Case study 2 Daniel - One of three case studies to choose from PDF

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One of three case studies to choose from...

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This case study looks at a crisis presentation to the emergency department for a person with depression and psychotic features. Daniel Jess is a 42-year-old man who has self-presented to the emergency department at 10am with his partner Rachel. Daniel is crying He is a Caucasian male, who looks older than stated age. He has brown shoulder length hair and a short beard which looks greasy. He appears agitated shifts in his chair a lot. He states he feels ‘depressed’ and he is teary, avoiding eye contact, and is very difficult to engage. Rachel provides necessary history and information regarding Daniel. When Daniel does speak, he is quietly spoken and monosyllabic. He is oriented to time and place. His is wearing a band t-shirt and blue jeans, both stained and dirty, and black sneakers. His fingers are stained yellow from smoking and some teeth are brown in colour. He’s ok to have a set of vital signs taken, but only his pulse: which is 95 bpm, and his respiration rate is 15 breaths per minute. Daniel looks overweight for his height, and there is a smell of alcohol on his breath, but he denies consuming any. He also has diabetes and cannot say the last time he checked his blood sugar levels or had any medications for this. He smokes a packet of ‘rollie’ cigarettes every week. Daniel is currently unemployed, lives with his partner Rachel, who is also unemployed, and their five children (Ricky aged 5, Robbie aged 7, Ruby aged 10, Roger aged 11, and Stephanie, aged 13; two have an autism diagnosis – Ruby and Roger). Daniel is not known to the health service but Rachel reports that he has a history of drug use – alcohol, marijuana, benzodiazepines and methamphetamines (ice). He has a brother in Victoria which he is close to, and a sister in Cairns who is estranged from the family. His mother is still alive and living in a local nursing home and he visits her once per fortnight. Rachel claims that Daniel has been increasingly withdrawn has not been sleeping very well for probably the last six months, and for the past month, he will sit at the front window of the house for hours, hiding behind the curtains and look the window and say things like, ‘the bikies are out to get me’. This makes him very distressed. He will drink about 4 litres of cask wine every 2-3 days, and 1520 marijuana bongs every day. He doesn’t want to leave the house due to fears for his safety: he’s afraid someone is going to hurt him. Now he’s starting to accuse Rachel of having affairs and is wanting to always know where she is and checks her phone all of the time. She’s worried he might start to get ‘rough’ with her.. Rachel states that he was ‘good’ until about 6 months ago; he was working as a landscape gardener with his cousin, then Daniel’s father died slowly and tragically from alcohol related complications. Daniel took it very hard even though they did not have a close relationship as his father was a violent alcoholic who was in-and-out of Daniel’s life. And Daniel has been getting worse ever since then. He feels guilty for not trying to make an effort to have a relationship before his fathers’ death. Daniel reports that he is a terrible husband to his wife and is a terrible father to his children. He’s ‘worthless’ and ‘hopeless’ and his family would ‘be better off without him’. He would like to do more with his kids but is too tired all of the time which just ‘proves how pathetic’ he is. He has lost interest in maintaining his friendships because ‘people are better off without me’. Rachael is concerned about Daniel but is getting sick and tired about his behaviour, his paranoia, and not helping around the house, especially with the kids. She feels that she has six kids to look after, ‘and one of them is a 42 year old man’....