Melanie is a 16-year-old who lived with her parents and two siblings in a suburban neighborhood until her parents separated 6 months ago.

QUESTION

Melanie is a 16-year-old who lived with her parents and two siblings in a suburban neighborhood until her parents separated 6 months ago. At that time her school performance began to decline and she was truant from school, frequently not returning home until after dark. When she arrived home, she was verbally abusive to her mother when asked where she had been. Three days ago, her relationship with her boyfriend of 1 year ended when he told her she had “changed” and he didn’t know how to “relate to her anymore.” That evening, Melanie became very disruptive at home, breaking lamps and mirrors and turning over furniture. her mother attempted to talk to Melanie, her daughter threatened her. Melanie was admitted to the children’s psychiatric unit of the local inpatient mental health facility.

Since her admission, Melanie has refused to attend any group sessions or talk to staff and spends most of her time in her room. At the change of shifts today, the staff heard a loud noise after which the registered nurse and two psychiatric technologists (psych tech) rushed to Melanie’s room. There they observed Melanie screaming incoherently and thrch•ving chairs against the wall; clothes were littered across the floor.

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1. Discuss your impression of the situation with Melanie.

2. WHAT impact might Melanie’s level of growth and development have on her response to life stressors?

3. What are the priorities of care for Melanie at this time?

4. What other assessment data would be helpful for the nurse to have to prepare Melanie’s care plan?

ANSWER

 Assessment and Priorities of Care for Melanie in a Psychiatric Unit

Introduction

This essay discusses the situation of Melanie, a 16-year-old girl who was admitted to a children’s psychiatric unit following a series of concerning behaviors. The essay explores the impression of the situation, the impact of Melanie’s level of growth and development on her response to life stressors, the priorities of care for Melanie at this time, and the additional assessment data that would be helpful for the nurse in preparing Melanie’s care plan.

 Impression of the Situation with Melanie

Based on the provided information, Melanie’s recent behavior suggests a significant emotional and behavioral disturbance. Her declining school performance, truancy, verbal abuse towards her mother, and destructive actions indicate a possible manifestation of emotional distress and coping difficulties (Brauner & Stephens, 2006). The termination of her one-year relationship with her boyfriend may have triggered an emotional crisis, leading to her escalating disruptive behaviors and outbursts.

Impact of Growth and Development on Response to Stressors

Melanie’s age and developmental stage as an adolescent play a critical role in her response to life stressors. Adolescence is a period characterized by rapid physical, emotional, and cognitive changes, as well as a quest for identity and autonomy. The challenges associated with her parents’ separation, coupled with the breakup with her boyfriend, can profoundly impact Melanie’s emotional well-being and exacerbate feelings of confusion, anger, and frustration. Adolescents often struggle with managing emotions effectively, and the accumulation of stressors can overwhelm their coping mechanisms, potentially leading to behavioral disturbances.

 Priorities of Care for Melanie

Given Melanie’s current state, the priorities of care should focus on ensuring her safety, stabilization, and establishing a therapeutic alliance. The immediate concern is to address her self-destructive behaviors and potential harm to herself or others. Staff should employ crisis intervention techniques to de-escalate the situation and ensure a safe environment(Treatment, 1999) . Once safety is established, efforts should be made to engage Melanie in therapeutic activities, including individual counseling, where she can express her emotions and receive support. Collaboration with her mother and involving her in family therapy can also be crucial in addressing the family dynamics and providing a support system for Melanie’s recovery.

 Additional Assessment Data for Care Planning

To develop an effective care plan for Melanie, the nurse should gather comprehensive assessment data. This may include conducting a thorough psychiatric evaluation, assessing for any underlying mental health disorders, and exploring any history of trauma or adverse childhood experiences. Gathering information about Melanie’s social support system, including her relationships with family and friends, can provide insights into her overall support network. Understanding her coping strategies, strengths, and areas of vulnerability can assist in tailoring interventions to her specific needs (Bethell et al., 2017). Additionally, assessing her level of engagement and willingness to participate in treatment modalities will help in developing an individualized care plan that promotes her active involvement in her own recovery.

Conclusion

Melanie’s situation highlights the need for comprehensive and individualized care in a psychiatric unit. Understanding the impact of growth and development on her response to stressors, prioritizing her safety and stabilization, and obtaining additional assessment data are crucial for effective care planning. By addressing her immediate needs, fostering a therapeutic alliance, and providing appropriate interventions, the psychiatric unit can play a vital role in supporting Melanie’s emotional well-being and facilitating her recovery.

References

Bethell, C., Carle, A. C., Hudziak, J. J., Gombojav, N., Powers, K. M., Wade, R., & Braveman, P. (2017). Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice. Academic Pediatrics, 17(7), S51–S69. https://doi.org/10.1016/j.acap.2017.04.16

Brauner, C. A., & Stephens, C. B. (2006). Estimating the Prevalence of Early Childhood Serious Emotional/Behavioral Disorders: Challenges and Recommendations. Public Health Reports, 121(3), 303–310. https://doi.org/10.1177/003335490612100314

Treatment, C. F. S. A. (1999). Chapter 4—Brief Cognitive-Behavioral Therapy. Brief Interventions and Brief Therapies for Substance Abuse – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK64948/ 

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