Internal Code: MAS1695
Ellen Hawkbridge is a 57-year- old woman, who was brought into the Emergency Department by police. She was found intoxicated at the local RSL club, harassing patrons and refusing to leave premises when requested by club security. Ellen’s husband, Simon, was notified by police of her behaviours; he arrived at the hospital approximately 30 minutes after Ellen and police. Simon reports that Ellen had been diagnosed with bipolar disorder when she was 23, with numerous admissions over the years; her last admission to hospital 18 months ago, for a depressive episode, a phase of her Bipolar disorder. At this time she was commenced on Sertraline 100mg mane. Ellen’s medications have been reviewed, and lithium carbonate 500mg BD and zulcopenthixol decanoate 150mg IMI 2/52 have been prescribed by the treating team.
Background in context of this admission: Ellen reports spending excessive amounts of money from her Disability Support pension on cigarettes, brandy and items from television shopping channels; Simon states, that little funds are left available following these purchases for her groceries. Simon says that the local community mental health team, had recently reviewed the need for Ellen’s Community Treatment Order, and due to her level of adherence to treatment and stability over the past 18 months, the order was ceased.
Family History: Simon reports that he and Ellen have a son, Jason (23 years old), who lives interstate. Jason has not been in contact with Ellen over the last few weeks due to her behaviour and deterioration in mental state. Jason is “embarrassed” by his mother and finds her too aggressive to talk to over the phone when she is in her “mood”.
Ellen presents with heavy bright coloured make-up on her face. She is dressed in clothes that, while appropriate for the cooler weather, are mismatched, unkempt and unwashed. She is noted to be overfamiliar towards others, especially younger male staff members. Ellen describes that she has not slept for days; she has not felt the need for sleep at night and that she is too busy. Her speech is loud, pressured and slurred. On interview her mood is elevated and labile. Ellen’s affect is congruent to her mood. She has periods of increased irritability, especially when her requests for perceived needs, are not immediately met by others. There is evidence of flight of ideas as her thoughts go from one topic to another and derailment is evident in conversation. Content of thoughts are grandiose, flirtatious and underlying sexual innuendo in conversation at times. Ellen denies any perceptual disturbances: nil evidence of behaviours suggestive of responding to perceptual disturbances. Ellen not oriented to time, (unsure of day/date), however is orientated toperson and place. There is evidence of poor levels of concentration (unable to complete serial 7’s). Her memory not formally tested at this stage due to intoxication, some blurring of recount of events. Assessment notes limited insight into her illness, as she stated, “there is nothing wrong with me”, stop giving me the drugs, lithium brings me down and stops me enjoying life!”. Judgement is impaired.
1. Identify and describe the following four (4) key components of the mental state, as they relate to Ellen’s presentation:
B. Thought Content
C. Thought form
2. Identify and describe two (2) areas of risk for Ellen in relation to her current presentation.
3. Discuss four (4) nursing care priorities for Ellen and provide a nursing intervention and a rational for each intervention identified.
4. Identify one (1) recovery principle (as per the National Framework for Recovery-Oriented Mental Health Services). http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs- n- recovfra. Describe how this recovery principle can assist in Ellen’s care?
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