Assessment and Diagnosis of Mr X

Describe one consumer’s issue you have identified through your assessment.

The analysis deals with the mental health nursing care plan of Mr X based on the assessment and the diagnosis of the consumer. As a part of the professional experience placement, based on the analysis and the consumer issue identified the care plan involves set goals expected outcomes, interventions and the outcome evaluation. The aim is to design the individualised, person-centred and recovery-orientated nursing care (Gilburt, Slade, Bird, Oduola & Craig, 2013). 

Mr X has been diagnosed with Schizophrenia. He has the past of significant mental health issues. He is lonely in life and socially isolated. He has poor housing and poverty is the noticeable factor. He has the history of criminal records and association with anti-social peers. The consumer has the history of the traumatic abuse throughout childhood. The patient is in good terms with his grandmother.  A reduced life expectancy is noticed in the patient. Due to early onset of the disease, the patient is experiencing the adverse outcomes of the illness. His social life is severely impacted as he is unable to socially interact with people and establish rapport.  The history of the patient also informs about the evidence of substance abuse. There is high probability of the poor health and the social outcomes. He has inadequate access to the mental health care. He is on medication currently. He has recently contracted scabies due to self-neglect.

A detailed examination is important for the patient as per the nursing practice. For Mr X, it is important to conduct physical and the mental state examination. Physical examination is to obtain the subjective and objective data using the head-to-framework. The mental examination will help achieve comprehensive description of the patient’s mental state. It will include the appearance, attitude, behaviours, mood and affect, speech, thought process, thought content, perceptions, insight, judgment, and cognition. Since the patient is in vulnerable condition, a risk assessment will also be conducted to identify the risk of self-harm (Norris, Clark & Shipley, 2016; Rothman, Solinger, Rothman & Finlay, 2012; Victorian Government Department of Health, 2010).   

The patient has demonstrated the poor and unkempt appearance. Mr. X has demonstrated several negative symptoms such as lack of goal directive behaviour, delusions, hallucinations, and abnormal motor behaviours. The patient showed limited emotional expression and ability to speak. His thought process is disorganized. He demonstrated poor hygiene. The patient’s judgment is impaired. He is not aware of the illness. He is not complying with the therapy as well as exploiting socioeconomic factor, which means poor insight. His social life is severely impacted as he is unable to socially interact with people and establish rapport. There is high risk of the patient entering into the criminal record. He seems to have negative social judgment regarding trustworthiness. He has poor insight of the people and demonstrates apathy. His mood and affect may be variable due to history of substance abuse. There is alteration in his perception as he considered the staffs are starving him. There was no suicidal thought observed in the client. The patient did show adverse cognitive outcomes.

Risk Assessment of Mr X

A risk assessment is a process to identify the hazard that can be caused by a person and the consequence of hazard. It means there is risk to the patient as well as to the environment (Victorian Government Department of Health, 2010). There is a risk to patient’s health due to self-neglect, harm to others and he is also at risk of exploitation from others. Mr.X is at self-harm as he has poor hygiene and lack of self-care. However, there is no trace of attempt to suicide. He is at risk of harming others considering his criminal history. He also has the history of substance abuse along with evidence of disoriented thought and insight. He is at high risk of others as he had experienced abused throughout childhood. There is the vulnerability of further abuse and exploitations, both from peers and the family.

The subjective and objective data demonstrated the skin infection scabies owing to poor hygiene. There are no other wounds. Overall the patient has an unclean appearance from tip to toe. Mr.X is also experiencing anhedonia. It is the inability to feel pressure. The patent has poor eating habits and poor weight management. The patient is losing weight due to poor diet. He had poor social relationship with family and peers. His musculoskeletal system may weaken with the progress of Schizophrenia and poor self-care. There are no abnormal findings related to the patient’s vital sign. The patient is, however, risk of range of medical conditions such as cardiovascular disease and cancer, with the progress of an illness.

It is registered by the psychiatrist based on the DSM-V criteria that the patient has schizophrenia. According to the DSM-V criteria, the patient must have two of the following symptoms: hallucinations, disorganized speech, delusions, catatonic behaviour, and negative symptoms, to be diagnosed with schizophrenia (American Psychiatric Association, 2013). Further, the criteria highlight about having at least one symptom. It is either presence of disorganized speech, hallucinations and delusions. Further DSM-V criteria include continuous signs of disturbance that must be persisting for at least 6 months, and during this period the patient must experience at least 1 month of active symptoms. Along with it, there should also be social or problems with occupational deterioration over significant time. Lastly, the signs must not be attributed to any other condition (American Psychiatric Association, 2013).  Mr X had demonstrated almost all of the symptoms.

Nursing Diagnosis for Mr X

On admission the nursing diagnosis for Mr. X using NANDA-I is Delusion. Delusion is the mental disorder and is the idiosyncratic belief of an individual that may be contradicted by rational argument (Wu & Shen, 2017). Mr. X had beliefs regarding persecution as he thinks that the care team wants to starve him.  The nursing diagnosis is disorganized speech. It is the condition of speaking where a person losses connection and shifts from one topic to other. There would be no connection with one thought and the next (Frith, 2014). .Further, the nurse has diagnosed Mr.X with negative symptoms. These symptoms comprise of social withdrawal, difficulty in taking care of themselves, inability to express emotions and inability to feel pressure (Frith, 2014). Mr. X was unclean and unkempt in appearance. He demonstrated self-neglect through his infections and poor eating habit. In Mr. X Further, diagnosis also showed the social problem as he cannot establish rapport with the people. He experiences problem with trustworthiness.

