Case Study: Healthcare Challenges, Patient Assessment and Treatment

This case study analysis presents several healthcare scenarios, including cases involving patients with Alzheimer's disease and urinary tract infections (UTIs), as well as those experiencing mental health challenges. The analysis delves into the assessment of patient conditions, such as cognitive decline, suicidal ideation, and the impact of hearing voices. It explores treatment approaches, including cognitive behavioral therapy (CBT) and nursing care plans for UTIs, emphasizing the importance of health promotion and recovery concepts. The study also examines the role of therapeutic relationships, communication skills, and person-centered care in managing complex patient needs, while addressing the influence of factors like smoking and drug use on mental health. The cases highlight the need for comprehensive care strategies, including family involvement, and the importance of recognizing and addressing the diverse needs of individuals facing various health challenges.

CASE STUDY

Table of Contents
INTRODUCTION...........................................................................................................................1
CASE-1 ...........................................................................................................................................1
CASE-2 ...........................................................................................................................................3
CASE 3 ...........................................................................................................................................6
Establish and maintain therapeutic relations with Louise...........................................................6
CASE 4............................................................................................................................................8
Mental health conditions that Kevin appears to be suffering with and its aetiology, sign and
symptoms....................................................................................................................................8
CONCLUSION..............................................................................................................................11
REFERENCES..............................................................................................................................12

CASE-1
Health promotion and recovery concepts for Dennis
As per the given case study, Dennis is suffering from Alzheimer's disease. In the middle
or in old age, this disease can take place. It is a progressive mental deterioration. In this disease,
the loss of memory and cognitive decline can be caused due to death of brain cells. As per the
case, Dennis was also not able to find back his way to home and also was dressed in pyjamas and
slippers. It is the most common type of dementia. A loss of mental ability has been described by
the dementia which is associated with gradual death of brain cells , Lopes, (2016).
In this case, Dennis can be given cognitive behavioural therapy. This is abased on the
relationship between feelings, thoughts and behaviour. In the 1960s, Albert Ellis first developed
Cognitive behavioural therapy (CBT). For a wide range of health problems, it is an effective
treatment. A major psychiatric disorder has been represented by psychosis and the specific
diagnosis of schizophrenia. In this the thoughts, feelings and behaviour of a person are altered
significantly.
The unique combination of symptoms and experiences will be there in individuals who
develop psychosis or schizophrenia. This may vary depending on their specific circumstances ,
Adeyemi and et.al., (2015). As per the given case study, the fluctuating periods of lucidity and
confusion is being faced by Dennis. When he is more aware of his deteriorating cognition, he
becomes extremely distressed. By some deterioration in person functioning, there will be
prodromal period. The memory and attention problems, unusual and uncharacteristic behaviour
are some difficulty included .By an acute phase marked by positive symptom, this prodromal
period are followed typically such as disturbance in behaviour causing agitation and distress.
Usually, after some treatment of the acute problem resolve, the positive symptoms may
disappear or reduce but for negative symptoms such as poor memory, it is still problematic.
In order to develop psychosis and schizophrenia, there are a number of genetic and
environmental risk factors. The timings, nature and degree of exposure to environment are some
risk factors . To the development of psychosis symptom, the psychological factors and
environment factors are some of critical factors that may develop psychosis and schizophrenia.
In basic cognitive function, the problems can be related to research structure and function. To the
social factors, the problems with emotional and reasoning process can be linked. In the
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development of the symptom of psychosis and schizophrenia, both type of psychological factors
may have implication , Neto and et.al., (2016).
Through assessment the current information about the symptom can be obtained . On the
individuals the effects of these symptoms and to cope up with them the strategies can be
developed by individual through assessment. In this case where Dennis has been suffering from
Alzheimer's disease and the assessment will help to find out the information related to diseases,
the effects of these symptoms and the strategies to deal with this. The biological, psychological
and social factors that are contributing towards this disease can be examined with the help of
assessment , Vallee, ( 2016.).. The health professional who is giving treatment to Dennis must be
able to analyse the behaviour of a person who is suffering from dementia. They need to find out
the confused and depressed behaviour of Dennis. Based on the interpretation of behaviour that is
been done the care should be given to them. With respect to the history, ability, experiences and
personality of each person the person centred care will focus on. The right to communicate their
likes, dislikes and preferences are often been retained by pole with dementia. On collaboration
between the individual, the family of person the quality of care depends on.
