NSB023 Assignment Paper: Mantel Health Nursing Case
Aim The aim of this assignment is to help you to begin to use your professional judgement and think like clinical nurses in mental health settings and/or in relation to the mental health needs of consumers. In order to achieve this aim, everyone will be assigned a case scenario involving a consumer who is experiencing issues relating to one of the various disorders commonly encountered in clinical practice. Description This is an individual assignment of 2000 words in two parts each with several steps. Follow the steps for each part carefully. The piece will demonstrate a sound grasp of the following as they relate to your consumer and include: • a Mental Status Examination(MSE) • a clinical formulation including biopsychosocial history and your own MSE observations leading to the clinical formulation • a nursing orientated handover • using Maslow’s hierarchy of needs to identity and prioritise consumer needs • identifying nursing interventions and goals, timeframes and evaluation criteria for their achievement • how to engage a consumer in a therapeutic relationship • the application of cultural safety • the application of the recovery model You will need to justify your ideas with reference to relevant literature; students who plan to do well, read and use the unit’s required readings and additional items drawn from respected academic sources. Presentation and submission • a proforma cover sheet is on BB>>>assessment. Copy and paste it into the beginning of your assessment and add your name, student ID number, name of the consumer and name of your tutor • please upload your assignment to the Turnitin link on blackboard under ‘assessment’. The link will only be open for 3 days (19/10/2016 – 21/10/2016 5pm) during which time you can submit your assignment. It is VERY important that you make sure you have submitted the CORRECT assignment to this link before the due date as whatever paper is in the submissions inbox at the time the link is closed, will be marked – if the wrong assignment has been submitted, then the teaching staff will not be resubmitting the correct one on your behalf • in-text citation of all items used - there is no set number of references required • full reference list at the end of the assessment of items used within the paper properly formatted in APA style • the reference list is NOT included in the word count • word counts include everything in the body of the assessment (including headings, citations, quotes) • include a word count AFTER EACH SCTION • the paper does not need an introduction or a conclusion and is to be organised into two parts using the headings and subheadings below Page 2 of 3 PART 1 Holistic assessment and planning: 900 words total This part does not require full paragraphs. Use appropriate templates/ tables to set out each part: EG: MSE, 5Ps as used in tutorials and the nursing care table as in the example below Ensure your work includes the name of the consumer and brief demographic data about them [e.g. Mary Citizen is an university educated 36 year old married woman and mother of a 14 year old girl] 1.1 The Mental Status Examination [350 words] • using the MSE format in your weekly tutorial guide provide a complete Mental Status Examination (MSE) of your consumer • use specific examples from this case study to illustrate each part of the MSE • you must use and define psychiatric terms accurately (e.g. Instead of “talks fast” use the correct term “pressure of speech“, define it properly and cite your sources) 1.2 A Clinical Formulation Table [250 words] • use information gathered from the MSE and the bio-psycho-social assessment (history of presenting complaint, family and social history, current living situation, the consumer’s strengths and coping strategies, medical history) to complete a table under the headings of presenting, precipitating, predisposing, perpetuating and protective factors (5Ps) relevant to your consumer’s clinical presentation 1.3 Plan for Nursing Care [300 words] • using Maslow’s Hierarchy of Needs, identify and prioritise the needs of your consumer • select the two (2) highest priority issues identified and clearly indicate what they are and why they are highest priority • outline your nursing care, focusing on one (1) nursing intervention for each of these needs and your rationale for each i.e. describe how the intervention assists your consumer to address or meet each need; interventions must be nursing related, detailed, practical and within your scope of practice ** NOTE: in part two you will be explaining how you would develop and use a therapeutic relationship with this consumer, and how cultural safety and the recovery model influenced your nursing care and choice of interventions • nursing care interventions must have a short term goal (short term = goal setting over a day or two) • for each nursing care intervention state how you will evaluate if its goal is being achieved
MENTAL HEALTH NURSING
By
Institution
PART 1: Holistic assessment and planning
1.1 Mental Status Examination (336 WORDS)
Appearance and Behavior
* Appearance
* Motor behavior
* Attitude to situation and interviewer
Adam is a 15-year-old Caucasian boy who lives with his parents. He is tall and slim with blue eyes and blonde hair, which appear un-brushed. He has dark circles under his eyes. He wears joggers, green gym shorts, and shirt.
He is quiet and sullen, clasping his hands and looking down during the interview. He is evasive and withdrawn ( Snydeman & Rovner, 2009).
His concentration is low and avoids eye contact. He shrugs his shoulders in response.
Speech form
* Rate
* Volume
* Quantity of information
Speech content
* Disturbance of meaning
* Disturbance of language
His speech rate is slow.
His voice is low, almost in whispers. He is quiet most of the time.
His speech suffers from paucity of information; has one-word-answers (Brannon, 2016).
