The purpose of this assignment is to explore the personal and social implications of mental illness, as well as, ethical, legal and clinical practice implications related to a mental health patient being admitted to a medical ward. Using a recovery and person-centred approach, explore the issues raised in the case study and how you can support this person during your early shift.
Students will be given a number of important documents related to this case study of a person who experiences a major mental illness. These documents will appear in the Learnonline Notice Board over the duration of the course. Students will need to access these documents in order to complete this case study.
You will be expected to analyse these documents, extract the main issues and reflect on how the information impacts on the client, the family, the case manager and how it informs your nursing care and approach. You will have opportunity to discuss these documents in your tutorial sessions or in the Learnonline environment.
You are a newly registered nurse working in a large metropolitan hospital on an early shift in a busy medical ward. You have been allocated Samantha to care for her as a 1:1 special in a single bed side-room. You are given the following hand-over by the night duty RN.
Samantha is a 37 year old woman admitted yesterday post overdose of Sodium Valproate & Seroquel, and laceration to her right wrist. Samantha has a history of Bipolar Disorder and is detained on DTOL1 which requires review today. Overnight she has had a fluctuating sensorium ? has been occasionally drowsy, but at other times very restless and agitated. Her conversation has had a paranoid and delusional flavour at times. She is confused and likely has a delirium related to ingested of prescribed medications.
She has an intravenous line of normal saline 1 litre over 8 hours ? started 1 hour ago. Urinary catheter insitu which is draining well. The last ECG showed lengthening of Q-T interval and a repeat ECG is booked for repeat 10:00 AM. Her TPR & BP are within normal limits ? for checking 4 hourly along with neuro-observations until reviewed by treating medical team.
Samantha has not presented any significant management problems overnight in the ward. However did present to the Emergency Department in a severely agitated state when a Code Black (Aggressive incident) was initiated. Because of Samantha’s fluctuating sensorium she is to be considered at risk.
The wound to her right wrist was sutured in ED and remains dry; the dressing will need to be changed during the day. Samantha is not to be given any medication unless severely agitated. The Consultation-Liaison psychiatry team are aware of Samantha’s admission to the medical ward and will review her later this morning. Over the morning Samantha will become more alert and likely more distressed and agitated. You are advised to call for assistance if you have any concerns.
In a parting comment by the night duty RN states that she does not know why we are wasting time on looking after people who want to kill themselves; there are plenty of sick people who need hospital beds.
Following this handover you have the time to review Samantha’s admission notes where you will find a number of documents which highlight past and recent concerns. (All of these documents can be found in the Learnonline Notice Board over the duration of the course).
Emergency Department Mental Health Assessment
Private Psychiatrist letter to Mental Health case manager
Letter from employer to Mental Health case manager
Letter from Mother to Mental Health case manager
Recent letter from identified client to Mental Health case manager
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