Past Medical History
John is 45-year-old man who is living with his family. John was referred to the Monash Medical centre with the history of headache and muscle pain in the legs that he was forced to leave his job as a carpenter. Upon diagnosis, it was found that John was going through anxiety and depression that have worsened in the past few months.
Mental Status Examination
John is an English Carpenter who is has come with the problem of major muscular pain and has problems in sitting and while walking. He is well oriented and well perfuse. There was no abnormality found while looking at him.
Mood and Affect
He does not have any extreme mood while talking to him. However, he remained disturbed due to his pain in the muscles.
John articulated himself very clearly. He answered all the questions very clearly but in a slower rate. He has soft spoken man and was having some breathing problems while talking for a very long time.
John exhibits a normal perception. The symptoms of illusions, delusions, hallucinations, misinterpretation and passively phenomenon were not seen elicited in John.
The thought process of John has decreased. It has also decreased the rate of the speech in him. He did not exhibit any formal form of thought disorder. He did not use or created his own word to express his feelings. No negative thought disorder was seen in John.
However, John is very much disturbed and anxious about his health and feels restless while thinking about his health. He is very much guilty that he is unable to care of himself and finance his own medication.
John is alert and oriented in terms of time and place. He is able to answer all the questions asked about his past and is able to recall every single incident.
Judgement and Insights treatment
However, when John was questioned about his condition, he accepted that he is ill and he requires treatment
Summary of presenting problems
- 80% blood clot in his left leg
- Persistent and worsened headache over a last 4 weeks
- Experienced non-epileptic tremors
- Symptoms of anxiety and irritability
- Acute depression
- History of melancholy
- Fear of brain tumor
- Financial crisis and stress
Major depressive disorder and anxiety is the main concern of the client.
John has a strong family history, which predisposes him to develop a mood disorder. According to Levinson et al. (2014), a large sample of people diagnosed with non-anxious control and general anxiety disorder showed the family history of the psychological problems. As per the behavioral genetics research, metal disorders are highly attributed to genetic factors. In the govern case study, John’s parental cousin Bipolar Affective Disorder and maternal cousin has anxiety. His older brother, Jeffrey has also suffered from panic and depression with admission at the clinic previously. His youngest brother, James is currently suffering from severe sleep deprivation due to being the new father of twins. John’s father suffered from Post-Traumatic Stress Disorder. Thus, it is evident that these genetic factors have cumulative influence on John’s psychological condition.
The precipitating factor in case of John is the financial dependence. He is financially not stable to fund the whole process of medications. Due to lack of financial independence, John started to have symptoms of anxiety and irritability. Anxiety and acute depression added to insomnia. (Cruwys et al. 2014). The history of drug and alcohol also precipitated his current condition. In addition, John has also suffered a lot of physical injuries. He suffered a spider bite that developed into cellulitis requiring IV antibiotics. He ruptured his anterior cruciate ligament while on the trampoline and had to undergo surgery. After debilitating pain from osteitis pubis he also had to undergo psychiatric consolation.
John also carries the feeling of guilt as he was not able to save his co-worker. He had short term relationships with his two women in the past, which may add to his guilt. Other precipitating factors are One of his sons has a developmental difficulty that has been categorized as a sensory processing disorder with attention deficit disorder. John was treated for a depressive illness that emerged after his son’s developmental difficulties. Increasing alcohol consumption of John’s wife Marie is the other cause of anxiety in John (Catarino et al. 2014).
The stress due to workplace bullying and fatal accident led to multiple inpatient admissions. Thus, he is currently in need of social support of community. The lack of rationalized thoughts, anger, guilt, lack of personal hygiene, and lack of financial stability are the precipitating factors of John. These factors are manifested as escalating panic attacks and phobic responses to the workplace, pervasively low mood and neuro-vegetative symptoms. John has the fear of brain tumor is further adding to anxiety and depression These psychosocial stressors are responsible for the Major depressive disorder and anxiety in the patient (Song and Lindquist 2015).
