Write a Discussion of main issues in relation to the MSE.

Write a Discussion of main issues in relation to the MSE.

With reference to the case presentation, discuss the approaches you would apply to enable you to engage with, and undertake a Mental State Examination for Annabelle. 1. Discussion of main issues in relation to recovery- demonstrated exceptional knowledge and understanding of the recovery approach. Drew upon excellent examples in its application. This refers to the issues you would consider to enable you to undertake the MSE 2. Discussion of main issues in relation to the MSE. Demonstrated exceptional knowledge and understanding of assessment using relevant components of the MSE. Draw upon excellent relevant examples in an integrative manner. This refers to a discussion on the main aspect of the MSE pertinent to the case presented. 3. Analysis of issues relating to mental health. Extensive integration of credible and relevant literature and evidence from a variety of sources to support discussions and substantiate key points and ideas. What is referred to, include the broader issues such as psychosocial, etc., that maybe of significance in relation to mental health care. They may be embedded within the discussions above, or separately if more appropriate. Introduction- case study You are working on a busy Emergency Department (ED) as a newly registered nurse. A young woman in her early adulthood presents at 0800 hours in the company of an older woman. The young woman is dressed in dirty jeans and a T-shirt and is barefoot. Her hair is dyed blue and pink but is unkempt and matted. She has a number of piercings in her nose, eyebrow and lip. She is very tense and paces up and down the ED corridor wringing her hands from time to time. She responds instantly to any sounds or movements in the ED that alert her attention and her eyes stare intensely either into the ceiling above or at staff members. Her gaze and manner alternates between being intrigued to afraid to hostile. She seems unable to sit still for any time at all and ignores the older womans pleas to relax and sit by her side. She does however, follow the ED bed coordinator to the bed/cubicle she has been allotted but insists upon as much distance as she can get from any physical contact. The young woman hesitates before entering the cubicle like she is about to enter a trap. The older woman nurtures her carefully into the cubicle. The bed coordinator leaves them and approaches you with a concerned smile on her face Shes yours until the psych team gets around to her get as many details as you can from the mother Interview preparation You are given her medical record file. From this record you read that her name is Annabelle and she is 22 years old. She lives in a nearby suburb with her parents and her occupation is listed as being between studying. She has no religion listed and she has never been married. You note that the older woman accompanying her is indeed her mother. With her file in hand you approach their cubicle Initial Interview As soon as you enter the cubicle Annabelle looks intensely at the ceiling and then suddenly glares at you. Her mother reassures her Annabelle Its all right theyre here to help you You notice Annabelle wrings her hands and begins to sweat. Her pupils are extremely dilated. After you introduce yourself, the mother asks if she can talk to you alone. You agree. She tells you Annabelle hasnt been herself since dropping out of university where she studied nursing 12 months ago. She has lost contact gradually with nearly all of her friends and become increasingly isolated listening to loud music in her bedroom and refusing to discuss her situation with either of her parents. Over the last three months her behavior has become increasingly odd and erratic. She spends increasing periods in her room alone but also goes out, sometimes for days at a time. She never lets her parents know where she goes, with whom or what she does. She comes home disheveled and dirty. She has lost a lot of weight over the past few months and often doesnt eat for a day or two. Recently, she has been heard talking loudly to herself in her room and over the past week she has been shouting as if at someone but she is alone. On one occasion when she returned from one of her walkabouts she was accompanied by a strange young man who had dreadlocks but refused to come inside when invited. He hung around the house for a few hours but left when he was approached by Annabelles father. The past week has been especially difficult. Annabelle has not slept nor has eaten or taken fluids enough to sustain her. Over the past two days she has started pacing and wringing her hands and behaving as if she is constantly in danger. Last night she burst out of her bedroom and screamed incomprehensibly at her father then stopped suddenly and went back into her room. It took her mother until this morning to coax Annabelle into visiting the hospital with her. Her mother begs you for some help. You decide to approach Annabelle to ask her some questions and decide to interview her alone. You show her mother to where she can have a cup of tea while you do this. When you return to Annabelles cubicle, she is smiling at you. Then looks up to the ceiling terrified. She mutters to herself and then smiles again, this time to herself, before she says to you: Why am I here???!!! You wont tell her anything will you? You begin to tell her that her treatment here is confidential but she interrupts: You know dont you? You know its in my veins! Annabelle stares intensely up and down her arms. Her arms are covered in sores that she is constantly picking at. Before you can answer she adds, Theyre everywhere. Everywhereunder my skin! Everyone of us is falling the whole planet is falling! She begins to giggle to herself. Then she looks up at the ceiling once more Shut up, shut up, shut up!!!!!!! then distressed, proceeds to scream and hold her ears as if to block a loud noise Suddenly there is a security guard and two nurse colleagues by your side. Annabelle stops screaming and slides down the wall saying to you: Forgive me! Forgive me! I never meant to hurt anybody please forgive me? You ask her: Forgive you for what, Annabelle? What have you done? She looks up at the ceiling intensely and then back at you: Cant you hear what theyre saying?! All the children have been hurt She slumps to the floor and begins to sob in both distress and despair
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