NRSG264 Integrating Practice 3 - Assignment Solution

This paper intends to provide a reflection upon a case study of ‘Alison’ a 38-year-old single mother of two working as a supermarket employee, with a current working diagnosis of Clinical Depression. In consideration of her current situation financially she appears to have trouble going to work because of her feeling of constant fatigue showing a poor level of functioning. Receiving decreased wages adds stress to her situation. Other significant stressors are also present such as pressure to provide for her children (e.g. new games), to reciprocate in her romantic relationship. However there are some protective factors such as family support (e.g. her sister who made her seek consult) and the love she has for her children and the fear of disappointing them. 

There are many areas to assess as the aetiology of mental health issues has been linked to a range of factors. As a clinician you need to know what areas these are and the rationale for incorporating them. The assessment of Alison requires a biopsychosocial approach, which looks at the patient from the biological point of view (i.e. neurotransmitters), social point of view (i.e. family and personal relationships), and psychological point of view (i.e. distress in not being able to provide). 

A key feature of this is the mental status examination (MSE). In Alison’s case this was undertaken by the GP. A summary of the findings was that her general appearance shows a late 30 year old Caucasian woman with a broad build. At the time of examination, she appeared well groomed and appropriated dressed for age with short blonde hair, wearing a pink sweater and purple pants. Her behaviour demonstrated that the patient was cooperative, maintains eye contact, and responds to questions. Cognitively she appeared to have to changes in sensorium and is able to focus on the conversation. Her speech was coherent and fluent, with an appropriate tone, normoproductive, but with a slightly slow rate. Thought process was organized and logical. Thought content was devoid of any classical delusional themes. However; her thoughts focused on her functional disturbances in her relationships and specifically contained cognitive distortions of being “useless” as a parent. Mood state was generally depressed described as “fed up” and “miserable” with appropriate affect. Perception indicates that there were no reports of hallucinations or delusions. Her level of insight was 4, meaning she acknowledges and accepts her problem without knowledge of it. She also demonstrates good judgement. The questions about her level of risk revealed static factors of Caucasian race, a previous history of suicide attempt and her age and current dynamic factors of alcohol use, emotional instability, and active suicidal ideation (Welton, 2007).