NRS222 - Mr Walter Reed Case Study Assessment Answer

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NRS222 - Mr Walter Reed Case Study Assessment Answer
Task:

Casy Study

Mr Walter Reed is a 69-year-old man with a history of bipolar disorder, type 2 diabetes, and hypertension. He presented at the local emergency department in a confused state. When his renal function was checked it showed raised serum creatinine. His medications on admission were:

• Lithium Carbonate, extended release, 600 mg orally, BD.
• Metformin, extended release, 1000 mg daily
• Candesartan 16mg orally once a day

Mr Reed has been on lithium for over 30 years. He was reviewed by the renal team and lithium was ceased. Mr Reed was admitted to the medical ward while his renal function stabilised. Due to his renal impairment and age it was decided that Mr Reed would be commenced on quetiapine. This medication would be titrated upwards over-time, with Mr Reed’s assessed for mood each day:

• Day 1: 50 mg PO at bedtime
• Day 2: 100 mg PO at bedtime
• Day 3: 200 mg PO at bedtime
• Maintenance (day 4 onward): 300 mg PO at bedtime

Mr Reed has now been in hospital for three weeks. You notice that Mr Reed’s mood has deteriorated. He doesn’t want to get out of bed or shower, has been sleeping poorly, and refusing his meals. This morning he tells you that he wants to die because he feels so miserable. When you sit down to talk to Mr Reed about this, he reveals he has been secreting his medication at night so that he could take an overdose and never wake up.
You then inform the senior Registered Nurse on shift, who asks you to continue observing Mr Reed until the Mental Health Consultation Liaison Team arrives to formally assess him. While you wait with Mr Reed, his wife arrives. You explain the situation and she becomes distressed and starts to sob. She tells you, in front of Mr Reed, that she sick and tired of the constant worry of caring for Mr Reed, she has no support, and she can’t manage any longer.

Assessment task - NRS222
This assessment requires you to analyse a case study. Read the case study carefully then answer the five (5) questions below

1. Accurately identify and describe the mental health issues experienced by the person.
2. Explain and justify the contemporary, evidenced-based, pharmacological and non-pharmacological care options for the person and their family members. Explain how to ensure these options are culturally safe.
3. Analyse the major factors, including opportunities and challenges, related to the lived experience of mental illness and/or substance abuse for individuals, families or communities.
4. Explain the ethical considerations and legal frameworks used when caring for the person.
5. Discuss the consultation/referral that would need to take place.

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