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NURSING CARE PLAN OF A PATIENT WITH MENTAL PROBLEMS

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Introduction

This essay explores the complex case of Ah-Lan, a Chinese lady who is 19 years old and

was admitted to Kwai Chung Hospital. Ah-Lan is dealing with several mental health issues. Her

difficult upbringing, which included the death of both of her parents and an adoption afterwards,

has resulted in intricate psychological issues. Given Ah-Lan's diagnoses, which include poor

nutrition, hallucinations, delusions, and the danger of suicide, a thorough care plan is required.

This study aims to thoroughly assess potential etiologies, pinpoint issues, outline nursing goals

and interventions, and carefully examine Ah-Lan's background (Yu et al., 2022). Following these

recommendations, the article hopes to create a comprehensive plan for Ah-Lan's healing that

considers her situation and offers a strong basis for kind, efficient nursing care.

Background

Ah-Lan is a 19-year-old Chinese lady with a history of severe loss and emotional

maltreatment. She was admitted to Kwai Chung Hospital under the F1/2/3 protocol. Her terrible

background of losing both of her parents at a young age resulted in social isolation and strained

familial ties. Ah-Lan, who was adopted by her aunt Mary, experiences a severe estrangement from

her adoptive family. Her mental health worries have increased due to recent behavioral

adjustments, such as poor eating, suicidal thoughts, and delusional ideas about a superstar named

Andy Lau. Ah-Lan's problems were made worse by the sad event of her birth mother's suicide at

their house (Yu et al., 2022). Amid these difficulties, Ah-Lan struggles with visions of the Chinese

god. With an emphasis on nutritional rehabilitation, managing delusions and hallucinations, and

preventing suicide, a comprehensive care plan is urgently needed to address her complicated

mental health difficulties.

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Assessment after Admitting Ah-Lan

Mental Assessment

To fully comprehend the complexity of Ah-Lan's condition, a comprehensive mental health

assessment is essential. Considering her diagnoses of delusions, hallucinations, and suicide risk, a

thorough assessment of her mental state is essential (Goncalves et al., 2020). This encompasses an

investigation of affect, mood, cognitive performance, and thought process and content. The

existence and type of hallucinations, particularly concerning the Chinese god, should receive

special attention.

A sophisticated method is needed to evaluate suicidal ideation, taking into account the

frequency, intensity, and possible intentions. Tailored response requires an understanding of the

elements that may increase these beliefs and their triggers (Bornheimer et al., 2022). Effective

therapeutic techniques are also developed by assessing Ah-Lan's understanding of her mental

health condition, particularly her understanding of the reason behind and significance of her acts.

Physical Assessment

Because of Ah-Lan's physical condition, a thorough assessment is necessary to determine

any possible causes of her mental health issues. It is essential to perform a thorough physical

examination, paying particular attention to vital signs, overall health, and any possible indications

of nutritional inadequacies. An in-depth nutritional evaluation is essential, given Ah-Lan's

resistance to food and the noted weight drop from 48 kg to 45 kg in less than a week (Yu et al.,

2022). This includes monitoring her body mass index (BMI), testing her blood to determine

important nutritional markers, and evaluating skin integrity for indications of malnutrition (Waite

et al., 2023). In addition, the evaluation ought to cover fundamental self-care and hygiene
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procedures, given Ah-Lan's past self-neglect. It is important to pay particular attention to any

physical deterioration indications, such as muscular atrophy or dehydration. To develop a complete

strategy that addresses her physical and emotional health, healthcare providers must collaborate

with nutritionists and physicians.

Nutrition Assessment

Considering Ah-Lan's dietary aversion, a cooperative nutritional evaluation is essential. In

close collaboration with a dietician, the evaluation should cover a comprehensive history of eating

habits, preferences, and aversions. It should investigate Ah-Lan's views and ideas regarding food

and address any underlying psychological issues that may be causing her inadequate nutrition. Ah-

Ban's nutritional state can be quantified by tracking her weight and BMI over time. Dietary

indicators and complete blood counts are two laboratory evaluations that may guide dietary therapy

and help identify deficiencies (Pacilio et al., 2020). Evaluating her connection with food and body

image is essential to fully comprehend her nutritional difficulties.

