Questions:: Assessment 2

Questions:
Assessment 2
Description: Four short-essay questions
Due Date: 2359 hours (CST) Monday, 7th September 2020.
Value: 40%
Length: 1600 words (maximum)
Clinical scenario
Angelo is a 19-year-old man. He lives with his parents and he is an apprentice diesel mechanic. Encouraged by
his family, Angelo presented for assessment at his local hospital. As a nurse, you are part of the
multidisciplinary team responsible for Angelo’s assessment. On admission Angelo appears withdrawn. His
parents report that Angelo’s behaviour has changed gradually over the last 6 months. He has become moody and
uncommunicative and seems to have lost interest in life. Angelo’s parents also report that in recent weeks he
has started talking about his thoughts being controlled by energy waves emitted by the television. At times he
has been overheard talking to himself. His parents state that Angelo has in the past used cannabis heavily. His
work performance has suffered, and his colleagues have also noticed the changes in Angelo’s mood and
behaviour.
Clinical scenario questions

1. During your interview with Angelo, you note that he is not forthcoming with personal information.
What communication techniques would you use to obtain a clinical history. (400 words)
2. Some aspects of Angelo’s history are suggestive of psychosis. Define psychosis and explain the
primary features of a psychotic presentation. (400 words).
3. A provisional diagnosis of schizophrenia is made, and Angelo is admitted to the mental health unit for
observation and further assessment. Explain the concept of positive and negative symptoms in schizophrenia
and the implications for treatment. (400 words)
4. Explain the potential role of neurotransmitters in the development of schizophrenia. (400 words)
Preparation
 Revise your set readings and lectures for weeks 1 to 6.
 Read to assignment question carefully. Identify the key areas you need to address in this essay. You
may use headings based on these key areas to signpost your essay. Ensure you understand the College of
Nursing and Midwifery Assignment Policy and penalties for overdue assignments.
 Revise your understanding of plagiarism and how to avoid this form of student misconduct. Revise
CDU-APA Referencing. Go to http://libguides.cdu.edu.au/cdureferencing for help with referencing. You can
submit a draft to the Draft Checking link to obtain a report on matched text (go to Draft Checking for
instructions and advice on interpretation of the text matching report). You can submit once only to Draft
Checking.
 Ensure that your computer and internet connection comply with CDU requirements (see
http://learnline.cdu.edu.au/support/learnline/systemrequirements.html).
 If you have technical problems, ring 24-hour Learnline Support for assistance. Keep the ticket no. for
reference. If you have not been able to complete your assignment submission due to technical problems, contact
the Unit Coordinator and quote this number.
Submission Instructions
 The assignment length is 1600 words (including in-text citations but excluding the reference list).
Penalties apply for being over or under the word limit.
 Signpost each essay as appropriate, Essay 1, Essay 2...etc.
 Use Arial 12-point font. Line spacing 1.5.
 An essay structure is required; include an introduction, body and conclusion for each of the four
questions.
 In-text citations and references are to be presented according to CDU-APA style 7th edition. The
reference list is placed at the end of the fourth short essay.
 Use sources within a 10-year publication range.
 The number of references you cite reflects the breadth of your reading. Include a minimum 10
references.
 It is the student's responsibility to ensure correct submission.
 Assignments MUST be submitted via the Learnline system and will not be accepted by any other
mechanism. Your assignment will be graded, and feedback returned online through My Grades in Learnline.
 Insert your name and student number on the first page and in the filename when you submit.
Marking and Feedback Criteria
Your assignment feedback and grading will be based on the following criteria:
 Understanding of clinical concepts.

 Application of clinical reasoning skills.
 Academic literacy skills - writing style, grammar and spelling.
 Academic integrity skills - accurate use of CDU-APA referencing style.
Lectures materials:---
 Pre-Readings (Week 2)
Your readings for this week are set out below. Required readings can be from your Set
Text, eReadings or hyperlinks. While Recommended Readings are not required, they are suggested as being very
useful for greater depth.
Required Readings
Hellsten, D, & Hakiaha, H. (2017). Indigenous mental health in Australia and New Zealand. In K. Evans, D. Nizette
& A. O'Brien (Eds.), Psychiatric and mental health nursing (4th ed., pp. 237-250). Sydney: Elsevier.
Nizette, D., & Barkway, P. (2017). Mental health theory and influence across the lifespan. In K. Evans, D. Nizette &
A. O'Brien (Eds.), Psychiatric and mental health nursing (4th ed., pp. 121-147). Sydney: Elsevier.
Recommended Readings
Crowe, M., Inder, M., & Beaglehole, B. (2016). More than medication – providing interventions that target the
complexities of mental disorder. Journal of Psychiatric and Mental Health Nursing, 23(1), 1-
2. doi:10.1111/jpm.12278
Watkins, A, & Park, T. (2017). Physical health. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric and
mental health nursing (4th ed., pp. 178-195). Sydney: Elsevier.
 Key Terms
At the end of this week students should have developed an understanding of the following clinical terms:
biomedical model mental illness
recovery mental health
nature versus nurture psychological theories
sociological theories cultural safety
Indigenous mental health colonisation
human rights stigma
racism culture
mainstream
 Self-directed Activities (Week 2)
The following short video features brief stories about the experience of mental illness. The stories are valuable as
they are told by real people about their real experiences. Listening to the people on this video helps to round out
your understanding of the concepts and ideas about mental health and mental illness - and perhaps more importantly
- the necessity to consider the role of our own values and attitudes that we bring to our practice as nurses.
Watch Video
Mental Health: In Our Own Words

Duration: 6:41
URL: https://www.youtube.com/watch?v=_y97VF5UJcc
Required Readings
Elders, A. (2017). Anxiety, trauma and stress-related disorders. In K. Evans, D. Nizette & A. O'Brien
(Eds.), Psychiatric and mental health nursing (4th ed., pp. 408-432). Sydney: Elsevier. [excluding
pages 426-427]. Click here for ebook link.
Oji, O., & Herring, H. (2018). Generalized anxiety disorder. In D. Pravikoff (Ed.). Glendale, CA: EBSCO
Publishing. (via Nursing Reference Center)
Usher, K. (2017). Psychopharmacology. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric and mental
health nursing (4th ed., pp. 613-617). Sydney: Elsevier.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: American Psychiatric Publishing. [Read especially pages 189-234]
Hungerford, C., Hodgson, D., Clancey, R., Monisse-Redman, M., Bostwick, R., & Jones, T.
(2015). Mental health care: an introduction for health professionals(2nd ed.). Milton, Qld: John Wiley.
[Read pp. 277-299]
McAllister, M., & Dares, G. (2014). Mood and anxiety disorders. In K.-L. Edward, I. Munro, A.
Welch & A. Robins (Eds.), Mental health nursing: Dimensions of praxis (2nd ed., pp. 166-188). South
Melbourne: Oxford University Press.
 Key Terms
Avoidance behaviours Psychological interventions

Chronic stress Psychopathology
Cognitions Rumination
Emotional dysregulation Screening
Fear Stress response
Fear responses Stressor
HPA axis Anxiolytic
Intrusive anxious thoughts Benzodiazepines
PTSD Dependence
Psychoeducation
 Examples of evidence-based practice for anxiety
There are a variety of sources for evidence-based nursing practice. Here are two examples of clinical
guidelines that can be used to inform your nursing practice related to anxiety. Clinical guidelines need to
be current - usually within the last five years - and show a rigorous authoritative review process.
National Institute for Health and Care Excellence. (2011, January). Generalised anxiety disorder and
panic disorder in adults: Management. Retrieved 7th February, 2017,
from https://www.nice.org.uk/guidance/cg113
NICE is a well-known resource intended for a wide range of clinical professions. Here is an example for
generalised anxiety disorder.
Therapeutic Guidelines Ltd. (2016). eTG complete. [see especially "Psychotropic"]

While registered nurses do not prescribe, we are accountable for many aspects of administering
medications including knowing why, providing accurate information, reporting and recording the
administration and effect, including side-effects. For these reasons, the electronic Therapeutic Guidelines
are a well-regarded set of clinical guidelines for medications.
Nursing Reference Center Plus, from EBSCO Publishing.
A third source of evidence-based information specifically targeted for nursing is the Nursing Reference
Center Plus (NRCP) by EBSCO. NRCP is available from the CDU Nursing Libguide. This resource is also
available as a mobile device app for iOS devices. You are able to download this from the CDU Library at
the Nursing Reference Center Plus (you will need to log in with your library access). Look for the link at
the foot of the NRCP page for the iOS app download. NOTE: NRCP is primarily a United States resource so
you will encounter some terms (e.g. medication trade names) that are not used in Australia.
The self-directed learning materials this week begins with an overview of the neurobiology underpinning the stress
response and anxiety disorders. This is followed by a small series of YouTube videos that talk directly about
specific disorders arising from the stress response.
Watch Video
Stress Response in Animation
Duration: 1:08
YouTube URL: http://www.youtube.com/watch?v=BIfK0L8xDP0
Anxiety can manifest in a number of discrete clinical conditions or disorders each with their own diagnostic criteria.
For example, Panic Disorder, Generalised Anxiety Disorder, specific phobias, etc. The following videos are useful
examples to see what a clinical presentation might be.
 Generalised Anxiety Disorder

