National Famework Recovery Oriented Mental Health Services

Question: Discuss about the National Famework for Recovery Oriented Mental Health Services. Answer: Introduction: Lithium carbonate is a medication widely used in the treatment of bipolar disorder. It has been listed by World Health Organization as an essential medication required in a basic health system (Who.int, 2016). It is used in the treatment of the manic episodes of bipolar disorder and also for the maintenance of the patients by diminishing the episodes. The symptoms of mania where lithium carbonate can be used are reduced sleep need, speech pressure, poor judgment and grandiosity (Cerimele et al., 2016). Ellen Hawkbridge has the chief complaint of bipolar disorder and it is defined by manic episodes that are followed by depressive episodes. Presently, she is suffering from the manic episode and the symptoms that she presented clearly indicate bipolar disorder that needs immediate medical intervention. She stated that she do not feel the need of sleep at night, her speech is pressured and slurred, poor judgment of clothes and makeup and her content of thoughts are grandiose and flirtati ous. For controlling these symptoms, she was prescribed lithium carbonate and this was the rationale for selection of the medication for Ellen. Since it is the mainstay of treatment for the treatment and maintenance of bipolar disorder, therefore Ellen is expected to adhere strictly to her prescribed medications to keep her manic episode of bipolar disorder under control (Cerimele et al., 2016). The major side effects of lithium carbonate are diarrhea, abnormal heart rhythm and shortness of breath. The most common side effects of the medication include tiredness, dizziness, drowsiness and increased thirst (Licht, 2012). However, they are common and can be managed by the pharmacist or physician. The major side effects require nursing intervention and treatment. Mild to moderate diarrhea is a major side effect of lithium carbonate that can get severe depending on the dose. The nursing interventions for controlling diarrhea include encouraging the patient to increase the oral fluid intake that contains electrolytes and to promote the use of the relaxation technique. The rationale behind these nursing interventions is to replace the lost fluid due to diarrhea and to decrease the anxiety and stress that can worsen diarrhea. The other major side effect includes abnormal heart rhythm which can get severe or even fatal if the patient has a medical history of heart disease. Nursing i ntervention includes monitoring of the vital signs with assessment of the adequacy of tissue perfusion and cardiac output and auscultation of the heart sounds, rhythm and the presence of dropped beats and extra heart beats. The rationale for these nursing interventions is to provide immediate treatment for termination of dysrhythmia in the presence of alternative tissue perfusion and cardiac output. Auscultation of the heart sounds and rhythm is done for the identification of dysrhythmia in the patients who are unmonitored by hearing the dropped beats and extra heartbeats (Oruch et al., 2014). Shortness of breath is another side effect of lithium carbonate that can get severe with the time. The nursing interventions for shortness of breath include monitoring of the vital signs, pulse oximetry and respiratory status and checking of the skin color for cyanosis. Rationale for these nursing interventions is monitoring of the vital signs and other parameters can alert the doctor and the nurse for any change in patient condition and blue discoloration or cyanosis indicates inadequate perfusion that is a medical emergency (Bschor, 2014). Ellen has been prescribed lithium carbonate 500mg bd and it is a high dose for a woman of 57 years age. Therefore, there are chances that side effects might occur with prolonged use of the medication for maintenance of her bipolar disorder. Mild to moderate side effects can be avoided by withdrawing the drug or reducing the dosage. However, the severe side effects require immediate management and nursing intervention that have been discussed. Since Ellen is already in a degraded state of mental health, any side effect of lithium carbonate has to be dealt with utmost medical care. The clinical condition for which lithium carbonate is prescribed includes the treatment and maintenance of manic episodes of bipolar disorder. The typical symptoms of mania are motor hyperactivity, pressure of speech, flight of ideas, poor judgment, hostility and aggressiveness (Saunders et al., 2016). Since all these symptoms were very much evident on Ellens presence in the emergency department, therefore it was evident that she has not been taking her medications. She did not felt the need of sleep at night, her speech was pressured, loud and slurred, there was flight of ideas in her thoughts and her content of thought was flirtatious and grandiose. These symptoms strongly suggested that she has been missing her medications and needs immediately put back to her medication regime. There are various strategies that can help Ellen to adhere to her medication and keep her manic episodes in control. One strategy is to arrange Psychotherapy for Ellen that will include a psycho-education component for increasing the understanding of the illness and the necessity of the preventive treatment. Another strategy includes collaborative discussion with Ellen regarding the preferred treatment formulation and reviewing the limitations and benefits of the prescribed medications with assessment of the tolerability and the available treatment options (Bauer Gitlin, 2016). Recovery principles encourage honest and open negotiation and discussion between the consumer and practitioner about the legal requirements. Learning and choice are promoted even in the restrictive settings that include security and forensic settings. Two recovery principles can be implemented for facilitating and supporting the self-management of Ellens medications. This includes supported or joint decision making regarding the risk management and safety promotion by considering the sensory modulation strategies for managing arousal (Health.gov.au, 2016). Since Ellen is in an elevated mood and her judgment has been impaired, this has to be brought under control and then a joint decision has to be taken by herself, her husband Simon and the clinician for self-management of her medication. The other strategy will include joint construction of the service plans with relapse signature plans and early warning signs (Health.gov.au, 2016). This will be a joint decision again by Ellen and h er husband Simon along with the clinician for early detection of the relapse if the medications are not taken regularly and designing a service plan for adhering to the medication regime by self-management. These strategies will help Ellen for self-management of her medications by designing plans and modulation strategies for controlling her elevated mood and prevent relapsing of the manic episode. References Bauer, M., Gitlin, M. (2016). Treatment of Mania with Lithium. InThe Essential Guide to Lithium Treatment(pp. 61-70). Springer International Publishing. Bschor, T. (2014). Lithium in the treatment of major depressive disorder.Drugs,74(8), 855-862. Cerimele, J., Chwastiak, L., Ludman, E., Ratzliff, A., Unutzer, J., Katon, W., Stephens, K. A. (2016). Bipolar Disorder.Integrated Care: Creating Effective Mental and Primary Health Care Teams, 55-77. Department of Health | A National framework for recovery-oriented mental health services: guide for practitioners and providers. (2016).Health.gov.au. Retrieved 18 August 2016, from https://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-recovgde Licht, R. W. (2012). Lithium: still a major option in the management of bipolar disorder.CNS neuroscience therapeutics,18(3), 219-226. Oruch, R., Elderbi, M. A., Khattab, H. A., Pryme, I. F., Lund, A. (2014). Lithium: a review of pharmacology, clinical uses, and toxicity.European journal of pharmacology,740, 464-473. Saunders, K. E., Cipriani, A., Rendell, J., Attenburrow, M. J., Nelissen, N., Bilderbeck, A. C., ... Harmer, C. J. (2016). Oxford Lithium Trial (OxLith) of the early affective, cognitive, neural and biochemical effects of lithium carbonate in bipolar disorder: study protocol for a randomised controlled trial.Trials,17(1), 1. WHO Model Lists of Essential Medicines. (2016).World Health Organization. Retrieved 18 August 2016, from https://www.who.int/medicines/publications/essentialmedicines/en/