NCM 117a Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) RLE

GROUP B2
Abidog Bernales Cando Dayandante Espeleta
Galang Ignacio Nilo Ocampo Sanchez
Visaya

Module 1.1
CASE PRESENTATION:
A 27-year-old woman presents to a clinic stating that she is
troubled by headaches and fatigue. She says that she always
feels tired and can’t sleep well, often waking up early. She
describes her headaches as dull, aching and generalized. These
symptoms began about three weeks ago and have been getting
worse. She reports a lack of interest in her usual activities. She
also reports that she is missing work due to fatigue and inability
to concentrate. Although her two children are both in school,
she is concerned that she is not spending quality time with
them.
CASE PRESENTATION:
She is worried that she might have “something bad” because she
has difficulty concentrating and is having frequent crying spells.
She reports not sleeping well and a loss of appetite, with a
weight loss of 10 pounds in the last month. The patient has no
significant past medical or psychiatric history and takes no
regular medications. However, she takes ibuprofen for
headaches. She denies using alcohol or drugs. The patient is
married, with two elementary school-age children. The physical
examination is unremarkable other than a cesarean scar from
surgery six years ago.
CASE PRESENTATION:
The patient is cooperative, alert, oriented; no delusions or
hallucinations, and her thoughts are goal-directed and logical.
You note the patient has some psychomotor slowing. During
the interview, the patient suddenly bursts into tears. She tells
you that she has been feeling sad almost all the time. She also
tells you that her husband is in abroad for his second year of
contract. She states that her thoughts are full of worries, with
feelings of hopelessness and worthlessness. She denies current
suicidal ideation. All of her lab values are within the normal
range.
A S S E S S M E N T: For the past 3 weeks the patient
reports that:
• She is troubled by headaches and
fatigue and says she always feels
tired and cannot sleep well.
• She had loss of appetite with a
weight loss of 10 pounds in the last
month.
• Her thoughts are full of worries,
with feelings of hopelessness and
worthlessness.
• She has been feeling sad almost all
the time.
• She is concerned that she is not
spending quality time with her
children.
A S S E S S M E N T:
For the past 3 weeks the patient
reports that:
• She reports a lack of interest in her
usual activities.
• She is missing work due to fatigue
and inability to concentrate.
• She is concerned that she is not
spending quality time with her
children.
• She is worried that she might have
“something bad” because she has
difficulty concentrating and is
having frequent crying spells.
A S S E S S M E N T:

• The patient has no significant

past medical or psychiatric
history and takes no regular
medications.
• The patient denies using alcohol
or drugs.
• All of her lab values are within
the normal range.
A S S E S S M E N T:

• The patient did not

mention any major loss or
bereavement within the
last 6 months.
A S S E S S M E N T:
The patient showed
symptoms of
depression such as:
• Multiple persistent physical
symptoms with no clear
cause
• Low energy, fatigue, sleep
problems
• Persistent sadness or
depressed mood, anxiety
• Loss of interest or pleasure in
activities that are normally
pleasurable
M A N A G E M E N T:

According to Protocol 1:
• Promoting therapeutic communication.
• Promoting Activities of Daily Living and Physical Care.
• Promoting sufficient time to rest.
• Strengthening social support managing stress.
• Use silence and active listening when interacting with the
client.
• When first communicating with the client, use simple, direct
sentence; avoid complex sentences or directions.
• Re-establishing balanced nutrition to stimulate appetite, food
offered frequently and in small amounts.
M A N A G E M E N T:

Nursing Interventions:
• Identifying the client’s physical health and social needs:
• In order for the client to meet her health needs, we nurses should address her problems
holistically. In order to do so, we should encourage the client to take adequate amount of
fluid and eat nutritious food.
• Advice the client to avoid caffeine intake later in the afternoon in order for her to have a
better sleep at night.
• Educate the client that exercises can help to improve mood, example is meditation for the
reason that it relaxes one’s body and mind.
• In achieving the client’s social needs, we should formulate a plan of care that involves the
client’s Family and friends.
• The plan of care includes encouragement from the family to persuade the client to join group
organizations and activities such as yoga class and church organization.
• Encourage the family and friends to have time to gather in order to do activities such as
historic family story-telling, scanning of old photo albums and doing things that the family or
group of friends usually do.
M A N A G E M E N T:
Nursing Interventions:
• Provide for the safety of the client and others.
• Begin a therapeutic relationships by spending nondemanding time with
the client.
• Establish adequate nutrition and hydration.
• Promote sleep and rest.
• Engage the client in activities.
• Encourage the client to verbalize and describe emotions.
• Work with client to manage medications and side effects.
• If available, consider referral for one of the following brief psychological
treatments such as, interpersonal therapy (IPT), cognitive behavioral
therapy (CBT), behavior activation and problem-solving counselling.
M A N A G E M E N T:

Client Family Education:

• Teach about the illness of depression.
• Identify early signs of relapse.
• Discuss the importance of support groups and assist in locating
resources.
• Teach the client and family about the benefits of therapy and
follow-up appointments.
• Encourage participation in support groups.
• Teach the action, side effects, and special instructions
regarding medications.
• Discuss methods to manage side effects of medication.
M A N A G E M E N T:

Barriers: Interventions:
Lack of Trust Effective communication
Medication Adherence 1. Use simple language. Be clear and
• Attitude against treatment concise.
• Stigma about mental health 2. Summarize and repeat key points.
3. Allow the person to ask questions
about the information provided.
4. Include the person (and with their
consent, their carers and family) in
all aspects of assessment and
management as much as possible.
Lack of Social Support Encourage patient to participate in
support groups
Reference:
• W.H.O. (2019b, June 24). mhGAP Intervention Guide -
Version 2.0. World Health Organization.
https://www.who.int/publications/i/item/mhgap-
intervention-guide---version-2.0
• S. K. Goldsmith, T. C. Pellmar, A. M. Kleinman, and W.
E. Bunney, Editors; Committee on Pathophysiology
and Prevention of Adolescent and Adult Suicide;
Board on Neuroscience and Behavioral Health;
Institute of Medicine. (2011). Read “Reducing
Suicide: A National Imperative” at NAP.edu. NAP.
https://www.nap.edu/read/10398/chapter/11#360