In а pаtient with аdvanced dementia, state three measures yоu can оbserve tо assess pain.
Whаt dоes nоt trigger аtriаl fibrillatiоn?
Scenаriо One Grаnt is а 52-year-оld single male. He has a histоry of type 2 diabetes and psychosis. He was diagnosed with schizophrenia at 27 years old. His mental health has been stable for several years. He uses antipsychotic medication alongside medication for his diabetes. He has his medication provided by his GP and does not have contact with mental health services currently. He lives in rented accommodation. Grant is prescribed olanzapine 5mg and metformin 1500mg – both daily. He has been prescribed the same medication for over 5 years. He drinks alcohol. He estimates 24 units of lager a week in two sessions. He smokes rolling tobacco. He is 16 stone in weight. BMI is 34.1. He has previously worked in construction but has been unemployed for the past 4 years. He is in receipt of benefits. He reports no significant debt. You meet Grant in clinic. You have been asked to review his progress. He is low in mood. He engages in conversation but is guarded in his answers. He talks about the breakdown of a recent relationship with his partner. He does not have children. Grant has two brothers who both live nearby. He has occasional contact with them but says "we are not close." He reports ongoing adherence with treatment. Grant says he loves his home but tells you he "sick of the local kids knocking and asking for money". Questions for Scenario One 1. Describe the pathophysiology of type 2 diabetes. Identify some potential complications of diabetes on Grant's body? (10 marks) 2. What issues and risks may be of concern when treating someone with both diabetes and serious mental illness? Discuss those that are present in the scenario. How might lifestyle and mental health needs impact these risks? (10 marks) 3. Discuss the social and economic factors that may impact Grant’s ability to manage both his physical and mental health needs. Consider how the factors may influence specific needs. (10 marks) 4. Propose a nursing care plan that addresses one of the needs identified. Apply SMART principles. (10 marks) Scenario Two Jane is a 64-year-old woman. She has recently recovered from breast surgery. She had a lumpectomy. She is awaiting further investigations to clarify the outcomes from surgery. Jane is also diagnosed with depression. Jane worked as a teaching assistant prior to recent retirement. She is married to her husband, Bob. They have two adult children. Her depression started following the birth of her second child, Jessica. Jessica has a mild learning disability. She lives locally in supported housing and has regular contact with her parents. Jane is prescribed sertraline 100mg daily for her depression and tamoxifen 20mg daily, as a preventative medication following breast cancer. You meet with Jane in the practice clinic. Her husband is with her. She made an appointment because she reports feeling her mood is worsening and that "I haven't felt this bad for years". She says she is finding it hard to get out of bed in the morning and that she is worried that Bob is taking time off work to support her. She reports occasional use of alcohol drinking 22 units weekly ie 2 bottles of white wine. Jane smokes 10 cigarettes a day. She also uses a nicotine based vape. She does not use illicit drugs. Jane is meeting with the breast clinic tomorrow. She has complained of discomfort around her surgery site. Her mother died following breast cancer. Jane tells you that she "doesn't want to end up like that" and that she is worried that she may need further treatment for both her depression and cancer in the future. You have been asked by her GP to provide an initial assessment. Scenario Two Questions 1. Describe the pathophysiological changes that may occur in cancer. What risk factors are present in the scenario that may impact her experience of cancer? (10 marks) 2. Summarise symptoms you would investigate or observe when assessing Jane's experience of depression. What impact may these factors have on her management of cancer and ongoing treatment? (10 marks) 3. What health promotion advice would you provide to Jane to support her recovery, reduce the risk of cancer recurrence and improve her mental well-being? What factors in the scenario may influence her engagement with health promotion advice? (10 marks) 4. Develop a plan for the management of one identified need in the scenario. Apply SMART principles to your plan. (10 marks)