In this video of a GP interviewing Mary who has a Generalised Anxiety Disorder you will hear about extensive
multiple social stressors presents to her and unrelated (vague) physical complaints. However, a close observation of
signs and symptoms shows that her anxiety is the core problem.
This is a typical presentation of generalised anxiety disorder (GAD) in a primary health setting where it can be
difficult for the nurse or doctor to evaluate anxiety from what could also be definite physical problems as well. Good
assessment skills for mental health and physical health are needed; and a sensitivity to the level of distress and
impairment that both can produce.
The closing moments of the interview also demonstrate the potential for dependence forming when benzodiazepines
are prescribed for a long-term.
Watch Video
Mary's story
Duration: 5:02
YouTube URL: http://www.youtube.com/watch?v=2TwvYtLeIKo

 Specific Phobias
In this video Roseanne describes the impact of phobic disorder on her daily life. Note the limitations and
interference with functioning that this type of anxiety disorder can cause.
Watch Video
Phobias
Duration: 4:05
YouTube URL: http://www.youtube.com/watch?v=nCmAmK_xKps
 Panic Disorder
Panic disorder is characterised by short and intense episodes of anxiety and fear. In this video Jamie describes the
physical symptoms which accompany panic attacks.
Watch Video
Panic Disorders
Duration: 4:57
YouTube URL: http://www.youtube.com/watch?v=iB6O1UEp4GI
Required Readings
Evans, K. (2017). Schizophrenia and psychotic disorders. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric
and mental health nursing (4th ed., pp. 341-369). Sydney: Elsevier.
Usher, K. (2017). Psychopharmacology. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric and mental health
nursing (4th ed., pp. 611-631). Sydney: Elsevier.
Dodd, S, & Jeffs, S. (2014). Psychosis and psychotic disorders. In K.-L. Edward, I. Munro, A. Welch & A.
Robins (Eds.), Mental health nursing: Dimensions of praxis (2nd ed., pp. 189-205). South Melbourne: Oxford
University Press.
Hungerford, C., Hodgson, D., Clancey, R., Monisse-Redman, M., Bostwick, R., & Jones, T. (Eds.).
(2015). Mental health care: An introduction for health professionals (2nd ed.). Milton, Qld: John Wiley. (pp.
377-421)
 Key Terms
Akathisia Hallucinations Metabolic syndrome
Akanesia Incoherence
Alogia Neologism
Anhedonia Persecutory delusion
Avolition Psychotic
Catatonia Antipsychotic
Delusion Ideas of reference
Derailment Schizophrenia
Dopamine Tangentiality
Dystonia Tardive dyskinesia
Flattened affect NMS
Grandiose delusion Word salad
Parkinson's syndrome Anticholinergic
 Examples of evidence-based practice for schizophrenia
The Royal Australian & New Zealand College of Psychiatrists. (2016). Clinical practice
guideline for the management of schizophrenia and related disorders. (link fixed on 13/8/18)
The RANCP provides an excellent evidence-based resource for a wider clinical audience than psychiatrists.
Although this version has reached the five-year limit generally accepted for clinical guidelines, it remains well
worth examining as a current comprehensive guide to best practice.
March, P. & Schub, T. (2016). Schizophrenia: An overview. Nursing Reference Center, from EBSCO
Publishing.
The Nursing Reference Center has a number of resources for schizophrenia that are oriented to nursing practice. The
link here is to a well-written overview of schizophrenia.
 Self-Directed Activities (Week 4)
The exploration of psychosis this week has schizophrenia as the focus. Your readings
will show you that hallucinations, delusions, and formal thought disorder are key signs
and symptoms. The series of videos blow are useful tools that demonstrate how these
signs and symptoms might present. As well as practising your ability to identify signs
and symptoms, also use these videos to think about therepeutic communication
techniques.
 Hallucinations
Hallucinations are false perceptions, indistinguishable from reality, that occur in the absence of an external stimulus.
This interview demonstrates a psychiatrist interview probing in depth for the precise experience (symptoms) of the
hallucinations being experienced.
Watch Video
Auditory Hallucinations
User: n/a - Added: 12/06/09
YouTube URL: http://www.youtube.com/watch?v=0tn8xLQY53U

