In accordance to the patients presentation and in conjunction with the DSM

In accordance to the patients presentation and in conjunction with the DSM, this patient was diagnosed with major depressive disorder. Major depressive disorder is characterised by an ongoing depressed mood lasting for a minimum of 2 weeks (Luty, 2015). The length of the episode may be up to 5 to 6 months. About 20% of cases become chronic, lasting more than 2 years (Sheehan et al, 2017). While depression begins with a single occurrence, most people will experience recurrent episodes (Sheehan et al, 2017). Approximately 50% of people will have a relapse within the first year of diagnosis and up to 85% will have a recurrence within a lifetime (Fiorillo et al, 2018). The DSM provides health care workers with a framework of diagnosing. According to the DSM to diagnoses MDD it is essential to have five or more of the following symptoms which must be present during the same two week period and show a decline or change in previous function (Rush et al, 2011). 1. A depressed mood which is present most of the day and nearly every day. Signified by either subjective description or observation of others (Rush et al, 2011). 2. Little interest or pleasure daily activities (Rush et al, 2011). 3. Weight loss without trying (Rush et al, 2011). 4. Insomnia or hypersomnia nearly every day (Rush et al, 2011). 5. Feeling restless or agitated (Rush et al, 2011). 6. Loss of energy or fatigue nearly every day (Rush et al, 2011). 7. Feeling worthless or an excessive amount of inappropriate guilt (Rush et al, 2011). 8. Inability to think or concentrate or displaying indecisiveness nearly every day (Rush et al, 2011). 9. Recurrent thoughts of death, or suicidal ideation without a plan, or a history of suicide attempt(s) or a specific plan (Rush et al, 2011). Following the framework of the DSM this patient was diagnosed with MDD due to fitting the specific guidelines. This particular patient expressed six of the nine symptoms listed above; Depressed mood, little interest or pleasure in activities, psychomotor agitation, Feelings of worthlessness, diminished ability to think or concentrate and recurrent thoughts of death/suicide attempt with specific plan. A holistic patient assessment is required in nursing to guide the nursing process and provide health care workers with the foundations of the individuals care (Wallace, 2013). Through a holistic approach, therapeutic communication, and ongoing assessment of objective and subjective data, nurses are able to provide improved person centred care to the uniqueness of an individual (Wallace, 2013). A holistic approach allows nurses to individualise and uniquely addresses and acknowledge sociological, psychological, physiological, developmental, spiritual and cultural needs of the patient (Wallace, 2013). Understanding the complexity and processes involved when taking a patients history is essential for allowing nurses to gain a better understanding of a patients presentation (Fawcett, 2015). Care priorities can be identified and allow for individualised interventions to be built (Fawcett, 2015). This patient had a very complex history which stresses the importance of assessing their history to gain a better understanding of their current presentation. He has had several pervious admissions to mental health due to MDD, abusive towards substances and alcohol, past aggressive behaviours and a long traumatic history of family violence in youth. Also disclosed was his family history which is extensive with mental health also, predisposing this patient to mental health. His family dynamics were strained due to his history of aggression when under the influence of alcohol. Due to this history his children had disassociated themselves from him and his had recently filed for divorce. Due to fear of safety, the family did not wish to have him home, therefore, leaving the patient homeless. He was referred to a social worker for financial aid and housing arrangements as well as Home to house which help locate accommodation. In conjunction with history, a risk assessment should be developed with regards to history and current presentation. The concept of risk is a complex issue with which having different meaning to different people (Halter, 2018). From a mental health perspective, how risk is defined and classified not only shapes the nature of the discourse but also builds the foundations and influences practice priorities that arise from classification (Halter, 2018). Mental health classifies risks into four different components; Suicide/self-harm, aggression, vulnerability and absent without leave (AWOL) (Cordall, 2009). This particular patient presented as a risk of suicide, with having a history but also previous attempts and stating having thoughts of suicide with a plan. He was also deemed at risk of vulnerability due to his presenting mental state, loss of hope and will. As well as at risk for AWOL due to previous attempts of AWOL, with most recent while an inpatient at Wisteria the prior day. It is also vital to assess patients for any history or current use of illicit substances and alcohol. Substance abuse is one of the most life threatening illnesses worldwide, untreated substance abuse may result in disturbances in social, occupational, or leisure activities (Rayan, 2017). Intoxication and withdrawal can have a devastating impact on a patient’s health, therefore, increasing the need for this type of assessment (Rayan, 2017). This patient has a long history of alcohol, nicotine and opioid dependence. When presented he was on the methadone program and willing to engage with the drug and alcohol team as he was wanting to reduce his dependencies to alcohol, nicotine and reduce his methadone. It is essential for a nurse to assess a patients mental state which can be done by using the mental state examination (MSE). The MSE is used to gain a more comprehensive understanding of a patients psychological functioning in a particular point in time to enable a direction of care most appropriate to the individual patient (Sencan, 2019). With the aid of the treating team a more detailed and comprehensive MSE can be done to establish presentation but also track the patients progress throughout their inpatient stay. This patients mental state was assessed daily by either the nursing staff or with the inclusion of the treating team, this helped guide the patients care and ensure the appropriate care was being delivered. There can be barriers when needing to provide care for patients. Unfortunately mental illness is still stigmatised in the current society, which creates a barrier for people seeking help and wanting that support. It has been shown that mental health stigma in Australia exists in the healthcare system and also among healthcare professional, which proves as a barrier to access the appropriate treatment and

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