Foundations of Mental Health Nursing: Case Study of Mrs. X, Semester 2

This report presents a detailed case study in mental health nursing, focusing on a 65-year-old patient, Mrs. X, who exhibits symptoms of cognitive decline, including poor motor coordination, confusion, lethargy, and memory loss. The assignment analyzes the patient's condition through risk assessments, mental state examinations, and neurological tests, considering factors like social isolation, hypertension, and smoking history. The report outlines specific, measurable, achievable, realistic, and timely (SMART) goals to improve the patient's mental and physical well-being, addressing issues such as emotional outbursts and shortness of breath. Intervention strategies, including social engagement, physical activity, community-level interventions, and cognitive stimulation, are proposed to enhance the patient's recovery. The discussion highlights the importance of comprehensive care plans and the impact of cognitive impairment on the patient's overall well-being, offering insights into effective nursing practices. The report concludes with a summary of the key findings and recommendations for patient care.

Running head: MENTAL HEALTH NURSING
MENTAL HEALTH NURSING
Name of the student:
Name of the university:
Author note:

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Introduction:
Cognitive impairment is defined as the mental illness, which disrupts the normal function
of the brain and hinders the decision making ability of the individual and along with that it also
troubles the person suffering from it in remembering and concentrating (Petersen 2016). Along
with the mental health, it is also possesses negative impacts on the physical and social well-being
of the patient which is discussed in the assignment. This discussion includes the case study of
Mrs. X, who is suffering from cognitive decline. The mental assessment test and the risk
assessment test of the illness is discussed along with the observed symptoms in the patient and
the diagnosis test. The intervention which can be used to improve the health condition is also
mentioned below.
Case study:
This assignment intends to focus on the treatment and care plan of the patient named X
(pseudonym), who has been admitted to the mental health sector due to the chief complaints of
poor motor co-ordination, confusion, lethargy, and poor memory. The patient is a 65-year-old
woman who has recently lost her husband and has only one son. She lives alone and has no one
who can take care of her, as her only son has moved out of the house and lives with his family.
Due to poor motor co-ordination, she was not able to walk properly due to lack of normal posture
and balance, which limits her interaction with the neighbors and other distant family members
and feels isolated. The patient often experience emotional outbursts and acts aggressively which
makes it difficult for the nurse to handle the patient. Upon interviewing the patient, it is observed
that the patient sometimes appear to be confused, experiences fatigue, shortness of breathing and
dazed and her eyes also have a glazed appearance. The patient often experience memory loss and

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hence is considered at the high risk of having dementia. Due to the frequent emotional outbursts
and aggressive behavior, she was isolated from other patient. The patient has a past history of
smoking and clinical history of hypertension but did not take any hypertensive medication.
Risk assessment
Risk assessment of the patient is also done in order to assess the risk associated to
patient’s condition. According to the World Health organization (2019), the risk factor that
which can lead to mental illness in case of elderly patient is poor memory, physical inactivity,
chronic health condition, drug use, unhealthy diet and social isolation. In the case of Mrs. X, the
risk factor which has been identified for his poor mental condition is her social isolation, poor
memory, past medical history of hypertension and smoking history. The risk factor involved for
shortness of breathing and fatigue is the hypertension. As the patient lives alone, there may be a
possibility that the patient is not getting the proper diet which is also a risk factor for cognitive
decline and mood disorder (Li et al. 2016).
From the symptoms observed in case of Mrs. X, it can be stated that the patient is
suffering from cognitive decline. However, to ensure that the patient is suffering from cognitive
impairment, different diagnosis test such as, mental assessment test, neurological test and other
test is performed.
Diagnosis:
Mental state examination is defined as the structured assessment which assesses the
behavior and cognitive functioning of the body. The mental state examination is used in the case
of Mrs. X, to assess the present mental condition of the patient. In the Mental state examination,

