Case Study-Janet




Theknowledge and understanding of mental illness for healthcareprofessionals is built by the ability to create a strong insight.Proper knowledge is essential to ensure that holistic and effectivecare is always provided (Charney, 2014).&nbsp The assignmentpresents a case study of an 18-year-old girl called Janet. She wasbrought to the Emergency Department by an ambulance. The studyinvolves a detailed hypothesis about her mental illness. Thepsychiatric liaison nurse is unavailable due to other presentationbut there is a nurse that is allocated to her for the night shift(Byck, 2011).&nbsp

Question1– Overview of presenting issues

Janet,an18-year-old Caucasian woman was brought to the emergency room by anambulance after her parents were concerned about her safety. She hadlocked herself in her bedroom shouting and breaking glass. Uponnoticing the situation, the parents called the police who persuadedJanet to open the door and found her sitting on her bed. She hadclosed her eyes and wrapped her arms around her she appeared to bein shock and cried loudly. The police discovered&nbspthat Janet hadhurt herself and broken the mirror inside the room from glass thatwas scattered all over the floor. Blood was oozing from Janet’sarms. Earlier in the afternoon, Janet had an argument with herparents and stated,” no one understands, I feel so rotten, there isno help for me… I want it all to end.” She ran away and cameback after some hours looking messy. The paramedics described Janetas disheveled, wore dirty, blood-stained clothes, and had an oily andtangled hair. Her alcohol level was 0.05mmol/L after she wasbreathalysed.

Janetwas in a relationship with Liam with whom they had met in school.Although they had been discussing how they will cohabit, Liam endedthe relationship two months ago giving the reasons that Janet hadbecome nervous and very distant. However, they remain friends.

Furtherinformation reveals that her parent’s air conditioning business isnot doing well at present. There were negotiations to close it. Herfamily was under stress due to a fall in income.

Janetused to work at their family business on a part time basis. Whilethere, she was observed to be forgetful and made many mistakes. Herparents advised that she should consider attending TAFE or the centerlink to seek a job and support the family with her income. Janetfailed to follow either advice.

Riskcan never be eliminated but it can be minimized by making sure thereis efficient sharing of communication. Effective communicationensures there is adequate concentration on the patient’s safety andstaff. However, when ever dealing with a violent patient, a nurseshould ensure that all her medical staff, patients and visitors aresafe. As a precaution to prevent Janet from anxiety, the nurseshould evacuate her from the emergency department, which is a loudand busy area, to a quiet place. To manage Janet’s hostilebehavior, the nurse should address Janet in a calm manner her bodylanguage should be relaxed, calm, open and nonthreatening. It isalso advisable for the nurse to have a security guard or a colleaguestaff when attending to a violent customer. To deliver customerfocus, the nurse should ensure that the information provided by thepatient and the family remains highly confidential. In a addition,the nurse should ensure privacy, respect and dignity towards thepatient and the family (Essentialsof Mental Health Nursing,2011). For example, the nurse should involve the patient in thedecision making process regarding her health. Whenever involved thepatients fell empowered and become educated. Patient involvement isone way of enhancing healing and ensuring that the customer does notget back to the emergency department in case the sickness strikesagain. Communication is indispensable to achieve effective riskmanagement in mental care provision. Obtaining a sufficientorganizational answer to the concern of occupational hostility andviolence from both health and security value and risk perspectiveswill have need of a cohesive, integrated approach.



Janetis an 18 years old, 54 kg, and 160 cm teenage girl. At the time ofexamination, her hair was coiled and oily. She was dressed in a messysingle, mini skirt and thongs despite the chilly weather of winter.According to her parents, her personal care has suffered, includingher decline from taking showers and changing her clothes. It was&nbspnother character as she had a history of being well dressed and groomed.


Janet’smood remained unknown. She did not express how she felt. A Nurseshould however seek for what she meant by saying “…i need allthis to end”


Janethad turned out to be irritated and often became angry whenever herfamily approached her to question about her conduct and appearance.In addition, her parent’s efforts to advice that she visits aphysician made her to scream at them. Janet said that no one seemedto understand her and that she felt so rotten. Her speech includedshouting aloud.


Themajor emotion displayed by Janet is anger. She shouts and scowls asan expression of anger. In addition her language to the nurse uponapproaching her depicts anger when she asked, “What can you do forme … How can you help me ?”


Janet’sstream of thought was not in order. Upon returning to her cubicle, the nurse found her standing next to her bed. Further, she hadremoved her dressings. In addition, she was putting on her thongs.


Janetexhibited formal thought disorders. She was not able to answerquestions spontaneously and directly instead she seemed to beoverwhelmed by emotions. She burst into tears, sat on her bedandstarted shaking upon seeing me. Further, when I introduced myself asher allocated nurse, she looked at me briefly andbecame sad andyelled at me saying, “what can you do for me, how can you possiblyassist me, I do not want to be here.&quotShe then began to throwher clothes all over the cubicle.


Suicidalideation was not detected but her claims,” I don’t want to behere” should be further investigated to identify what it is thatshe exactly means. It could mean that she did not want to be in thehospital or in earth as an indication of suicide intentions.


Otherthan feeling irritated, Janet had definite signs of hallucination,irrational fear and pressure.


Janetseems alert, and familiar to time and space. Upon being approached bythe nurse, she tells her, “I don’t want to be here.” This couldmean that she did not want to be in the hospital.

Insightand judgment

Althoughnot questioned about her condition, a simple observation of herindicated that she was not conscious about her health. It isdepicted by her shouting at the nurse, “ what can you do for me ,how can you help me” she does not seem to identify she is in thehospital for her safety purposes.

Potentialrisks to patient and others

Thefirst potential risk that Janet will face in the next twenty-fourhours is self-harm. If Janet is left alone, she is prone to causingmore damage to her just like she did in her room. She may executeharm through the items that she finds close to her. It is henceimportant that her actions be continuously monitored by the nurse incharge, whenever she is left alone, the nurse has to watch forpotential items that may cause harm. (Charney, 2014). Secondly, Janetmay end up causing harm to others as a result of her unconsciousirritable nature. It calls for the nurse to inform other personnelabout her conditions. It will make them cautious to cause irritationto her (Epstein, 2011).

Thirdis the risk of anxiety or depression. It is a bad temper disorderthat creates a constant feeling of remorse and loss of interest. Itaffects how she feels, thinks and behaves. As a result, she will havea variety of emotional and physical problems. She will feel as lifeis not worth living. Depression can go along with sleep, health, andconfusions characterized by constant lack difficulty of sleep and/ orreduced quality of sleep (Fundukian, 2012). Sleeplessness istypically followed by functional impairment while awake. It canhappen at any age bracket although it is common to old age. It can beshort term or long-term. Depression causes memory troubles, sadness,bad temper and an amplified peril of heart disease and motor vehicleaccidents (Gregoire, 2010).


Janetis an 18-year-old teenage girl. Her parents provided informationabout her declination to eat meals with the family. As a result, shehas lost a lot of weight in the past few weeks. The loss of weightmade her appear pale. They added that Janet had become irritableespecially when the parents complained about her appearance andconduct. For example, during her admission, the parents had madeeffort to convince her to visit their physician and obtain help.Janet screamed to them saying that no one seems to understand her andthat she felt rotten. Further, she said that she would like for theneglect to end. After the incident, Janet ran out of the house andreturned a few hours later. Upon her return, the parents indicatedthat she appeared messy. She refused to converse and shelteredherself inside her room. The family’s concerns about her safetymade them contact the police.

Herparents revealed that a few years ago, Janet was a content, friendlyand active young teenager. Shetook great pleasure in playingnetball, jazz ballet and also loved going out with her acquaintances.The parents testified that a year back, they lost their niece Ally,Janet’s cousin in a motor vehicle calamity. Janet was very close toher that she never got over it. Janet is said to talk about hercousin a lot lately. She is recorded to have been an average studentin school but her performance declined swiftly halfway through her11thyear. As a result, she left school immediately after starting her12thyear. She was not performing in all her subjects she has become lesssocial and only keeps contact with a handful of friends. She stoppeddancing and playing sport and told her parents that she feltdisturbed while in the middle of people and that she starts shakingwhen she is meeting new people (Levin, Hennessy, &amp Petrila,2010).

Janetwas in a relationship with Liam with whom they had met in school.Although they had been discussing how they will cohabit, Liam endedthe relationship two months ago giving the reasons that Janet hadbecome nervous and very distant. However, they remain friends.

