MENTAL HEALTH CASE STUDY – Complex Nursing Practice 1
CASE STUDY
Sam Nelson is a 72 year old widowed gentlemen brought in to hospital via ambulance after his daughter found him at home. He had taken a poly-pharmaceutical overdose of medications he found around his house including pain killers, cardiac medications and sleeping pills. He also had left a stack of paperwork including a will and all his recently paid bills for his daughter on the kitchen bench with a suicide note explaining his decision. She found him lying in his bed and called an ambulance.
Mr Nelson spent 2 weeks in Intensive Care (ICU) and has been now transferred to your voluntary mental health unit. Vital signs on admission: BP = 104/54, HR = 51bpm, temp = 36.8, respirations 20, BSL 5.3 mmol/mL. On interview, Mr Nelson is dressed in pajamas, has disheveled hair and sitting hunched over in the chair in his room. He does not make eye contact and is speaking a quiet voice and mostly answering only yes or no, to your questions. He has not touched his meal tray and you note he has only eaten minimal food since admission and he states he thinks he may have lost about 10 or 12 kilos over the last few months. He states he does not want to talk about his suicide attempt, but does talk about how he is not happy with his life at the moment and sees no hope for the future. He does not appear to have any delusional content or perceptual disturbance, and is able to provide a clear history about recent events. He becomes tearful when his daughter arrives to visit.
Mr Nelson is a retired School teacher who has lost his wife 18 months ago to cancer. His daughter reports that since his wife’s death Mr Nelson has not been visiting with friends as he normally would, hasn’t attended his local Darts Club every Tuesday night, or RSL every Sunday afternoon, as is his normal routine. His daughter reports he has also stopped gardening which he normally loves, has not been cooking for himself and only eating if she brings cooked meals over. Mr Nelson has no previous psychiatric history, no history of deliberate self-harm and never attempted suicide in the past. He is currently taking medication for type 2 diabetes, but does not check his blood sugar levels regularly and has missed his last 2 GP appointments. Nil other significant history of drug and alcohol usage.
CARE PLAN
The psychiatric medical team review Mr Nelson and have commenced the following plan:
1. Mr Nelson can remain in the voluntary ward as long as he is compliant with treatment
2. 15/60 visual observations
3. Maintain safe environment
4. 1:1 time to ventilate and support
5. Regular suicide risk assessments
6. Commence health education
7. Develop a crisis safety plan
Question 1.
Complete the mental state examination (MSE) template using information from the case study.
Question 2.
Complete the risk assessment and clinical alert forms for Mr Nelson.
Question 3.
Choose three items from the care plan above and provide an explanation of how you would achieve these nursing expectations using references.
Marking Rubric
Does not meet expectation(Fail) / Meets expectation
(Pass)
Expectations / Not all questions attempted. / Responses submitted for all three questions. Questions 1 and 2 to be completed using black pen.
Question 1:
Mental State Examination (MSE) / Unable to identify mental health symptoms. Did not correctly identify what section of the MSE the symptoms belongs to. / MSE form used to answer Question 1.
Student identified mental health symptoms, and correctly classified them within the MSE subheading. Minimal errors or omissions.
Question 2:
Risk Assessment / Unable to identify key risk concerns from the case study, and unable to correctly list the alert categories. / Risk Assessment and Clinical Alert forms used to answer Question 2.
Able to identify key risk elements and complete the assessment form thoroughly. Identified clinical alerts, and categorised them correctly on the clinical alert form. Minimal errors or omissions.
Question 3:
Care plan / Unable to identify a minimum of three interventions for each item. Did not give an explanation of how these will be achieved. Little or no references. / Question 3 completed in Word document. Clearly identified at least three nursing interventions for each item, with rationale. Reference provided for each rationale. Table or essay format allowed. Word limit = 1,000 words.
Formatting / Written in first person. Content unclear due to frequent grammar and/or spelling errors. / MSE, Risk assessment and Clinical Alert forms all scanned and added as pictures to word document containing Question 3.
Marking guide included in submission.
Written in third person with minimal grammar and spelling errors.
Referencing / Referencing not in accordance with APA 6th edition expectations. / Referencing in accordance with APA 6th edition
***All red elements must be passed in order to pass the case study.
Result:
Feedback to student:
Marker:Date: