A 76-year-old man named Dennis, who is a widow, is brought to the Emergency Department by an ambulance. Dennis, a widower was found in a confused state on the bedroom floor of his unit and when asked whether he recognized his environment, he was unable to tell the Ambulance offices what day, time, or season it was. He could tell them the address and name of his GP (doctor). A number of different medications were found on the table nearby. Dennis’s neighbors alerted the police after noticing that his curtains had not been drawn and reported he had not been seen at the local social club for several weeks. A note addressed to his son who lives interstate was also discovered on the bedside table. Among the medications, there was an unopened pack of paroxetine recently prescribed by his GP. In addition, a bottle of temazepam was also found empty with some spilled onto the floor.
Dennis appears to be very thin and is wearing soiled and smelly clothing hanging loosely from his frame suggesting a large weight loss. His fingernails are overgrown and he is unshaven. He had made superficial cuts to his wrists. He says very little, does not establish eye contact, just sits with his head slumped down. When he eventually responds to an effort to ask him about what happened, he talks in a barely audible whisper using very few words. When asked why he took all the pills he answers, “Too late. I must be punished” finishing with a sound that could be a sigh. Upon asking if he wanted anyone to be contacted, he did not make any further response.
Brief Description of Nursing assessment and Resultant Nursing issues/Client needs
From the case study above, it is clear that Dennis is suffering from some form of mental disorder. Mental health can be referred to as a level of emotional or cognitive wellbeing or an absence of a mental condition (Barry & Farmer, 2002, p.233). This includes one’s ability to enjoy life as well as procure a balance between efforts to achieve psychological resilience and life activities (Lloyd-Sherlock, 2000, p.887). Sensitive and systematic nursing assessment has been an important requirement as per the government policy concerning primary health as well as community care.
Assessment and care plans in nursing have mainly been influenced by the problem-solving structure found in the nursing process and nursing models (Boyd, 2007, p.804). Assessment is perceived as being the first step in the process of nursing care for an individual and as concerns the elderly, it requires a comprehensive collection of relevant data about the biological, functional, psychological, psychosocial, and physical aspects of the elderly individual (Craig, 2002, p. 17).
An assessment was already being carried out by the ambulance officers after they were informed of Dennis for instance when they were trying to determine his psychological state. This is observed where the ambulance officers were interviewing Dennis’s neighbors in a bid to gather information as to what had happened for him to be in such a state. An assessment was also carried out by observing Dennis’s posture, eating habits, grooming, and physical characteristics (Buckner, 2007, p.99).
Dennis’s mental state was assessed as being suicidal and exhibited a state of being delusional for instance, where he was asked to give a reason as to why he had taken all those pills and instead of providing a direct answer, replied that it was too late and he had to be punished. On reaching the hospital, a Registered Nurse conducts a nursing assessment as the nursing process continues and new information is gathered about Dennis.
A standard assessment tool assists in categorizing the data collected from the client by the Registered Nurse.
Prioritized Nursing issues/Client needs for the Care Plan
Determining nursing issues or client needs required for the formulation of a care plan is important as it provides a foundation for planning nursing interventions to cater to these needs that are a responsibility of the nurse. From the case study, there are a number of needs that are to be considered as a priority as per the urgency and intensity of the problem presented. This is done once the Registered Nurse has diagnosed Dennis’s condition. Priorities are determined such that any health or mental condition that appears to endanger the life of an individual receives a higher priority than those conditions that are recurrent or chronic (Barry & Farmer, 2002, p.234). Dennis has been diagnosed as having suicidal ideation or intent as exhibited in the superficial cutting of his wrists and therefore considered as being an immediate danger as regards self-injury (Craig, 2002, p.18).
The first client needs that the Registered Nurse should prioritize in regards to Dennis’s condition is that of basic needs.
According to Maslow’s hierarchy of needs, basic needs that include food, warmth, sleep, elimination, and oxygen have been considered as the first priority in human health before other needs (Boyd, 2007, p.805). Therefore, these must be catered to in situations where diagnoses such as that of Dennis’s have been passed. Dennis was observed to have lost a large amount of weight in addition to not properly grooming himself. The Registered nurse should concentrate on providing food, water, and sleep to Dennis before other needs such as love, self-esteem and security can be fulfilled (Buckner, 2007, p.111).