Risk Assessment

A thorough risk assessment is necessary to guarantee Ah-Lan's safety and the protection of

those in her vicinity. Assessing the degree of suicidal ideation, the existence of a detailed plan, and

the resources available to execute the plan are all factors in determining the risk of suicide

(Niemantsverdriet et al., 2022). The risk management plan must include constant monitoring and

limiting her access to any tools that could be used for self-harm, given her history of hanging

attempts. It is important to investigate the environmental elements that increase the risk of suicide,

including social support, family dynamics, and accessibility to deadly weapons (Khanna et al.,

2022). Developing a crisis intervention strategy in conjunction with the psychiatric team that is
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customized to Ah-Lan's unique risk factors improves the overall efficacy of suicide prevention

initiatives.

Possible Etiologies

Lack of Support and Isolation

Ah-Lan's psychological discomfort might be made worse by social isolation and a tense

connection with her foster family, especially Mary. Her emotions of alienation and disconnection

have probably been exacerbated by her upbringing in the absence of a strong social network and

close connections (Bornheimer et al., 2022). The absence of emotional closeness and a stable

attachment figure may be a factor in her difficulties establishing deep connections and finding

comfort during periods of emotional upheaval.

Trauma and Loss

The primary cause of Ah-Lan's poor mental health is her terrible past, especially the early

death of both of her parents. The psychological turmoil brought on by her parents' deaths and the

adoption she experienced from her aunt Mary may have created the foundation for ingrained

feelings of trauma, loss, and abandonment (Wearne et al., 2020). The suddenness of her mother's

death by suicide and the absence of emotional guidance throughout her early years may be factors

in her complicated grief and persistent emotional suffering.

Delusional Beliefs

Ah-Lan's obsession with an affair with Andy Lau, the actor, could be an attempt to fill the

emotional vacuum caused by her parent's divorce as well as unfulfilled emotional demands.

Delusional ideas frequently arise as an escape from unpleasant facts or a coping mechanism for
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upsetting emotions (Vallath et al., 2020). The need to examine her attachment styles and emotional

deficiencies is highlighted by the possibility that the idealizing of a celebrity figure could act as a

stand-in for unfulfilled emotional relationships in her personal life.

Spiritual and Cultural Factors

Ah-Lan's hallucinations of the Chinese god highlight how spiritual and cultural elements

interact. Spiritual and cultural contexts can have an impact on the meaning and substance of

hallucinations. A thorough comprehension of Ah-Lan's experiences requires an investigation of

her cultural upbringing and personal spiritual beliefs, which may also help to guide culturally

appropriate therapeutic methods.

Psychotic Features

Delusions and hallucinations raise the risk of severe depressive symptoms or an underlying

psychotic illness. Deformed thinking and sensory abnormalities are examples of psychotic

symptoms that can seriously impair a person's capacity to navigate reality (González-Rodríguez,

et al., 2021). Determining whether Ah-Lan's hallucinations and delusions are the result of intrinsic

psychotic diseases, mood disorders with psychotic elements, or dissociation brought on by trauma

requires an understanding of their nature and content.

Guilt and Self-Blame

Ah-Lan can experience self-blame or remorse because of the circumstances surrounding

her parents' deaths, particularly her mother's suicide at home. The absence of psychological

processing and assistance during these traumatic events may have led to internalized blame, which

lowered her self-esteem and increased her sense of worthlessness (Somes, 2023).
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Unattended Developmental Needs

Ah-Lan may have had unfulfilled developmental requirements as a result of her turbulent

upbringing, which was characterized by feelings of abandonment and a lack of parental

participation. She may be experiencing identity, self-worth, and interpersonal interaction issues

now since she was not provided with constant emotional support and guidance during critical

developmental stages (Cummings, 2020). Taking care of these unfulfilled needs becomes essential

to creating a care plan that works.

