Assessment and Management of Miss J: A Case Study

Mental Health Form Completed by Police

Miss J is a 26 year old female who presents to the emergency department escorted by the police. Bystanders at the local train station called 911 stating they were concerned about her safety due to erratic behavior. The police tell you that she is “formed”.1.Discuss which mental health form has most likely been completed by the police. (2) 2.Describe which conditions must be met for the police to complete this form legally and bring a patient in for assessment (3)Police tell you that bystanders reported the patient jumping down onto the train tracks and laying down on them twice. Each time members of the public encouraged her to get back on the platform and she complied. EMS was called on the second attempt and when they arrived the patient was sitting on a bench crying with bystanders. She refused to come with EMS/Police for assessment and attempted to strike one of the officers when they told her she would be escorted to the hospital.Upon entering the room, you notice that Miss J is curled in a ball on the bed and has tears on her cheeks. She is staring at the wall and does not sit up when you enter. She appears disheveled, her hair looks unwashed and she has multiple stains on her shirt. She appears stated age. She allows you to take vital signs, which are normal.3.List at least three relevant personal safety factors that you need to consider when entering the room to interview this patient and discuss why they are relevant (6)During your interview with Miss J you note that she will not make eye contact with you, and maintains a flat affect with monotone, one word answers. She states that she has been sleeping 14 hours a day for the past few weeks, and has been eating junk food when she can get it. She reports a weight gain of 10 lb. in the last 2 months. She states she feels sad and then eventually tells you that she lost her job five months ago and was kicked out of her apartment when she couldn’t afford rent. She has been living in her car ever since and eating at the shelters. She tells you that she feels “sad, pathetic and hopeless” and states she doesn’t think her life is going to get any better. She does not want to see her friends and has been avoiding meeting with her counsellor.4.What is your priority concern/assessment for Miss J knowing the above information? (2) 5.List two specific questions you would ask to gain more information based on your priority concern from her current assessment findings above(4)Miss J informs you that she wasn’t trying to kill herself by lying on the tracks, and that she scared herself by doing it. She denies auditory, visual and tactile hallucinations and she is answering questions appropriately. She would like to stay in the hospital and be seen by a psychiatrist. Miss J is on no medications and does not have any allergies. The emergency physician assesses her and tells you that she is not eligible to have a new form initiated. He lists her diagnosis as Major Depressive Disorder/Anxiety. 6.Why is the physician unable to complete the required form on this patient? (2) 7.What symptoms/signs would you be assessing for to determine whether the patient is anxious? (5)8.Are there any further assessments related to Major Depressive Disorder that you would like to complete? (4) The doctor orders fluoxetine 20mg PO once daily and lorazepam 1mg SL q2h PRN for anxiety. He admits Miss J to the inpatient short stay psychiatric unit.9.Discuss how fluoxetine works in the body, the medication class, side effects and patient teaching information. (8)10.Discuss how lorazepam works in the body, the medication class, side effects and patient teaching information. (8)While awaiting a bed on the psychiatric unit Miss J remains in the ED. On your next shift you assess Miss J and find her sitting in her room rocking back and forth. When you ask her if she has any plans for self-harm she states “Yes”.11.What questions would be most important to ask the patient at this time? (2) 12.Discuss 3 common safety interventions that nurses use with patients experiencing suicidal or homicidal ideation