Sample answer by Lifestyle Training Centre

Team Leader
Ryde Community Mental Health Team.

26 /04/2011

Dear Sir/Madam,
Re: Mr Ming Zhang, aged 24 years.

I am writing to refer Mr Zhang who requires your close monitoring and support, following his discharge today. He is currently recovering from an episode of deliberate self-harm poisoning and major depression.

Mr Zhang, is a migrant labourer from China. He is depressed and unemployed since last year, after his divorce. He was hospitalized a year ago due to DSP and major depression. He lives in own house with his conservative mother who has utmost reliance in Chinese medicines.

On 5th April 2011, he was admitted to our hospital for a second time with the afore mentioned diagnosis. During hospitalization, he was frequently seen by Chinese speaking transcultural mental
health worker and received 1:1 CBT counselling. He suffered from increased insomnia and low mood. Dosage of his medicine, Mirtazipine, was doubled to 30mg. His mother also was educated on the importance of Antidepressant medicines.

At present, Mr Zhang shows no suicidal ideation and has good response to CBT, which needs to be continued. Though his mood is low, there is improvement.

Based on the above, please monitor him closely, continuing the care support. As Mr Zhang speaks only basic English, please assign him to a Chinese speaking clinician or use interpreter service. Please monitor his medication regimen, and avoid prescribing Benzodiazepines as Mr Zhang could use it for DSP. Should you have further queries, please do not hesitate to contact me.

Yours faithfully,
Charge Nurse.

(word count: 219)

Writing task

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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