Furtherinformation reveals that her parent’s air conditioning business isnot doing well at present. There were negotiations to close it. Herfamily was under stress due to a fall in income.

Janetused to work at their family business on a part time basis. Whilethere, she was observed to be forgetful and made many mistakes. Herparents advised that she should consider attending TAFE or the centerlink to seek a job and support the family with her income. Janetfailed to follow either advice.


Uponthe evaluation of all the information gathered, there arepossibilities that Janet could be ailing from one of the followingmental illness diseases.

Firtsis Post-Traumatic Stress Disorder. It occurs to someone who hasexperienced shocking events like rape, war, natural catastrophes,captivity or abuse. The patient’s exhibit symptoms such as constantmental images which act as flashbacks. In addition they experiencenightmares, depression, anger and irritation. In conclusion, thepatients become weak in terms of their concentration. As a result,they are easily distracted (Wing, 2013).

Secondhypothesis is that she is suffering from depression. It is a familiarcondition but is frequently unnoticed by the health practitionersonly their psychologists recognize about half of persons with thecentral misery. As a result of depression, she might experienceinsomnia. It is a sleep disorder that will lead to her inability tohave enough sleep(Williams, 2011).&nbsp

Thesignificant presenting issues

Thefirst presenting problem for Janet is post-traumatic stress disorder.It is recorded that

shewas content, outgoing and an active young girl. Her hobbies includedplaying jazz ballet, netball and hooking up with her folks. Theparents recalled that a year ago, they lost Ally she was Janet’scousin. Since Janet was very close to her cousin, she took the lossvery hard and never got over it. In addition, Janet is said to talkabout her cousin a lot lately. In addition, Janet is recorded to havebeen an average student in school but her studies deterioratedswiftly midway while she was in her 11th year (Epstein,2011).&nbspAs a result, she quit school immediately after she began her 12thyear that she failed in all her subjects. Since she left school, shebecame less communal and only kept contact with a handful ofacquaintances. She also quit playing sport and dancing. Further, shehas been noted to be easily distracted while at work (Thompson,2012).

Thesecond presenting issue is depression. It is as a result of constantsadness and loss of interest. Janet may be stressed by the parentsbusiness that is currently not doing so well. Further, it may affecther when she imagines that the company is considered to be closed.Her depression could also emerge from the fact that she is pushed tolook for employment elsewhere which her parents indicate she did notshow interest. Depression could be the reason why Janet has becomeirritable and careless about her appearance and conduct.(Silverstein,2011)

Nursing care plan 1

Actual problem

Self harm

Clinical manifestations

Janet was found in her room with blood on her arms. It was revealed that she had hurt herself with the mirror that was in the room. It is as a result of feeling that people don’t listen to someone a sjanete also expressed feelings of neglection. It also happens when the patient is unemployed, depression , relationship with partners, friends and family (Silverstein, 2011.)

Plan and implementation

The nurse should gently explore Janet’s thoughts and feelings about the trauma, she should help her work through the feelings of the trauma and train her how to control the intrusive memories. The nurse should offer Janet a prescription of anti depressants to relieve secondary symptoms of anxiety. Janet and her Nurse should work together to figure out the best treatment, with the fewest side effects, for her symptoms and situation. (Szasz, 2010).&nbsp

Nursingcare plan 2

Actual problem


Clinical manifestations

Some of the systems by janet that exhibit depression include not going out anymore, not getting things done at work/school, withdrawing from close family and friends, relying on alcohol and sedatives, not doing usual enjoyable activities and being unable to concentrate at work (Szasz, 2010).&nbsp

Psychological treatment

It includes cognitive behavior therapy. It is structured to recognize the way a person thinks (cognition), acts (behaviour) and feels. Janet and her doctor should work together to identify the patterns of thought and behavior that either make her more likely to become depressed or stops her from improving (Kim, 2012).&nbsp

Medical treatment

The main treatment is anti depressant medication. It is used when there is severe depression. The patient and the doctor should work hand in hand to reduce the side effects on the patients and in choosing the most appropriate medicine (Roy,2010).&nbsp


Thecase study revolved around Janet who is an 18 year girl that wasbrought into the Emergency Department after she caused harm toherself in her room. A mental state evaluation was conducted toestablish the risks that Janet is exposed to. It was established thatJanet could be suffering from posttraumatic disorder or depression.Two nursing care plans have been formed and include posttraumaticdisorders and depression


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