Nursing Assignment: Medical Care Management Plan For A Patient With PTSD
Question
Task:
BEN
Ben is a 28-year-old male who has recently returned to Westtown after serving 10 years in the Australia Defence Force. Ben grew up on a farm in the Westtown area and returned to the region to be close to family and to seek employment in the mining sector.
Prior to returning home Ben’s tasks in the Defence Force were primarily office-based following a training accident 3 years ago which resulted in an L4-L5 spinal fusion and associated medical restrictions resulting from chronic lower back pain. Ben was forced to leave the ADF on medical grounds 9 months ago.
Ben does receive assistance with medical costs from The Department of Veteran’s Affairs (DVA) in relation to both his PTSD and back injury. Prior to his accident Ben had a very active role in the ADF as an infantry soldier and felt frustrated by the restricted duties due to his injuries. He says he would rather ‘work with his hands’ than ‘drive a desk’.
Ben returned to the care of his childhood GP when he returned to Westtown with whom he has a good rapport. Ben visits the clinic monthly for psychological consultation for PTSD associated with is military service which is paid for by the Department of Veterans Affairs (DVA).
Ben was successful in gaining a job working at the local mine where his role involved driving heavy machinery. Ben enjoyed the role however the long hours of sitting plus the vibration of the heavy earthmoving equipment aggravated his lower back. The mine is above ground and explosives are occasionally used on site. Ben tries to avoid being at work these days as he finds these activities sometimes act as a trigger for his PTSD.
Ben is reluctant to say anything as he was afraid that his medical issues might interfere with his employment. Ben tries to ensure he has a rostered day off when he needs to attend medical appointments so he doesn’t draw attention to the same.
For the last 3-4 months Ben’s lower back pain has been increasing to the extent that the discomfort was affecting his ability to operate at work and also his ability to get adequate sleep at night. Ben is increasingly relying on pain medications to ‘get through the day’ and get to sleep at night. Ben has been attending the Youbeaut clinic on a regular basis since he commenced work for pain relief. He is currently prescribed Ibuprofen, Panadeine Forte, and if required Oxycodone, all PRN. Ben’s GP has referred him to the local Physiotherapist which is covered by DVA.
Six weeks ago, Ben was forced to take sick leave due to his discomfort. He was unable to operate heavy machinery due to the lower back discomfort and the requirement to take Endone for pain relief. During this time Ben was notified that after being employed at the mine for only 6 months Ben has been laid off due to downsizing associated with lower commodity prices.
Ben has been unable to find employment in town as a result of the economic downturn associated with the ongoing drought in the area. As a result, Ben has had to move back to the family farm with his parents. The farm is located 25km from Westtown and the nearest neighbours are 5km away.
Ben is used to having a close network of friends and has enjoyed living in town particularly socialising with old friends and with the younger members of the mining workforce. Ben likes to unwind with a ‘few beers’ at the end of the week which he used to relieve the stress and ‘help him forget about his problems’. Ben is finding that the amount of alcohol he is consuming during these sessions and the frequency with which he is drinking alcohol is increasing since he was laid off at the mine.
He is reluctant to move back to the farm as all of his siblings have moved away and he has a tenuous relationship with his father (Doug) who is himself struggling with the psychological impacts of the drought. Doug has low health literacy in relation to the benefits of psychological therapy (or a willingness to engage the same). His attitude has always been to ‘toughen up and get on with it’. Ben has a good relationship with his mother (Mary) although she is a reserved character who doesn’t like conflict and tends to not discuss these issues for fear of Ben or Doug getting upset.
Ben has been receiving psychological treatment focused on cognitive behavioural therapy for several years with good effect. He has a high level of health literacy in relation to these practices and to date he has been happy to engage as he has found it very beneficial.
That said, events over the last 6 months have led to him feeling increasingly depressed. Ben has commenced treatment with a local psychologist in addition to the regular monthly psychiatrist appointments. Despite this, his depression has continued to escalate over the last few months and at his most recent psychiatrist appointment his specialist suggested he commence medication to help control his depression.
Apart from the psychological strategies Ben uses to deal with his PTSD and depression he finds exercise very useful in managing his symptoms. Ben has a membership to one of the Gyms in town however has not been attending regularly lately due to his back discomfort. Now that he is back living with his parents the distance makes it difficult to attend regular.
Task to be addressed in the nursing assignment:
The newly formed Youbeaut clinic is currently in the process of applying for the federal governments Healthcare Home Program. In order to show the ability of the new practice to undertake this program, the healthcare team has already adopted some of the practices associated with this program namely, the use of a screening tool to identify complex patients who would be considered eligible for the program. The practice has been able to create a RN position to act as care coordinator for these patients. Both Ben is a at the Youbeaut clinic who meets the inclusion criteria. Review Ben’s case study and care plan then answer the following questions:
1. Discuss the elements of Ben’s medical history that contribute in him being classified as medically complex.
2. Consider Ben’s situational complexity. Identify and discuss how these factors may create barriers to Nursing management.
