Assignment: Mental Health Case Study

Date Due: November 7, 2014

Table of Contents

Page

I. Scenario 1

II. Brief Risk Assessment Form 2

III. Identified Risk Factors and Nursing Diagnosis 3

IV. Mental Health Needs Care Plan 5

V. Physical Health Needs Care Plan 7

References 9

1

I. Scenario

Mr Smith is a 49 year old male. He was diagnosed with depression five years ago, following a difficult

divorce. He had counselling for six months, but has had no ongoing counselling since then and has never

been medicated. Mr. Smith has had limited contact with his teenage children since the divorce. He was

adopted as a young child, and has no awareness of any family history.

Mr. Smith is a business executive in a large company, and is responsible for sixty employees as well as

facilitating arrangements with other companies. He is a smoker, and has recently been drinking more than

usual. For the last six months he has not been engaging with his friends as he used to, and is no longer

taking part in his weekly golf lessons. He has become increasingly worried about the business’s recent

financial losses, and is not sleeping well.

This morning, Mr. Smith’s assistant came into his office to find him with three bottles of tablets scattered

on his desk and a full bottle of whiskey next to them. He had his head in his hands looking at the tablets.

When his assistant approached him, he was vague and disconnected. He told her, “I’ve had enough. I

don’t want to live anymore”.

The assistant convinced Mr. Smith to let her take him to the local emergency department, and it is here

that you meet him as you are a nurse working in the emergency department that day. Mr Smith reports no

previous attempts of self-harm. You note him to have an elevated BMI that classifies him as obese, and

has a 5x5cm leg ulcer that he states “has been there for a while”.

1. Identify the mental health risk factors and nursing diagnosis suggested in this scenario.

2. Prioritize and devise a plan of care to address Mr. Smith’s mental and physical needs (three

of each).

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II. Brief Risk Assessment Form

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III. Identified Risk Factors and Nursing Diagnosis

Petrila (2006) stated that brief risk assessment has a vital role in assessing and evaluating the safety

of the patient and even the security of others. According to Petrila (2006) it is the first step or a

gateway for the patient’s treatment and appropriate management in relation to suicide risk, violence

risk and the protective factors. Brief risk assessment also recognizes alternatives that would aid in

identifying possible the suitable plan for the patient that would manage in considering in estimating

the health care needs that the patient will be receiving (Petrila, 2006).In Mr. Smith’s case, the brief

risk assessment presented that he was high risk for suicide by having a score of 16 in the suicidal

risk section but on the other hand, it was shown in his assessment that he is low risk for violence

The case study presented that Mr. Smith is a middle aged man who is a 49 years old, in the brief

risk assessment his age is age and gender puts him in a greater risk for suicide. According to Gotlib

and Hammen (2008) men in their middle age are more likely to experience lowest moment of their

well being because men usually find it more difficult to talk about their feelings. The middle years

of the male gender can be filled with anxiety and sometimes they regret about their careers and even

marriages (Gotlib & Hammen, 2008)

It was mentioned that Mr. Smith was diagnosed with depression which increases his risk for

suicide. Zhang and Li (2013) stated that an individual who is suffering from depression loses the

ability to think of a solution about their future and they don’t tend to remember happy memories

which can become a reason for an individual to do some irrational choices or actions in life while

they are depressed.

Following his depression is a difficult divorce which led into a limited communication with his

children. Zhang and Li (2013) pointed out that it is common that a mother’s bond with her children

is stronger in comparison to a man between his children, as an outcome of a divorce agreement the

mother is more likely to win custody. For Mr. Smith’s situation, he loses not only his marriage but

also his children (Zhang and Li, 2013) .A divorce is a stressful event in that increases the amount of

an individual’s level of depression that can lead to anxiety, resentment and even regret (Zhang &

Li, 2013)

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Miller, Teti, Lawrence and Weiss (2010) stated that increased alcohol intake and is a sign that Mr.

Smith is not coping very well in his life situation. Wyder, Ward and De Leo (2009) indicated that

alcohol abuse will not provide a positive effect in a person’s decisions and judgment in a situation

instead, it will alter their way of thinking that is why drinking is their way to mask and forget what

pain and stress .Alcohol decreases self esteem and during binge drinking will entail suicide attempts

(Miller et. al., 2010)

According to Dobson, Dozois and David (2011) Mr. Smith verbalized that he’s had enough and he

does not want to live anymore, that statement gives a signal or a warning that Mr. Smith is having a

suicidal ideation or plan, this implies that Mr. Smith needs a close monitoring due to his

hopelessness and inability to control the circumstances or challenges that he is experiencing at the

moment. Dobson, et. al. (2011) claimed that suicidal ideation is common during a great stress or

occurrence of life crisis.

People who think that they have no ability to fix their problems will end up wishing or thinking

they don’t want to live anymore. Mr. Smith who was found with three bottles of tablets scattered on

his desk and stating that he does not want to live anymore is a sign that he is taking an action to

commit suicide and also an indication as a cry for help (Dobson, et. al. 2011).

