NRS222-Mental Health Nursing

Presenting History 

Mr Barry William is a 55 year old man who present to Emergency Department at small regional hospital with his wife Lorraine with severe back pain.  He scores his back pain on presentation to Emergency Department 9/10.  His PR is 98 but other vitals are within normal limits for his age.  He is sitting on edge of the bed at present. 

Whilst taking the history the following information is gathered.  Approximate 10 year history of depression diagnosed by the GP and has been on anti-depressants for the last 6 years.  Back injury due to manual work approximately 10 years ago, this has meant significant loss of employment and has not held full time employment since.  He drinks alcohol, he states he has 4 to 6 ‘stubbies’ a night and sometimes a few glasses of Bourbons (spirit) also. 

Mr Williams lives with his wife and has two young adult children who have both left home and town. 

Medication History: 

Sertraline Hydrochloride (Zoloft) 50mg BD 

Endone 5mg TDS 

Diazepam 5mg PRN (Max Dose QID)

Pantoprazole 40mg daily 

Mr Williams is admitted to the Medical Ward for further investigations for his back pain.  It is now day three and you notice Mr Williams is quite low in his mood and can be agitated and abrupt when responding to conversation with you and others.  You ask Mr Williams if there is anything worrying him and also do a pain assessment and he discloses to you the following information: He pain is unbearable, and that is why he takes up to 8 Valium a day and as many Endone as he can.  He has asked the GP to increase his anti-depressants as he wants to ‘end it’ and the GP told him ‘might be good to see a counsellor’ and gave him a name of someone to see, which he has not follow up.  He also informs you he has been drinking more than what he stated. 

You acknowledge to Mr Williams the importance of the information he has told you and inform the senior Registered Nurse on your shift.  You are to continue to observe Mr Williams until Mental Health Team are contacted and a team member can come and review Mr Williams.  

While waiting for the Mental Health Team to respond Mr Williams’s wife arrives and you inform her of what has happened on your shift.  Mrs Williams begins to cry and become quite upset and informs you he has been drinking quite heavily for some time (over 12 months) and taking all sorts of tablets and his mood is getting worse.  She feels she has not support and does not know what do to next. 

With the above information, now address the assessment tasks. 

Task

This assessment requires you to analyse a case study.

Read the case study carefully, then answer the five (5) questions below. Your case analysis should include a brief introduction and conclusion.

1.Accurately identify and describe the mental health issues experienced by the person.

2.Identify and discuss the major approaches to the care and treatment of a person with depression.  Include at least one evidence based pharmacological and non-pharmacological care options for the person.  Explain how to ensure these options are culturally safe.

3.Analyse the major factors, including opportunities and challenges, related to the lived experience of mental illness and/or substance abuse for individuals, families or communities.

4.Explain the ethical considerations and legal frameworks used when caring for the person.

5.Discuss the consultation/referral that would need to take place both for the person and the family.