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Scenario PatientAdmission You are an EN working at the mental…

 

Scenario

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Patient Admission

You are an EN working at the mental health ward in a local hospital. Jason, a 37-year-old Caucasian male with multiple past mental health hospitalisations, was admitted 4 days ago in your ward, under the provisional diagnosis of depression, suicidal ideation and alcohol abuse.

Jason lives with his de facto partner,who is currently in the waiting lounge.

After high school, Jason was on and off drug and alcohol rehabilitation programs. The couple are currently living on government grants. Past social history indicates possible sexual abuse. Jason currently denies suicidal ideation but has had past attempts using knives; details regarding these attempts are unclear. He denies any legal history of violent/criminal behaviours.

 

History of Present Illness:

This is one of multiple hospitalisations for Jason who has a diagnosis of schizoaffective disorder. Jason has a history of alcohol dependence and this intensified after his friend recently died. Also, Jason’s father died last year on his birthday, due to prostate cancer.Jason himself was diagnosed with a lymphoma in 2010, and underwent a biopsy of axillary lymph nodes. He says it has now resolved but he states this is contributory to his increasing depression and SI. He admits to increased drinking of “about 6 beers a day and some vodka”. He reports having blackouts. He denies any change in weight or appetite. He reports his concentration is poor, sleep is decreased. He reports his mood as depressed and he says he feels overwhelmed. Jason self admitted to the ED because of feeling unsafe, but upon admission to the unit, he denies that he had suicidal tendencies. He also denies symptoms of psychosis, although he appears preoccupied and guarded during the interview. He appears to have some thought blocking, but when questioned, reports he is “trying to concentrate”. No history of withdrawal seizures present. Patient has been admitted for substance abuse numerous times, at several locations.

 

Admitting Assessment Data & Mental Status Examination:

You are responsible for undertaking a Mental Status Examination and Admitting Assessment for Jason.The below is the examination result and data.

Jason appears older than the stated age of 37. He is heavyset with fair grooming. Mild psychomotor retardation noted. Maintains eye contact, though at times is staring intently and seems

preoccupied. Concentration is poor. Mood is reported as depressed and anxious. Affect is odd, anxious and constricted in range. Speech halting at times. Thought process significant for thought blocking. Denies any visual or auditory hallucinations. No delusions elicited. He currently denies suicidal ideation or homicidal ideation. Judgment and insight are fair.

 

What is happening now?

At the end of assessment, Jason becomes increasingly wild, grabs a scissors from under his bed and threatens to kill himself.You then use your negotiation and communication skills and implement the various strategies to manage and reduce risk of his challenging behaviours.

 

Nursing Care plan development to contribute to recovery

Based on the assessment outcome,in collaboration with the registered nurse, interdisciplinary health care team, Jason and his partner, you develop a nursing care plan for Jason’s recovery. After being treated for 1 month, Jason recovers well. The doctor and RN inform you that Jason can discharge from the hospital and use community services for further treatment.

 

Questions based on Scenario

1. Identify 2 conditions relating to the mental state and behaviour of Jason and 4 signs and symptoms of identified mental health conditions, and their associated broad classifications of mental illness and terms.

2. How should you as an EN respond to Jason’s signs and symptoms of mental health conditions within your scope of practice? State at least ten (10) strategies that you can use.

3. Identify at least 2 biopsychosocial effects from Jason’s history that may have contributed to his mental illness.

4. How will you negotiate with Jason to calm him down? State 2 measures you will use.

5. Describe briefly how you, as an EN, can maximise Jason’s health outcomes with support from an

interdisciplinary team using recovery principles. Provide at least 4 strategies that you would implement and explain briefly what principles are applied to your decisions and who you will consult with.

6. Based on Jason’s health condition and risk assessment and in consultation with RN and interdisciplinary team, develop a nursing care plan that includes 3 nursing interventions contributing to Jason’s recovery which are related to Jason’s reduced physical health, depression, shizoaffective disorder and

alcohol abuse, using the following template:

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