Mental Health Case Study: Patient 'A' Nursing Assignment NURS6055

This nursing assignment presents a comprehensive case study of a 26-year-old Aboriginal female, 'A,' admitted to an inpatient facility due to a mental health disorder. The paper delves into A's physical, mental, and psychosocial health, highlighting vulnerabilities and strengths. It examines presenting complaints, life stressors (breakup, work stress, delayed promotion, loss of a pet), and the history of the present problem, including symptoms of dysphoria, anhedonia, sleep disturbances, and anxiety. The Mental State Examination (MSE) reveals a depressed mood, blunted affect, and suicidal ideation. The assignment then proposes nursing intervention strategies, including pharmacological interventions (mild sedative), referral to a psychotherapist for mindfulness-based therapies, and referral to a dietician to address weight loss and low blood pressure, aiming to promote recovery and improve the patient's overall well-being. The assignment concludes with a call to consider the patient's physical, psychosocial, and family history when diagnosing mental health issues.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
According to Tiller (2013), dealing with mental health disorders is extremely complex
pertaining to the difficulty in diagnosing the problem and accordingly planning an intervention.
Problems related to mental health often remain unnoticed on account of social stigma and
absence of external symptoms (Bennett & Shepherd, 2013; Gilbert, 2014). According to a report
published by the Lin et al. (2013), it has been stated that one in every seven Australians
irrespective of their age experienced a mental health disorder. In addition to this, the report also
revealed that suicide accounted for 10.5% of the mortality rate among Australians (Collins et al.,
2013; Smith, 2014)). The above mentioned statistics suggest that mental health has become a
serious concern within the Australian context. This paper critically intends to investigate the case
study of A who at present is admitted to the inpatient facility because of suffering from a mental
health disorder. The paper would typically discuss the physical, mental as well as the
psychosocial health of the patient and at the same time present details about the vulnerabilities
and strengths of the patient. The paper would further draw on the symptoms of the patient and
devise an intervention strategy for the patient.
Role of Clinician: Admitting Nurse (Adult Inpatient Unit)
Case Presentment:
A is a 26 year old, aboriginal female who was presented to the clinic by her sister B. B
mentioned that A had lately been behaving strangely and experienced sudden mood swings. She
would be normal one moment and the next moment would be shouting at her and their little
brother for trivial things. B mentioned that this had been going for a quite long time when she
talked about this with her boyfriend and he suggested that they should seek professional advice.

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A agreed but was scared to visit the clinic alone and that was the reason her sister had
accompanied her.
Presenting complaint: The Nurse conducts an interview session with A and asks her about the
problem. A mentions, ‘I just don’t like people around me, I know I am mean to my siblings
sometimes but I can’t help it. I am just always irritated and angry.’
Present Life stressors mentioned by A:
 Her recent breakup with her boyfriend Mike after a 7 year of relationship. A reports him
being disloyal and cheating on her with another common friend.
 A’s overtly stressed work-life. She works as an architect designer. She states that she has
hardly had a day off and is always working extremely hard on the projects.
 Her delayed promotion because or organizational politics and bullying. She mentions,
‘they make me do all the hard work and then they never recognize my sincere efforts. I
strongly believe I should have been promoted to the post of assistant manager but they
preferred X, because he is the son the best friend of our Manager.’
 The death of her pet dog, Y. I could count on Y. He had been my best friend always and
he died 6 months ago due to food poisoning and everything just turned upside down.’
History of Present Problem:
 A states that she has been experiencing Dysphoria and anhedonia since about a
month. She has become rude and mean to her siblings and finds it difficult to
understand her own difficult behavior. She is always sad and cries a lot and falls
asleep while crying.

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 She finds it extremely difficult to find a sound and uninterrupted sleep and has also
lost weight. She relies upon ready to cook meals for her meals.
 She feels devoid of any energy and finds it difficult to socially interact with her
family and friends
 She feels extreme anxiety and relieves her stress and anxiety by smoking 8-10
cigarettes a day
 She has no history of attempting a suicide but wishes to die because she believes the
world is not a good place for her
Past Psychiatric History:
 She reports no prior hospitalization because of mental health problems.
Pre-morbid personality:
She describes herself as a cheerful and amiable person who loved her siblings dearly and
enjoyed her work. She describes herself as a positive individual who would always make
everyone feel happy and optimistic.
Medical History:
The patient has a medical history of low blood pressure. Apart from that, she reports
having no medical history and is not known to have any allergies.
Family History:
The patient’s parents were divorced 7 years ago and stayed in United States. Both of
them had remarried and were happy in their new lives. She reports herself and her siblings never
being close to their parents and admits occasionally calling them. It was one year prior to the

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divorce that the siblings had applied in three different universities of Australia for different
courses. She admits all three of them were tired of the arguments of their parents and wanted to
move away. All three of them shifted to Australia for their course and also took up part time jobs
to sustain themselves. It was then she had met her boyfriend who ultimately cheated on her and it
led to their breakup.
Psychosocial Health:
Mental Health:
 Quick triggering of temper
 Presents poor coping skills
 Experiences headaches, abnormal sleep and reduced appetite
Emotional Health:
 No zest for life
 Feels down and is remains socially isolated
Spiritual Health:
 Spiritually down
 Possesses negative thoughts
Vulnerabilities:
 Thoughts about death
 Self-harming ideation
Strength:

