NRS222 Case Study Analysis: Mr. William's Depression and Care Plan

This case study analyzes Mr. William, a 55-year-old man admitted to the hospital with severe back pain and a 10-year history of depression. The assignment examines his medical history, including his back injury, unemployment, alcohol use, and medication regimen (Sertraline, Endone, Diazepam). The analysis identifies Mr. William's mental health issues, including low mood, agitation, and potential anxiety. It discusses both pharmacological treatments (antidepressants, painkillers) and non-pharmacological approaches like counselling, physical therapy, and exercise. The case study also addresses ethical considerations, legal frameworks, and the importance of family and community involvement in the patient's care. The study highlights opportunities for improved social awareness of mental health and challenges related to Mr. William's reluctance to engage with mental health services.

Running head: case study
Case Study Analysis
Name of the Student
Name of the University
Authors Note

1Case study analysis
Introduction
This assignment focuses on a case study of a patient who was diagnosed with
depression ten years ago and was suffering from back pain. He was admitted to the hospital
due to severe back pain, and chronic depression became an obstacle for the patient. The aim
of this assignment to analyse the medical condition, especially the mental health situation of
the patient. Major approaches for care plan and treatment of a mental health patient will be
discussed in this assignment. Ethical consideration and legal frameworks will be addressed
in this assignment. Patient’s family and community can be involved in the consultation and
referral. Depression can occur in any stage of life and affect the interests and preferences of
the individual’s life (World Health Organization., 2017). Depression can bring several issues
such as speech problems, alcohol and substance abuse and thoughts of self-destruction.
Numerous factors are responsible for depression in an individual; for example, loneliness and
isolation, lack of sense of purposes, health problems and different impairment.
Discussion
Identification and description of mental health issues of the patient
Mr William admitted to the hospital due to severe back pain. He was shifted to the
Emergency Department, and nurses observed that his back pain scored 9/10. The score
represented that the level of pain was severe or high rated. 10 years ago, he got an injury
during manual work, and that led him to the condition of unemployment. He was unable to
find a full-time job or work after that injury. He was suffered from depression since he was
injured and this affected both his health and mental condition. Health problems and physical
inability are some of those reasons for which depression can happen. Depression can cause
insomnia and low esteem, lack of hope and energy. Low mood and psychosocial addiction to
alcohol have been observed in Mr William. He suffered from agitation and mood disorders,

2Case study analysis
which are caused by regular and severe pain. Anxiety can be occurred due to chemical
imbalance, especially low levels of serotonin in the brain (Forrester et al., 2016).
Neurotransmitters between nerve cells and the brain can affect a person’s mood and overall
feelings (Jack, 2016). Difficulties in concentrating, short-term memory and agitation are the
reasons for depression in older adults. However, GP suggested him to visit a psychological
counsellor to resolve the problems of the patient. His alcoholic nature is affecting his health
and mood. The deterioration of mood can be observed in the patient as he has been drinking
quite heavily for some time. His wife was worried about frequent mood disorders and alcohol
abuse.
Identify and discuss the major approaches to the care and treatment
Mr William was diagnosed with low mood and depression with severe back pain.
Sertraline Hydrochloride is to treat depression, panic attack, and obsessive-compulsive
disorder and post-traumatic disorders in patients. As the patient was suffering from severe
back pain, the GP suggested him Endone, which is a painkiller. Alcohol withdrawal and
muscle spasms can be treated with Diazepam. This medication is used for the treatment of
anxiety and seizures as it can affect the chemicals of the brain. Diazepam consists of
benzodiazepine, which can influence unbalanced people with anxiety (O’Connor et al.,
2016). Pantoprazole is a proton pump inhibitors, which decrease the amount of acid in the
stomach (Alolabi & Liem, 2019). Pain assessment has been suggested to the patient, and he
took an excessive amount of Valium or painkiller.
Registered nurses of the hospital can execute different treatments and care plan
approach. Counselling is part of the treatment procedure suggested by the GP. Non-
pharmacological pain management can be applied to Mr William for example comfort
therapy, physical and occupational therapy, psychological therapy or counselling and neuro-

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stimulation. If pain is not treated, some psychological disturbances and difficulties can be
observed in the patient. Non-pharmacological approaches help people to take control over
their pain. Non-pharmacological and non-opioid treatments are effective on the chronic pain.
Both psychological and clinical treatment are considered as beneficial for pain management
of patients with chronic pain. Reasons for the pain management can be analysed during the
non-pharmacological approaches. Physical exercises such as isometric exercise for lower
back pain, lumber rehabilitation exercise program, chronic mechanical pain management for
lower back pain are effective(Mazyarkin et al., 2019). RICE methods are explained as Rest,
Ice, Compression and Elevation method. This method can be applied on the chronic pain
management or any injury related pain under control. Progressive muscle relaxation helps to
decrease blood pressure and muscle tension in patients. This muscle relaxation technique will
help in body’s requirement for oxygen and reducing fatigue with anxiety (Amini et al., 2016).
Tensed muscle will send stimulus that the body is stressed. Muscle relaxation can help to
reduce anxiety and low mood of patients with back pain. This method can help the patients to
reduce pain and increase sleep.
Pharmacological method
Antidepressants medications are included in pharmacological treatment or approach.
Medication can combat episodes of moderate to severe depression. Medication should be
taken within the proper period. The antidepressants may have side effects, and some people
can be affected by these medicines. These medicines are usually used for restoring the
balance of neuro-regulating amines by blocking and reuptake in the brain. Selective serotonin
reuptake inhibitors can be used in the pharmacological method of Mr William’s treatment.
The prescribed antidepressants for the patient were Sertraline Hydrochloride, Endone and
Diazepam or Valium. Sertraline Hydrochloride is an antidepressant, which comes under the
group of SSRI or Selective Serotonin Reuptake Inhibitors. This group of drugs are used to

