Case study analysis Academic Essay - Write My Academic Essay

You are working on a busy emergency department (ED) when paramedics bring in Joshua (Josh)
Smith at 21:30 hours. Prior to his arrival at the ED, Joshâs parents had phoned the police, as they
were concerned for his safety. Josh had locked himself in his bedroom and refused to open the
door. His parents could hear loud banging, breaking glass and shouting coming from Joshâs room.
The police arrived to assess the situation and were able to persuade Josh to open the door to his
room. On entering the bedroom, Josh was sitting on his bed with his arms wrapped around him,
eyes closed, and rocking. They found that Josh had smashed a mirror in his room and there was
glass all over the floor. Police observed a lot of blood in the room that appeared to be coming from
cuts on Joshâs arms. An ambulance was called to transport Josh to the hospital for treatment.
Handover from paramedics
The paramedics hand over the following information about the patient. Josh is a 180 cm, 85 kg, 19
year old Caucasian man who lives with his parents and two younger siblings in a house in
Mandurah. Joshâs family reported to the paramedics that over the past few months Joshâs
appearance and behaviour has changed. He has become socially withdrawn, some days in the past
fortnight even refusing to leave his room. Joshâs personal care has suffered, often not showering or
changing his clothes for several days. Today his hair is unkempt and greasy and he is dressed in a
dirty Tâshirt, short and thongs despite the fact that it is winter. This is out of character for Josh who
was previously appropriately dressed and well groomed.
Josh no longer eats meals with the family and he has lost several kilos in the past few weeks and
appears pale. Josh is often irritable and angry especially when approached by his family about his
appearance and behaviour. His parents tried to talk with Josh this afternoon and persuade his to
see their GP for help. Josh screamed at his parents âno one understands, I feel so miserable, there
is no help for me…I just want it all to endâ and ran out of the house. When he returned home
several hours later, his family stated that he looked dishevelled, smelled of alcohol, refused to talk
and locked himself in his room. Concerns for Joshâs safety led his parents to contact police. The
paramedics have dressed and treated deep lacerations to both of Joshâs wrists and his observations
are stable. Josh had a blood alcohol level of 0.09mmol/L when breathalysed; no medication had
been administered in transit. Josh was silent on the way to ED but compliant with interventions.
Presentation
On arrival to the ED, Josh has his head lowered and will only make intermittent eye contact. He is
lying on a trolley with his bandaged arms wrapped around his and still dressed in blood stained
clothing. Josh is taken to a cubicle, where he lies on his bed sobbing quietly. The psychiatric liaison
nurse is unavailable due to several other presentations that evening and the bed coordinator
allocates Josh to you for the shift. You are told the family is in the waiting room and âheâs yours â¦
get as many details as you can from the familyâ.
Information obtained from parents
Joshâs parents are in the waiting room and give you the following information. His parents have
been concerned for some months about the decline in Joshâs mood and change in behaviour. Josh
was a happy, outgoing and active child and teenager who enjoyed playing soccer and going out
with friends. Joshâs parents report that their nephew died through suicide a year ago. Josh was
close to his cousin and took this very hard at the time. His mother reports âHe never really got over
it and has been taking about his cousin a lot lately; I think that might be because it will be a year
ago next week that we lost Andieâ. Josh was an average student in primary school, but his studies
declined rapidly midway through year 11 and Josh left school shortly after starting year 12 as he
was failing all of his subjects. Since leaving school four months ago, Josh has become much less
social, keeping in contact with only a handful of friends and has stopped playing sport. He has told
his family that he doesnât feel relaxed around people anymore and will often start to shake when
meeting new people. Josh was in a relationship with Michelle, who he met at school and they had
been talking of moving in together. Michelle ended the relationship two months ago as she felt
Josh was becoming ânervyâ and distant, however, they still remain friends.
Joshâs parents own an air conditioning business that is not currently doing well and the family has
been discussing closing the business. His parents have been under a great deal of stress around
their reduced income and future employment. Josh has been working at
the family business part time since leaving high school. Due to the downturn in the business, there
has been less work for Josh in the past month. When Josh is at work, his parents have noticed that
he becomes easily distracted, has been forgetful and has been making many mistakes. The family
has encouraged Josh to consider attending TAFE or going to Centrelink for job seeking and income
support, but Josh has lacked motivation and has not done either. His parents report that Josh will
have an occasional glass of wine at a social event but does not drink regularly or take any drugs.
Current scenario
You then approach Josh to ask his some questions and take his observations. When you return to
Joshâs cubicle, he is standing by the side of his bed putting on his thongs and has removed his
dressings. Josh bursts into tears when he sees you and starts shaking and sits on the bed. You
introduce yourself and explain that you are his allocated nurse. Josh looks briefly at you, scowls,
screams and yells âwhat can you do for me, how can you possibly help, I just donât want to be
hereâ, throws his dressings across the cubicle and starts kicking the wall. Suddenly there is a
security guard and two nurse colleagues by your side.

1. Introduction: Present a brief overview of the presenting issues as outlined in the case
scenario. Then briefly describe how you would manage the client, yourself and the other staff.
You need to consider in your answer issues of safety, consumer focus and selfâefficacy. Include
the scope and structure of the whole assignment.
(250 words)
Body of Assignment
2. MSE: Document the clientâs Mental State Examination in the medical record. Present your
information in the MSE format using the provided sequencing.
(500 words)
3. Risk Assessment: Based on your mental state examination, prioritise and briefly list and
describe THREE potential risks that the client is likely to pose over the next 24 hours.
Describe the management plan of the potential risks within the 24 hours in the
emergency department
(750 words)
4. Case Formulation/hypothesis: Develop a formulation based on the information gathered in
questions 1, 2 and 3. What might be the hypothesis surrounding the clientâs presenting issues?
(250 words)
5. Conclusion: Effectively summarise main points of assessment, management, and
intervention.