The unpaid care and support can be provided to Dennis by family members that are from
his two children. In order to deliver successful effective intervention the carers may be often
important. With dementia caring for a person can be emotionally, psychologically and financially
challenging, Bossers and et.al., (2014). The change in the behaviour of Dennis needs to be
noticed in order to give care. Regarding it the health professional need to be informed. The
behaviour of individuals can be influenced due to dementia such as false ideas, anxious,
depression etc. In a way the person communicate the way of a person need to be noticed. In
order to work, speak fluently etc they may find it hard. The normal social connection of
conversation can be lost by them. The causes of communication complexities need to be
considered by heath professionals in order to give care to people suffering from dementia. The
eating and nutritional need also need to be identified by the person or health professionals who
are giving care. The eating and drinking habits need to be monitored carefully by the person
giving care, van Alphen and et.al., (2016. ). This is because the person who is suffering from
dementia forgets to eat and drink. As per this scenario, Dennis forgets to get his dress change and
stays in the pyjama most of the time. In order to remind them, the alarms need to be set and on
regular basis, the snacks and meal should be offered. In order to provide quality care to Dennis
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the key skill that will be needed will be communication skill. The help to the nurses can be given
by using both verbal and non-verbal communication and also with this more person centred
care can be given to the patients , Luhrmann and et.al., (2015. ).. At all levels of dementia
communication is necessary to provide person-centred care. It is been suggested by department
of health that in order to provide a quality of care to their dear ones and appropriate support a
knowledge of the condition of the patients need to be given to the family(Department of health,
2012). As per the case it is been found that Dennis recalls her mother during distress time. This
shows that people with dementia have their long term memory intact .The use of reminiscence
they can be adopted by the nurses. In order to bring back the memory of Denis the use of portrait
pictures or objects.
In order to manage the memory loss all time the appropriate identification need to be
carried out of name, address and an emergency contact number need to provided to such
individual suffering from dementia. In order to manage the confused behaviour of Dennis to their
familiar environment the changes need not to be made unless they are important . With
medication the assistance need to be offered to them , Sposito and et.al.,( 2015). In order to
promote individualised care identifying ways need to establish familiarized routines. The
people need to be encouraged to make use of remaining skills and abilities. As per the case, the
carers giving care to Dennis need to examine the change in behaviour and based on that, the care
need to be given. Rather than efficiency of care providers the person centred care will focus on
individual need of person. On the strength of the person living with dementia, it is essential to
focus. In order to understand, communicate and interpret the meaning of behaviour of Dennis, it
is essential to enter his world and based on this, the care should be given by carers and health
professionals.
CONCLUSION
When giving care to patients with dementia person centred care approach is vital. In their
condition and care it gives patients the opportunity to be more knowledgeable. The person
centred approach will also not happen without communication. The person centred care can be
maintained with the help of good communication. The nurse need to aware about the
communication skill in order to provide person centred care to patients.
References
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Adeyemi,. and et.al., (2015). The effectiveness of the Memory Orientation Screening Test
(MOST) for potential dementia patients.
Bossers, W.J., and et.al., (2014). Feasibility of a combined aerobic and strength training program
and Therapeutic its effects on cognitive and physical function in institutionalized
dementia patients. A pilot study. PloS one. 9(5), p.e97577.
Sposito, T., and et.al., (2015). Developmental regulation of tau splicing is disrupted in stem cell-
derived neurons from frontotemporal dementia patients with the 10+ 16 splice-site
mutation in MAPT. Human molecular genetics. 24(18) pp.5260-5269.
Neto, E., and et.al.,(2016). Regularized linear discriminant analysis of EEG features in dementia
patients. Frontiers in aging neuroscience. 8.
Reading, R., 2014. Psychosis and schizophrenia. Child: Care, Health and Development. 40(2),
pp.298-299.
Luhrmann, T.M., and et.al., (2015). Differences in voice-hearing experiences of people with
psychosis in the USA, India and Ghana: interview-based study. The British Journal of
Psychiatry. 206(1). pp.41-44.
Department of health. (2012). Recognised, valued and supported: next steps for the Carers
Strategy Date assessed [18/02/2015]
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/
213804/dh_122393.pdf
CASE-2
Assessment for Susan
As per the given case study, the suicide thought was there in the mind of Susan so an
effective care planning need to be done for Susan that will help to cope up with Urinary Tract
Infection (UTI). In order to deal with urinary tract information and recover from it. The impaired
urinary elimination nursing care plan can be followed by the nurse. By the bacterium micro
organisms in the urinary tract , the infection are been caused. By the bacterium Escherichia coli,
the majority of UTIs are caused , Desjarlais, (2014.). They are mainly discovered in the digestive
system. In urinary elimination dysfunction is there which is related to the frequent urination,
surgery and hestinacy The patient's pattern of elimination will be assessed by the nurse. This
will serve as a basis for determining appropriate interventions. Every 4 hours, palpate the
person's bladder in order to find out the presence of urinary retention. The intake of fluid need to
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be encouraged by the person. This will help to improve renal blood flow. The acidic environment
of bladder need to be maintained in order to prevent the occurrence of bacterial growth. For the
infection, the nursing care plan for urinary tract infection can also be made. In this, the signs and
symptoms of urinary tract infection are being assessed. The fever, chills etc. are some common
symptoms of this. For UTI, the risk factors need to be assessed , Leimbacher, (2017). It is been
revealed that Susan is also being use to smoke in past due to he is suffering from hearing
voices.
