MENTAL HEALTH CASE STUDY
€“
NP 365
Scenario
Mrs Johnson is a 47 year old lady a
dmitted to hospital following a motor vehicle
accident. In the accident she sustained multiple lacerations and a fractured right
femur which required surgical repair
. She
a
lso
had extensive suturing to her
lacerations.
Mrs Johnson was transferred after surger
y to an orthopaedic ward and
since
admission
has
presented with low mood, poor appetite and early morning wakening.
She is tearful a lot of the time and has revealed t
o the nurse that she recently lost
her job because she was having difficulty concentrating. Her marriage has broken
down and she is going through a divorce and may need to sell her house as part of
the divorce
settlement
. She tells the nurse that
: my
chi
ldren would be better off
without
me
and
I am
a failure and there is nothing in
my
life that give
s
me
a sense
of enjoyment

.
She reports a three month history of worsening anxiety that is particularly bad early
in the morning. I wake at three in the m
orning and I can’t get back to sleep. My
thoughts torment me. She
reports having a
decreased level of energy and
tells the
nurse
I feel so hopeless
that it is
no
longer
worth living. She denies drug and
alcohol misuse and has no physical problems apart
from those resulting from the
motor vehicle accident.
The family history is positive for depression in
her
p
aternal grandfather and great
grandfather and her uncle committed suicide about 10 years ago.
Assessment
In
approximately
1200 word
s
:
1.
List an
d prioritise
Mrs Johnson’s
me
ntal and physical health issues.
This is to be developed as one list
with the mental and physical health issues
included. You must provide brief rationale for
the health
issues and
order of
priority
.
2.
Identify the
mental hea
lth
risk factors suggested in this scenario.
Please complete and
submit
the attached Risk Assessment Form. In your
paper, include rationales for your selections on the Risk Assessment Form.
3.
For the top four priorities from Question 1, d
evise a plan of car
e
for each,
with referenced rationales.
You may use a table format if preferred, but not required.
31
3041
Nursing Practice 365
Mental Health Case Study
Marking Guide
Student Name_______________________________
Needs
Very
Improvement
Satisfactory
1
2 3 4 5
Mark
Subject
content
Have the mental health issues been
prioritised adequately with rationale?
/5
Have the physical health issues been
prioritised adequately with rationale?
/5
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
/5
Plan of care
Plan of care formulated for the
top four priorities from the list
generated in question one
a) Appropriate, accurate and
relevant detail in care plan
b) Provided relevant rationales
for interventions identified
supported by appropriate
references
/10
/5
Formatting
a)
Content and title page
b)
Headings and page numbers
c)
Spelling and grammar
d)
APA 6
th
Edition referencing
/5
TOTAL
/40
Comments
NURSING PRACTICE 365
RISK ASSESSMENT FORM
ELABORATE ON RISK FA
CTORS IDENTIFIED
Enter dates of
other significant reports detailing
risks identified
Signed __________________________
________
__ Designation
__________________
__________
Clinical Assessment Point
(tick if present)
First contact with the service
Change or transfer of care
Change in legal status
Occurrence of a significant life event
Change in mental state
Source of
information
( tick if present)
The consumer
Primary care giver
Other informants(friends, family)
Police or other agencies
Other factors that may increase risk
Parents/carers have significant
physical/mental disability
Parents/carers have
significant substance
abuse
Relationship problems
Physical illness or disability
Lives alone/socially isolated
Has no supports
Criminal charges/arrest
Criminal conviction
Persecution or threats from others
Loss, including death
Financial
stress
Substance use
Intoxication or withdraw
a
l
Past history of child abuse or other abuse
Access to weapons
Access to medication(risk of overdose)
OTHER CONCERNS
Concern expressed by significant others
Compliance/reliability
Factors in the person’s HISTORY and
MENTAL STATE
that may
Increase
risk (tick
all that apply)
H= Historical, C = Current
H
C
Harm to self
–
threat
Harm to self
–
actual harm
Harm to self
–
with c
lear intent to die
Harm to other
–
threat physical harm
Harm to other
–
threat to kill others
Harm to others
–
damage property
Harm to others
–
actual physical harm
Harm to others
–
assault charge
Fire setting
Wandering/disinhibition
THE ABO
VE WAS/IS SECONDARY TO:
Low mood
Elated mood
Delusional or other disorder of thought
Hallucinations/altered perceptions
Cognitive disturbance
Impulsiveness
Personality factors

Mental health case study

write about the case study so when you start writing the essay open the file essay design it will direct you to a better essay outcome also the file essay assignment making info has the essential info
please note that the case i have chosen in the case studies file case 2 you will find it below the page his name is jesse (Patient in his bedroom crying. Jesse has been yelling and screaming at his partner and young child and threatening self-harm.)