For recovery of Mr., there is a need for SMART goals ((Specific, Measurable, Achievable, Realistic and Timing). It will help design individualized, patient-centered and recovery-oriented nursing care.

The first goal for the patient is to enhance the self- hygiene address the grooming self-care deficit. The second goal is to improve nutrition, where nurse must provide well-balanced diet. The long-term goal is to improve the social life and decrease the social isolation. In doing so, the nurse must avoid stimulated environment, ensure adequate sleep, therapeutic relationship and provide relaxing therapy (Patel et al., 2014).

In the first intervention, the nurse must provide education to the patient on good hygiene and self-care habits. The nurse must provide food to the patient on clean plates and help in proper grooming. It includes bathing on time, maintaining neat and clean clothes. Avoid body odour and on the regular trim of nails and hair (Rajji Miranda & Mulsant, 2014). It will help improve patient’s image of self and increase self-esteem. It will also enhance the independent nature of the client.  The nurse maintains the privacy of the client during bathing and dressing to respect the dignity.

In the second intervention, the nurse must collaborate with the dietitian to design a well-balanced diet for Mr. X. The nurse must monitor the patient’s nutritional status. Considering the delusion the nurse must allow the patient to cook his food as it will help reduce delusion. It will also promote self-dependency in client. Healthy eating will help improve his weight and muscle strength. The nurse must also monitor if there is effect of medication on appetite (Sheffield et al., 2014).

Goals for Mr X’s Recovery

In the third intervention, the nurse must use self-therapeutic technique. The nurse must establish rapport and trust with the client. The interaction with the patient would be positive with calm gestures and positive facial expressions. The nurse would not be demanding and plan simple activities for Mr. X. It will help promote client’s self-esteem. The nurse must be patient and honest with the consumer. The care must be as per the patient centered model for nurses (Adaji et al., 2017). The nurse would encourage and promote him to interact with friends, encourage family involvement and provide social skills training (Linz & Sturm, 2013).

Using the subjective and objective data, the outcomes will be evaluated. In the subjective data the records on personal hygiene, grooming and care can be recorded, and patents perception on self-care can be assessed using open-ended questions. Further assessment includes mini-mental state exam to rule out negative symptoms (Norris, Clark & Shipley, 2016). The expected outcome is the improved physical appearance of the client.  There may be proper Wight gain and muscle strength of the client in two months of time. The client may show the positive relationship with the people around him in the long term.

Conclusion

In conclusion, the nursing care plan for Mr. X was designed that addresses social isolation and self-care deficits. As a part of the nursing process, the physical, mental and risk assessment was conducted. The nursing interventions were appropriate as per the patient-centred goals. The evaluation process will ensure if the nursing intervention is successful.

References

Adaji, A., Melin, G. J., Campbell, R. L., Lohse, C. M., Westphal, J. J., & Katzelnick, D. J. (2017). Patient-centered medical home membership is associated with decreased hospital admissions for emergency department behavioral health patients. Population health management.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) [electronic resource]. Washington, D.C. : American Psychiatric Publishing, 2013.

Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology press. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=oz24AwAAQBAJ&oi=fnd&pg=PP1&dq=schizophrenia+and+delusions+&ots=o4MkiP4rDu&sig=6qfNekxDUT9jjDheDfaaQt-aca0&redir_esc=y#v=onepage&q=schizophrenia%20and%20delusions&f=false

Gilburt, H., Slade, M., Bird, V., Oduola, S., & Craig, T. (2013). Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study. BMC Psychiatry, 13(1), 167. Retrieved from https://dx.doi.org/10.1186/1471-244x-13-167

Linz, S. J., & Sturm, B. A. (2013). The phenomenon of social isolation in the severely mentally ill. Perspectives in psychiatric care, 49(4), 243-254. DOI: 10.1111/ppc.12010

Norris, D. R., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. American Family Physician, 94(8).

Patel, K., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and Treatment Options. Pharmacy And Therapeutics, 39(9), 638-645. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/

Rajji, T. K., Miranda, D., & Mulsant, B. H. (2014). Cognition, function, and disability in patients with schizophrenia: a review of longitudinal studies. The Canadian Journal of Psychiatry, 59(1), 13-17.  https://doi.org/10.1177/070674371405900104

Rothman, M., Solinger, A., Rothman, S., & Finlay, G. D. (2012). Clinical implications and validity of nursing assessments: A longitudinal measure of patient condition from analysis of the Electronic Medical Record, BMJ open, 2(4), e000849

Sheffield, J. M., Gold, J. M., Strauss, M. E., Carter, C. S., MacDonald, A. W., Ragland, J. D., … & Barch, D. M. (2014). Common and specific cognitive deficits in schizophrenia: relationships to function. Cognitive, Affective, & Behavioral Neuroscience, 14(1), 161-174.  

Victorian Government Department of Health. (2010). Statewide mental health triage scale Guidelines. Retrieved from https://www.health.vic.gov.au/mentalhealth

Wu, Y. Y., & Shen, Y. C. (2017). Delusions of control in a case of schizophrenia coexisting with a large cerebellar arachnoid cyst. Tzu-Chi Medical Journal, 29(2), 115. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509203/