Nursing Diagnosis:

Risk for suicide related to situational crises, stress and hopelessness as evidenced by verbal

statement: “I’ve had enough. I don’t want to live anymore” (Moyet, 2010)

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IV. Mental Health Needs Care Plan

Risk for Suicide

As for the case of Mr. Smith, his brief Risk Assessment shows that he has a high Risk for suicide by

having a score of 16 which needs an immediate intervention such as providing safe environment.

As stated by Moyet (2010) patients with suicidal tendency are usually desperate to escape their

situation and monitoring the patient’s safety will prevent them in harming themselves. Removing

sharp objects and checking the patient constantly in a different time frame will keep the patient in

planning a suicide (Moyet, 2010)

Another intervention that will prevent Mr. Smith in committing suicide is to perform therapeutic

nurse-patient relationship. According to Townsend (2008) a good rapport between the nurse and

patient promotes a trusting environment.

An additional implementation such as encouraging Mr. Smith to express his feelings and giving

time to listen for his concerns are essential part of taking care of a risk for suicide patients

(Townsend, 2008).Expression of feelings will aid in the development of understanding of the

situation and it will be a helpful way to open up what they feel and think (Townsend, 2008)

Based on Mr. Smith’s Brief risk assessment, he needs a referral in a Mental Health Service due to

his high score for suicide. According to Mental Health Act (1996) Mental Health Services can

facilitate Mr. Smith’s case such as providing therapies, support groups and interventions that will

prevent the patient from attempting or committing suicide.

For the evaluation, Mr. Smith remained safe and kept from harming himself and manifested a

trusting attitude towards the nurse. In addition, Mr. Smith was able to tell his feelings towards his

current situation.

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Hopelessness

Hopelessness is another Health priority that needs an urgent action that would facilitate in Mr.

Smith’s problem in relation to his current life events. According to Townsend (2008) it is necessary

to provide opportunities to make choices for Mr. Smith with his current situation and provide

options will increase Mr. Smith’s feeling in his sense of control in life.

It is vital to help the patient identify personal strengths and establish realistic goals in Mr. Smith’s

life (Moyet, 2008).Having an unrealistic goals will not increase the patient’s feelings of being

hopeful and will not solve the patient’s problem solving ability (Moyet, 2008).

Furthermore, it will be helpful if Mr. Smith will be encouraged in sharing and voicing out areas

of his life that he thinks is out of control (Townsend, 2008)

Mr. Smith’s evaluation shows that he verbalized number of choices and plans to be able to take

control over his life situation by accomplishing step by step problem solving to increase his

optimism. Mister Smith was able to verbalized his feelings about his current life situations which he

has no control.

Ineffective coping related to situational crises.

Newfield, Hinz, Tilley, Sridaromont and Maramba (2007) stated that as a part of nursing

management it is important to encourage Mr. Smith to discuss angry feelings and assist him in

identifying the reasons of declined coping skill. Expression of feelings with a trusted person can

facilitate the patient to work through unsettled issues (Newfield et al., 2007)

Moreover, emphasize the importance of performing independent behaviors as possible issues

(Newfield et al., 2007).Being independent in overcoming obstacles in life reinforces and enhances

the coping skill of a person (Newfield et al., 2007).

Lastly, assist or support Mr. Smith to recognize different strategies to cope up and adapt to

whatever situational changes that he will encounter aspect of his life which control is maintained

(Newfield et al., 2007). Acknowledgment of individual control increases an individual’s self-esteem

(Newfield et al., 2007)

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For the evaluation, Mr. Smith manifested increased knowledge by verbalizing various alternatives

in doing socially acceptable and lifestyle appropriate coping skills to use in response to stress.

V. Physical Health Needs Care Plan

Impaired skin integrity as evidenced by presence of leg ulcer

With Mr. Smith’s skin condition, it is recommended to observe and educate Mr. Smith’s about his wound and watch out for signs and symptoms of any complication (Moyet, 2010).Early assessment and action or interventions will avoid the development of harmful and damaging problems (Moyet, 2010).

An individualized plan about the skin condition would increase improvement of Mr. Smith’s wound management plan, encourage Mr. Smith in planning interventions in wound care (Moyet, 2010).According to Moyet (2010) it is essential to include the patient in planning the wound care to know his preferences and educate him at the same time.

In Mr. Smith’s case, assessment of diet or nutritional status is vital and referral for a nutritional consult to organize dietary supplements as needed (Moyet, 2010).As stated by Moyet (2010) an inadequate nutrition can compromise or interfere in faster wound healing and puts patients for more skin breakdown.

Mr. Smith demonstrated a clear understanding in monitoring and checking any signs or changes in his leg ulcer as evidenced by no report of further injury on the wound. Mr. Smith presented an adequate understanding in proper nutrition to promote faster healing as evidenced by following the dietary regimen. In addition, Mr. Smith verbalized his preferences regarding his wound management care plan.

