chapter 22 case study

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Essentials of Mental Health Nursing

Student resources, chapter 22: mental health assessment, case study: bipolar disorder.

Mary is a 40-year-old teacher who has bipolar disorder and she has just been referred by her General Practitioner to the Crisis Resolution Home Treatment Team.  She has recently relocated with her partner’s job to a different part of the country and has lost regular contact with her wide circle of friends and her family. Mary has not slept well over the last 2 weeks and is feeling agitated and increasingly irritable. Her partner is very concerned about her and she is angry that she is meeting the mental health practitioner. 

To manage Mary’s current frustration and ambiguity about the value of any potential input the mental health practitioner needs to ensure that a shared understanding of potential benefit can be reached. The main priority is improving Mary’s mental health and functioning alongside a recovery-focused approach. The mental health practitioner therefore needs to ensure that during the assessment process the central themes underpinning the approach are: collaboration, involvement of partner, managing distress, identifying strengths and building on existing coping strategies. These themes will underpin working towards improved mental health and functioning and Mary’s ongoing self-management.

Theoretically, when beginning the assessment process with Mary it can be difficult for the nurse to manage large amounts of information and to establish a systematic approach to increasing understanding of the current and ongoing issues that are faced by Mary. It is this process of gathering together information that will underpin your clinical decisions and will be used to plan interventions. By starting with a broad based assessment process and then clarifying areas that warrant further consideration,  either/or symptoms and needs, using a range of specifically focused assessment tools can help to determine the most appropriate course of action. 

Using a systematic approach to assessment with Mary enables the nurse and Mary to develop a collaborative relationship. Working together and using a systematic approach to the assessment process can help both Mary and the nurse to make sense of the situation. It is an essential part of the care process and should inform decision making. For Mary and the nurse the assessment process is central to understanding experiences and building on strengths and an essential component in developing meaningful outcomes against which to measure recovery, self-management and treatment alike.

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Appendix C:  Answers to Case Study Questions

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Sedative-Hypnotic Drugs

What is the most likely reason for R.S.’s poor performance in the morning rehabilitation sessions?

The sedative-hypnotic (flurazepam) appeared to be producing a hangover-like effect, which limited the patient’s cognitive skills during the early daily activities. Flurazepam is a benzodiazepine drug with a half-life of 2.3 hours and a duration of action of 7 to 8 hours. This drug, however, is metabolized in the liver to active metabolites with half-lives ranging from 30 to 200 hours. It seems likely that R.S. was continuing to experience sedative effects from these active metabolites well into the next morning.

What would be the likely solution?

The therapists can deal with this problem initially by reserving the early morning session for stretching and ROM activities and then gradually moving into upper-body strengthening. Activities that require more patient learning and comprehension can be done later in the morning or in the afternoon. The hangover-like problem should also be brought to the attention of the physician. In this case, the physician switched the hypnotic drug to zolpidem (Ambien), 10 mg administered at bedtime. Zolpidem has a half-life of 2.5 hours and a duration of action of 6 to 8 hours, so R.S. should still get the benefit of a full night’s sleep. Because zolpidem is not metabolized to active metabolites, it is unlikely that it will continue to exert sedative-hypnotic effects into the next morning. Zolpidem also affects neuronal GABA receptors differently than benzodiazepines such as flurazepam. This difference might reduce the risk of problems, such as rebound insomnia, when it is time to discontinue the drug.

Antidepressant Drugs

How can the therapist reduce the risk of orthostatic hypotension during rehabilitation sessions?

To reduce orthostatic hypotension, the therapist decided to place the patient on the tilt table for the first day after imipramine was started and to monitor blood pressure regularly. The therapist had the patient perform weight shifting and upper-extremity facilitation activities while he was on the tilt table. The patient tolerated this well, so the therapist had him resume ambulation activities using the parallel bars on the following day. With the patient standing inside the bars, the therapist carefully watched for any subjective signs of dizziness or syncope in the patient (i.e., facial pallor, inability to follow instructions). Standing bouts were also limited in duration. By the third day, ambulation training continued with the patient outside the parallel bars, but the therapist made a point of having the patient’s wheelchair close at hand in case the patient began to appear faint. These precautions of careful observation and short, controlled bouts of ambulation were continued throughout the remainder of the patient’s hospital stay, and the therapist observed no incident of orthostatic hypotension during physical therapy.

Will clinicians notice an immediate improvement in J.G.’s mood after starting this?

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Class 11 Biology: Case Study of Chapter 22 Chemical Coordination and Integration PDF Download

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In Class 11 Final Exams there will be Case studies and Passage Based Questions will be asked, So practice these types of questions. Study Rate is always there to help you. Free PDF Download of CBSE Class 11 Biology Chapter 22 Case Study and Passage Based Questions with Answers were Prepared Based on Latest Exam Pattern. Students can solve NCERT Class 11 Biology Chemical Coordination and Integration to know their preparation level.

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In CBSE Class 11 Biology Paper, There will be a few questions based on case studies and passage-based as well. In that, a paragraph will be given, and then the MCQ questions based on it will be asked.

Chemical Coordination and Integration Case Study Questions With Answers

Here, we have provided case-based/passage-based questions for Class 11 Biology  Chapter 22 Chemical Coordination and Integration

Case Study/Passage-Based Questions

Case Study 1:

The thyroid gland is composed of two lobes which are located on either side of the trachea. Both the lobes are interconnected with a thin flap of connective tissue called isthmus. The thyroid gland is composed of follicles and stromal tissues. Each thyroid follicle is composed of follicular cells, enclosing a cavity. These follicular cells synthesise two hormones, tetraiodothyronine or thyroxine (T4) and triiodothyronine (T3). Iodine is essential for the normal rate of hormone synthesis in the thyroid. Deficiency of iodine in our diet results in hypothyroidism and enlargement of the thyroid gland, commonly called goitre. Hypothyroidism during pregnancy causes defective development and maturation of the growing baby leading to stunted growth (cretinism), mental retardation, low intelligence quotient, abnormal skin, deaf-mutism, etc. In adult women, hypothyroidism may cause menstrual cycle to become irregular. Due to cancer of the thyroid gland or due to development of nodules of the thyroid glands, the rate of synthesis and secretion of the thyroid hormones is increased to abnormal high levels leading to a condition called hyperthyroidism which adversely affects the body physiology.

