Chen is a 48-year-old three times divorced

Chen is a 48-year-old three times divorced woman who is brought to the emergency department by the police after being found at 3am walking in the middle of the highway against the traffic. Chen was noted to communicate with police in a provocative and suggestive manner, asking one of them if he was interested in receiving a “freebie” in the back of the divisional van. Chen appeared to be in good health, with no evidence of assault or injury. Chen was evicted from her flat 2 weeks ago after refusing to pay the rent. Chen’s second husband has custody of their 4 children and she hasn’t seen them in a number of months. Chen has been assessed in Emergency by a registrar, and is going to be admitted involuntarily to the Adult Psychiatric Unit. Chen is dressed in a long, leopard-print coat, purple negligee and stockings with holes and dirty yellow, stilettos. Chen has an offensive, strong body odour which suggests she has poor hygiene. Her bleach-blond hair is mattered and dirty, and has grown out exposing about 10cms of brown hair. Bright red lipstick is crudely on her lips and cheeks, and most of her long, fake fingernails have broken. Chen’s mood is extremely labile and her affect is cheerful and bright. Chen’s speech is rapid, pressured and loud. When questioned, Chen states that she was searching for her “movie agent” as the reason why she was walking down a dark street at 3 in the morning. Chen is dismissive and amused by the thought that she may have been in any imminent danger by doing this, and adamantly denies any substance misuse or need for psychiatric treatment. Chen admits to an undetermined amount of weight loss stating “Oh man, I’m too busy to eat. Anyway, now that I’m in demand for Hollywood blockbuster movies, I need to look after my figure!” During your nursing intake assessment, Chen frequently starts singing, dancing and getting up and out of her chair. Conversation with Chen is very difficult to follow due to not completing sentences and moving rapidly from topic to topic. When you ask Chen if she has been prescribed medication in the past, she becomes surely and states “hmm well I was supposed to take Lithium, but its poison and I don’t like it.” Chen cannot remember (or refuses to tell you) when she ceased the Lithium nor elaborate reasons why she stopped taking it. What condition does it appear Chen is suffering from? Identify four (4) appropriate nursing diagnoses for Chen’s Nursing Care plan. Have at least one (1) goal for each diagnosis, three (3) interventions for each diagnosis, with associated rationale. Nursing Diagnosis Goals of care Nursing Interventions Rationale Nursing Diagnosis Goals of care Nursing Interventions Rationale Nursing Diagnosis Goals of care Nursing Interventions Rationale Nursing Diagnosis Goals of care Nursing Interventions Rationale Identify the symptoms Chen is exhibiting which are suggestive of the mental illness she is suffering. _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ It is 4.30am. Chen demands to leave the hospital. She becomes agitated and belligerent, demanding to know her rights. She confronts you in an intimidating manner demanding to know why you won’t let her out. As an Enrolled Nurse what are your responsibilities with regards to this request? What do you say to Chen? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Chen is unhappy with your response and begins yelling and screaming. Four other clients are awoken to her screams and enter the lounge area where you are. Chen and Sally (a client with acute Paranoid Schizophrenia) become embroiled in a physical altercation. What do you do? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Chen is placed in seclusion, whilst Sally is taken to the treatment room to have her wounds attended to, and to be counselled re her actions. You can hear Chen yelling from the seclusion door, she is distressed and agitated. What grounds for seclusion do you think Chen’s behaviour fall into? __________________________________________________ What are the legal requirements of nursing and medical staff for the use of seclusion? ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________

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