in a generic form (Guerrera et al., 2020).  The goal of treatment is to optimize the quality of life of MG to enable her to function emotionally and physically to the best of their ability. CBT is crucial for MG to help her cope with the loss of a spouse and move on with life. Exercise is critical in helping to improve mood and other health benefits such as improving diabetes and blood pressure.

Mrs. Gomez should be educated on the possible side effects of sertraline. Education should also cover the need to adhere to the medication’s proper dosage even after starting to feel better (Guerrera et al., 2020). She should be advised to report any problem or side effects she encounters during the treatment process. Mrs. Gomez should also be advised to create a sleep schedule. She should be discouraged from using certain drinks such as alcohol, sugary foods, and caffeine a few hours before going to bed. On the other hand, follow-up is necessary to determine the effectiveness of the medication (Schramm et al., 2019). Follow-up is also crucial in monitoring medication compliance since some patients do not report side effects or missing doses.

NURS 3325 Module 3 Discussion Mental Health References

Guerrera, C. S., Furneri, G., Grasso, M., Caruso, G., Castellano, S., Drago, F., … & Caraci, F. (2020). Antidepressant drugs and physical activity: a possible synergism in the treatment of major depression? Frontiers in Psychology, 11, 857. https://doi.org/10.3389/fpsyg.2020.00857

Paykel, E. S. (2022). Basic concepts of depression. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/espaykel

Schramm, E., Kriston, L., Elsaesser, M., Fangmeier, T., Meister, R., Bausch, P., … & Härter, M. (2019). Two-year follow-up after treatment with the cognitive behavioral analysis system of psychotherapy versus supportive psychotherapy for early-onset chronic depression. Psychotherapy and psychosomatics, 88(3), 154-164. https://doi.org/10.1159/000500189

Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: diagnosis and treatment. American family physician, 103(10), 605-613. https://pubmed.ncbi.nlm.nih.gov/33983002/

When I Was Growing Up…How were older adults in my family treated?

What did I observe about the treatment of older adults in society?

How were people with mental or emotional disorders viewed?

What language was used to describe aging, old age, and older adults with altered mental function?

What words did my family use, and what was the connotative meaning of the words used, to describe older adults? Was it positive, negative, or mixed?

Be sure to use reference to support statements, what was the culture of the time regarding mental health for example,

Mental health refers to cognitive, behavioral, and emotional well-being. It is all about how people think, feel, and behave. People sometimes use the term “mental health” to mean the absence of a mental disorder.

Mental health can affect daily living, relationships, and physical health.

However, this link also works in the other direction. Factors in people’s lives, interpersonal connections, and physical factors can all contribute to mental health disruptions.

Looking after mental health can preserve a person’s ability to enjoy life. Doing this involves reaching a balance between life activities, responsibilities, and efforts to achieve psychological resilience.

Conditions such as stress, depression, and anxiety can all affect mental health and disrupt a person’s routine.

Although the term mental health is in common use, many conditions that doctors recognize as psychological disorders have physical roots.

In this article, we explain what people mean by mental health and mental illness. We also describe the most common types of mental disorders, including their early signs and how to treat them.

What is mental health?

Mental health disorders are one of the leading causes of disability in the U.S.
According to the World Health Organization (WHO)Trusted Source:

“Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.”

The WHO stress that mental health is “more than just the absence of mental disorders or disabilities.” Peak mental health is about not only avoiding active conditions but also looking after ongoing wellness and happiness.

They also emphasize that preserving and restoring mental health is crucial on an individual basis, as well as throughout different communities and societies the world over.

In the United States, the National Alliance on Mental Illness estimate that almost 1 in 5 adults experience mental health problems each year.

In 2017, an estimated 11.2 million adultsTrusted Source in the U.S., or about 4.5% of adults, had a severe psychological condition, according to the National Institute of Mental Health (NIMH).

Risk factors for mental health conditions

Everyone has some risk of developing a mental health disorder, no matter their age, sex, income, or ethnicity.

In the U.S. and much of the developed world, mental disorders are one of the leading causesTrusted Source of disability.

Social and financial circumstances, biological factors, and lifestyle choices can all shape a person’s mental health.

A large proportion of people with a mental health disorder have more than one condition at a time.

It is important to note that good mental health depends on a delicate balance of factors and that several elements of life and the world at large can work together to contribute to disorders.

The following factors may contribute to mental health disruptions.

Continuous social and economic pressure

Having limited financial means or belonging to a marginalized or persecuted ethnic group can increase the risk of mental health disorders.

A 2015 studyTrusted Source of 903 families in Iran identified several socioeconomic causes of mental health conditions, including poverty and living on the outskirts of a large city.

The researchers also explained the difference in the availability and quality of mental health treatment for certain groups in terms of modifiable factors, which can change over time, and nonmodifiable factors, which are permanent.

Modifiable factors for mental health disorders include:

socioeconomic conditions, such whether work is available in the local area
occupation
a person’s level of social involvement
education
housing quality
Nonmodifiable factors include:

gender
age
ethnicity
The study lists gender as both a modifiable and nonmodifiable factor. The researchers found that being female increased the risk of low mental health status by 3.96 times.