Imbalanced Nutrition: More Than Body Requirements related to obesity as evidenced by elevated BMI

It is essential to assess Mr. Smith’s physical status with regards to weight control and refer as needed (Newfield et al., 2007).Non dieting can affect thoughts and emotions and body image in relation to obesity but on the other hand, performing weight maintenance helps an obese person to have a positive outlook about oneself (Newfield et al., 2007).

Another intervention is to determine Mr. Smith’s attitudes in relation to dieting, eating habits and patterns that is affecting Mr. Smith’s weight status (Townsend, 2008).A person’s beliefs and thinking towards eating may affect one person’s appetite and metabolism (Townsend, 2008).

Educate Mr .Smith regarding the significance of eating healthy foods and its benefits to his body (Newfield et al., 2007). Education provides ample ideas on how to modify or improve a person’s perspective about nutritious foods (Newfield et al., 2007).

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Mr Smith articulated actions that are important to reduce weight Mr. Smith also cooperated in recognition verbalized his eating patterns and was able to cooperate Mr. Smith exhibited appropriate behaviors towards eating healthy foods and recognized consequences of having an unbalanced diet.

Risk for infection as evidenced by display of 5x5 leg ulcer

Assess Mr. Smith if he is exhibiting signs and symptoms of infection that includes checking his temperature, unwanted discharges, changes in color or size and sensation (Moyet, 2010). Unwanted changes around the wound or elevated temperature or fever may indicate infection, and the other manifestations are also significant in detecting an infection (Moyet, 2010).

Promote and emphasize to Mr. Smith the importance of hand washing technique and keeping a clean surrounding (Moyet, 2008). As stated by Moyet (2008) hand-washing serves as a first line of defense to fight infection and prevent it to spread around the Mr. Smith’s wound area.

Provide health teachings to Mr. Smith such as keeping the wound area always clean and dry (Newfield et al., 2007). A wet area specially a wound that is not properly dried can harbor bacteria that can lead to infection (Newfield et al., 2007).

Part of the evaluation shows that Mr. Smith was free from any signs of fever. He was able to prevent the spread infection by executing the correct way of hand washing technique.

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References

Dobson, Keith, S., Dozios, David, J. A. (2011). Risk Factors in Depression. Burlington: Elsevier

Science.

Gotlib, Ian H., Hammen, Constance L. (2008). Handbook of Depression. New York. U.S.A:

Guilford Publications.

Mental Health Act (1996) retrieved from:

http://www.health.wa.gov.au/mhareview/resources/legislation/wa_mental_health_act_199

6.pdf

Miller, T. R., Teti, L. O., Lawrence, B. A., & Weiss, H. B. (2010). Alcohol involvement in

hospital-admitted nonfatal suicide acts. Suicide & Life - Threatening Behavior, 40(5),

492-9. doi:http://dx.doi.org/10.1521/suli.2010.40.5.492

Moyet, L. J. C. (2010a). Handbook of Nursing Diagnosis. Philadelphia, PA: Lippincott

Williams& Wilkins.

Moyet, L. J. C. (2008b). Nursing Diagnosis: Application to Clinical Practice. Philadelphia, PA:

Lippincott Williams& Wilkins.

Newfield, S. A., Hinz, M. D., Tilley, D. S., Sridaromont, K. L., Maramba, P. J. (2007). Cox's

clinical applications of nursing diagnosis: adult, child, women's, mental health, gerontic,

and home health considerations. Philadelphia, PA: F.A Davis Company.

Petrila, J. (2006). Introduction to this issue: brief risk assessment. Behavioral Sciences & The

Law. John Wiley and Sons.

Townsend, M. (2008). Nursing Diagnoses in Psychiatric Nursing: Care Plans and Psychotropic

Medications. Philadelphia, PA: F.A Davis Company.

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Wyder, M., Ward, P., & De Leo, D. (2009). Separation as a suicide risk factor. Journal of

Affective Disorders, 116(3), 208-213. doi:http://dx.doi.org/10.1016/j.jad.2008.11.007

Zhang, J., & Li, Z. (2013). The Association between Depression and Suicide when Hopelessness

is controlled for. Comprehensive Psychiatry, 54(7), 790-6.

doi:http://dx.doi.org/10.1016/j.comppsych.2013.03.004

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313041

Nursing Practice 365

Mental Health Case Study

Marking Guide

Student Name_____________________________

Needs

Very

Improvement

Satisfactory

1 2 3 4

5

Mark

Risk

assessment

and nursing

diagnosis

a) A completed risk assessment

form

b)A nursing diagnosis for the

main mental health issue based

on the risk assessment

/5

Subject

content

Have the mental health and

physical health issues been

prioritised adequately with

rationale?

/5

Plan of care Plan of care formulated

for each of the mental

and physical health care

needs identified in

question two.

a) Appropriate,

/10

12

accurate and

relevant detail in care plan

b) Provided relevant

rationales for interventions

identified supported by

appropriate references

/5

Formatting a) Content and title page

b) Headings and page

numbers

c) Spelling and grammar

d) APA 6th Edition referencing

/5

TOTAL /30

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