3. A diagnosis of more than one medical condition (multimorbidity) is a well-documented barrier to effective care delivery. Provide a brief discussion relating to how multimorbidity impact diagnosis and treatment for complex patients.
4. Refer to the nursing care management plan for Ben. Identify and discuss any conflicting treatment or management elements of this plan.
Answer
1.Medically complex disease mentioned in the preset case of nursing assignment is a disease that has many different causes and requires many different kinds of treatment. It is not only an issue of the quantity, but also quality of the treatments.Each individual needs to find out what works best for his/herself. Sometimes it may be necessary to take several medications simultaneously in order to control the symptoms well enough for someone to be able to work or have some kind of a life. Most people suffering from medically complex disease are not satisfied with the treatments they get, even though the main reason for this is that many need more intensive treatment than can be given at outpatient care levels and often receive only limited treatment.
PTSD is a psychological disorder that occurs after one experiences or witnesses something traumatic, such as violence, death, or dying. Like chronic pain and depression, PTSD has on-going symptoms that do not improve on their own. They are continuing problems that require constant care and attention over an extended period of time. PTSD often leads to additional medical complications because of the nature of how it impacts one’s life. Even if a veteran experiences only mild symptoms of PTSD, they may have major problems with sleep or eating habits, leading them to have obesity or underweight conditions that could require treatment in an inpatient facility.
The patient in discussion is a veteran who was diagnosed with PTSD (posttraumatic stress disorder) after serving on the frontlines in his war.First, Ben is a veteran who served on the frontlines in his war. Second, he became ill after returning from service and continues to have symptoms of PTSD today. Third, his history of being affiliated with the military, having PTSD, and being classified as medically complex are all related to the severity of his conditions. Lastly, PTSD often leads to additional medical complications because of the nature of how it impacts one’s life. Veterans are susceptible to PTSD because of the nature of their jobs and what they experience both on and off duty. The experiences that veterans have been exposed to cause them to live with memories that could haunt them for the rest of their lives, creating anxiety and other symptoms that could lead to major health concerns. These elements all contribute in Ben being classified as medically complex.
Veterans are susceptible to PTSD because of the nature of their jobs and what they experience both on and off duty. The experiences that veterans have been exposed to cause them to live with memories that could haunt them for the rest of their lives, creating anxiety and other symptoms that could lead to major health concerns. Ben is a veteran who has been diagnosed with PTSD, which contributed to his condition being classified as medically complex. 2.Whentreating Ben with PTSD, there are several barriers that can make it difficult to provide proper treatment. Some of these barriers include the psychosocial factors Ben brings into the situation and how complex this disorder may be in comparison to others. Situational complexity is another factor for consideration when developing a plan of care for patients with PTSD. The situational complexity of PTSD can be the main reason why patients experience impaired functioning. The patient's situation often includes physical environment, social interactions, family dynamics, and role expectations that are all factors in the creation of his or her anxiety disorder.
Confronting any mental illness brings with it a sense of stigma. This is particularly true for Ben’s PTSD case, which is often viewed as an illness that results from weakness or poor character. Unfortunately, this view can lead to patients feeling ashamed or embarrassed and may hinder their willingness to seek help. Ben's self-esteem can also be affected by PTSD, leading to feelings of worthlessness, powerlessness, or hopelessness. These factors can affect the Ben's ability to maintain relationships with family members and friends. A great deal of social isolation may occur owing to avoidance behavior. Several other problems such as emotional detachment, irritability, anxiety, mood swings, feelings of guilt or shame, suicidal thoughts, or lack of concentration can cause significant disruptions in the Ben's personal and professional life.
In addition to the psychosocial factors, Ben also have comorbid disorders. This means that they experience more than one psychiatric disorder at the same time. Substance abuse is a common comorbidity in patients with PTSD. In fact, it is estimated that as many as 50% of patients with PTSD also have a substance abuse disorder. This high rate can be attributed to the fact that alcohol and drugs are often used to self-medicate the symptoms of PTSD. Other comorbid disorders that may be seen in patients with PTSD include panic disorder, obsessive-compulsive disorder, social phobia, eating disorders, major depressive disorder (MDD), bipolar disorder, and borderline personality disorder. Patients with PTSD may also exhibit avoidant behavior. This can be part of the patient's efforts to cope with situations that cause distress or threat. Unfortunately, avoidance can also lead to disruptions in the patient's life. For example, the patient may miss work or school, avoid social activities, or have difficulty forming relationships. One of the goals of treatment is to help patients face their fears and resume activities that they have been avoiding. Due to the many factors that can affect a Ben with PTSD, it can be difficult to manage. Listed above are factors that contribute to the situational complexity of Ben’s PTSD case, which itself contributes to management problems in many cases. It is important for nurses to have an understanding of this disorder in order to better provide care for Ben. When providing care for a Ben with PTSD, it may be necessary to have a multidisciplinary approach to treatment. This means that various types of health care providers with different areas of expertise work together to care for Ben. The goal is to provide the most comprehensive, individualized treatment possible. Although a multidisciplinary approach increases cost and requires more coordination, it can lead to better outcomes.
