You are an R.N working in an authorised mental health hospital when police bring in ‘Scott’. Prior to his arrival, Scott’s parents had phoned the police as they were concerned for his safety and wellbeing. He had refused to leave his room, and had stated ‘he was feeling fine’ even though his behaviour suggested otherwise. Scott had also recently been discharged from hospital for a deep cut on his arm, but at the time denied he had deliberately done it.
Information reported from parents
Scott is a 21 year old, Caucasian male, he is 190 cm tall, and weighs 87 kg. Scott lives at home with his parents and has no siblings. Scott’s parents report that over the last few months Scott’s appearance, mood, and behaviour have changed. He has become withdrawn (when before he was social), he sleeps more than he used too, and sometimes they hear him talking to himself. Scott’s personal care has also suffered, often not showering or changing his clothes for several days. This is out of character for Scott who has previously been well dressed and groomed. Scott did have an apprenticeship, but the business closed and he has not been able to work for 4 months. This put strain on his long term relationship and this ended a month ago. As a result he has not seen his usual circle of friends, and has been spending more time out with a group of ‘older people’ that the parents have only seen from a distance. The parent’s report they think Scott’s change in behaviour may be due to drugs or alcohol – but they can’t be certain. They also report they think Scott’s grandfather had a mental illness, and are concerned Scott may have ‘the same thing’.
Scott has also stopped eating meals with them preferring to eat alone in his room. His parents report that he was grouping his food in colours and when they tried to talk to Scott about this, he got angry and irritable. He has lost weight recently. His parents tried to talk with Scott this afternoon (prior to the police being called) and persuade him to see their GP for help. Scott screamed at his parents “no one understands, they said you would try to do this, there is no help for me … I just want it all to end” and ran out the house. This was when the police were notified, and Scott is brought to the mental health facility for assessment.
On presentation to your ward
Scott is taken to a cubicle for assessment, you introduce yourself and commence your assessment.
Scott is dressed in a dirty singlet, shorts, thongs, and a baseball cap, despite the fact it is winter – he looks dishevelled. His light brown hair is unkempt, and greasy. His eyes are brown and he will only make intermittent eye contact with you. Scott is sitting on a chair, he is initially guarded in his responses to your questions, and stares fixated at the wall in front of him. Scott then becomes agitated, he moves from the chair to pacing the room, and back to the chair. He gets up again and goes towards the door to leave, you ask him to sit down and he does. Scott then sits in the chair quietly, bent forward, head in hands. When you ask Scott how he is feeling, he states “I want to leave, there is nothing wrong with me, I’m fine” and then he smiles at you. Scott’s expression is flat, there are tears in his eyes as he describes how he is concerned that someone is poisoning his food at home, and that people are telling him to leave the hospital because he is not safe here. Scott denies he has tried to harm himself before, but says he does have active thoughts of suicide now. Scott answers your questions, he is pleasant in his demeanour, he knows where he is, he doesn’t think he needs the medications that have been written up for him, and insists he must go home.
End of case study
ASSIGNMENT – CASE STUDY QUESTIONS
Based on the above scenario:
1. Introductory paragraph – clearly articulates the topic being addressed, with aims, and the key points you will address within the essay.
2. Brief overview of presenting issues (Consider predisposing, perpetuating and precipitating factors in your answer).
3. MSE: Document the clients Mental State Examination (MSE) on presentation to your ward. Document your information in the MSE format using the provided sequencing. Attach as Appendix 1 in your assignment.
4. Risk Assessment: Based on your MSE, prioritise and briefly describe THREE potential risks that Scott is likely to pose over the next 48 hours when admitted to the ward. Then describe how the nurse will manage these potential risks during the first 48 hours, providing rationale and literature evidence to support your justification for the risks and nursing care / management given.
5. Case formulation and hypothesis: Based on the information gathered from within the case study, and presentation to the ward (the MSE), develop a formulation and hypothesis (with supporting evidence from the literature).
6. Conclusion: Should be a summary of the key points discussed within the essay, and the conclusion reached and a result of the discussion.
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