400218 | Mental Health Nursing Assessment Answers

Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion. Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promo-tion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months. Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung's parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very difficult. Chung found their wedding day emotionally difficult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn't as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family. Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and difficulties moving around. Chung was off work for one week after the baby's birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 - 24 hours. Harriett's parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett's parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter. You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His affect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte's birth and his wife's health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.

1. a. Using the case study provided, identify an urgent risk area. Ensure your answer details why you have identified this risk area including specific information about the client and current literature.

1.b. Identify one nursing / midwifery intervention you would immediately undertake with your client to address the risk area noted in question la and include a rationale for the intervention.
Ensure the intervention includes who and when you would actually carry out the intervention. Your rationale should state how and why you would carry out the particular intervention. Ensure literature is included. 

2.a. Using the case study provided, identify a mental health concern. Ensure your answer details why this an area of concern. Include specific information about the client and current literature.

2.b. Identify one nursing / midwifery intervention you would undertake with your client to address the mental health concern noted in question 2a and include a rationale for the intervention.

Ensure the interventions includes how, who and when you would actually carry out the intervention. Your rationale should state how and why you would carry out the particular intervention. Ensure literature is included when you discuss the rationale. 

3.a. Using current literature, identify and discuss (2) two legal, ethical or professional issues a nurse / midwife may need to consider when working with the client in the ca. study.

1.a. In context to the given case study, Chung, a 35-year old operate whom was a doctor, working in the Accident and Emergency and in a busy inner-city hospital represented a number of problems. These problems about the client in the case study were identified past six weeks defined about his poor health condition. Symptoms identified in this case were sleeplessness; anxious behaviour and Chung started waking up at 3 am in the morning depicts his submissive behaviour. In addition, it was also found that 3 months ago, Chung had regular thoughts of cutting his wrists with a razor blade, this led to the emergence of safety concern for the patient. He described the cause of his self-harm thoughts to be his family contacts which triggered him causing these mental problems. Therefore, suicidal thoughts and overdose were the major safety concerns, as an urgent risk area that should be dealt by the nurses in the healthcare and his family members (Bruce et al., 2015).

1.b. Nursing interventions or approach to improve the health condition of Chung involves a number of ways, which will help in understanding the patient’s behaviour and take appropriate measures. Developing a therapeutic relationship and using recovery-based language with Chung will help in improving his health condition. As the urgent risk area relates to the safety concerns, therefore maintaining a safe environment can be a useful approach for the patients’ wellbeing. Nurse’s role is to involving him in a regular 30-minute daily exercise and other refreshing activities, which would help him regaining hope and confidence in work and social relationships. Healthcare must focus on building trust and mutual understanding with such patients. Moreover, a nurse must interview Chung, gain an understanding of his self-harm thoughts, and communicate properly to develop effective therapeutic alliance with him. Interventions undertaken by nurse/midwifery states about the rationale, i.e. purpose of implementing them. Rationale following a recovery-based language approach is that it facilitates gaining an understanding about the patient’s perspective towards and stress (McClay et al., 2015).