With a mental health problem hearing voices may or may not be associated .It an auditory
hallucination. In people with psychotic disorders such as schizophrenia it is the most common
type of hallucination. The traumatic life experiences can be the cause of hearing voices .As per
the case study it is shown that Susan is been neglected by her friends so this can be one reason
behind it. The intake of drugs, lack of sleep ,other traumatic experiences and mental health
problems can be the reason behind the hearing voices. As per the case it is been found that Susan
used to consume drugs and smoke due to which the hearing voice is been caused, Bossers and
et.al., (2014).. With people suffering from Psychosis and schizophrenia smoking and tobacco is
more common in people in comparison with general population. In order to reduce or stop
smoking, intervention need to be followed.
The peer support groups – They can help Susan in order to overcome the problem of hear
voices. The loneliness will not be felt and in safe , non-judgemental place they will help them to
talk about hearing voices , Luhrmann and et.al., (2015. ).In the voices they will help them to
gain to find perspective and they will be able to find the cause of depression and sadness and
will be able to recover quickly. Across the UK the hearing voices network runs over 180 groups.
Enough sleep need to be taken by Susan - In order to cope up with the complex feelings and
experiences, the sleep can give her the energy. In order to get enough sleep the voices may make
it difficult. Also the relaxations and techniques will be helpful for Susan .
The diets need to be taken seriously by the people who are having hearing voices-The food need
to be taken by them regularly and the blood sugar need to be stable .For the mental health-
being the exercise can be helpful for Susan .
To the voices the learning voices network have a particular approach. It is been said by them
that they need to accept that their voice is real as it comes from you and is related with the
history of their life. On an approach to voices recovery approach it is been based. With the life
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experiences the best is been given. The diagnosis and treatment can be given by psychiatrist. The
person need to intake food and water on a regular basis and also exercise daily .As a result of an
illness , psychiatric may see the voices and the medication and other treatment can be prescribed
by them.
Psychotherapy – The voices can be felt through psychotherapy and they are related with
experiences of trauma. The voices what they say and why they say can be recognised by a
psychotherapist. In order to make the voice better, the way will be found by them. In order to
cope up with them, the better way will be found.
Cognitive Behavioural therapy (CBT)- In order to cope up with how the voices may make the
person feel and think about oneself, this can help. About the voices it may reduce the
anxiety .Over the voices it will help to control the voices.
Medication – The anti psychotic drugs are been prescribed by the psychiatrist when the voices
are very troubling. The indifference to the voices can be felt due to use of these drug. In the
short term medication something that can be useful. With the ways of coping up the voices it
may help .
Mindfulness -based cognitive Therapy – The mindfulness and CBT is been combined in this. It
will help to pay attention on things that is taking place in the surrounding when the voices are
distracting the individual , Vallee, (2016.).
CONCLUSION
The medication, proper sleep , the peer group support etc can be taken by Susan in order
to overcome the problem of hearing voice. The CBT therapy can also help her. The
psychotherapist will also help her in order to make their life better more before.
REFERENCES
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Desjarlais, R., 2014. Liberation upon Hearing: Voice, Morality, and Death in a Buddhist
World. Ethos. 42(1). pp.101-118.
Leimbacher, I., 2017. Hearing Voice (s): Experiments with Documentary
Listening. Discourse. 39(3). pp.292-318.
Vallee, M., 2016. Hearing Voice: A Theoretical Framework for Truth Commission
Testimony. Law and Critique.27(1). pp.45-61.

CASE 3
Establish and maintain therapeutic relations with Louise
This case study is about Louise who is suffering from depression. It is the case of Louise
who is 28 year old lady, she suffers from depression and she attempted suicide. She has faced
huge difficulties in her relationship due to which she has gone in traumas in her life. She is not
able to maintain a stable sense of self worth and self esteem. She has lost her confidence due to
her bad experiences in her life. When medical professionals and crisis team were operating her,
then she has discussed the topic that she has become disconnected from the world and no one
loves her. When she was in the age of 17, then Louise tried to cut her arm because she was
feeling lonely. She has discussed the issue with her mother that she has been sexually abused by
her uncle. Currently, she does not have any job and friend. Thus, she spends her most of the time
in drinking alcohol. It becomes very difficult for her to get adjusted in new environment easily.
Her parents got retired and due to this they were unable to meet her for a month. She was very
angry and she did not her medication and tried suicide. From the case study of Louise it is
analysed that person suffering from emotional withdrawal, impulsive behaviour and unstable
relationship. This essay will take support of communication skills and will define ways of
maintaining therapeutic relationship with Louise so that her mental condition can be recovered.
