Assignment Case Study Introduction You are working on a busy emergency
Assignment Instructions This assignment is based on the attached Case Study and is designed to assess your understanding and application of MSE, Risk Assessment, Case Formulation and Care Planning. Assignment Case Study Introduction You are working on a busy emergency department (ED) when paramedics bring in Joshua (Josh) Smith at 21:30 hours. Prior to his arrival at the ED, Josh’s parents had phoned the police, as they were concerned for his safety. Josh had locked himself in his bedroom and refused to open the door. His parents could hear loud banging, breaking glass and shouting coming from Josh’s room. The police arrived to assess the situation and were able to persuade Josh to open the door to his room. On entering the bedroom, Josh was sitting on his bed with his arms wrapped around him, eyes closed, and rocking. They found that Josh had smashed a mirror in his room and there was glass all over the floor. Police observed a lot of blood in the room that appeared to be coming from cuts on Josh’s arms. An ambulance was called to transport Josh to the hospital for treatment. Handover from paramedics The paramedics hand over the following information about the patient. Josh is a 180 cm, 85 kg, 19 year old Caucasian man who lives with his parents and two younger siblings in a house in Mandurah. Josh’s family reported to the paramedics that over the past few months Josh’s appearance and behaviour has changed. He has become socially withdrawn, some days in the past fortnight even refusing to leave his room. Josh’s personal care has suffered, often not showering or changing his clothes for several days. Today his hair is unkempt and greasy and he is dressed in a dirty T?shirt, short and thongs despite the fact that it is winter. This is out of character for Josh who was previously appropriately dressed and well groomed. Josh no longer eats meals with the family and he has lost several kilos in the past few weeks and appears pale. Josh is often irritable and angry especially when approached by his family about his appearance and behaviour. His parents tried to talk with Josh this afternoon and persuade his to see their GP for help. Josh screamed at his parents “no one understands, I feel so miserable, there is no help for me…I just want it all to end” and ran out of the house. When he returned home several hours later, his family stated that he looked dishevelled, smelled of alcohol, refused to talk and locked himself in his room. Concerns for Josh’s safety led his parents to contact police. The paramedics have dressed and treated deep lacerations to both of Josh’s wrists and his observations are stable. Josh had a blood alcohol level of 0.09mmol/L when breathalysed; no medication had been administered in transit. Josh was silent on the way to ED but compliant with interventions. Presentation On arrival to the ED, Josh has his head lowered and will only make intermittent eye contact. He is lying on a trolley with his bandaged arms wrapped around his and still dressed in blood stained clothing. Josh is taken to a cubicle, where he lies on his bed sobbing quietly. The psychiatric liaison nurse is unavailable due to several other presentations that evening and the bed coordinator allocates Josh to you for the shift. You are told the family is in the waiting room and “he’s yours … get as many details as you can from the family”. Information obtained from parents Josh’s parents are in the waiting room and give you the following information. His parents have been concerned for some months about the decline in Josh’s mood and change in behaviour. Josh was a happy, outgoing and active child and teenager who enjoyed playing soccer and going out with friends. Josh’s parents report that their nephew died through suicide a year ago. Josh was close to his cousin and took this very hard at the time. His mother reports “He never really got over it and has been taking about his cousin a lot lately; I think that might be because it will be a year ago next week that we lost Andie”. Josh was an average student in primary school, but his studies declined rapidly midway through year 11 and Josh left school shortly after starting year 12 as he was failing all of his subjects. Since leaving school four months ago, Josh has become much less social, keeping in contact with only a handful of friends and has stopped playing sport. He has told his family that he doesn’t feel relaxed around people anymore and will often start to shake when meeting new people. Josh was in a relationship with Michelle, who he met at school and they had been talking of moving in together. Michelle ended the relationship two months ago as she felt Josh was becoming ‘nervy’ and distant, however, they still remain friends. Josh’s parents own an air conditioning business that is not currently doing well and the family has been discussing closing the business. His parents have been under a great deal of stress around their reduced income and future employment. Josh has been working at the family business part time since leaving high school. Due to the downturn in the business, there has been less work for Josh in the past month. When Josh is at work, his parents have noticed that he becomes easily distracted, has been forgetful and has been making many mistakes. The family has encouraged Josh to consider attending TAFE or going to Centrelink for job seeking and income support, but Josh has lacked motivation and has not done either. His parents report that Josh will have an occasional glass of wine at a social event but does not drink regularly or take any drugs. Current scenario You then approach Josh to ask his some questions and take his observations. When you return to Josh’s cubicle, he is standing by the side of his bed putting on his thongs and has removed his dressings. Josh bursts into tears when he sees you and starts shaking and sits on the bed. You introduce yourself and explain that you are his allocated nurse. Josh looks briefly at you, scowls, screams and yells “what can you do for me, how can you possibly help, I just don’t want to be here”, throws his dressings across the cubicle and starts kicking the wall. Suddenly there is a security guard and two nurse colleagues by your side. End of case study Assignment – Case Study Questions Based on the above scenario: 1. Introduction: Present a brief overview of the presenting issues as outlined in the case scenario. Then briefly describe how you would manage the client, yourself and the other staff. You need to consider in your answer issues of safety, consumer focus and self?efficacy. Include the scope and structure of the whole assignment. (250 words) Body of Assignment 2. MSE: Document the client’s Mental State Examination in the medical record. Present your information in the MSE format using the provided sequencing. (500 words) 3. Risk Assessment: Based on your mental state examination, prioritise and briefly list and describe THREE potential risks that the client is likely to pose over the next 24 hours. Describe the management plan of the potential risks within the 24 hours in the emergency department (750 words) 4. Case Formulation/hypothesis: Develop a formulation based on the information gathered in questions 1, 2 and 3. What might be the hypothesis surrounding the client’s presenting issues? (250 words) 5. Conclusion: Effectively summarise main points of assessment, management, and intervention. (250 words) Assignment Notes: • Please note that you must validate any specialised terminology you use. For example: Agitation, as evidenced by the patient pacing the unit, appearing to be tense and is easily irritated. •
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