People with a “weak economic status” also scored highest for mental health conditions in this study.

Biological factors

The NIMH suggest that genetic family history can increase the likelihoodTrusted Source of mental health conditions, as certain genes and gene variants put a person at higher risk.

However, many other factors contribute to the development of these disorders.

Having a gene with links to a mental health disorder, such as depression or schizophrenia, does not guarantee that a condition will develop. Likewise, people without related genes or a family history of mental illness can still have mental health issues.

Mental health conditions such as stress, depression, and anxiety may develop due to underlying, life-changing physical health problems, such as cancer, diabetes, and chronic pain.

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Common mental health disorders

The most common types of mental illness are as follows:

anxiety disorders
mood disorders
schizophrenia disorders
Anxiety disorders
According to the Anxiety and Depression Association of America, anxiety disorders are the most common type of mental illness.

People with these conditions have severe fear or anxiety, which relates to certain objects or situations. Most people with an anxiety disorder will try to avoid exposure to whatever triggers their anxiety.

Examples of anxiety disorders include:

Generalized anxiety disorder (GAD)

The American Psychiatric Association define GAD as disproportionate worry that disrupts everyday living.

NURS 3325 Module 3 Discussion Mental HealthPeople might also experience physical symptoms, including

restlessness
fatigue
tense muscles
interrupted sleep
A bout of anxiety symptoms does not necessarily need a specific trigger in people with GAD.

They may experience excessive anxiety on encountering everyday situations that do not present a direct danger, such as chores or keeping appointments. A person with GAD may sometimes feel anxiety with no trigger at all.

Find out more about GAD here.

Panic disorders

People with a panic disorder experience regular panic attacks, which involve sudden, overwhelming terror or a sense of imminent disaster and death.

Read more about panic attacks here.

Phobias

There are different types of phobia:

Simple phobias: These might involve a disproportionate fear of specific objects, scenarios, or animals. A fear of spiders is a common example. Learn more about simple phobias here.
Social phobia: Sometimes known as social anxiety, this is a fear of being subject to the judgment of others. People with social phobia often restrict their exposure to social environments. Find out more here.
Agoraphobia: This term refers to a fear of situations in which getting away may be difficult, such as being in an elevator or moving train. Many people misunderstand this phobia as a fear of being outside. Read all about agoraphobia here.
Phobias are deeply personal, and doctors do not know every type. There could be thousands of phobias, and what might seem unusual to one person may be a severe problem that dominates daily life for another.

Obsessive-compulsive disorder (OCD)

People with OCD have obsessions and compulsions. In other words, they experience constant, stressful thoughts and a powerful urge to perform repetitive acts, such as hand washing.

Find out more about OCD here.

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Post-traumatic stress disorder (PTSD)

PTSD can occur after a person experiences or witnesses a deeply stressful or traumatic event.

During this type of event, the person thinks that their life or other people’s lives are in danger. They may feel afraid or that they have no control over what is happening.

These sensations of trauma and fear may then contribute to PTSD.

Discover how to recognize and treat PTSD.

NURS 3325 Module 3 Discussion Mental HealthMood disorders
People may also refer to mood disorders as affective disorders or depressive disorders.

People with these conditions have significant changes in mood, generally involving either mania, which is a period of high energy and elation, or depression. Examples of mood disorders include:

Major depression: An individual with major depression experiences a constant low mood and loses interest in activities and events that they previously enjoyed. They can feel prolonged periods of sadness or extreme sadness.
Bipolar disorder: A person with bipolar disorder experiences unusual changesTrusted Source in their mood, energy levels, levels of activity, and ability to continue with daily life. Periods of high mood are known as manic phases, while depressive phases bring on low mood. Read more about the different types of bipolar here.
Seasonal affective disorder (SAD): Reduced daylight triggers during the fall, winter, and early spring months trigger this type of major depressionTrusted Source. It is most common in countries far from the equator. Learn more about SAD here.
Schizophrenia disorders
Mental health authorities are still trying to determine whether schizophrenia is a single disorder or a group of related illnesses. It is a highly complex condition.

Signs of schizophrenia typically develop between the ages of 16 and 30 yearsTrusted Source, according to the NIMH. The individual will have thoughts that appear fragmented, and they may also find it hard to process information.

Schizophrenia has negative and positive symptoms. Positive symptoms include delusions, thought disorders, and hallucinations. Negative symptoms include withdrawal, lack of motivation, and a flat or inappropriate mood.

Learn more about schizophrenia here.

Early signs
There is no physical test or scan that reliably indicates whether a person has developed a mental illness. However, people should look out for the following as possible signs of a mental health disorder:

withdrawing from friends, family, and colleagues
avoiding activities that they would normally enjoy
sleeping too much or too little
eating too much or too little
feeling hopeless
having consistently low energy
using mood-altering substances, including alcohol and nicotine, more frequently
displaying negative emotions
being confused
being unable to complete daily tasks, such as getting to work or cooking a meal
having persistent thoughts or memories that reappear regularly
thinking of causing physical harm to themselves or others
hearing voices
experiencing delusions
Treatment
There are various methods for managing mental health problems. Treatment is highly individual, and what works for one person may not work for another.

