2809NRS: Mental Health Practice - Rachel Case Study - Nursing Assignment Help

Assignment Task:

Task Description: 

1. Choose one case study from the case studies supplied 2. With reference to appropriate scholarly literature, answer the following questions about your chosen case study: 

a. Explain the importance of identifying the biopsychosocial factors that impact on the well-being of a client during a mental health assessment.

b. Identify three (3) factors that have impacted on the presenting problem of the client from your chosen case study. Explain the significance of each factor in understanding the development of the client’s presenting problem.

c. With reference to the presentation of the client from your chosen case study, identify and justify three (3) appropriate nursing interventions.

d. Discuss the ethical and/or legal implications the nurse must consider for the client from your chosen case study.

Case Study 1 

Rachel 29 years. 

Rachel has returned for assessment following her discharge from an inpatient episode of care two weeks ago. Rachel states that she has broken up with her boyfriend, and a friend accompanying Rachel reports that her neighbours have raised concerns about her staying up all night listening to music and singing loudly. The neighbours have had multiple arguments with her regarding the noise, when previously there was a friendly relationship between them. Her neighbors have lodged a complaint with the landlord about the noise and she has received a warning about ongoing noise from her unit. It has also been reported that since breaking up with her partner, many deliveries of online shopping packages have arrived, as well as an increasing number of men leaving her apartment after nights out. 

Rachel is presently prescribed Lithium 500mg BD, Olanzapine 10mg nocte with PRN Diazepam 10mg, Olanzapine 5mg and Temazepam 20mg. Rachel reports “I’m too busy with my online fashion empire to take medication” and hasn’t taken medication since leaving hospital. Rachel states she no longer needs medication as it makes her “mind numb”. 

Rachel is admitted to the unit and she has been observed to be teary at times in her room about her break up and then at other times overly friendly with male patients and staff. The Nurse Unit Manager and staff have communicated with her about appropriate behavior with male patients and staff which Rachel laughed off, saying “I’m just friendly, what’s the problem?” 

Rachel has been observed to be changing her clothing multiple times throughout the day with increasing make up application. Her clothing is at times revealing and the staff have had to prompt her to change into more appropriate clothing when on the unit. Rachel has reported not sleeping well the last few nights, and night staff report she was up on several occasions through the night, despite having the maximum dosages of PRN charted. 

Rachel is estranged from her family; her father is living in another state and her mother who had a diagnosis of manic depressive in the 80s, died when Rachel was 16yrs. Rachel found her mother “sleeping” with a bottle of tablets beside her. Despite paramedics attending, Rachel’s mother was not able to be revived. The family suspect suicide, however, there was no investigation at the time. Rachel found life harder after her mother died and began to withdraw from her family. Her sisters have reported they noticed Rachel partying more after their mother died. Rachel’s two sisters live nearby but no longer have contact with her due to “Rachel’s drinking, lying and poor behaviour at all hours”. Rachel does not talk about her mother’s death or her relationships with her family as “they don’t get me”. 

Rachel’s few friends from work are concerned about her increasing erratic and inappropriate behaviors. She is often “too busy to eat” and staff note she is not eating much at mealtimes however her weight has not decreased since being on the ward. 

Case Study 2 

Sam 17 years 

Sam has just been admitted to your unit and this is her first episode of care. Sam was born a male and is now living as a female. Physically, Sam is tall and solid in stature and dresses in female oriented attire. Sam reports past trauma in childhood involving an older cousin and reports ongoing nightmares, “I just can’t sleep; when I close my eyes, I have nightmares”. 

Sam copes by cutting her arms and legs. The cuts are usually superficial in nature and she will dress them herself with bandaging provided by staff. If they are deeper requiring closer attention, her plan is to go to the local GP clinic for assistance. Often though Sam will find new or agency staff and ask them to dress her cuts. This has been causing some issues amongst the treating team and staff as Sam is often heard to state “well X nurse helps me – she/he is the only nurse who understands me” 

Sam is at high school and reports regular bullying from some of the students calling her names and she has stopped attending her school. Sam often finds it hard to source the kinds of clothing she would like to wear, as her stature is bigger than most female clothing. This is a source of frustration for her and she often makes her own clothes. This requires a sewing machine, which is not currently allowed on the unit due to safety risks. Sam is not happy with this decision and she often asks staff when she can have her sewing machine. There is a sewing machine in the craft room, so she often wants to be let in there to use it. Yesterday she removed a needle and cut herself requiring a trip to the local GP for stitches. 

Sam lives with her family who are supportive and has some friends who visit her in the hospital. Her friends often bring her pizza and high fat foods. Sam has gained 15 kgs since being on the unit and despite education about healthy weight range she is not listening and reports, “I don’t really care – pizza is nicer than the food here”. 

Sam is currently prescribed the following medications and Sam’s doctor would like to review her medication however, Sam is resistant. 

• Mirtazapine 30mg Mane, Seroquel 200 nocte, Seroquel 100 mane, Olanzapine 5mg BD. PRN Olanzapine 10mg, Diazepam 10 mg, Diazepam 20mg. 

Sam has a community psychologist and has been part of a transgender support group for 2 years. Sam reports: “they are a good support but they are mostly old and don’t get what I’m going through...... no one does”. Recently Sam’s only close friend from the support group completed suicide and “this has been on my mind”.

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