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.

Case study

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.

Students are expected to use the Case Study template (available from the Learnonline environment) to complete this case study. Please read the sections on the Case Study template and ensure that you answer all sections on the template. Please also take note of the marking guide for this assessment item as this will provide some additional guidance for students.

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.

Assignment Task

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 Roger to care for him as a 1:1 special in a single bed side-room. You are given the following hand-over by the night duty RN.

Roger is a 35 year old male admitted yesterday post overdose of Sodium Valproate & Seroquel, and self inflicted lacerations to both wrists. Roger has a history of Bipolar Disorder and is currently on an ITO-L1 which requires review today. Overnight Roger has had a fluctuating sensorium – has been occasionally drowsy, but at other times very restless and agitated. His conversation has had a paranoid and delusional flavour at times. Roger is confused and likely has a delirium related to the ingestion of prescribed medications.

Roger 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 10:00 AM. TPR & BP are within normal limits – for checking 4 hourly along with neurological observations until reviewed by treating medical team.

Roger’s behaviour has not presented any significant management problems overnight in the ward. However Roger did present to the Emergency Department in a severely agitated state when a Code Black (Aggressive incident) was initiated.

Because of Roger’s fluctuating sensorium he is to be considered at risk.

The self inflicted wounds to Roger’s wrists were sutured in ED, the wound site is intact but there is some ooze from the sutire site; the dressing will need to be changed during the day. Roger is not to be given any medication unless severely agitated. The Consultation-Liaison psychiatry team are aware of Roger’s admission to the medical ward and will review him later this morning. Over the next few hours it is likely that Roger 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 Roger’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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