Mental Health
CASE STUDY: SARAH JONES
You are coming onto a late shift (1430-2300 hrs) at the Base Hospital as an Enrolled Nurse.
The ISBAR handover from the morning shift is as follows:
INTRODUCTION:
⦁ Miss Sarah Jones
⦁ 36 year old female
SITUATION:
⦁ Brought into ED by ambulance on a EEO.
⦁ Ambulance stated that Sarah’s neighbours had seen her acting bizarrely in the street.
⦁ Sarah was unable to answer questions from the Ambulance.
⦁ Sarah appeared disorientated.
⦁ Sarah did agree to go with Ambulance to the hospital.
⦁ Sarah is known to Mental Health Services and has had previous admissions over the past 10 years
BACKGROUND:
Biological factors
⦁ Diagnosis of schizophrenia
⦁ Smoker
⦁ Currently prescribed anti psychotic medication
⦁ Hx Depression, Anxiety
⦁ no Advanced Health Directive in place.
⦁ Previous admissions notes highlights that she can be verbally aggressive when unwell.
⦁ Additionally it has been recorded that she has attempted suicide for one of the previous admissions.
⦁ Triggers for aggression can be stress related.
⦁ On this particular occasion she is not displaying any verbal aggression.
⦁ Previous documentation states that Sarah has not attempted to abscond.
⦁ Sarah is vulnerable to exploitation when she becomes unwell.
⦁ Sarah has admitted to using illicit substances. She states they stop the voices that she is constantly hearing in her head.
⦁ Sarah has become non-compliant with her oral medications. She took herself off them as she noticed she was gaining weight.
⦁ Consequently by using illicit substances and not taking her medications are contributing reasons for this admission.
⦁ Sarah when well does have insight to her mental illness which is a protective factor for her.
Psychosocial factors
⦁ Has been having trouble sleeping
⦁ Has lost interest in food
⦁ Has become increasingly paranoid.
⦁ Poor self cares
Social factors
⦁ Lives alone in Department of Housing unit complex.
⦁ No children.
⦁ Mother is her only support.
ASSESSMENT:
⦁ Sarah is at risk of harm to self due to paranoia.
⦁ For admission to the Adult Mental Health Inpatient unit.
⦁ Currently Sarah is clearly psychotic, however she is able to concentrate on what you are saying.
RECOMMENDATIONS:
⦁ Needs a full admission which includes relevant information.
⦁ Sarah is to be transferred to Mental Health Impatient unit after being medically cleared from ED
⦁ Based on your assessment, she may need referrals to appropriate allied health.
PLAN FOR MHU ADMISSION:
⦁ Admitted as per the organisational admission policy
⦁ Place on 15/60 minute observations
⦁ After consultant review Sarah is to be placed on a involuntary admission as she is not willing to take medication and accept treatment
⦁ administer PRN medications to assist with psychotic symptoms
⦁ Base line observations: QADDS, height, weight, stomach circumference to initiate metabolic monitoring, bloods,
MSE attended
⦁ UDS screening for illicit substances or any organic issues
MSE
Appearance/Behaviour – Sarah presents as 36 y/o female of stated age. Good eye contact, co-operative, personal hygiene is acceptable.
Speech- normal rate, rhythm and volume.
Mood is stated as ‘6/10’,
Affect is congruent.
Thought form is normal amount of thought production that flow continuously.
Thought content – nil delusional content
Perception – Sarah states that she is hearing voices.
Insight/Judgment – poor – Sarah states that she does not need her medications and that she should not be in hospital.
Orientation – Sarah is oriented to time, place and person.
Rapport was easily established.
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Question 1
As an Enrolled Nurse, describe your role in the admission process for a consumer in an Adult Mental Health Inpatient Unit.
Also list the forms used in this admission process.
Question 2
Analyse Sarah’s case study.
a. List at least three actual health problems?
b. List at least three potential health problems?
Question 3
Using the actual and potential health problems you are required to plan Sarah’s care.