Exopthalmic goitre is a form of hyperthyroidism, characterised by enlargement of the thyroid gland, protrusion of the eyeballs, increased basal metabolic rate, and weight loss, also called Graves’ disease. Thyroid hormones play an important role in the regulation of the basal metabolic rate. These hormones also support the process of red blood cell formation. Thyroid hormones control the metabolism of carbohydrates, proteins and fats. Maintenance of water and electrolyte balance is also influenced by thyroid hormones. Thyroid gland also secretes a protein hormone called thyrocalcitonin (TCT) which regulates the blood calcium levels.

1.) _______________ Protein hormone secreted by thyroid gland regulates the blood calcium levels along with PTH.

• a) thyromelatonin
• b) thyrocalcitonin
• c) thyrocalciumtonin
• d) thyrocarbotonin

Ans: b) thyrocalcitonin

2.) cretinism is referred as,

• a) stunted growth due to deficiency of iodine
• b) stunted growth due to deficiency of thyroid hormones
• c) mental retardation due to deficiency of iodine
• d) deaf-mutism due to deficiency of iodine

Ans: a) stunted growth due to deficiency of iodine

3.) Explain how the both lobes of thyroid gland are interconnected?

Ans: Thyroid gland is composed of two lobes these lobes are interconnected with a thin flap of connective tissue called isthmus.

4.) Give the composition of thyroid follicle and their function?

Ans: Thyroid follicle is made up of follicular cells.

5.) What are adverse effect of iodine deficiency on human body?

Ans: Iodine is essential for the optimum level of thyroid hormones secretion. Deficiency of iodine in our diet results in hypothyroidism and enlargement of the thyroid gland, commonly known as goitre. Deficiency of iodine during pregnancy causes defective development and maturation of the growing baby leading to stunted growth (cretinism), mental retardation, low intelligence quotient, abnormal skin, deaf-mutism, etc. In adult women, deficiency of iodine may cause menstrual cycle to become irregular.

Hope the information shed above regarding Case Study and Passage Based Questions for Class 11 Biology Chapter 22 Chemical Coordination and Integration with Answers Pdf free download has been useful to an extent. If you have any other queries about CBSE Class 11 Biology Chemical Coordination and Integration Case Study and Passage Based Questions with Answers, feel free to comment below so that we can revert back to us at the earliest possible. By Team Study Rate

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Master of Public Health Competencies: A Case Study Approach

Anthony J. Santella

©2020   ISBN: 9781284166323 List of Content Removed Due to Copyright Restrictions  

In October 2016, the Council on Education in Public Health (CEPH) released new competencies that all accredited Master of Public Health (MPH) programs must adhere to. Master of Public Health Competencies: A Case Study Approach covers each of the 22 required competencies to demonstrate how they can be applied in public health practice. Spanning all five key disciplines of Public Health – biostatistics, epidemiology, health policy and management; social and behavioral sciences; and environmental and occupation health – Master of Public Health Competencies covers the full breadth of public health. Each chapter is focused on a single CEPH competency and provides the background of the public health issue, followed by a case study to learn that competency and understand its application. Written by MPH faculty and community practitioners and based on real world public practice, these concise case studies are accompanied by discussion questions that facilitate classroom discussion.

Chapter 1 Epidemiologic Methods Applied in Various Settings of Public Health Practice

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Chapter 2 Mixed Methods for Evaluating Alcohol Norms, Access, and Behaviors Among Youth in Chicago Heights, Illinois

Chapter 3 overweight children: analysis of three interventions in reducing bmi z-scores, chapter 4 designing policy to reduce particulate matter air concentrations in cache county, utah, chapter 5 comparing organizational structure and function of healthcare and public health systems: the q5c model for quality, coverage, cost, choice, coordination, and context, chapter 6 centering wellness: using black feminist literature as a public health pedagogical tool for personal healing, community health, and social justice, chapter 7 using participatory methods to create a community action plan for a rural community coalition, chapter 8 adapting an evidence-based, sexual risk reduction intervention to be more inclusive of trans and cis girls, chapter 9 radon, the silent killer: colorless, odorless, but forever present within us, chapter 10 ryan white hiv/aids program priority setting and resource management process, chapter 11 evaluating a multi-site campus-based sexual assault prevention intervention, chapter 12 developing primary laws and secondary regulations for food safety: the case of fsma and its attendant rules, chapter 13 within “reach”: community–campus partnership to support research, education, and community health, chapter 14 photovoice as a tool for change: engaging the community in public health advocacy, chapter 15 health equity in the aftermath of a natural disaster, chapter 16 collaboration among county health department directors to formulate realistic response plans in the event of mosquito-borne zika outbreaks, chapter 17 flint water case study: negotiation and mediation, chapter 18 interagency communication and public information during disasters and emergencies, chapter 19 get fit for health: using service learning to teach students how to address physical activity and healthy eating among african american congregants, chapter 20 cultural competence in healthcare delivery among immigrant populations in the united states: identifying and addressing the challenges, chapter 21 oral rapid hiv testing in university-based dental clinics in metro new york city, chapter 22 a coordinated, multisectoral response to the opioid crisis in a high-overdose region, current project.