Case Scenario
Lily is a 79 year old Caucasian female who is frail in health. Lily suffers from depression and type 1 diabetes. She experienced numerous of falls at home and is showing traits/symptoms of dementia. Lily was admitted to the general hospital due to her diabetes being extremely low which can be a contributing factor to her falls. (Literature go back up).
Lily was exhibiting memory loss and challenging behaviour of dementia. While she was in hospital her physical and mental health started to deteriorate leaving her frail and unable to attend to her activities of daily living (ADL). She disengages with the medical team and refuses to take her medication often. Her diabetes had become critically unstable as a result, and she had collapsed at home before taken into the hospital with a bump on her forehead.
During her stay in general hospital, lily became disorientated and fell out of bed sustaining bruises at the side of her head, arms, legs and hips which resulted in long hospital stay.
On discharge she was sent back home with no care package in place. Two weeks later, Lily returned back to the same hospital and ward from having a fall at home which was discovered by her close friend. Lily did not stay in hospital long as she was then transferred to the inpatient unit.
Due to Lily’s behaviour and deterioration in mental state she was admitted to inpatient acute mental health which specialises in elderly people with complex functional needs. Lily’s mobility is good and requires little to no assistance. She does not have any past medical history of having arthritis. After Lily was admitted to the hospital, she had consented and done her all her physical observations as per trust policy and settled in. After a few days, lily fell out of bed a sustained bruises on her arms. She was then put on level 2 15 minutes observations at night time.
During medication round, Lily’s insulin was due I drew up her insulin (26 units) and administered it under direct supervision. I administered the insulin in front of the nurse. The dose was checked by the nurse and I. After an hour, I went to check Lily’s glucose level and noticed it had been dramatically dropped from 17.1mmol to 3.4mmol. I informed the nurse I was doing medication rounds with and checked the medication chart again. We noticed that the patient is prescribed 2.6 units instead of 26 units. Lily was fine afterwards after the doctors on the ward intervened.
After being on the ward for a few weeks Lily started to become well and managing her diabetes with the help of the nurses. Lily was discharged to long stay rehabilitation mental health wards for older adults.
This assignment is broken into 3 parts. The first part critically analyses the notion of complex care within mental health nursing. The second part explores the patient and their journey that they may have had and how they fit within the broader system of healthcare considering access and barriers to accessing healthcare. The final part I will reflect on how nurses manage complex patient and their role within the Multidisciplinary Team (MDT). To conclude, the essay will summarise what is deemed to be complex in mental health and further recommendations for future practice.
