TASK 77: Mr Ming Zhang is a 24 year old male patient on the mental health ward where you are a charge nurse.

Name: Ming Zhang               

Age: 24

Cultural background: From China. Speaks ↓English. Needs interpreter. 

Admission Date: 5th April 2011 Macquarie Hospital Rosella Ward 

Discharge Date: 26th April 2011

Diagnosis: Major depression and deliberate self poisoning (DSP)

Social background: – Came to Australia as a labourer 5 years ago

-Permanent resident now        -Wife had affair and divorced pt 1yr ago.      -Depressed and unemployed since

-Lives in own house with NESB mother out from China.

-Mother doesn’t like pt taking psych meds due to her Chinese medicine beliefs

-Pt hobbies are fishing & online trading

Psychiatric & Medical background: – Nil Hx of depression pre divorce

• 1st presented 1 yr ago with 1st episode DSP and major depression
  • Attended Chinese psychologist sporadically this year
  • Current presentation is 2nd DSP and mental health admission.
  • Medical history of gout, previous hepatitis A, # L tibia, # R humerus, # L clavicle (all separate occasions and resolved; work related)

Medications: – Mirtazipine 30 mg nocte

Nursing Management and Progress: –Frequently S/B Chinese speaking transcultural mentalhealth worker and received 1:1 CBT counselling.   

++ insomnia & ↓mood                       

Mirtazipine ↑from 15mg to 30mg 12/4/11

-Mother educated via interpreter re importance of Antidepressant (AD) meds

-Nil suicidal ideation (SI) at present, please monitor closely for SI in community

Assessment: Mood low but improved. Low risk of self harm with close follow up and support

Good response to CBT

Discharge Plan: – For case management via community mental health team

-Ideally assign pt to Chinese speaking clinician or use interpreter service;               Continue CBT

-Observe response to ↑ AD Rx, monitor for side effects;     

Encourage ↑ physical exercise & job hunting

-Avoid prescribing benzo meds as pt uses these to DSP

Writing task: You are the Charge Nurse on the mental health ward where Mr Ming Zhang will be discharged from and need to write a nursing referral letter to the local community mental health team. Address the letter to Team Leader, Ryde Community Mental Health Team.

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