Cognitive Distortions

Ah-Lan's depressed symptoms could be caused by persistently negative ideas and cognitive

distortions, which could have their roots in early experiences and be perpetuated by events later in

life. Recognizing and addressing these erroneous beliefs is crucial to encourage cognitive

restructuring and a more adaptable mental process.

Identified Problems

Relationship Strain and Social Withdrawal

Significant withdrawal and social anxiety are indicated by Ah-Lan's avoidance of social

engagements, palpitations, and hand tremors while she is outside of the Tuen Mun District. Her

solitude is made worse by her tense connection with Mary, her adopted mother. Ah-Lan's distaste

for friends and doubts about their motivations for studying nursing point to interpersonal issues

(Georgiades et al., 2023). These difficulties affect how she functions in general and make it more

difficult for her to participate in treatment activities. To address social withdrawal, Ah-Lan has to

be progressively exposed to social situations, have better communication skills, and be in

supportive partnerships.
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Poor Nutrition

Ah-Lan's reluctance to receive enough nourishment presents a serious obstacle that calls

for a comprehensive intervention plan. Collaboration with a nutritionist is essential to perform a

thorough nutritional assessment that considers Ah-Lan's cultural background, preferences, and any

potential psychological barriers to eating. A customized meal plan is created to foster a good and

encouraging eating environment, emphasizing therapeutic meal support treatments (Osuji and

Onu, 2021). As part of the care plan, regular meal routines become crucial to establishing

continuity and consistency in Ah-Lan's everyday life. Her refusal to eat is explored in detail during

individual therapy sessions, which create a therapeutic environment for problem-solving and

investigation. Therapies' efficacy is ensured by systematically tracking nutritional indicators,

weight, and food consumption. This enables rapid modifications according to Ah-Lan's progress.

Suicidal Ideation

Ah-Lan's history of suicide ideation, which includes uncontrollably thinking about

hanging, overdosing on drugs, or jumping from an elevated position, is quite concerning—her

prior attempt at hanging highlights the seriousness of the risk. Ah-Lan poses a serious risk, as

evidenced by her careful planning of the suicide deed and her unwillingness to tell the case medical

officer that she was considering suicide (Freeman et al., 2019). The danger evaluation is further

complicated by the serene way she described hearing the words of the Chinese god telling her to

jump from a high place. To guarantee her safety, a focused suicide prevention plan and ongoing

observation are essential.

Delusions and Hallucinations

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Ah-Lan's irrational fantasy of a love affair with film star Andy Lau reveals a warped sense

of reality. This obsession has likely impacted her everyday activities and social relationships in an

impossible situation, which has become a considerable source of unhappiness. The mistaken belief

might be her coping method because she does not have any important relationships in her life

(Pietkiewicz et al., 2021). It takes cognitive-behavioral techniques, reality orientation, and an

examination of the underlying emotional demands that underlie this delusion's persistence to

address it.

Nursing Objectives

Relationship Strain and Social Withdrawal

Goal: Boost social interaction and strengthen bonds amongst people.

Sub-Objective 1: To lessen anxiety, gradually introduce Ah-Lan to social settings, beginning with

brief, supervised exchanges.

Sub-Objective 2: Lead group therapy sessions emphasizing communication, interpersonal skills,

and forming relationships with peers.

Sub-Objective 3: Hold family therapy sessions with Mary to strengthen the support network,

improve communication, and address and resolve disputes.

Sub-Objective 4: Foster a sense of social inclusion and belonging in Ah-Lan by encouraging her

to engage in therapeutic activities in the hospital setting.

Poor Nutrition

Goal: Increase dietary consumption and treat psychological obstacles to eating.

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Sub-Objective 1: Work with a nutritionist to create a customised meal plan that considers Ah-Lan's

dietary requirements and preferences.