 Delusions
Delusions are false beliefs which persist in spite of incontrovertible evidence to the contrary and which are out of
harmony with the individual's cultural and religious background. This short video demonstrates the kind of
experience a person could express when delusional.
Watch Video
Delusions
YouTube URL: http://www.youtube.com/watch?v=xIrA6iCke2M
 Psychosis
This video demonstrates how a person likely to be suffering a psychotic illness might present in a primary health
care setting. Watch the video for the signs and symptoms you are learning about: delusions, hallucinations, and
disordered thinking. Additionally, note how the psychiatrists communicates in order to obtain clinical information
and at the same time is engaging in a therapeutic relationship. (NOTE: Take the opportunity to discuss this video
with others in the Discussion Board.)
Description: In this film, an on-call psychiatrist is assessing a young man who has been referred urgently by his GP.
The psychiatrist takes a history in which she elicits persecutory delusions, third person auditory hallucinations,
running commentary, thought insertion, and somatic hallucinations. She then makes a risk assessment, takes a drug
history and assesses risk. The patient is clearly suffering from a psychotic disorder and the most likely diagnosis is
schizophrenia. Differential diagnoses would include a drug-induced psychosis.
Watch Video
Psychiatric Interviews for Teaching: Psychosis
YouTube URL: http://www.youtube.com/watch?v=ZB28gfSmz1Y
Text, eReadings or hyperlinks. While Recommended Readings are not required, they are
suggested as being very useful for greater depth.
Required Readings
Evans, K. (2017). Schizophrenia and psychotic disorders. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric and mental
health nursing (4th ed., pp. 341-369). Sydney: Elsevier.
Usher, Kim. (2017). Psychopharmacology. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric and mental health
Dodd, S, & Jeffs, S. (2014). Psychosis and psychotic disorders. In K.-L. Edward, I. Munro, A. Welch & A. Robins
(Eds.), Mental health nursing: Dimensions of praxis (2nd ed., pp. 189-205). South Melbourne: Oxford University Press.
Hungerford, C., Hodgson, D., Clancey, R., Monisse-Redman, M., Bostwick, R., & Jones, T. (Eds.). (2015). Mental
health care: An introduction for health professionals (2nd ed.). Milton, Qld: John Wiley. (pp. 377-421)
 Key Terms
Review the table of terms from the previous week. Practice using these terms accurately in the context of the focus
this week on nursing intervention.
 Examples of evidence based practice for schizophrenia
The Royal Australian & New Zealand College of Psychiatrists. (2016). Clinical practice guideline for the
management of schizophrenia and related disorders. (link fixed on 13/8/18)
The RANCP provides an excellent evidence-based resource for a wider clinical
audience than psychiatrists. Although this version has reached the five-year limit
generally accepted for clinical guidelines, it remains well worth examining as a current
comprehensive guide to best practice.
The electronic Therapeutic Guidelines is an excellent resource for current best practice for the treatment of psychosis.
 Self-Directed Activities (Week 5)
The activities this week will focus on the following video and an interactive learning tool related to schizophrenia.
Before watching the video of below, it is worth reviewing the action of dopamine. One of the main biological theories for the causati
symptoms of schizophrena centres on the action of dopamine and its pathways in the brain.
Watch Video
Dopamine Pathways
Duration: 1:14
URL: http://www.youtube.com/watch?v=FM-leD0Iyk4

Now watch the short video below explaining how anti-psychotic medications work at the level of individual neurotransmitters.
Watch Video
Dopaminergic Synapses
Duration: 1:10
URL: https://www.youtube.com/watch?v=Nt5AkMDLIdo

This short video provides a first-hand account of the experience of schizophrenia. Quentin's story illustrates the impact of a diagnosis
have on a family and importantly the role of family in recovery.
Watch Video
AFTER WINTER : A Real Life Schizophrenia Treatment Story
Duration: 15:03
URL: https://www.youtube.com/watch?v=ZNDBInn5neE

