Mental Health Nursing: Andrew's Case Study, Medication and Monitoring

This assignment delves into a mental health nursing case study involving a patient named Andrew, focusing on key aspects of patient care and clinical decision-making. The assignment begins by exploring the crucial interpersonal skills a nurse should employ when interacting with Andrew, emphasizing the importance of active listening, paraphrasing, summarizing, and non-verbal communication to build rapport and facilitate engagement. It then examines the signs and symptoms that support a diagnosis of psychosis, specifically highlighting Andrew's auditory hallucinations, delusional thoughts, and disorganized speech patterns. The assignment addresses patient education regarding medication, discussing the pharmacology of Risperidone, potential side effects, and the importance of adherence. Finally, the assignment outlines a plan for monitoring Andrew's condition, emphasizing the need for careful observation of his physical and mental state, as well as the importance of providing him with information about his condition and self-care strategies. The assignment references several scholarly articles to support its claims.

Running head: MENTAL HEALTH NURSING
Mental health nursing
Name of the Student
Name of the University
Author note

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1. Discuss the key interpersonal skills you will use to engage with Andrew
In mental health nursing, communication is an essential component for all
therapeutic interventions. The knowledge of interpersonal skills while communicating
with the client is necessary and develops positive nurse-client relationship. In the given
case study, key interpersonal skills are important while communicating with Andrew as
he is greatly overwhelmed by the external environment. Skillful communication is
required that can make a difference in the ability of Andrew to be engaged in the
interview. Interpersonal communication is the building block for the so that Andrew
engages properly in the interview. This communication includes a variety of skills that
are client-centred communication like listening, paraphrasing, summarizing, questioning
and using non-verbal communication (Stein-Parbury, 2013).
Listening is the most challenging and essential component that allows the client to
talk. While conversing with Andrew, the nurse needs to listen to him and this acts as a
therapeutic effect. By employing this, she would be able to give opportunity to Andrew to
tell about him when he will feel that he is being heard. In the given case scenario,
Andrew spoke in a low monotone voice and listening would make him feel that his
feelings are being cared and accepted. It helps to establish a trust worthy relationship
when the nurse hear and understand him. It would help Andrew to feel less isolated and
loosely connected with the present. Therefore, the nurse should provide time to Andrew
to tell his story or experiences, with a purpose of understanding his concerns and paying
full attention to what he says and tuning of the internal and external distractions
(Bramhall, 2014).

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Paraphrasing is also a way of interpersonal communication where it helps to
express the core message of the client in own words. The nurse should be careful during
paraphrasing as the words should be different and does not change the meaning. It would
help to demonstrate that the nurse heard whatever Andrew has said and feel supportive
about it. It would also help to check clarity and understand rather than questioning
(Morgan & Yoder, 2012).
Summarizing would help Andrew to assess and reassure that the nurse heard him
correctly and provide chance for clearing the misunderstandings. In addition, questioning
would also help Andrew to be engaged in the conversation Questioning is associated with
probing skills with open-ended questions that gives a full descriptive picture (Lin et al.,
2013). As Andrew mentioned that he experience hearing voices, then “when”, “how”,
“what" type of questions involving the hearing of voices would help focus on his
cognition, behaviour, beliefs and thoughts.
Non-verbal skills are important called SOLER methods that involves S; sitting
facing Andrew, O: open posture, L: leaning towards him, E: maintaining eye contact and
R: relaxed posture (Perry et al., 2013). The above mentioned interpersonal skills would
help to engage with Andrew.
2. The doctor stated that Andrew has symptoms of a psychosis. Using correct clinical
terms and the clinical cues in the scenario, discuss three important signs and
symptoms that support the doctor’s opinion
There are certain clues in the scenario that are significant and indicate psychosis
in Andrew. Psychosis is a condition where a person has impaired relationship with the

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reality. They experience either delusions or hallucinations that are the recognising
symptoms for psychosis.
In the given case scenario, Andrew experiences auditory hallucinations where he
mentioned that he could hear people talking about him. However, there was no person in
the room and no external distractions. He even stated that he could clearly hear voices
talking about him. Hallucination is sensory perception in the absence of external stimuli.
This means that the person sees, hears, feels or smells that is not present. Andrew
experience auditory hallucinations where he can hear voices and communicate with them.
He could experience false perceptions of sound that have no real origin and connection
with the outer world. It seems real to Andrew and these experiences are frightening
characterized by emotions and thinking that are impaired (Oorschot et al., 2012).
The person who experiences psychotic symptoms has thoughts that are
contradictory to the real situation. They even face social withdrawal and loss of
motivation. These are called delusions where a person holds false beliefs and impression
that are contradicted by the reality. In this given case scenario, Andrew spoke of evidence
that people are conspiring against him and electrical items kept outside his unit that are
being operated to interfere with his thoughts and claimed that other people are discussing
to conspire and trying to put him into trouble. He has false belief and convinced that real
people does not know who they are (Vorontsova, Garety & Freeman, 2013).
Andrew also illustrated disorganized speech and switched topics erratically.
During the interview, he suddenly started saying that people in his university are ASIO
spies who conspire against him. They have fitted a transmitter chip in his brain that can