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the speech, mood and effect, thought process and behavior of the patient is observed (Chesin et
al. 2016) In this case, the patient is experiencing emotional outbursts and aggressive, which may
be due to the cognitive impairment. Hence to ensure that, cognitive impairment test should be
conducted by the nurse. In the cognitive test, several questions are examined to the patient in
order to determine the mental well-being of the patient (Beer et al. 2018). The patient is also
recommended to involve in certain simple tasks to determine the memory or language of the
patient. In the case of neurological examination, the reflexes, balance and posture is assessed by
the aid of CT scan and MRI (Volpe 2019). As the patient is also experiencing shortness of
breathing, confusion and fatigue which are the symptoms of high blood pressure, the blood
pressure of the patient is also measured. If the blood pressure of the patient is observed to be
above 120/80, the blood pressure of the patient is said to be increased (Kharbanda et al. 2019).
Goals:
The primary goal in this case is to improve the mental condition of the patient. The
framework which is used set appropriate goal for the patient is A SMART goal, which focusses
on five different area of the goal such as, Specific, Measurable, Achievable, Realistic, and
Timely (Bowman et al. 2015).
The goals formulated in the case of patient are:
1. Patient will be able to walk (specific) and is able to do her own task (measurable) by
enhancing involvement in the physical activity (realistic) within 6 months (timely).
2. Patient will experience less emotional outbursts (achievable), which will minimize her
aggressive behavior (measurable) with the aid of Cognitive stimulation and training
(realistic) within 2-3 hours (timely).

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3. Shortness of breathing in the patient can be reduced (specific), which will reduce pulse rate
(measurable) by the help of repositioning (realistic) within 2-3 hours (timely).
Intervention:
By reviewing the case study of Mrs, X, it is evident that the primary issue in the case of
Mrs. X is shortness of breathing, fatigue, confusion, poor memory, social isolation, physical
inactivity, aggressive behavior and emotional outburst, which needs to be addressed for the
proper recovery of the patient.
Social engagement:
In this case, the patient lives alone which possess an emotional burden and social
isolation is also considered as the risk factor of cognitive impairment. Therefore, the nurse
should engage the family of the patient into the care plan. Her son should be educated about the
adverse impact of social isolation in her health. She should also encourage the patient to get
involved with the neighbors or should involve with the community members. Social engagement
of the patient will help to reduce the emotional outbursts ad mood swings (Dawes et al. 2015). It
will also reduce the risk of patient getting into depression. In will make the patient happy from
within and will help the nurse to improve the mental well-being of the patient.
Physical activity:
Social engagement by the patient is hindered due to the physical inability of the patient.
Hence, the nurse should encourage the patient to involve in different kind of physical activity
such as brisk walking (Brasure et al. 2018). For better treatment the patient is referred to
physiotherapist which will enhance the patient’s involvement in the physical activity. The patient

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is also provided with walking aid, with the help of which she can increase her engagement with
the neighbors. It will benefit the patient in improving the body posture and physical inability of
the patient (Brown et al. 2016).
Community level interventions:
Community level intervention is one of the most effective method that can be used for the
treatment of the patient suffering from any mental illness. In this method, the environment of the
patient is improved. It primarily focusses on the individual and the environment change
strategies which aims to enhance the physical and mental dysfunction of the patient and
promotes the well-being of the patient ( World Health Organization 2017). It aims to enhance the
social, mental and physical well-being of the patient.
Cognitive stimulation and training:
It is a non-pharmacological treatment, which helps in the treatment of people suffering
from cognitive impairment and dementia. In this the patient is encouraged to participate in
different activity which enhances the memory of the patient and also aid in treating the emotional
outbursts (Fusi et al. 2019).
Short ness of breathing:
Patient is also experiencing shortness of breathing, which can be treated by reposition the
patient. the patient is encouraged to sit forward, stand with the supported back, sleep in relaxed
position, diaphragm breathing and pursued lip breathing (Bolzani et al. 2017).

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Conclusion:
From the above discussion, it is concluded that cognitive decline or impairment disrupts
the social, mental and physical well-being of the patient. Hence, it is important for the nurse to
conduct risk assessment test and diagnosis test to gather information regarding the signs and
symptoms and severity of the patient. Based on that, the care plan is formulated to hence the
health outcome of the patient.

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References:
Beer, J.C., Snitz, B.E., Chang, C.C.H., Loewenstein, D.A. and Ganguli, M., 2018. Does a
cognitive stress test predict progression from mild cognitive impairment to dementia equally well
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Chesin, M.S., Benjamin-Phillips, C.A., Keilp, J., Fertuck, E.A., Brodsky, B.S. and Stanley, B.,
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