NRSG263 Case Study: Mental Health of a Schizophrenic Patient

This case study analyzes the mental health of Rachael Tomkins, a 55-year-old woman with schizophrenia and Type II Diabetes. The assignment applies the Clinical Reasoning Cycle to assess Rachael's condition, including her mental state, risk factors, and relevant legislation. It explores ethical considerations, strengths-based assessments, and necessary additional assessments, such as diabetic counseling. The study examines psychotropic medications like Olanzapine, detailing their drug class, side effects, and adverse effects. References are provided. The case study highlights the importance of a holistic, recovery-oriented approach to mental health care, emphasizing the integration of physical and mental health management. It also includes application of principles of Recovery Oriented principles.

Running head: MENTAL HEALTH
MENTAL HEALTH
Name of the Student:
Name of the University:
Author Note:

1MENTAL HEALTH
Application of the CRC to the scenario:
The clinical reasoning cycle developed by Levett Jones assists care professionals with
a step-wise decision making process so as to undertake critical clinical decisions and assist
with a recovery process (Forsberg et al. 2016). The case scenario involves the client Rachael
Tomkins who is 55 years old and is a certified practicing accountant. The patient suffers from
Type II Diabetes and had been diagnosed with Schizophrenia at the age of 20. At present the
client experiences acute exacerbation of her Schizophrenic symptoms and has been presented
to the inpatient psychiatric clinic. An appropriate care plan would be devised for the patient
so as to stabilise her symptoms.
MH assessment (MSE):
The Mental State Evaluation for the patient upon arrival to the emergency ward
reveals the following:
Appearance: Dishevelled, dressed in pyjama top and tract pants with no shoes
Speech: Poverty of speech and disorganized speech
Mood/Affect: Dysphoric and labile
Thought Form: Derailed and looseness of associations
Thought Content: Paranoid delusions
Perception/Cognition: Derogatory and Persecutory auditory hallucinations and disorganized
thinking
Insight Judgment: Poor insight and impaired judgment
Risk assessment:

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On accessing the case scenario it can be said that Racheal is at an increased risk of
inflicting self-harm or harming others on account of her psychotic symptoms and poor insight
and judgment.
Role of relevant MH legislation:
The Australian legislation of Mental Health Act 2014, places patients with mental
health illness at the core of decision making process about mental health treatment (Mental
Health Act 2014 2019). Further, the Act drawn on the holistic needs of the patients and
established robust safeguards in order to preserve the rights, dignity and autonomy of patients
suffering from mental illness disorders.
Ethical considerations of MH legislation:
The ethical considerations involved in the care process would include, assessing and
treating the patient in the least intrusive and restrictive manner. In addition to this, Rachael
and her family members would be appropriately supported and actively involved in the
decision making process concerning her recovery (Health.gov.au 2019). Also, the care
process would be devised in accordance to the holistic needs of the patient and patient needs
of the patient would be prioritized while planning the treatment process. Also, steps would be
undertaken to ensure that individual rights, dignity and autonomy are preserved and promoted
at all times (Mental Health Act 2014 2019).
Strengths assessment (including the application of principles of Recovery Oriented
principles):
The elements of strengths that can be used for planning a holistic intervention for the
patient would comprise of adapting a family centred approach as the family members of the
client are aware about the mental health condition of Rachael (Health.gov.au 2019). The
second strength element would comprise of empowering Rachel with self-management

3MENTAL HEALTH
strategy and health literacy so as to promote recovery. These strengths would be considered
so as to develop an appropriate recovery plan to assist the client with holistic recovery
(Health.gov.au 2019).
Other assessments needed that would be relevant to each scenario:
On account of her unmanaged Type II Diabetes, Racheal would be referred to a
Diabetic counsellor so as to ensure that her physical health symptoms in relation to Diabetes
is controlled and efficiently managed and does not exacerbate as it could interfere with the
mental health recovery.
Psychotropic medications
Research studies suggest that the use of first generation antipsychotics such as
Olanzapine can help in stabilising Schizophrenia symptoms. Studies further suggest that the
prescribed daily dose varies in between 2.5 mg to 10.0 mg and must be administered at an
interval of 6 to 8 hours (Gitlin 2016). A combination of Lithium and Olanzapine is generally
used to treat Schizophrenia but the combination has been reported to elicit adverse chemical
reactions which might interfere with normal sleep pattern (Gitlin 2016). In such cases, the
prescribed medication must be reviewed for a change or altered dose.
Drug group:
The drug belongs to the class of atypical antipsychotics and helps in restoring the
balance of chemical released by neurotransmitters in the brain (Gitlin 2016).
Side effects:
The most common side effects associated with the medication include, dizziness,
gastrointestinal problems, dry mouth, constipation and increased body weight which leads to
weight gain (Gitlin 2016).

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Adverse effects:
The adverse side-effects associated with the consumption of the medication include
weight gain, elevated blood cholesterol level and rise in blood glucose level which leads to
poor management of Diabetes (Wani et al. 2015). Further, the intake of medication also leads
to tardive dyskinesia which is a condition characterized by uncontrolled movements of face,
lips and tongue.

5MENTAL HEALTH
References:
Forsberg, E., Ziegert, K., Hult, H. and Fors, U., 2016. Assessing progression of clinical
reasoning through virtual patients: An exploratory study. Nurse education in practice, 16(1),
pp.97-103.
Gitlin, M., 2016. Lithium side effects and toxicity: prevalence and management
strategies. International journal of bipolar disorders, 4(1), p.27.
Health.gov.au 2019. [online] Health.gov.au. Available at:
https://www.health.gov.au/internet/main/publishing.nsf/content/CFA833CB8C1AA178CA25
7BF0001E7520/$File/servpri.pdf [Accessed 6 Jun. 2019].
Mental Health Act 2014 2019. Mental Health Act 2014. [online] Www2.health.vic.gov.au.
Available at: https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/
mental-health-act-2014 [Accessed 6 Jun. 2019].
Wani, R.A., Dar, M.A., Margoob, M.A., Rather, Y.H., Haq, I. and Shah, M.S., 2015.
Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia, before and
after antipsychotic treatment. Journal of neurosciences in rural practice, 6(1), p.17.