CASES for ESSAY

Below are two (2) cases for you to choose from for your Essay assignment. Please use one from your own practice or clinical placements and only use these if you have no direct case to analyse.
Case 1:
https://www.sane.org/snapshots/jesse (below is an example of how to develop the scenario for your PBL from a consumer story)
Case 2
Consumer story: Things change
http://www.sfnsw.org.au/Help-for-You/Personal-Stories-for-Consumers (the accompanying story)

ESSAY Case – Jesse:
Case 2:
Set up:
Patient in his bedroom crying. Jesse has been yelling and screaming at his partner and young child and threatening self-harm.
Job Information:
Priority 2: to a residential address for a 33 year old male with feelings / threatening self- harm. His partner has called the ambulance service with concern about her safety after a major argument. Case 133, received at 20.12, dispatched at 20.14.
The residential address is a 4 bedroom house in a quiet street with young families. ‘Jesse’ is in the main bedroom and his partner and 5 month old baby are sitting in the lounge room.
On Arrival:
There appears to be no immediate danger to the paramedics or others as the paramedics enter the house. The paramedics are greeted by the partner with the baby in her arms at the front door (clear front door and back door entry and exit). The partner explains that she and Jesse have been together for approximately 3 years and Jesse has been diagnosed with bipolar disorder approximately 2 and half years ago. They have a 5 month old son.
As the paramedics enter the bedroom Jesse is sitting on the edge of the bed with his head down with his hands covering his face. He his quietly talking to himself with tears running down his face. He is approximately 180 centimetres tall (5 foot 11 inches), short dark brown hair, old grey shirt, tracksuit pants. He appears to be focussed on the ground and starts to turn his body away as you approach the room. He fails to make eye contact as you enter and continues to speak softly to himself.
He appears exhausted and tired (not clean shaven, hair is dishevelled and he has dark rings under his eyes).
History & Past History;
Partners perceptive:
Over the past 3 months the partner has noticed that Jesse has been drinking more particularly in the evening and going into the study to do what he describes as work. He still seems to enjoy time with their son, but he has not been as involved or attentive to their son as he used to be. She describes their relationship as loving and caring but he appears more distant and they have been having more arguments that she describes as serious recently. She describes Jesse having increasing mood swings, becomes more irritated and unreasonable when discussing day to day issues (work, care for their son, household and financial matters). He became obsessively organised and seemed to be excited over a new project at work with the mindfulness training for business programme that he is involved in which started 5 months ago. She has noticed over the last month Jesse has found it harder to get out of bed and seemed to lose purpose and was not finishing anything he started. Jesse was employed as a navy architect but left the navy when he was 27. At that time he ended his previous relationship and began to take drugs and increasingly used alcohol to try to help him to feel socially comfortable again and to fit in when he struggled.
Patient role / perspective:
Mental Health Emergencies

Jesse is very hesitant to have paramedics in the room. He feels as though he is showing signs of weakness and is very sorry he frightened and yelled at his partner. He keeps repeating to himself that he need to do better and that he knows he should not let his own anger and irritation overwhelm him and take these feelings out on others. He is tired of feeling ‘out of control’ and that his moods have started to be so confusing that he needs to take control. He feels that he can take control by just ending the confusion by taking his own life.
Social and Family History:
Jesse was previously a drug user (methamphetamine) and was a heavy drinker which started during his early career with the navy. He found his depression debilitating and was self-medicating to alleviate the feelings of sadness and his lack of motivation. He was a very outgoing person and enjoy social occasions with the “guys”, but found himself increasingly irritable and with mood changes that were easily triggered by what seemed minor incidents (e.g. a word or look from other people would make him feel angry for no apparent reason, he felt targeted). He kept contact with his family until he was 28 but slowly has less and less communication with them. He sought help with his drug and alcohol use and managed to stop taking methamphetamines and was not drinking from the age of 30.
Background:
PHx (past history) – bipolar disorder
Med’n – lithium
Allergies – none known
Comm. Diseases – none that he/ she are aware of
Social Hx: has a current partner – they have been together for the past 3 years. Oldest of two children, sister 4 years younger
Family Hx: Father and mother in Scotland
Diet: Eats a varied diet appetite has reduced over the last 2 months.
Alcohol: Increased intake during the week and over the weekends.
Smoking: non-smoker
Assessment:

O/A
10 mins later 20 mins later
HR
85 (usual is mid 70’s)
87 90
Pulse Strong Strong Strong
Rhythm regular regular regular
BP 125 /80 131/80 134/80
Cap Refill 2 sec 2 sec 2 sec
RR 20 21 21
Breathing Shallow and irregular (related to distress) Shallow and irregular (related to distress) Shallow and irregular (related to distress)
Sats 99% on air 99% on air 99% on air
Skin Pink warm & dry Pink warm & dry Pink warm & dry
BGL 4.6 mmol 4.6 mmol 4.6 mmol
GCS 14 (distracted and hesitant when answering questions) 14 14
Pupils PEARL PEARL PEARL
Pain
2 survey Intense feelings of self-hate and disappointment
Feelings of guilt and shame with treatment of partner
Feels despondent about future and is ‘worn-out’ and exhausted
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