In this cases, sometimes Ben may not want to actively participate in his care plan. In these instances, the nurse's goal should be to engage Ben and support him in a relationship with the health care team. Caregivers must also consider that there is no typical PTSD experience. The disorder is different for everyone and may have a variety of presentations. Ben with PTSD may be reluctant to share his thoughts and feelings, especially if he feel that the events that precipitated his illness are shameful or embarrassing. In cases where a Ben is not willing to discuss his traumatic experiences, it may be appropriate for counselors to meet with family members to gain a better understanding of the patient's situation.
Given the many factors that can affect Ben with PTSD, nurses must be prepared to deal with a wide range of issues. A multidisciplinary approach is often necessary to provide comprehensive care for Ben. Nurses must also be willing to engage Ben and support him in their relationships with the health care team. It is important to remember that there is no typical experience of PTSD and that each patient's situation is unique.
3.Most people with PTSD have more than one mental health diagnosis. In a study of veterans, the most common diagnoses were depression, panic disorder and social phobia. Similarly, in a national epidemiological survey of Iraq and Afghanistan veterans, 70% of those who had screened positive for PTSD also had another mental health diagnosis: 61% had major depressive disorder, 49% had alcohol abuse or dependence, and 45% had an anxiety disorder. Multimorbidity can make diagnosis and treatment more complex. When a person has multiple conditions, each condition needs to be considered when developing a treatment plan. For example, a person with PTSD and diabetes may need different medications to manage their symptoms. Similarly, a patient with PTSD and depression may need a different treatment plan than a person who only has PTSD or only has depression.
In addition to the complexity of treating multiple conditions, having more diagnoses can also increase health care costs. A study examining over 88 000 veterans found that those with at least three chronic illnesses had average annual health care costs almost three times higher than those with no chronic conditions. In the case of PTSD, a patient's mental illness may not be diagnosed or treated due to lack of awareness about how it can affect other medical conditions. Research indicates that doctors often view PTSD as a psychiatric condition only and do not consider its impact on physical symptoms. As a result, patients with PTSD may not receive the necessary treatment for their other medical conditions.
Given the complexities of multimorbidity, it is important for both patients and health care providers to be aware of the potential interactions between mental and physical health conditions. Patients should ask their doctors about the possible impacts of their mental health conditions on their other medical conditions. The National Center for PTSD has developed materials to help health care providers better understand the ways in which PTSD can affect physical health and make recommendations about treatment plans.
4.Nursing care management plans for Ben with PTSD can be complicated and may involve conflicting treatments or management elements. It is important for nurses to be aware of these potential conflicts and work with the Ben and his therapist to manage them. By doing so, nurses can help ensure that the treatment plan is effective and leads to improved quality of life for the Ben.
One potential conflict in the plan is the use of medication. While medication may be helpful in managing some symptoms of PTSD, it can also be addictive and have other side effects. Another conflict could arise if the patient does not feel comfortable discussing his feelings or experiences with the therapist. If this is the case, it may be difficult for the therapist to help the Ben work through the emotions associated with PTSD. Finally, if Ben is not comfortable discussing his experiences with others, he or she may be less likely to adhere to the treatment plan. It is important that nurses are aware of these potential conflicts and can help manage them so that Benhas the best chance of recovering from PTSD. By working with Benand his therapist, nurses can help ensure that the treatment plan is effective and leads to improved quality of life for the Ben.
Nurses should also be aware of potential conflicts between medications and other treatments. For example, if Benis taking medication for PTSD but is also seeing a therapist for a different issue, the side effects of the medication could cause a conflict with some of the other treatments. It is also important to be aware that PTSD affects family members as well. Nurses should consider how the family dynamics may influence treatment and provide support for everyone in order to ensure effective treatment for Ben and his loved ones.
Nurses should also be aware of the potential for PTSD patients like ben to exhibit violent behaviors. They may need special safety precautions, including avoiding areas where violence is more likely to occur and ensuring that other measures are in place to keep them safe. For example, if Ben has experienced violence while on deployment, he should be encouraged not to visit certain public places alone.
It is important for nurses to be aware of any potential conflicts in the treatment plan for Ben and to work with him and his therapist to manage Ben. By doing so, nurses can help ensure that the treatment plan is effective and leads to improved quality of life for Ben.
References:
Trends And Risk Factors for Mental Health Diagnoses Among Iraq And Afghanistan Veterans Using Department Of Veterans Affairs Health Care, 2002-2008 - PubMed. (2009, September 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/19608954/.
Posttraumatic Stress Disorder In the National Comorbidity Survey - PubMed. (1995, December 1). PubMed.https://pubmed.ncbi.nlm.nih.gov/7492257/.
Post-traumatic Stress Disorder (PTSD) - Symptoms And Causes. (2018, July 6).Nursing assignment Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967. Symptoms - Post-traumatic Stress Disorder - NHS. (n.d.). nhs.uk. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/symptoms/.
Post Traumatic Stress Disorder In Parents Of Children With Cancer In Jordan - PubMed. (2017, February 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/28104064/.