1. Identify what actual health problem is a priority.
2. What are 3 nursing interventions that you, as the Enrolled Nurse, can do at her bedside?
3. List at least two other service providers you could suggest being involved with Sarah’s care?
4. After you have provided the nursing care, how can you evaluate the outcomes.
Question 4
a. Stigma and discrimination may be encountered by Sarah. What could be the impact of stigma and the discrimination that Sarah may encounter as a mental health consumer?
b. How do culture and belief systems effect a mental health consumer? You may find it helpful to review the information in the link below to help you respond to this question.
Question 5
Sarah was placed on a Involuntary (compulsory) admission
a. Explain (50-100 words) what an involuntary (compulsory) admission means and what are the obligations of the treating team. Ensure you provide a reference in your answer.
b. What are the consumer rights within mental health? You may find it helpful to review the Australian Government document “Mental health statement of rights and responsibilities” to help with your response.
c. Explain (50-100 words) the objectives and principles of the Mental Health Act 2016. Ensure you put this in your own words.
Question 6
(a) What are the community or online support services available in the local area to support Sarah’s recovery when she is discharged from the Mental health Unit ( MHU)?
(b) What are the community or online support services available in the local area to support Sarah’s mother as her carer?
CASE STUDY:
You are coming onto a early shift (0700 – 1530 hrs) at the Base Hospital as an Enrolled Nurse.
The ISBAR handover from the night shift is as follows:
INTRODUCTION:
⦁ Miss Joan Smith
⦁ 59 year old female
SITUATION:
⦁ BIBA to ED
⦁ OA QAS stated that Joan contacted 000 after ingesting 30 antidepressant tablets.
⦁ Joan was able to answer some questions.
⦁ Joan did agree to go with QAS to the hospital.
⦁ Joan was transferred to Mental Health Inpatient unit after being medically cleared.
BACKGROUND:
Bio
⦁ Uncontrolled Type 2 Diabetes
⦁ Recent weight loss
⦁ Smoker – @ 30 cigarettes per day.
⦁ Hx Depression, Anxiety
⦁ Reported “exhaustion”
Psycho
⦁ Has been having trouble sleeping
⦁ Irritable
⦁ Has lost interest in food
⦁ Has become increasingly paranoid.
⦁ Poor self cares
Social
⦁ Lives alone
⦁ No children.
⦁ Minimal support
⦁ Family expect her to look after their mother –
⦁ Employed
⦁ When well enjoys craft
ASSESSMENT:
⦁ Joan is at risk of harm to self due to still voicing ‘nobody has ever loved me and if I died my family would be better off’.
⦁ For admission to the Adult Mental Health Inpatient unit.
RECOMMENDATIONS:
⦁ Needs a full admission to Adult Mental Health Inpatient Unit which includes relevant information.
MHU ADMISSION:
⦁ Admitted as per the organisational admission policy
⦁ Voluntary patient
⦁ Placed on 15/60 minute observations
⦁ Base line observations: QADDS, height, weight, stomach circumference to initiate metabolic monitoring, bloods,
MSE attended
⦁ UDS screening for illicit substances or any organic issues
MSE
Appearance/Behaviour – Joan presents as 59 y/o female of stated age. Good eye contact, co-operative, disheveled,
Rapport was easily established.
Speech- normal rate, rhythm and volume.
Mood is stated as ‘4/10’,
Affect is congruent.
Thought form is normal amount of though production that flow continuously.
Thought content – nil delusional content
Perception – Nil perceptual disturbances.
Insight/Judgment – poor to moderate – Joan made the call to 000 as she became frightened after ingesting tablets.
Orientation – Joan is oriented to time, place and person.
Risks
Joan is at risk of harm to self as she is still voicing that “nobody has ever loved her and if I died, my family will be better off”.
Joan is at low risk of absconding as she willingly called help.
Blood results
Elevated cholesterol
Elevated blood glucose levels
UDS Results
NAD (No abnormality detected)
Question 8
Analyse Joan’s case study.
a. List at least two actual health problems?
b. List at least two potential health problems?
Question 9
Using the actual and potential health problems you are required to plan Joan’s care.
1. Identify what actual health problem is a priority.
2. What are 3 nursing interventions that you, as the Enrolled Nurse, can do at her bedside?
3. What other service providers could you suggest being involved with Sarah’s care?
4. After you have provided the nursing care, how can you evaluate the outcomes.
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