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 Is aware about the fact that she is experiencing a mental health problem
 Understands the problem can be solved with professional assistance
 Stays with her siblings who could support her deal with the problem
Mental State Evaluation:
General appearance: The patient is underweight and has an unkempt appearance with shabby
clothes and untidy hair. She was observed to have an averted gaze.
Speech: She speaks slowly and in a flat tone. Her responses are appropriate but she takes time to
answer.
Thought Content: Themes of helplessness and hopelessness were evident.
Mood and affect: Mood was observed to be depressed and sad and affect was observed to be
blunted with a restricted range.
Motor behavior: The posture was found to be rigid with a forward bent and a few quick
movements were observed
Thought perception: No evidence of any psychotic phenomenon such as hallucinations or
delusions
Suicidal ideation: She wishes to die because she believes that the world is not good enough for
her. She however does not actively plan a suicide
Orientation: She is oriented to the place, person and timing
Concentration: Her ability to concentrate is slightly impaired which can be inferred from her
inability to complete serial 7’s correctly.

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Insight and Judgment: Her insight and judgment ability are intact and she is convinced that she
needs professional help
Recent and Remote activity: Her recent memory is intact which is represented by her ability to
recall the three things after a span of five minutes.
Articulation of Impression:
The patient has presented to the impatient clinic with a one month history of anhedonia,
depressed mood, feelings of helplessness and hopelessness, sadness, socially withdrawn
behavior, reduced concentration. Impaired sleep pattern and reduced appetite. The above listed
symptoms are aligned with the symptoms of depression (Edward & Alderman, 2013).
Diagnostic Criteria:
 Social isolation
 Improper nutrition
 Deficit in maintain self-care
 Disturbance of self-esteem
 Disturbance of mood
 Dysfunctional grieving
 High risk of inflicting self-harm
 Sleep pattern disturbance
 Anxiety
Nursing Intervention Strategy:

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The possible intervention strategies that could help in the treatment process of A, would
include the following:
Implementation of pharmacological intervention:
On the basis of the details presented in the case study, the patient has been reported to
experience increased anxiety as well as feelings of anhedonia. The study also reports her to
experience sleep abnormalities. Therefore, administration of a mild sedative such as (Diazepam
or Valium; 2mg) could help in promoting a feeling of calmness in the patient (Calcaterra &
Barrow, 2014).
Referral to a psychotherapist:
The rationale for the referral can be explained as the implementation of multiple
psychotherapies such as mindfulness based therapies or counseling to promote recovery of the
mental health problem (Fu et al., 2013).
Referral to a dietician:
As indicated by the case study, the patient has lost weight and has low blood pressure.
Weight loss has been reported to be a common occurrence in case of mental health problems.
Studies indicate that weight loss leads to poor health outcome and weakens the immune system
which subsequently makes the body susceptible to other ailments and infection (Fernandez-
Mendoza et al., 2015). Therefore, the rationale of referral to a dietician can be explained as the
proper drafting of the meal plans which would help in regulating the body weight to achieve the
optimal body weight.
Conclusion:

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Therefore, to conclude, it can be mentioned that while diagnosing a patient with a mental
health problem, it is extremely important to take note of the physical history as well as the
psychosocial and family history. In addition to this, paying close attention to the problem and the
life stressors can help in diagnosing the problem. Further, on the basis of the MSE evaluation and
the diagnosis, the intervention strategies should be planned and implemented to promote
recovery.

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References:
Bennett, K. S., & Shepherd, J. M. (2013). Depression in Australian women: The varied roles of
spirituality and social support. Journal of health psychology, 18(3), 429-438.
Calcaterra, N. E., & Barrow, J. C. (2014). Classics in chemical neuroscience: diazepam
(valium). ACS chemical neuroscience, 5(4), 253-260.
Collins, E., Drake, M., & Deacon, M. (Eds.).(2013) The Physical Care of People with Mental
Health Problems: A guide for best practice. London: Sage Publications Ltd. Pp.112
Edward, K.L., & Alderman, C. (2013) Psychopharmacology: Practice and Contexts. London:
Oxford University Press.Pp.92
Fernandez-Mendoza, J., Vgontzas, A. N., Kritikou, I., Calhoun, S. L., Liao, D., & Bixler, E. O.
(2015). Natural history of excessive daytime sleepiness: role of obesity, weight loss,
depression, and sleep propensity. Sleep, 38(3), 351-360.
Fu, C. H., Steiner, H., & Costafreda, S. G. (2013). Predictive neural biomarkers of clinical
response in depression: a meta-analysis of functional and structural neuroimaging studies
of pharmacological and psychological therapies. Neurobiology of disease, 52, 75-83.
Gilbert, P. (2014). Depression: The evolution of powerlessness. Psychology Press.
Lin, N., Dean, A., & Ensel, W. M. (Eds.). (2013). Social support, life events, and depression.
Academic Press.
Smith, K. (2014). Mental health: a world of depression. Nature News, 515(7526), 180.p.67-77
Tiller, J. W. (2013). Depression and anxiety. The Medical Journal of Australia, 199(6), 28-31.