Sub-Objective 2: Establishing a good and encouraging eating environment through therapeutic

meal assistance interventions, such as consistent mealtime routines.

Sub-Objective 3: To enhance Ah-Lan's connection with food, organise private therapy sessions to

investigate the psychological and emotional aspects underlying her eating resistance.

Sub-Objective 4: Regularly track and record dietary consumption, weight, and nutritional markers;

modify interventions in response to difficulties and advancements.

Suicidal Ideation

Goal: Reduce the likelihood of suicide by putting a customised safety plan into action.

Sub-Objective 1: Maintain ongoing surveillance to enable prompt action in the event of increased

distress or suicidal thoughts.

Sub-Objective 2: Work together with the mental health team to carry out a thorough assessment of

suicide risk, pinpointing triggers and creating coping mechanisms.

Sub-Objective 3: Hold frequent therapy sessions with Ah-Lan, emphasising the development of

coping mechanisms, improving emotional control, and investigating the underlying causes of

suicidal ideation.

Sub-Objective 4: Encourage a cooperative method for Ah-Lan's safety by involving Mary, the

foster mother, in suicide avoidance education and support.

Delusion and Hallucination

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Goal: To encourage a more realistic view of relationships and challenge and refute false notions.

Sub-Objective 1: Use cognitive-behavioral techniques to confront erroneous thought patterns and

investigate the sources of delusional and hallucination ideas.

Sub-Objective 2: Teach Ah-Lan to differentiate between genuine reality and deluded thoughts by

introducing reality orientation strategies.

Sub-Objective 3: Conduct group and individual therapy sessions to give Ah-Lan a secure

environment to explore different viewpoints and express her feelings.

Sub-Objective 4: Involve Mary in sessions with her family members to improve understanding

and communication while addressing any factors that might support or feed her delusions.

Nursing Interventions

Relationship Strain and Social Isolation

Ah-Lan needs therapies that are centred on reestablishing ties and encouraging social

participation because of her tense connection to her adoptive mom, Mary, and her propensity for

social isolation. A crucial tactic is gradual exposure, which introduces Ah-Lan to social settings,

beginning with brief, supervised encounters to decrease anxiety. Group therapy sessions focusing

on relationship-building, communication, and interpersonal skills are intended to give Ah-Lan a

safe space to interact with peers and overcome her social disengagement (Allé and Berntsen, 2021).

Sessions for family therapy are also started to resolve issues and improve Ah-Lan and Mary's

communication.

Poor Nutrition
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Ah-Lan's reluctance to receive enough nourishment presents a serious obstacle that calls

for a comprehensive intervention plan. Collaboration with a nutritionist is essential to perform a

thorough nutritional assessment that considers Ah-Lan's cultural background, preferences, and

potential psychological barriers to eating (Adriani, 2021). A customized meal plan is created to

foster a good and encouraging eating environment, emphasizing therapeutic meal support

treatments. As part of the care plan, regular mealtime routines become crucial to establish

continuity and routine in Ah-Lan's everyday life. Her unwillingness to eat is explored in detail

during individual therapy sessions, which create a therapeutic environment for problem-solving

and investigation (Aucoin et al., 2020). A systematic evaluation of nutritional indicators, weight,

and food consumption ensures the efficacy of therapies. This enables rapid modifications

according to Ah-Lan's progress.

Risk of Suicide

Ah-risk Lan's for suicide requires a multipronged strategy that includes quick assistance,

building mental fortitude, and establishing a wide safety net. When continuous observation is used,

a watchful monitoring system is guaranteed, enabling prompt action during increased discomfort.

Our approach is based on regular therapeutic involvement, which builds a trust-based therapeutic

relationship (Freeman et al., 2019). Ah-Lan is motivated to express her feelings, investigate the

underlying causes of suicidal thoughts, and work together to create coping mechanisms throughout

therapy sessions.

