MENTAL HEALTH CASE STUDY
€“
NP 365
Scenario
Mrs Johnson is a 47 year old lady a
dmitted to hospital following a motor vehicle
accident. In the accident she sustained multiple lacerations and a fractured right
femur which required surgical repair
. She
a
lso
had extensive suturing to her
lacerations.
Mrs Johnson was transferred after surger
y to an orthopaedic ward and
since
admission
has
presented with low mood, poor appetite and early morning wakening.
She is tearful a lot of the time and has revealed t
o the nurse that she recently lost
her job because she was having difficulty concentrating. Her marriage has broken
down and she is going through a divorce and may need to sell her house as part of
the divorce
settlement
. She tells the nurse that
: my
chi
ldren would be better off
without
me
and
I am
a failure and there is nothing in
my
life that give
s
me
a sense
of enjoyment

.
She reports a three month history of worsening anxiety that is particularly bad early
in the morning. I wake at three in the m
orning and I can’t get back to sleep. My
thoughts torment me. She
reports having a
decreased level of energy and
tells the
nurse
I feel so hopeless
that it is
no
longer
worth living. She denies drug and
alcohol misuse and has no physical problems apart
from those resulting from the
motor vehicle accident.
The family history is positive for depression in
her
p
aternal grandfather and great
grandfather and her uncle committed suicide about 10 years ago.
Assessment
In
approximately
1200 word
s
:
1.
List an
d prioritise
Mrs Johnson’s
me
ntal and physical health issues.
This is to be developed as one list
with the mental and physical health issues
included. You must provide brief rationale for
the health
issues and
order of
priority
.
2.
Identify the
mental hea
lth
risk factors suggested in this scenario.
Please complete and
submit
the attached Risk Assessment Form. In your
paper, include rationales for your selections on the Risk Assessment Form.
3.
For the top four priorities from Question 1, d
evise a plan of car
e
for each,
with referenced rationales.
You may use a table format if preferred, but not required.
31
3041
Nursing Practice 365
Mental Health Case Study
Marking Guide
Student Name_______________________________
Needs
Very
Improvement
Satisfactory
1
2 3 4 5
Mark
Subject
content
Have the mental health issues been
prioritised adequately with rationale?
/5
Have the physical health issues been
prioritised adequately with rationale?
/5
Risk
assessment
and
nursing
diagnosis
a) A
completed risk assessment form
b) A nursing diagnosis for the main
mental health issue based on the
risk assessment
/
5
/5
Plan of care
Plan of care formulated for the
top four priorities from the list
generated in question one
a) Appropriate, accurate and
relevant detail in care plan
b) Provided relevant rationales
for interventions identified
supported by appropriate
references
/10
/5
Formatting
a)
Content and title page
b)
Headings and page numbers
c)
Spelling and grammar
d)
APA 6
th
Edition referencing
/5
TOTAL
/40
Comments
NURSING PRACTICE 365
RISK ASSESSMENT FORM
ELABORATE ON RISK FA
CTORS IDENTIFIED
Enter dates of
other significant reports detailing
risks identified
Signed __________________________
________
__ Designation
__________________
__________
Clinical Assessment Point
(tick if present)
First contact with the service
Change or transfer of care
Change in legal status
Occurrence of a significant life event
Change in mental state
Source of
information
( tick if present)
The consumer
Primary care giver
Other informants(friends, family)
Police or other agencies
Other factors that may increase risk
Parents/carers have significant
physical/mental disability
Parents/carers have
significant substance
abuse
Relationship problems
Physical illness or disability
Lives alone/socially isolated
Has no supports
Criminal charges/arrest
Criminal conviction
Persecution or threats from others
Loss, including death
Financial
stress
Substance use
Intoxication or withdraw
a
l
Past history of child abuse or other abuse
Access to weapons
Access to medication(risk of overdose)
OTHER CONCERNS
Concern expressed by significant others
Compliance/reliability
Factors in the person’s HISTORY and
MENTAL STATE
that may
Increase
risk (tick
all that apply)
H= Historical, C = Current
H
C
Harm to self
–
threat
Harm to self
–
actual harm
Harm to self
–
with c
lear intent to die
Harm to other
–
threat physical harm
Harm to other
–
threat to kill others
Harm to others
–
damage property
Harm to others
–
actual physical harm
Harm to others
–
assault charge
Fire setting
Wandering/disinhibition
THE ABO
VE WAS/IS SECONDARY TO:
Low mood
Elated mood
Delusional or other disorder of thought
Hallucinations/altered perceptions
Cognitive disturbance
Impulsiveness
Personality factors