Question

Tony Rossi is 73 years old man living in regional NSW. His is part of a large Italian community that established itself in the area mid last century. His family are farmers and Tony as always worked in the family business, planting and harvesting crops. These days he keeps himself busy helping his cousins maintain the farm machinery. Tony never married and now he lives on his own following the death of his mother, six months ago. His cottage is fifteen kilometers out of town, located near the home of his older sister and her husband.

Tony was diagnosed with schizophrenia when he was 19 years old. He has always been supported by his family, and he has not had an admission to for almost fifteen years. Over the years he has been case managed by community mental health nurses at the community health Centre. Now he sees his GP once a month for a depot injection. He has been offered his medications as oral tablets, but he has always preferred the depot injection. He fears becoming unwell, and then made an involuntary patient under the State Mental Health Act and spending time in seclusion. After his first admission to a large regional psychiatric hospital in 1968 he experienced periods of long inpatient stays until a community mental health team was set up at the new community health center in the early 1980's. For many years Tony could not talk about his experiences in the hospital where his treatment included long periods of seclusion and physical restraint, and several treatments of Electroconvulsive Therapy. However, later in his 60's he shared his story of hope and recovery from the trauma of his time in the hospital, to a local group supporting young people who were known to the juvenile justice system.

Tony sees his GP every month and is currently being managed for schizophrenia, diabetes type 2, hyperlipidemia, chronic obstructive airways disease and arthritis in his left hip. He is reluctant to agree to a hip replacement because he does not want to be admitted to hospital. He does not drink but does report smoking ten cigarettes a day.

Medications: paliperidone palmitate 100mg monthly; Atorvastatin 10mg bd; Metformin ER 1500mg daily, Panadol Osteo 665mg TDS.

Today Tony arrives at the Community Health Centre to see Jenna, the mental health nurse. Jenna had been his case manager several years ago, before he was transferred to GP care. He had asked for an appointment because since his mother passed away six months ago, he finds he feels sad all the time, and does not want to join his cousins in the machinery shed. He is worried he will end up in hospital again. On arrival he noticed how noisy the waiting room was with people crowding around the reception desk, people yelling and phones ringing. When it came to his turn to speak, he was told that he had missed his appointment and his doctor couldn’t see him. The person at reception said they were booked out and if he couldn’t be on time, that was too bad, and he would have to wait till the next available time. But he said was sure he had the right time and he said so, using a profanity in Italian. He fumbled in his pockets for the card with the appointment date, but she crossed her arms, raised her voice, and told him to ‘go away and learn to speak English and if he didn't move away from the desk, she would call security'. Tony could feel himself starting to shake, his face feeling hotter and hotter, and clenched and unclenched his fists. He was trying so hard to keep control and he knew if he didn’t move, he might do something he'd regret and end up in seclusion again. Just then Jenna, the practice nurse came through the door. She made eye contact and smiled and said ‘Hi Tony, I’m glad you made it. Come inside and let's have a chat.'

1. Tony is worried about being made ‘involuntary’. What is the difference between ‘voluntary’ and ‘involuntary’ treatmentin the context of mental health legislation in your state or territory?
2. Identify incidents in Tony’s life that are known to cause traumafor people when they are admitted to an inpatient mental health unit and describe how these have impacted his life.
3. Identify the psychotropic medicationprescribed for Tony, for the treatment of the symptoms of schizophrenia and consider the importance of effective monitoring, consumer experiences (side effects) and safety factors; Include nursing responsibilities when administering a LAI medicationand include specific knowledge about increased risk factorsfor a person diagnosed with schizophrenia.
4. What does the nurse need to be aware of about MetSynwhen caring for Tony, who is prescribed an atypical antipsychotic? Outline the actions the prescribed medications- Metformin ER, Panadol Osteo and Atorvastatin.
5. What is the difference between grief and depression? What factors and signs indicate Tony may be depressed and not experiencing an acute exacerbation of schizophrenia? Week 1 Introduction to unit Mental state examination
6. He may be commenced on antidepressant medication. What drug classification does Sertralinebelong to, and what are the common side effects associated with this drug?

Answer 1

Mental health America beliefs access to voluntary mental health treatment and service should focus on protecting human rights and recovery from mental health illness. It respects the right of a person with their mental health condition to make decisions. Involuntary treatment options occur only at the last moment when patients pose a serious risk of physical harm to themselves and having more risk. involuntary treatment safeguards the patient using inpatient admission.
Patient fear of becoming unwell increases the chance of his mental illness with impact grave disability, feeling of helplessness, the frustration that made tony life to vulnerable for mental health illness.
Paliperidone palmitate used for tony schizophrenia disorder and for associated mental symptoms. this is antipsychotic drugs (atypical type) that restore the balance of natural chemicals in the brain. Assess the patient safety, side effects, and tolerability of these drugs is important. Monitor the patient side effects of drugs like dizziness, weakness, dry mouth, high saliva secretion, weight gain, stomach pain. advise the patient about safety factors if it is overdose symptoms like slow movement, restlessness, drowsiness, fast heartbeat, etc. Advice the patient to keep followup regularly and never stop the drugs without doctors' advice.
Lon acting injections (LAI) need careful monitoring and watch for allergic reactions. This LAI should be administered with a valid, written prescription. the person who administered this medication have responsibility for its action and monitoring. LAI medication should have the correct choice for use. the nurse should help the patient with medication adherence. it should be administered at the time in a specific place, nurse knowledge about psychopharmacological and anatomy and physiology of the LAI and skills focus and supervision is important. because of LAI associated with many complications. Patients with schizophrenia can not adhere to LAI which causes admission and involuntary admission. the treatment of schedules causes the balance in risks and benefits.
risk of complications from the failure of treatment causes a metabolic syndrome that makes the patient at high risk and causes serious health outcomes. regular monitoring of weight, hyperglycemia, glucose in a chronically medicated patient with schizophrenia is important with met syn... when using atypical antipsychotic medication contribute to cardiometabolic and endocrine side effects and make the patient more vulnerable to these effects.
Metformin ER decrease the hepatic glucose production, intestinal absorption of glucose and it improves insulin sensitivity by increasing peripheral glucose uptake and utility.
Panadol osteo is an effective pain reliever that exhibits the analgesics. it inhibits prostaglandin synthesis in the CNS.
Atorvastatin is a lipid-lowering drug, it is a statin class of medication.