Delusion and Hallucination

A focused intervention strategy that tackles cognitive distortions encourages reality

orientation, and offers a therapeutic environment for inquiry is necessary to address Ah-Lan's
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delusional views. Cognitive-behavioral techniques are applied to investigate the roots of delusional

ideas, confront erroneous thought processes, and assist in the formation of more realistic

perceptions (Niemantsverdriet et al., 2022). These therapies aim to increase Ah-Lan's awareness

of her illusions and advance a more comprehensive comprehension of interpersonal interactions.

Checklist for Effectiveness

Relationship Strain and Social Withdrawal

Gradual Exposure: Is there a systematic strategy with tracked results for gradually introducing

people to social situations?

Has there been a decrease in anxiety and an improvement in tolerance for social interaction?

Group Therapy: Do the sessions address peer relationships, communication, and interpersonal

skills effectively?

Does it exist as proof of heightened involvement and participation in therapeutic activities in the

hospital context?

Family Therapy: Do Ah-Lan and Mary's discussions during family therapy sessions help them

resolve their differences and communicate better?

Does Mary take an active role in assisting Ah-Lan with her social reintegration?

Poor Nutrition

Nutritional Evaluation: Has a thorough nutritional evaluation been done with a dietitian?

Are preferences, cultural factors, and psychological obstacles to eating documented?

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Meal Support: Do therapeutic meal support strategies, including set mealtime schedules, become

consistently applied?

Is there proof that the setting in which people eat is encouraging and supportive?

Individual Counseling: Does Ah-Lan's eating disorder receive any attention from individual

counselling sessions about emotional and psychological issues?

Are food consumption, weight, and nutritional indicators regularly recorded to track progress?

Risk of Suicide

Constant Observation: By the safety strategy, is Ah-Lan constantly observed?

Are there any records of her mental health observations or any modifications to her risk factors?

Therapeutic Engagement: Is the goal of frequent therapy sessions to establish a relationship based

on trust?

Is there proof that coping strategies were developed together during therapy sessions?

Safety Plan: Has an individual safety plan been created and updated regularly?

Does Ah-Lan actively participate in creating and comprehending her safety plan?

Delusions and Hallucinations

Cognitive-Behavioral Techniques: Do cognitive-behavioral therapies often aim to refute and

confront erroneous beliefs?

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Is there any record of Ah-Lan's participation and development in sessions addressing maladaptive

thought patterns?

Reality Orientation: Does Ah-Lan frequently use reality orientation to assist her in discerning

between reality and her delusions?

Are the effects of delusions on relationships with others discussed in therapy sessions?

Treatment Sessions: Does Ah-Lan have a secure environment in which to express her feelings and

consider other viewpoints during individual and collective treatment sessions?

Insights

Understanding the complex interactions between cultural, familial, and individual factors

affecting mental health has been made possible by Ah-Lan's care. The prevalence of fantasies

about a supposed love connection with a celebrity emphasizes how society and culture have a

significant impact on personal psychopathology. Furthermore, the development of hallucinations

associated with the Chinese divinity highlights the importance of culturally sensitive psychiatric

methods. The complexity of Ah-Lan's problems emphasizes how crucial an integrated and team-

based care strategy is. Understanding the importance of family dynamics—especially in light of

her tense relationship with Mary, her adopted mother—highlights the necessity of family-centred

therapies to improve support networks and combat social disengagement.

Conclusion

In summary, Ah-care Lan's carefully designed care plan represents a comprehensive and

culturally aware response to her complicated mental health issues. This all-encompassing approach

emphasizes the complex interactions between cultural, familial, and individual factors while
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addressing suicide risk, interpersonal tension, and delusional beliefs. The methodical effectiveness

checklist guarantees continued flexibility and reactivity. Gained insights emphasize the necessity

of customized interventions, and the patient-centred, team-based approach strives for long-lasting

resilience and symptom relief. Ah-Lan's journey sheds light on the significant influence that subtle

nursing care has on the recovery of mental health.

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