Contradictory; changes thought often.
Language suffers from unclear explanations.
Mood and Affect
* Mood
* Affect
* Congruency
He is depressed, sad, feels he is a failure, and feels sleepy (Goldberg, 2015).
Consistent with mood; implications observed is blunted and sad.
Consumer’s mood is congruent with effect.
Form of thought
* Excess, absence, quality of thought
* Continuity of ideas
Form of thought is linear and coherent. The consumer’s mood matches with ideas.
Ideas have loose associations; consumer denies suicidal attempt but agrees to personal harm.
Content of Thought
* Delusion
* Suicidal thoughts
Empathetic and regretful; Consumer displays no illusions (Henderson & Martin, 2014).
Inconsistent; consumer considers harming himself but not committing suicide. Suicidal thoughts reported previously.
Perception
* Hallucinations
* Illusions
* Depersonalized/ DE realization
Consumer shows no illusion effects; feels guilty and worthless.
Consumer has thoughts of sadness and guilt; irrational fear for undone mistakes.
Consumer is consistent with thoughts.
Sensorium and Cognition
* Level of consciousness
* Memory
* Orientation
* Abstract thinking
Consumer is quiet but responsive;
Remembers previous answer but confabulates words.
Consumer knows he is in hospital.
Accurate in thinking; remembers biking competition.
Insight and Judgment
* Extent of individual’s awareness of the problem
* Can they make rational decisions
The consumer is aware of his feeling; regrets about not participating in oncoming biking event.
Consumer is decisive; agrees to be hospitalized
Risk Assessment
The consumer admits of having feelings of self-harm. Family fears of suicidal attempt. Requires treatment, monitoring the early warning signs, supervision the patient and organizing for victim safety (Doyle & Logan).
1.2 Clinical Formulation (249 WORDS)
Summary of Adam’s pertinent information
Presenting factors
* Consumer disturbed by the news of his uncle’s imminent release from prison. Memories of past defilement and guilt of causing his parents’ marriage to break cause him depression.
Precipitating factors
* Consumer suffered from poor mood, low appetite, and loss of drive. His physical activity has reduced and he is very antisocial. The patient suffers from depression and suicidal thoughts.
Predisposing factors
* The consumer feels he is vulnerable to the presence of his uncle who defiled him at five years old. He feels guilty about his parents’ broken marriage. His family fears he can harm himself and commit suicide. His decline in mood and behavior is affecting his education and activities.
Perpetuating factors
* Other family members except the sister do not treat Adam normally. His parent’s broken marriage leaves him with guilt. Use of antidepressants and the news of his uncle’s oncoming release from prison leave him with suicidal ideation.
Protective factors
* Consumer agrees to hospital admission; cooperates with psychiatrists.
1.3 Plan for Nursing Care (317 WORDS)
The Maslow’s hierarchy of needs is a model for classifying the level of motivation among people (Chapman, 2014). According to Doyle and Logan, this method aids in assessing the needs of a mentally impaired patient in order to address the risk by identifying the need. In this case, the need rating of the consumer’s includes:
Basic Needs – the needs comprise of food, shelter, warmth, rest, and clothing (Chapman, 2014). The consumer especially requires nutritious food to overcome malnutrition and increase energy especially from the poor food intake he has had.
Security needs – the consumer requires protection from his uncle, and from causing harm to himself. Vigilance from family, health officials, and teachers is imperative to safeguard his safety.
Social needs – the consumer needs to inculcate good relationship with friends and family. A lot of positive response and intimate relationship ought to be encouraged between the consumer and his family.
Esteem needs – the consumer needs to be encouraged to be positive about life. His involvement in sports and academics will bring him success he can pride. The consumer also requires motivation to assure him of his worth. Risk factors such as abuse from childhood, hopelessness, and poor support are highly geared towards suicidal attempts (Martin, 2016).
Self-actualization – the consumer especially requires inspiration to actualize his personal achievement and reach his potential in achieving success in biking competition, going to school and becoming a future pilot.
When doing the planning for nursing care, conditions such as changes in sleep, appetite, concentration, memory and behavior should be considered since they assist in learning and evaluating the progress of an individual (Vergare et al. 2006). The issues of highest priority to the consumer are security and esteem needs. The consumer requires protection and close supervision to stop him from harming himself and committing suicide (Petro-Yura, 1988). The worry posed by the family relays the intensity of this matter. The consumer also requires drive for improved self-esteem. This shall enable improvement of his mood, behavior and eating, which shall go hand in hand with him resuming his education and biking. The rationale favored in this scenario will be a personal contact as this makes it easy to monitor the patient’s behavior and progress (RNCentral, 2016).
Issue
Intervention
Goal
Evaluation
Low mood, poor eating, absconding school
Consumer is given motivational talk and family involved to show love and support
Mood improves and resumes normal activities.
Assess response to...
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