 Clinical scenario of "John S"
Try out an interactive learning tool to guide you through the nursing response for a person with schizophrenia
( www.wisc-online.com/learn/career-clusters/health-science/nur3704/care-of-the-client-with-schizophrenia ). This
link will take you to an external site where you can step through a changing scenario and respond to the different
needs of the person being admitted to hospital suffering from an episode of schizophrenia.
NOTE: The learning material requires Flash Player (https://get.adobe.com/flashplayer/). Most web browsers now
block Flash content by default. You will need to need authorise Flash for this site if this is requested.
Required Readings
Athanasos, P. (2017). Mood disorders. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric and mental health
Usher, K. (2017). Psychopharmacology. In K. Evans, D. Nizette & A. O'Brien (Eds.), Psychiatric and mental health
Hungerford, C., Hodgson, D., Clancey, R., Monisse-Redman, M., Bostwick, R., & Jones, T.
(2015). Mental health care: an introduction for health professionals(2nd ed.). Milton, Qld: John Wiley.
(pp. 277-299)
McAllister, M, & Dares, G. (2014). Mood and anxiety disorders. In K.-L. Edward, I. Munro, A.
Welch & A. Robins (Eds.), Mental health nursing: Dimensions of praxis (2nd ed., pp. 166-188). South
Melbourne: Oxford University Press.
 Key Terms
Chronic Grief SSRI
Cognitive therapy Serotonin
Depression Major depression
Emotion-focused Dysthymia
therapy
Exaggerated grief Anti-depressant
Grief Supportive
therapy/counselling
Masked grief
Mood disorder
Mood episode
 Examples of evidence-based practice for depression

Here are three examples of evidence-based resources to support your clinical practice for major depression in adults.
Holle, M. N. & Smith, N. (2018). Depression: major depressive disorder. Nursing Reference Center Plus, from
EBSCO Publishing.
The Nursing Reference Center Plus provides evidence-based information specifically targeted for
nursing. The NRC can be access via CDU Library. NOTE: NRC is primarily a United States resource so you
will encounter some terms (e.g. medication trade names) that are not used in Australia.
National Institute for Clinical Excellence. (2016, April 2016). Depression in adults: Recognition and
management. Retrieved 13th February, 2017, from https://www.nice.org.uk/guidance/CG90 .
The NICE is a well-known resource intended for a wide range of clinical professions. Here is an example
for the management of depressive disorder in adults.
While registered nurses do not prescribe, we are accountable for many aspects of administering
medications including knowing why, providing accurate information, reporting and recording the
administration and effect, including side-effects. For these reasons, the electronic Therapeutic Guidelines
are a well-regarded set of clinical guidelines for medications.
The self-directed activities this week will focus on the following videos and animation. Before watching the
video clip below on depression, it is worth reviewing the (major) related neurotransmitter for depression.
Watch Video
Human Anatomy Serotonin Pathways
Duration: 1:47
YouTube URL: http://www.youtube.com/watch?v=HojawnHt1yU

 Depression
Use this video to obtain a view of a presentation of major depressive episode. In addition to practising your ability to
assess the signs and symptoms, also consider the effectiveness of therapeutic engagement and the interview style.
Use the Discussion Board to explore this interview with other students.
In this film, the GP is seeing a patient who has a depressive disorder. The patient describes symptoms including low
mood, tearfulness, reduced energy, reduced motivation, early morning wakening, loss of appetite, weight loss, poor
concentration, reduced enjoyment and reduced interest in self-care. The GP explores the effect of the symptoms on
other people in the patient's life, explores the past history of low mood, and makes an assessment of suicide risk.
The GP then gives the patient an explanation of depression.
Watch Video
Psychiatric Interviews for Teaching: Depression
Duration: 14:45
YouTube URL: http://www.youtube.com/watch?v=4YhpWZCdiZc

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Questions:

Clinical scenario questions

 Understanding of clinical concepts.

biomedical model mental illness

recovery mental health

nature versus nurture psychological theories

sociological theories cultural safety

Indigenous mental health colonisation

human rights stigma

Mental Health: In Our Own Words

Avoidance behaviours Psychological interventions

Therapeutic Guidelines Ltd. (2016). eTG complete. [see especially "Psychotropic"]

 Generalised Anxiety Disorder

Akathisia Hallucinations Metabolic syndrome

Anhedonia Persecutory delusion

Delusion Ideas of reference

Dystonia Tardive dyskinesia

Flattened affect NMS

Grandiose delusion Word salad

Parkinson's syndrome Anticholinergic

 Examples of evidence-based practice for schizophrenia

 Self-Directed Activities (Week 4)

 Examples of evidence based practice for schizophrenia

Chronic Grief SSRI

Cognitive therapy Serotonin

Depression Major depression

Exaggerated grief Anti-depressant

 Examples of evidence-based practice for depression

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