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monitor his thoughts. These thoughts are highly loose and implausible that has no
connection with the reality. A person experiencing psychosis shows the symptoms of
erratic and disorganized speech in the later stages. The speech is incoherent in nature and
hard to follow (Brenner et al., 2016).
These above three signs and symptoms clearly explain that Andrew has symptoms
of psychosis that clearly supports the doctor’s opinion.
3. Andrew asks you why he has a prescription for medication. Briefly discuss how you
would respond
The nurse needs to explain the pharmacology of the medication to Andrew and the
psychotic symptoms that he is suffering from. In psychosis, the presentation is not clear
to the patient as the patient lacks insight that is distressing for the person and his or her
family. Risperidone 1 mg nocte was prescribed to Andrew before he left the clinic. As a
nurse, she has to explain the pharmacology of the medicine to him. This medicine is used
to treat mood disorder that helps one to think clearly and lead a normal life. Risperidone
is an anti-psychotic drug that helps to restore the natural substances and its balance in the
brain (Pérez-Iglesias et al., 2012).
Through free speech and lucid language, she needs to explain the mechanism of
the prescribed medicine. She needs to explain to him that by taking this medicine, he
would feel better and relax his mind. He need to be explained the voices that he hear
would decrease if he takes this medicine regularly and greatly improve his mood,
thinking and behaviour. The nurse needs to convince him that by taking this medication,
nobody would be able to read his thoughts and manipulate those (Meltzer et al., 2014).
Apart from this, he also needs to be informed about the side effects of the medicine like

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dizziness, drowsiness, nausea or tiredness and tell him to inform the doctor when he
experiences any of these side effects. He should not panic and lie down and take rest if he
experiences any if these side effects. Moreover, he should be explained on how to take
the medicine. He should take the tablet in his mouth that would dissolve in few seconds.
This drug can be taken with or without food and should continue the medicine as directed
by saying him that he would feel better and think more clearly. He should be warned not
to continue the medicine without the doctor’s approval and improve his general health
(Koivunen et al., 2012).
He should also be cautioned not to engage in activities that require alertness like
driving or machinery use. He should be warned not to take alcohol while taking this
medicine and not to overdose it, without consulting the doctor. The nurse should clearly
say him not to share this drug with anyone else and not to skip any dose and need to be
taken on a daily basis. She should inform Andrew to take the medicine at the scheduled
time and even if he misses, he should not double up the dose. Patient education regarding
risperidone would help Andrew comply with the medication and improve his health
(Pitkänen et al., 2012).
4. The GP has requested Andrew is informed and carefully monitored over the next
few weeks. Briefly discuss your plan
Before the careful monitoring, Andrew need to be informed about his psychotic condition
as he is experiencing delusions, auditory hallucinations and have distorted thoughts. For
this, an empathetic communication is required where the nurse would explain the
distinguishing psychotic signs and symptoms to the patient in a clear language that avoid
confusion regarding medical jargons. Value of truthfulness is given priority in healthcare

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and treatment and so he should know about his medical condition and clearly monitor his
condition until the next appointment (Minzenberg et al., 2014).
Before he leaves, he should be informed that would help him to monitor his
condition as well as the side effects of the prescribed medication. He should be informed
to monitor his weight, pulse and blood pressure over the next two weeks before he comes
for the next appointment with the GP. This measure is important, as diabetes, weight
gain, breathing problems and increase in heart rate are the common problems associated
with psychosis. He should monitor for the side effects of the medicine like less sweating,
dizziness, drowsiness and nausea and in case, he is experiencing he should inform the
GP. This monitoring is important that help to understand the positive symptoms and
degree of psychosis in the patient (Brookwell, Bentall & Varese, 2013). He should be
provided with every piece of information that he need to know before leaving the clinic
that make him well informed about his condition until his next appointment.
When he is informed, he can take proper care of himself, become aware of his
psychotic condition and enhance compliance. He should monitor his sleep patterns,
appetite and any abnormality in his behaviour. Psychotic education is important for him
to know the condition of psychosis (Waghorn et al., 2012). He should also be informed
about the physical and health assessment tests required and how to access the healthcare
services. Accordingly, the nurse should fix the next appointment in two weeks for the
physical and mental assessment of Andrew. Apart from monitoring, Andrew should be
taught about self-care strategies like getting proper sleep, eating well and seek help and
support from friends. Providing information to Andrew would enhance self-advocacy
over his health. Through careful monitoring, he would be able to understand his present

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psychotic episode that would be helpful for the health assessment in the next appointment
with the GP.

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References
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Brenner, C., Ratzliff, A., Unutzer, J., Katon, W., & Stephens, K. A. (2016). Psychotic
Disorders. Integrated Care: Creating Effective Mental and Primary Health Care Teams,
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Brookwell, M. L., Bentall, R. P., & Varese, F. (2013). Externalizing biases and hallucinations in
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6mg/day. Schizophrenia research, 141(2), 144-152.

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