“Assessment is one of the most important and fundamental skills of the mental health nurse.Through assessment we develop an understanding of the consumers, formulate a plan of care and contribute to the decision making of multidisciplinary teams.”1
2809NRS Application of Case Study To Nursing Practice Assignment-Griffith University Australia.
Task Description:
1.Choose one case study from the case studies supplied
2.With reference to appropriate scholarly literature, answer the following questions about your chosen case study:
a. Explain the importance of identifying the biopsychosocial factors that impact on the well-being of a client during a mental health assessment.
b.Identify three (3) factors that have impacted on the presenting problem of the client from your chosen case study. Explain the significance of each factor in understanding the development of the client’s presenting problem.
c.With reference to the presentation of the client from your chosen case study, identify and justify three (3) appropriate nursing interventions.
d.Discuss the ethical and/or legal implications the nurse must consider for the client from your chosen case study.
Further information:
a.This written task is not an essay and does not need an introduction and conclusion, however your answers must be written using appropriate academic writing conventions including referencing of research evidence less than 10 years old (since 2010).
b.Please refer to the Griffith Health Writing & Guide for accepted standards in writing and referencing styles.
c.*‘Nursing interventions’ refers to interventions that could be conducted by a newly graduated registered nurse, not a specialist mental health nurse.
d.Refer to the ‘Marking Criteria’ for further information regarding the requirements of each question.
1 Evans, Nizette & O’Brien, 2017, p.516.
2 Nursing intervention:
Express hope that clients will get better. Focus on their strengths, however small these may seem.
Justification:
By identifying their strengths and giving them hope and positive regard, the nurse encourages clients to regain a sense of self-worth. (Evans, Nizette & O’Brien, 2017, p. 374)
- The reference list that will include references from all four questions will be included at the end of the written answers, on a separate page.
- State your word count (excluding your reference list) on the title page. The word limit for this assessment is 1500 words. Word limits for assessment items need to be strictly adhered to. The word limit for an assessment item includes in text citations, tables and quotations. The word limit DOES NOT include the reference list. Please note the marker will cease marking your submitted work once they have reached the allocated word limit.
2809NRS Application of Case Study To Nursing Practice Assignment-Griffith University Australia.
Submission:
Your responses to the questions must be submitted as an electronic file to the campus- specific “final” Turnitin portal available from the 2809NRS Learning@Griffith site.
Case Study 1 Rachel 29 years
Rachel has returned for assessment following her discharge from an inpatient episode of care two weeks ago. Rachel states that she has broken up with her boyfriend, and a friend accompanying Rachel reports that her neighbours have raised concerns about her staying up all night listening to
music and singing loudly. The neighbours have had multiple arguments with her regarding the noise, when previously there was a friendly relationship between them. Her neighbors have lodged a complaint with the landlord about the noise and she has received a warning about on going noise from her unit. It has also been reported that since breaking up with her partner, many deliveries of online shopping packages have arrived, as well as an increasing number of men leaving her apartment after nights out.
Rachel is presently prescribed Lithium 500 mg BD, Olanzapine 10 mg nocte with PRN Diazepam 10mg, Olanzapine 5mg and Temazepam 20 mg. Rachel reports “I’m too busy with my online fashion empire to take medication” and hasn’t taken medication since leaving hospital. Rachel states she no longer needs medication as it makes her “mind numb”.
Rachel is admitted to the unit and she has been observed to be teary at times in her room about her break up and then at other times overly friendly with male patients and staff. The Nurse Unit Manager and staff have communicated with her about appropriate behavior with male patients and staff which Rachel laughed off, saying “I’m just friendly, what’s the problem?”
Rachel has been observed to be changing her clothing multiple times throughout the day with increasing make up application. Her clothing is at times revealing and the staff have had to prompt her to change into more appropriate clothing when on the unit. Rachel has reported not sleeping
well the last few nights, and night staff report she was up on several occasions through the night, despite having the maximum dosages of PRN charted.
Rachel is estranged from her family; her father is living in another state and her mother who had a diagnosis of manic depressive in the 80s, died when Rachel was 16yrs. Rachel found her mother “sleeping” with a bottle of tablets beside her. Despite paramedics attending, Rachel’s mother was
not able to be revived. The family suspect suicide, however, there was no investigation at the time.Rachel found life harder after her mother died and began to withdraw from her family. Her sisters have reported they noticed Rachel partying more after their mother died. Rachel’s two sisters live
nearby but no longer have contact with her due to “Rachel’s drinking, lying and poor behaviour at all hours”. Rachel does not talk about her mother’s death or her relationships with her family as “they don’t get me”.
Rachel’s few friends from work are concerned about her increasing erratic and inappropriate behaviors. She is often “too busy to eat” and staff note she is not eating much at mealtimes however her weight has not decreased since being on the ward.
Case Study 2 Sam 17 years
Sam has just been admitted to your unit and this is her first episode of care. Sam was born a male and is now living as a female. Physically, Sam is tall and solid in stature and dresses in female oriented attire. Sam reports past trauma in childhood involving an older cousin and reports ongoing
nightmares, “I just can’t sleep; when I close my eyes, I have nightmares”.
Sam copes by cutting her arms and legs. The cuts are usually superficial in nature and she will dress them herself with bandaging provided by staff. If they are deeper requiring closer attention, her plan is to go to the local GP clinic for assistance. Often though Sam will find new or agency staff and ask
them to dress her cuts. This has been causing some issues amongst the treating team and staff as Sam is often heard to state “well X nurse helps me – she/he is the only nurse who understands me”
Sam is at high school and reports regular bullying from some of the students calling her names and she has stopped attending her school. Sam often finds it hard to source the kinds of clothing she would like to wear, as her stature is bigger than most female clothing. This is a source of frustration for her and she often makes her own clothes. This requires a sewing machine, which is not currently allowed on the unit due to safety risks. Sam is not happy with this decision and she often asks staff
when she can have her sewing machine. There is a sewing machine in the craft room, so she often wants to be let in there to use it. Yesterday she removed a needle and cut herself requiring a trip to the local GP for stitches.
Sam lives with her family who are supportive and has some friends who visit her in the hospital. Her friends often bring her pizza and high fat foods. Sam has gained 15 kgs since being on the unit and despite education about healthy weight range she is not listening and reports, “I don’t really care –pizza is nicer than the food here”.
Sam is currently prescribed the following medications and Sam’s doctor would like to review her medication however, Sam is resistant.
• Mirtazapine 30mg Mane, Seroquel 200 nocte, Seroquel 100 mane, Olanzapine 5mg BD. PRN Olanzapine 10mg, Diazepam 10 mg, Diazepam 20mg. Sam has a community psychologist and has been part of a transgender support group for 2 years.
2809NRS Application of Case Study To Nursing Practice Assignment-Griffith University Australia.
Sam reports: “they are a good support but they are mostly old and don’t get what I’m going through…… no one does”. Recently Sam’s only close friend from the support group completed suicide and “this has been on my mind”.
Case Study 3 Tina 38 years
Tina presented to the hospital after retiring from the Army following 15 years of service. Tina reports on going nightmares and periods of disassociation. Tina has been drinking four bottles of red wine a
night “to manage the nightmares and flash backs”. She is currently monitored and her observations ae being recorded on an Alcohol Withdrawal Scale. Tina’s scores on this scale have averaged 15 since
admission three days ago.
Tina is a quietly spoken woman who stays in her room for long periods and only briefly attends the programs provided by the unit. She does not engage with other patients or staff. Staff have reported that Tina is “brittle and sharp” at times when they interact with her. Other patients have also
complained about ‘the rude lady’.
Tina lives alone in her own home and received a veteran’s pension. She attends a specialist PTSD treatment program for returned service members. During her stay on the unit, Tina starts to refuse to attend the programs stating, “I don’t have the same problems as these people and I already go to
the veteran’s program”.
Tina is a smoker but is currently trying to quit and is taking nicotine replacement therapy (NRT) to assist. Staff often notice she smells of cigarette smoke, but Tina has denied she is still smoking.
Staff have reported that Tina is often awake on the night shift rounds and is a “light sleeper”. She is often up first thing in the morning and keeps her room very tidy. She does not like the nursing staff coming into her room often asking staff to “leave my room please” and only tolerating brief
interactions with the staff.
She has no family and very few friends – none that come to visit or that she wishes to contact. Tina does have a service dog who remains with her on the unit for support. Her service dog is aging, and Tina has expressed concern about him dying.
Tina has experienced much loss in her life. When she was five years old her father was killed in the line of duty on deployment and her mother and brother died in a car accident when she was ten. Tina reports she “tried grief counselling but it didn’t help – its best to ignore feelings”. Tina was
raised by her elderly grandparents who she states, “weren’t very caring so I left as soon as I could”. Tina recalls “my grandmother often drank sherry all day, so I used to take sips when she wasn’t looking”. When in the services she reports “we all drank to numb the stuff we see and do”
2809NRS Application of Case Study To Nursing Practice Assignment-Griffith University Australia.
Tina reports craving alcohol especially in the evenings as that is when she would usually drink to then fall asleep.
Tina is currently prescribed the following medications:
• Thiamine100mg TDS, Diazepam 10 mg, Latuda 40 mg Nocte and Prazosin 4mg nocte. PRN Temazepam 20mg, Diazepam 10 mg, Seroquel 25mg.
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