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Case Study for Assessment 1 and 2 – Note: your student assessment work must focus on Chung, regardless of your status as a nursing or midwifery student.
Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion.
Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promo- tion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months.
Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung's parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very difficult. Chung found their wedding day emotionally difficult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn't as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family.
Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and difficulties moving around. Chung was off work for one week after the baby's birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 – 24 hours. Harriett's parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett's parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter.
You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His affect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte's birth and his wife's health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.
Question 1 – 500 words – 10 marks
Using relevant literature critically discuss the mental health status of the client in the case study.
Your work should make reference to two (2) components of the Mental State Examination (MSE) related explicitly to the case study and the DSM V.
(4 marks MSE, 4 marks DSM V, 2 marks for references)
Question 2 – 500 words – 10 marks
Critically discuss two (2) factors which have contributed to the development of the client's current mental health status.
You should demonstrate your knowledge of the Stress Vulnerability Model. Your work should clearly identify the contributing factors; make reference to the case study and relevant literature.
(2 marks for Stress Vulnerability Model, 3 marks for each contributing factor, 2 marks for references)
Question 3 – 500 words – 10 marks
Respect, empowerment and hope are three (3) positive aspects of mental health recovery. Using relevant literature and the case study, critically discuss how these three (3) principles could positively contribute to the client's journey of recovery.
You should demonstrate your knowledge of recovery orientated mental health theory and practice.
(2 marks for recovery orientated mental health theory and practice, 2 marks each for factors, 2 marks for references)
Mr. Chung is a doctor by profession and working in the Accident and Emergency department in a hospital in Australia. Lately, he has been upset and anxious due to heavy workload and issues at his workplace, resulting in various investigation and 12 months practice supervision. Further, he was distressed as he felt he was incapable of taking care of his sick wife and new-born daughter. This led to the development of various symptoms. Chung's mental state and DSM V examination is presented below.
Mental state examination
Mr Chung is a 35 years old man, who migrated from China. He appeared listless, lacking eye to eye contact on communication. He looked upset and teary-eyed. His voice was very slow and spoke at several instances only after repeated inquiring, indicating impoverished speech. On questioning, he said that he was increasingly anxious due to his long and rest fewer working hours, shift work schedules, high work pressure in the department, and health issues of his wife, and inadequate time for his new-born daughter. He experienced physical health symptoms of chest pains, breathlessness and palpitations for six to seven weeks. He also experienced insomnia for six weeks, especially late-night sleeplessness (initial insomnia) and early morning awakening (terminal insomnia) at 3 am. He reported a 5 kg weight reduction since the previous month. He had suicidal thoughts since last week and revealed that he was aware of the lethal drugs, which could cause overdose and lead to death. He believed that he was responsible for his condition (delusional guilt) and it could not be cured by medical help (somatic delusion) (Norris, Clark, & Shipley, 2016).
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