Some strategies or treatments are more successful in combination with others. A person living with a chronic mental disorder may choose different options at various stages in their life.

The individual needs to work closely with a doctor who can help them identify their needs and provide them with suitable treatment.

Treatments can include:

Psychotherapy, or talking therapies
This type of treatment takes a psychological approach to treating mental illness. Cognitive behavioral therapy, exposure therapy, and dialectical behavior therapy are examples.

Psychiatrists, psychologists, psychotherapists, and some primary care physicians carry out this type of treatment.

It can help people understand the root of their mental illness and start to work on more healthful thought patterns that support everyday living and reduce the risk of isolation and self-harm.

Read more about psychotherapy here.

NURS 3325 Module 3 Discussion Mental HealthMedication
Some people take prescribed medications, such as antidepressants, antipsychotics, and anxiolytic drugs.

Although these cannot cure mental disorders, some medications can improve symptoms and help a person resume social interaction and a normal routine while they work on their mental health.

Some of these medications work by boosting the body’s absorption of feel-good chemicals, such as serotonin, from the brain. Other drugs either boost the overall levels of these chemicals or prevent their degradation or destruction.

Find out more about antidepressant medications here.

Self-help
A person coping with mental health difficulties will usually need to make changes to their lifestyle to facilitate wellness.

Such changes might include reducing alcohol intake, sleeping more, and eating a balanced, nutritious diet. People may need to take time away from work or resolve issues with personal relationships that may be causing damage to their mental health.

People with conditions such as an anxiety or depressive disorder may benefit from relaxation techniques, which include deep breathing, meditation, and mindfulness.

Having a support network, whether via self-help groups or close friends and family, can also be essential to recovery from mental illness.

Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:

Ask the tough question: “Are you considering suicide?”
Listen to the person without judgment.
Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
Stay with the person until professional help arrives.
Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

Read this article in Spanish.

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Last medically reviewed on April 13, 2020

DepressionMental HealthSchizophreniaAnxiety / StressPsychology / Psychiatry
11 sourcescollapsed

Medically reviewed by Timothy J. Legg, PhD, PsyD — Written by Adam Felman on April 13, 2020

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What to know about anxiety
What is anxiety?
Symptoms
Types
Causes
Treatment
Prevention
Takeaway
Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a medical disorder.

Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry

These disorders alter how a person processes emotions and behave, also causing physical symptoms. Mild anxiety might be vague and unsettling, while severe anxiety may seriously affect day-to-day living.

Anxiety disorders affect 40 million people in the United States. It is the most common group of mental illnesses in the country. However, only 36.9 percent of people with an anxiety disorder receive treatment.

NURS 3325 Module 3 Discussion Mental HealthWhat is anxiety?
Disproportionate reactions of tension and worry characterize anxiety.
The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

Knowing the difference between normal feelings of anxiety and an anxiety disorder requiring medical attention can help a person identify and treat the condition.

In this article, we look at the differences between anxiety and anxiety disorder, the different types of anxiety, and the available treatment options.

When does anxiety need treatment?
While anxiety can cause distress, it is not always a medical condition.

Anxiety

When an individual faces potentially harmful or worrying triggers, feelings of anxiety are not only normal but necessary for survival.

Since the earliest days of humanity, the approach of predators and incoming danger sets off alarms in the body and allows evasive action. These alarms become noticeable in the form of a raised heartbeat, sweating, and increased sensitivity to surroundings.

The danger causes a rush of adrenalin, a hormone and chemical messenger in the brain, which in turn triggers these anxious reactions in a process called the “fight-or-flight’ response. This prepares humans to physically confront or flee any potential threats to safety.

For many people, running from larger animals and imminent danger is a less pressing concern than it would have been for early humans. Anxieties now revolve around work, money, family life, health, and other crucial issues that demand a person’s attention without necessarily requiring the ‘fight-or-flight’ reaction.

The nervous feeling before an important life event or during a difficult situation is a natural echo of the original ‘fight-or-flight’ reaction. It can still be essential to survival – anxiety about being hit by a car when crossing the street, for example, means that a person will instinctively look both ways to avoid danger.

Anxiety disorders

The duration or severity of an anxious feeling can sometimes be out of proportion to the original trigger, or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. These responses move beyond anxiety into an anxiety disorder.

The APA describes a person with anxiety disorder as “having recurring intrusive thoughts or concerns.” Once anxiety reaches the stage of a disorder, it can interfere with daily function.

Symptoms
While a number of different diagnoses constitute anxiety disorders, the symptoms of generalized anxiety disorder (GAD) will often include the following:

restlessness, and a feeling of being “on-edge”
uncontrollable feelings of worry
increased irritability
concentration difficulties
sleep difficulties, such as problems in falling or staying asleep
While these symptoms might be normal to experience in daily life, people with GAD will experience them to persistent or extreme levels. GAD may present as vague, unsettling worry or a more severe anxiety that disrupts day-to-day living.