use online article and book from google scholar and use Harvard references style

PARA2006 CASES for ESSAY
Below are two (2) cases for you to choose from for your Essay assignment. Please use one from your own practice or clinical placements and only use these if you have no direct case to analyse.
Case 1:
https://www.sane.org/snapshots/jesse (below is an example of how to develop the scenario for your PBL from a consumer story)
Case 2
Consumer story: Things change
http://www.sfnsw.org.au/Help-for-You/Personal-Stories-for-Consumers (the accompanying story)
PARA 2006 Mental Health Emergencies
ESSAY Case – Jesse:
Case 2:
Set up:
Patient in his bedroom crying. Jesse has been yelling and screaming at his partner and young child and threatening self-harm.
Job Information:
Priority 2: to a residential address for a 33 year old male with feelings / threatening self-harm. His partner has called the ambulance service with concern about her safety after a major argument. Case 133, received at 20.12, dispatched at 20.14.
The residential address is a 4 bedroom house in a quiet street with young families. ‘Jesse’ is in the main bedroom and his partner and 5 month old baby are sitting in the lounge room.
On Arrival:
There appears to be no immediate danger to the paramedics or others as the paramedics enter the house. The paramedics are greeted by the partner with the baby in her arms at the front door (clear front door and back door entry and exit). The partner explains that she and Jesse have been together for approximately 3 years and Jesse has been diagnosed with bipolar disorder approximately 2 and half years ago. They have a 5 month old son.
As the paramedics enter the bedroom Jesse is sitting on the edge of the bed with his head down with his hands covering his face. He his quietly talking to himself with tears running down his face. He is approximately 180 centimetres tall (5 foot 11 inches), short dark brown hair, old grey shirt, tracksuit pants. He appears to be focussed on the ground and starts to turn his body away as you approach the room. He fails to make eye contact as you enter and continues to speak softly to himself.
He appears exhausted and tired (not clean shaven, hair is dishevelled and he has dark rings under his eyes).
History & Past History;
Partners perceptive:
Over the past 3 months the partner has noticed that Jesse has been drinking more particularly in the evening and going into the study to do what he describes as work. He still seems to enjoy time with their son, but he has not been as involved or attentive to their son as he used to be. She describes their relationship as loving and caring but he appears more distant and they have been having more arguments that she describes as serious recently. She describes Jesse having increasing mood swings, becomes more irritated and unreasonable when discussing day to day issues (work, care for their son, household and financial matters). He became obsessively organised and seemed to be excited over a new project at work with the mindfulness training for business programme that he is involved in which started 5 months ago. She has noticed over the last month Jesse has found it harder to get out of bed and seemed to lose purpose and was not finishing anything he started. Jesse was employed as a navy architect but left the navy when he was 27. At that time he ended his previous relationship and began to take drugs and increasingly used alcohol to try to help him to feel socially comfortable again and to fit in when he struggled.
Patient role / perspective:
Jesse is very hesitant to have paramedics in the room. He feels as though he is showing signs of weakness and is very sorry he frightened and yelled at his partner. He keeps repeating to himself that he need to do better and that he knows he should not let his own anger and irritation overwhelm him and take these feelings out on others. He is tired of feeling ‘out of control’ and that his moods have started to be so confusing that he needs to take control. He feels that he can take control by just ending the confusion by taking his own life.
Social and Family History:
Jesse was previously a drug user (methamphetamine) and was a heavy drinker which started during his early career with the navy. He found his depression debilitating and was self-medicating to alleviate the feelings of sadness and his lack of motivation. He was a very outgoing person and enjoy social occasions with the “guys”, but found himself increasingly irritable and with mood changes that were easily triggered by what seemed minor incidents (e.g. a word or look from other people would make him feel angry for no apparent reason, he felt targeted). He kept contact with his family until he was 28 but slowly has less and less communication with them. He sought help with his drug and alcohol use and managed to stop taking methamphetamines and was not drinking from the age of 30.
Background:
PHx (past history) – bipolar disorder
Med’n – lithium
Allergies – none known
Comm. Diseases – none that he/ she are aware of
Social Hx: has a current partner – they have been together for the past 3 years. Oldest of two children, sister 4 years younger
Family Hx: Father and mother in Scotland
Diet: Eats a varied diet appetite has reduced over the last 2 months.
Alcohol: Increased intake during the week and over the weekends.
Smoking: non-smoker
Assessment:
O/A
10 mins later
20 mins later
HR
85 (usual is mid 70’s)
87
90
Pulse
Strong
Strong
Strong
Rhythm
regular
regular
regular
BP
125 /80
131/80
134/80
Cap Refill
2 sec
2 sec
2 sec
RR
20
21
21
Breathing
Shallow and irregular (related to distress)
Shallow and irregular (related to distress)
Shallow and irregular (related to distress)
Sats
99% on air
99% on air
99% on air
Skin
Pink warm & dry
Pink warm & dry
Pink warm & dry
BGL
4.6 mmol
4.6 mmol
4.6 mmol
GCS
14 (distracted and hesitant when answering questions)
14
14
Pupils
PEARL
PEARL
PEARL
Pain
2 survey
Intense feelings of self-hate and disappointment
Feelings of guilt and shame with treatment of partner
Feels despondent about future and is ‘worn-out’ and exhausted

Introduction
Rewrite the case that I attached in my order but briefly
(350 words )
Clinical Features of the Case and Diagnosis
(550 words)

Causes of Bipolar Disorder
Biological and psychological factors
( 550 words ) .
Differential Diagnosis
Write three possible differential diagnosis the patient may have. And evidence of that based on his symptoms
(350 words)
Mental Status Examination (MSE)
Definition and relative Info about MSE
Here is a link that will help you to understand MSE http://www.rch.org.au/clinicalguide/guideline_index/Mental_State_Examination/
(130 words)
Below are the MSE findings for Mr. J.
Appearance
(100 words)
Affect/Mood
(100 words)
Thought Content
(90 words)
Perceptions
(140 words).
Judgment/Insight
(80 words)
Cognition
(50words).

Relevant History Taking
(300 words)
Management
Divide this section into two parts
Prehospital management ( paramedic)
Hospital management and further care (medication)
(400 words)