The second client need that should be prioritized by the Registered Nurse is that of mental well-being. From the observations made by the ambulance officers upon reaching Dennis’s home, there was an unopened pack of paroxetine and a bottle of temazepam that was empty. Paroxetine is tablets that are usually prescribed by a doctor to treat panic disorders, depression, or restlessness (Barry & Farmer, 2002, p.235). On the other hand, temazepam is usually prescribed for treating insomnia or difficulty in falling asleep (Lloyd-Sherlock, 2000, p.888). From these facts, it can be concluded that Dennis was suffering from some form of mental disorder that led him to be prescribed these medicines. The Registered Nurse, once having provided the basic needs as per Maslow’s hierarchy of needs, should concentrate on filtering the temazepam from Dennis’s body to reduce the side effects associated with overdose of the medicine such as confusion and hallucinations (Craig, 2002, p.19).
The third consideration to be made as a priority by the Registered Nurse as concerns Dennis’s case is that of provision of intense individual care. Recent research has shown that older patients especially those who suffer from mental illnesses require higher individual care as compared to younger patients (Buckner, 2007, p.113). Dennis was also observed to exhibit symptoms of loneliness in addition to feelings of being unloved and uncared for as indicated by the letter he had written to his son, found on top of the table by the ambulance officers. The Registered Nurse put in charge of Dennis should ensure that constant care is shown and given to him in order to restore his sense of being loved and cared for (Barry & Farmer, 2002, p.236). The nurse should also make an effort of encouraging other older patients who are in the recovery process to visit and chat with Dennis to take away his feeling of loneliness. This will also help in restoring self-esteem and self-actualization in him.
A Care Plan for Identified Prioritised Client Issues or Needs
Nursing care plans outline the form of nursing care to be provided to a particular patient (Boyd, 2007, p.806). They are established to guide nurses in the implementation of solutions to problems identified during nursing assessments. The main characteristics of a care plan include relating to the future, being founded upon identifiable health and nursing problems, focusing on actions meant to solve or minimize an existing problem, and being a product of a deliberate systematic process (Lloyd-Sherlock, 2000, p.889). A care plan for the aforementioned client’s needs and issues as regards Dennis’s case will be required.
In mental health, a nursing care plan starts with a diagnosis being made by a doctor followed by a few recommendations for treatment (Barry & Farmer, 2002, p.237). This usually takes place once the patient has been referred to a hospital and is being processed for admission.
This has already been done in Dennis’s case. Next, the doctor also identifies what the mental health needs are and the assistance needed to cater to these needs (Boyd, 2007, p.807). This, too, has already been done as regards Dennis’s case. The doctor then determines the results the patient is would like or is likely to achieve in addition to the best course of treatment for meeting those needs (Craig, 2002, p.28). Once this process has been completed, a patient is then admitted to a facility where a Registered Nurse is assigned together with a nursing team to take up the responsibility of ensuring that this recommended treatment is followed and met (Barry & Farmer, 2002, p.238). Dennis will follow the same process prior to his admission.
Being part of the mental health team, a nurse is charged with the responsibility of communicating and assessing information as regards the status of a patient to the physician and other members of the mental health team. It is therefore important to formulate nursing care plans that will prove effective and be able to resolve identified client problems while being safe for the client and other involved parties. Moral and mental support should also be provided to assist the mentally ill patient in the recovery process.
Barry, Patricia D., and Farmer, Suzette 2002. Mental Health & Mental Illness, 7th edition, Philadelphia: Lippincott Williams & Wilkins. Pp. 233 – 512.
Boyd, Mary Ann 2007. Psychiatric Nursing: Contemporary Practice, 4th edition, Philadelphia: Lippincott Williams & Wilkins. Pp. 804 – 952.
Buckner, Julia D 2007. Mental Health Care for People of Diverse Backgrounds, Oxford: Radcliffe Publishing. Pp. 99 – 164.
Craig, Sarah 2002. Mental Health in Older People in Practice, London: RSM Press. Pp. 17 – 61.
Lloyd-Sherlock, P 2000. Population Ageing in Developed and Developing Regions: Implications for Health Policy, Social Science and Medicine, 51. Pp. 887 – 895.