It is very difficult to develop communication feeling with the person who is suffering
from borderline personality disorder. In order to build therapeutic relationship with patients
medical professional are required to adopt effective verbal communication. Louise is in bad
condition and the main reason of her bad mental condition is her loneliness. It is very important
for the medical professionals that to develop healthy therapeutic relationship with her (Reading,
2014). One of the best way of establishing therapeutic relationship with the lady is to enhance
communication with her and develop her interpersonal skill. In this respect, medical
professionals are required to give their detail introduction with name, title and role in the
hospital. This can support in enhancing friendliness among patients and they can know doctors
well (Guide to Therapeutic Relationships and Professional Boundaries, 2017). She was abused
by her uncle in early days, it was the mental trauma for her so nurses are required to build thrust
of her. Staff members need to make her aware since how long they are in services so that her
prevention and protection feeling can be developed. Health care professionals are required to
address their patients with their name as it develops personal feeling and individual feel
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comfortable. This can develop strong relationship with care users and individual feel safe and
discuss their issues with medical professionals effectively. In order to establish therapeutic
relationship with the patients like Louise, doctors are required to listen their point of view
properly and have to communicate with them in non judgemental manner (Taylor and Perera,
2015).
In order to establish and maintain therapeutic relationship with Louise, doctor need to set
boundaries. As Louise now do not believe on anyone so setting boundaries is very important for
establishing relationship with her. Establish mutual respect between medical staff and Louise is
very important. Staff members need to show their empathy and unconditional positivity for her
so that she feel safe and think that there is no tension in this relationship. It can make her
comfortable, Zimmerman and Morgan (2013).
Furthermore, adoption of patient-centred approach is the good way through which
medical professionals can easily meet with their goal and can maintain therapeutic relationship
with their patients. In addition, health care professionals are required to provide all details about
their issues and causes of their problems (Therapeutic Relationships Resource Guide for Alberta
Physiotherapists, 2017). They need to discuss about their illness openly. Apart from this, doctors
are required to give them choice and right to take decision of treatment before providing them
such treatment.
Non verbal communication also plays significant role in this respect for patients who are
suffering from borderline personality disorder. Nursing team is required to use open posture so
that she can get engaged while building therapeutic relationship. Conveying about emotional
state of Louise with her can make her comfortable and will support in establishing healthy
working relationship, Norman, Ryrie. (2013).
Success of therapeutic relationship depends upon practices that are applied by medical
professionals while providing treatment to Louise. Implement Reflective practice: It is the best
approach through which medical professionals can maintain therapeutic relationship with the
lady. Proper interaction, understanding perspective of patients, their age and culture can enhance
their confidence and they will be able to trust the doctors. This would develop strong relationship
between doctors and patients (Rupert and Watters, 2017).
Follow care plan and be sensitive regarding providing proper care:By following
appropriate plan for providing quality care to patient, such type of relationship can be build up.
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Positive behaviour: Self disclosure, accepting gifts from patients, giving gifts to patients
etc. are the main ways through which medical professionals can establish and maintain
therapeutic relationship with Louise. If surrounding people behave positively with the lady, then
it may support in improving her condition and she may come out of her depression.
These processes and ways are effective enough in establishing and maintaining
therapeutic relationship. By this way, Louise will be able to communicate well with others, this
will minimise her loneliness and she may feel better (Sánchez-Blázquez, Rodríguez-Muñoz and
Garzón, 2014).
Louise is suffering from mental illness, it is required to promote mental health so that her
health condition can be improved. Promoting safe, effective care services to patients are
beneficial in improving condition of Louise soon. Currently, main issue is faced by her that bad
experience, abusing from uncle and poor relationship with her partners. Due to these problems,
she has become unable to discuss her issues with others. She is out of social world that is why
she is feeling unable, Mental health foundation. (2012). In such condition, it is required to
enhance her communication skill. Medical professional need to provide them safe environment
in the hospitals so that she feel protected. In addition, they are required to coordinate well with
them and have to behave friendly. This will develop confidence of patients and their mental
health condition can be recovered soon. As she was not having good relationship with her
partners, that is why she is under depression. This is the main reason due to which she has
stopped communicating with others. This loneliness forces her many times to attempt suicide.
Recovery focuses rather than illness making can enhance knowledge of service users and
they can get aware with their condition. It is essential for nursing staff to involve parents of
Louise, she has strong relationship with them so with them she would feel comfortable. Setting
realistic goals will be better for her in recovery soon. This will help in building strong
therapeutic relationship with her, Cranmer and Nhemachena, (2013).
Conclusion
Developing healthy therapeutic relationship with Louise can help in improving her
condition. Establishing boundaries, setting realistic goal and involvement of parents can support
in recovery of the patients. Good verbal and non verbal communication can establish a strong
therapeutic relationship.
References
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