Impact of Biopsychological Factors on Jeremy's Mental Health

Assessment Details
Qualification Code: Title HLT54115–Diploma of Nursing
Assessment Type Assessment 1 Underpinning Knowledge/Questions
Due Date
Location
Term-Year
Unit of Competency
Unit Code/Title HLTENN009 Implement and monitor care for a
person with mental health conditions
Student Details
Student Name Student ID
Feedback to Student
RESULTS (Please Circle) SATISFACTORY NOT SATISFACTORY
Assessor Details
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Australian Harbour International College, 114-120 Castlereagh Street, Sydney NSW 2000, Australia
|RTO NO: 41338 | CRICOS Provider Code: 03449J
Filename:HLTENN009Implement and monitor
care for a person with mental health conditions
Version 2.0/ March
2018
Review Date: March
2019
Page 2 of
15

Assessment 1 Underpinning knowledge questions
Instruction to Students:
 Answer the questions below in the spaces text box provided.
 Ensure all references are documented under each individual question.
 Answers are to be typed or for written submissions, useblack or blue ink and
ensure your name is attached to the responses.
This case study was developed by Health Workforce Australia 2012 and has been adapted for this
assessment booklet.
Case Study
Mr Jeremy Black is a 37-year-old architect who has been an inpatient on a mood
disorders unit for the last 20 days. His current presentation is calm, with the
appearance of a resolution towards his life and problems. This is in contrast to his
clinical presentation 2 days ago when he was anxious, unable to concentrate, and
worried about everything in his life.
Jeremy is casually dressed. He has early morning wakening and difficulty going to
sleep which is reflected in his presentation. He sits in a relaxed unguarded position.
He doesn’t initiate conversation but is pleasant and replies when spoken to.
Conversation is slow to begin with Jeremy answering initially in a relaxed nonchalant
manner. As the conversation expands Jeremy becomes more engaged but remains
relaxed with an unusual degree of composure.
Background
Previous admissions have involved Electro Convulsive Therapy (ECT) as a treatment
strategy in combination with antidepressant medication. Since his last admission
Jeremy has been receiving maintenance ECT every 2 weeks, however, there has
been a gradual decline in Jeremy’s mood and functioning. During this admission,
Jeremy has had a review of his antidepressant medication and has attended group
therapy as appropriate, together with receiving ECT three times a week.
Current Medication
Jeremy is taking Duloxetine hydrochloride commonly known as Cymbalta 120mg
which consists of 2 x 60mg blue/green pellets, taken once a day with or without
food.
He has been taking this medication for some time and is experiencing a few side
effects i.e. dry mouth; orthostatic hypotension (drops in blood pressure when
changing position from sitting to standing and dizziness).
Cymbalta side effects may also include suicidality (Jeremy’s suicidal thoughts
may/may not be related to his medication) raised blood pressure; withdrawal
symptoms; palpitations; gastrointestinal upset; chills; musculoskeletal pain; muscle
spasms; lethargy; somnolence; paraesthesia (loss of sensation); anxiety; sleep
disorder; agitation; micturition abnormality (problems with urination); yawning;
oropharyngeal pain (pain in face, jaw & neck); pruritus (itching sensation); mania;
Australian Harbour International College, 114-120 Castlereagh Street, Sydney NSW 2000, Australia
|RTO NO: 41338 | CRICOS Provider Code: 03449J
Filename:HLTENN009Implement and monitor
care for a person with mental health conditions
Version 2.0/ March
2018
Review Date: March
2019
Page 3 of
15

hypomania; very rarely, serotonin syndrome; hyperprolactinaemia; hypersensitivity.
Current treatment
ECT is quite well tolerated by Jeremy with the most frequently reported side effects
being a headache, which resolves within a couple of hours, and short term memory
loss which can resolve over a variable time frame.The benefits of ECT is an increase
in patient’s level of motivation. However, this can also increase the risk of self-harm
etc.
Presentation on admission
On admission Jeremy was noted as being low in mood with increased level of anxiety
when contemplating everyday activities e.g. grocery shopping, collecting his
children from school each day etc.
Jeremy reported a lack of motivation for social activities e.g. going out with his wife
(Judy) to a restaurant, visiting relatives, going to the park with his children; he is
unable to think about work at present. Jeremy has expressed worries that his
manager is questioning his ability to do his job, also verbalising that he frequently
feels distraught and panicked i.e. pressured; shaking; dry mouth; sweating; feeling
sick when he thinks about his life situation, stating that he “can’t see a way out”.
Current Presentation at Interview
Jeremy is pale and appears tired which is a consistent presentation for poor sleep
patterns including early morning wakening. Jeremy’s appetite is poor and he has
recently lost weight.
Jeremy’s presentation in the last 2 days is that of calm resolution. He describes his
previous concerns and worries as “under control” but when asked about this he is
unable to outline what has changed. This might account for his current relaxed
state.
Jeremy is quiet, presenting as relaxed, sitting comfortably in the chair with his arms
unfolded, legs uncrossed.
Social History
Jeremy has been married for 10 years to Judy who is 35 years old. Jeremy describes
his marital relationship as “on the rocks” and getting worse. Judy, a home maker,
has threatened to take the children to her parents if Jeremy doesn’t “do something
to make things better”.
Jeremy has 2 children; Jodie aged 5 and Marcus aged 9. His parents both live in
Perth and he has a married sister living in Japan with her husband and their 2
children.
Jeremy feels isolated from friends, has no hobbies or pastimes and smokes a packet
of cigarettes per day.
He has work stress and feels pressured to return to work as the mortgage has not
been paid for months and he fears the bank will foreclose.
Jeremy described feeling depressed at age 20 years when at university, recounting
that his girlfriend, whom he described as “the love of his life” died from a drug
overdose. Sometimes Jeremy uses drugs as an escape mechanism as he feels that
Australian Harbour International College, 114-120 Castlereagh Street, Sydney NSW 2000, Australia
|RTO NO: 41338 | CRICOS Provider Code: 03449J
Filename:HLTENN009Implement and monitor
care for a person with mental health conditions
Version 2.0/ March
2018
Review Date: March
2019
Page 4 of
15