Mental Health Case: George Palo

Documentation Assignments
1. Document your findings related to the focused assessment regarding Mr. Palo’s possible cognitive decline and
depression. Include his responses to your assessment.

- The findings related to the focused assessment involve the loss of his wife and recent passing of his dog Max
contributing to his possible cognitive decline and depression. Mr. Palo states that “If I try to eat or shower, I get so tired
that I give up”. When asked about having energy to the activities that give him enjoyment, the patient stated: “I would
like to go take walks like I used to, but I don’t do it so much anymore”. George is demonstrating a lack of interest in the
activities that he once used to enjoy which may indicate depression.

2. Document your findings related to the assessment of Mr. Palo associated with the Geriatric Depression Scale screening
tool. Include his responses to your assessment.

-The Geriatric Depression Scale screening tool indicates that Mr. Palo is depressed as he scored 10 points out of a

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possible 15. Mr. Palo marked that he is not satisfied with his life and lacks the interest of doing what he used to enjoy.
When asked what was going on with him today, he stated: “Sometimes I’m not sure where I am or what is happening. It

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scares me”. George lost his wife three years ago and just recently lost his dog, Max. Grief is taking over Mr. Palo and he
even stated that “Max gave me a reason to live and now he’s gone too”.

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3. Referring to your feedback log, document all nursing care provided and Mr. Palo’s response to this care.
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0:00 You checked scene
safety. It was correct to
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check scene safety in

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order to maintain your

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own safety.

0:07 You introduced yourself.

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0:37 You washed your hands.

0:43 You identified the patient.

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2:01 You asked the patient: Is it OK for your daughter to be here, while
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we talk? The patient said: Yes. It was correct to let the patient
give his consent for letting his daughter be a part of the interview.

2:12 You made a safety check of the surroundings and the patient's
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belongings.

2:43 You asked the patient: Can you tell me a little bit more about
what's going on with you today? It was appropriate to ask the
patient what was going on with him to get an understanding of
this.

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 3:17 The patient said: Sometimes I'm not sure where I am or what is
happening. It scares me.\nYou answered: What seems to lead up
to those feelings? \nYou used the therapeutic technique of
placing the event in time or sequence.

3:34 You asked the patient: Over the past year, when did you feel your
best? It was appropriate to ask the patient about when he felt his
best.

3:57 The patient said: Max gave me a reason to live and now he's
gone too.\nYou answered: Are you saying you feel hopeless?
\nYou used the therapeutic technique of translating to feelings.

4:02 You supported the patient about loss of dog.

4:24 You measured the blood pressure.

4:47 You measured the temperature.

5:08 You checked the pulse oximetry.

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5:27 You checked the radial pulse.

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5:40 You assessed the respiration.

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5:52 You auscultated the lung sounds.

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6:06 You asked the patient: Do you have any difficulty with your
breathing? The patient said: No.

6:12 You asked the patient: Do you have chest pain? The patient said:
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No, I don't.
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6:17 You asked the patient: Do you have any pain? The patient said:
No, I don't have any pain.

6:25 You checked the patient's skin.

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7:08 You asked the patient: Have you lost or gained weight over the
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past month? The patient said: I think I have lost weight, but I
don't really weigh myself.

7:39 You asked the patient: Have you been eating much less or much
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more over the past few weeks?

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7:56 The patient said: I'm not hungry and I'm tired all the time.\nYou
answered: That's not uncommon when you are grieving. \nYou
used the nontherapeutic technique of denial.
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7:57 You asked the patient: Do you notice that your clothes are fitting
looser or tighter than they were a few weeks ago? The patient
said: Come to think of it, I did have to move the notch over in my
belt to tighten up my pants.

8:15 You asked the patient: Have you had any changes in your
appetite over the past month?

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 8:44 The patient said: If I try to eat or shower, I get so tired that I give
up.\nYou answered: Physical symptoms are often related to grief.
You must miss your wife and Max very much. \nYou used the
therapeutic technique of giving information.

8:50 You asked the patient: How many meals do you eat each day?
The patient said: Maybe three.

8:59 You asked the patient: Tell me about any changes you have had
in your sleep over the past few weeks? The patient said: I have a
hard time falling asleep. Sometimes I lay in bed for quite some
time staring at the clock before I go to sleep, and then I wake up
a few times during the night.

9:28 You asked the patient: Do you have any trouble falling asleep?
The patient said: Yes, I think so.