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treat depression, obsessive-compulsive disorder, anxiety and post-traumatic stress disorder
(PTSD). During these medicines, an individual should not consume alcohol. This mediation
can tolerate and enhance the safety of other antidepressants. Sertraline should not be taken 14
days before or 14 days after of MAO inhibitor. SSRIs treat depression by increasing the level
of serotonin in the brain. Serotonin is a chemical messenger or neurotransmitter, which can
carry signals among brain cells. SSRIs are selective as this only affect serotonin (Bérard et
al., 2019).
Non-pharmacological method
The patient is suffered from lower back pain due to which he was unemployed for a
long time. He could not get a proper job for his livelihood. There are different non-
pharmacological treatment approaches such as physical exercise, yoga, spinal manipulation,
acupuncture and multidisciplinary rehabilitation. Psychological treatment approaches have
also come under non-pharmacological treatments such as psychological therapies and
mindfulness-based stress reduction. Psychological approaches are interpersonal therapy and
cognitive behaviour therapy. Interpersonal therapy involves talk therapies and time-limited
interactive sessions with the patients. Interpersonal therapy aims to reduce depression, reduce
interpersonal distress and to help a person to build and increase social support (Zuroff et al.,
2017). The person can be treated with CBT or Cognitive Behavioural Therapy, which is
another significant part of psychological treatments (Ballesio et al., 2018). CBT is mainly
focused on two main aspects, such as cognition and behaviour. CBT is to assist patients to
recognise the connection between negative and irrational thoughts with the associated
behaviours. CBT shows positive effects on mental health people, so professionals widely
recommend it. The recommended interventions are related to treatment settings. The acute
treatment with the help of CBT takes twelve to twenty sessions. These sessions are active in
resolving the issues related to mild to moderate depression.

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Communication skills are most important for health to treat culturally diverse patients.
Health workers need to communicate with the language, which is familiar to the patient. Both
verbal and non-verbal approaches are important during the treatment of the patient. Nurses
and other health workers should interact with the patient by maintaining mutual respect and
professional integrity. During interpersonal therapy and CBT, professionals should ask such
questions, which would maintain the patient’s beliefs and values.
Major factors
Mr Williams was suffering from lower back pain due to some manual work 10 years
ago. After that injury, his financial conditional weakens, and this deteriorates his mental
health. The major factors for these patients are financial condition, medical history of that
patient, behavioural changes in the patient, addiction and lack knowledge about his condition.
His financial condition makes difficulties in his daily life, and he could not avail the adequate
amount of medical services.
Opportunities and challenges
In this case, Mr William is a patient of depression for a long time. He is suffering
from lower back pain for the past ten years. This case study shows different challenges and
opportunities to prevent the critical condition of the patients.
The patient showed different disruptive behaviours and tremendous agitation, which
are some obstacles to implementing different nursing approaches. Depression and anxiety can
affect a patient’s cognitive development and sleep. The patient was an alcoholic and suffering
from insomnia for a long time. He is not aware of his health condition; moreover, he is not
interested in the knowledge of awareness of a particular health condition. His relationships
with family members should be developed effectively. Depression and anxiety affected his

6Case study analysis
mode, and this reflected in his behaviours (Goh & Griva, 2018). The patient showed an
unwillingness to visit recommended mental health counsellor. He wanted to end his
sufferings regarding mental depression by consuming high dosages of antidepressants. As a
result, the doctor will face some trouble to make the patient to understand the actual process
of treatment.
Management of this health condition have some opportunities such as increasing
social awareness on mental health and enhance the effectiveness. Awareness about
psychological treatments can be increased in the patient. Family and community can be
involved in the therapies provided by the psychologist. There are opportunities regarding the
self-management of the patient so that he can tackle his mental health conditions. Different
non-pharmacological approaches such as music therapy, play therapy, problem-solving
sessions, and acceptance therapy can be explored during the treatment procedure.
Ethical considerations and legal frameworks
The autonomy of an individual is one of the most important attributes, which should
be maintained by the professionals (Fowler, 2016). The patient had issues related to agitation
and depression, and as a result, there is a possible chance of loss of autonomy.
Nonmaleficence of any treatment approach is another aspect of ethical consideration of
treatment procedure (Baillie, 2017). During the treatment, any physical and psychological
harm should not be occurred by the mistake of nursing or clinical professionals. Every
approach of treatment should maintain ethical consideration regarding the beneficence of the
patient. Beneficence maintains the welfare of patients and growth with the development
condition (www.icn.ch, 2020). Confidentiality should be maintained during the treatment as
the patient tends towards alcohol abuse and financial crisis
(www.nursingmidwiferyboard.gov.au, 2020). Maintenance of above-discussed considerations

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leads to an equal, fair and impartial treatment approach. Treatment of the patient should
promote recovery-oriented practice by protecting the rights related to the mental health act.
Assessment and treatments should maintain the core principles and objectives of the
Australian Mental Health Act 2014(Martin, 2017). Mental health act protects and promotes
individual’s rights, dignity and autonomy during treatment.
Consultation that would need to take place both for the person and the family
The patient should opt for a clinical psychologist if notable improvements cannot be
observed. ECT or Electroconvulsive Therapy is a simple and effective treatment procedure
for treating depression as dopaminergic pathways of the brain are stimulated with the
electricity (Joshi et al., 2016).
Conclusion
This assignment concludes that different pharmacological and non-pharmacological
approaches of depression and anxiety in mentioned case study. Identification of health
condition and major approaches for treating the patient. Every approach of treatment should
maintain ethical consideration and legal frameworks related to mental in Australia. The
assignment has described referral and consultations for the person and the family.

8Case study analysis
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