The major perpetuating factor is the financial strain which is allowing John’s depression to continue. It is the ongoing problem along with the debilitating pain from osteitis pubis it is also adding to stress. His son’s developmental disability. Fear of brain tumor and wife;s increasing alcohol consumption are the perpetuating factors. The use of the antidepressant and antipsychotic medication and treatment process in condition where he is having financial crisis is increasing his depressive state (Swank et al. 2014).
The protective factors in case of John are having ECT that improved is condition, adequate family support to cope with illness, ongoing medications to improve his physical health. His perceptions, insight and judgments are good. As John is cooperative, he is suppose to recover soon provided he adheres to medication and interventions (Cuijpers et al. 2014).
Care plan- Nursing interventions
Short term goal:
1. Strict adherence to medication
2. Express feelings atleast once daily
Long term goal:
1. Express feelings of emotional state
2. Able to gain work function and maintain and job
1.Establish a therapeutic relationship with John through patient cantered care. The nurses should always maintain the therapeutic distance with the patients and exhibit their proper postures (Hockenberry and Wilson 2014).
2.Allow John to express feelings, expectations, concerns and fears- Nurses must have some sense of empathy towards their patients (Lehne and Rosenthal 2014).
Nurses should motivate them to do activities that will improve their personal health and should train them to start to take care of themselves, when needed (Song and Lindquist 2015).
1.Arrange of group sessions and therapy among people with similar problems (Young and Skorga 2013)
2.Refer client to occupational therapy
Ongoing relationship builds trust and may facilitate coping (Hans and Hiller 2013)
Use of empathetic communication skills and by demonstrating sensitivity to client’s problem, it becomes easy for the client to interpret the circumstances in better way (Thompson and McCabe 2012).
Communication and discussion of feelings and thoughts help voicing of actual threats and immediate intervention (Pennebaker 2012).
Acknowledging and empathizing promotes a supportive environment that enhances coping. Interacting with people other than nurse allows patent to gain better insight (Hans and Hiller 2013).
Occupational therapy will help client to gain independent functioning by learning new skills to cope with personal and professional activities in daily basis (Muskett 2014).
On discharge John will have better physical health due to medications and decrease in depression. Patient is expected to accept circumstances.
Reduced depressive state is expected by regaining work function, improved communication skills and emotional confidence.
Short term goal:
Decrease disturbed thoughts
Long term goal:
Resolve the problem in correct way and enhance the
Self promoting behaviour of client and self motivation activities
The nurses should interact with the patient with a very low and soft tone, refuse negative thoughts (Temel, and Kutlu 2015). Engage client in reflective practice such as writing journals (Varcarolis 2016).
Set non repetitive routine for the client where he will encounter low responsibility to high responsibility tasks to be accomplished on daily basis.
This can be followed by increasing the self motivating ability of client (Song and Lindquist 2015).
Maintaing journal help the client to keep track of thoughts and source of anxiety (Kircanski et al. 2012)
Taking responsibility will decrease anxiety and panic as the patient will gain confidence by fulfilling responsibilities. It will eliminate the feeling of hopelessness and improve self motivation (Thompson et al. 2012).
The patient should self-motivate himself or herself thinking that life is worth living for. They should indulge in various forms of activities that will motivate them to do the work that are related to the self-motivation. It will help them gain confidence and prevent them from any sort of suicidal works (Lehne and Rosenthal 2014).
On discharge time, John will have high self-esteem and better problem solving skills. The client will report reduced anxiety. The client will less fears once he learn to self motivate himself.
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Cruwys, T., Haslam, S.A., Dingle, G.A., Haslam, C. and Jetten, J., 2014. Depression and social identity: An integrative review. Personality and Social Psychology Review, 18(3), pp.215-238.
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Swank, S., Harden, R., Bakshi, R. and Maletta, E., 2014. (224) Pain predicts depression in for-profit nursing home residents. The Journal of Pain, 15(4), p.S32.
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