9:36 You asked the patient: Approximately how many hours of sleep
do you get each night? The patient said: I'm not sure

9:52 You asked the patient: Do you have energy to do the normal

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activities necessary to get through the day? The patient said: No,
it is not as good as it was, and now I don't have Max to nudge

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me along, so I find myself sitting on that sofa most of the day.

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10:13 You asked the patient: Do you have energy to do the activities
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walks like I used to, but I don't do it so much anymore.

10:26 You removed potentially dangerous objects.

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11:03 You said: I would like to ask you a few questions and for you to
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draw a specific thing, which will help me to better assess you.

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May I ask you these questions? The patient said: Yes.

You should have completed the Mini-Cog© assessment tool.

11:18 You said: Please listen carefully. I am going to say three words
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that I want you to repeat back to me now and try to remember.

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The words are banana, sunrise, chair. Please say them for me
now. The patient said: Banana, sunrise, chair.

11:39 You said: I want you to draw a clock for me. First, put in all of the
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numbers where they go. Then, set the hands to ten past eleven.
The patient said: Ok.
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11:59 You said: What are the three words I asked you to remember?
The patient said: Banana...chair.... I don't know.
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12:26 You educated about the difference between grief and depression.

13:09 You educated about getting active.

13:45 You educated about coping.

14:21 You educated about home care needs.

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 15:00 You called the community nurse.

15:20 You referred the patient to a physician.

4. Document all patient teaching regarding assessments and safety issues provided to Mr. Palo, and his response to the
teaching.

- The first safety issue addressed was the hunting gun in Mr. Palo’s living room. This was removed and given to his
daughter. It was mentioned to Mr. Palo that if he wants to go hunting, he can get it from his daughter whenever he
pleases. He was not too happy with this, but it was in best interests for his safety. Education was given to Mr. Palo about
the difference between grief and depression, getting active, and coping. Different resources were suggested to Mr. Palo
so that he may find the willingness to find interest in the activities that he once used to enjoy.

5. Document your handoff report in the SBAR format to communicate Mr. Palo’s future needs.

Situation: George Palo is a 90-year-old male who had been diagnosed with minor neurocognitive decline and
Alzheimer’s type around six months ago. After the death of his wife and, just recently, his dog, George had seemed to

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decline further. His daughter contacted us and asked for a visit due to increased concerns of George becoming more

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forgetful, weaker, and skinnier from losing weight. George reports no pain or difficulty breathing. He does demonstrate a

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sad demeanor, weight loss, and lack of motivation to perform ADL’s.

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Background: George Palo’s daughter, Maggie, contacted the nurse in concern of her father who reportedly has become
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more depressed. Upon visitation, he did mention that “Max gave me a reason to live and now he’s gone too”. He points
out that he does not have the energy to do anything anymore and just ends up sitting on the sofa for most of the day.
The Geriatric Depression Scale was performed on George recently and he scored 10 points which indicates depression.
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Assessment: Vital signs were stable upon assessment. They were as follows: Blood pressure 140/88mmHg, respirations
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at 16 breaths/minute, pulse at 78 beats per minute, temperature at 98.6 F, and O2 saturation at 96% on room air. Lung
sounds were clear upon auscultation and heart rate and rhythm were normal. Blood pressure medications seem to be
working. Mr. Palo does seem to be in distress with grieving over the lost of loved ones. He has given up on self-care and
mental health has declined tremendously. Mr. Palo is going through an extreme difficult time and his appearance shows
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it as well. Interventions are in need to be placed.

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Recommendation: I suggest a follow up appointment with the Physician for further evaluation. Support groups should be
searched to allow Mr. Palo to attend for grief. He mentioned that he would start walking again if he had someone to go
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with, so finding a walking partner within the community is recommended. Lastly, it is recommended that Mr. Palo find a
way of transportation to get to and from the Humane Society to continue with his volunteer work that he loves so much.
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From vSim for Nursing | Mental Health. © Wolters Kluwer.

This study source was downloaded by 100000822865927 from CourseHero.com on 04-07-2021 11:40:49 GMT -05:00

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From vSim for Nursing | Mental Health. © Wolters Kluwer.

This study source was downloaded by 100000822865927 from CourseHero.com on 04-07-2021 11:40:49 GMT -05:00

https://www.coursehero.com/file/68300516/George-Palo-Vsimdocx/
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