Running head: LEARNING DISABILITY NURSING: MENTAL HEALTH 1

Learning Disability Nursing: Mental Health

Name

Institution Affiliation
LEARNING DISABILITY NURSING: MENTAL HEALTH 2

Introduction

This paper will identify an individual with learning disabilities from clinical practice. It

will provide relevant history and formulation of the patient’s current mental health diagnosis. It

will complete a range of assessments related to an individual’s mental health needs and analyze

the data from the assessment to develop a differential and primary diagnosis. Furthermore, the

essay will present a range of interventions using the bio-psycho-social assessment model to meet

the patient’s health needs.

Background

Ryan is a (years) old male patient presented at North Kent Mental Health of Learning

Disability Team for Post-traumatic stress disorder (PTSD). According to Glenn, a Senior Nurse

and Comfort, an LD Student Nurse, Ryan complained of having flashbacks, disturbing his sleep

at night. Ryan is at high risk of getting into a rage and could throw or smash an object when he

feels stressed. According to the mental health presentation, the patient has been taking his

medication regularly and has not reported any side effects. Therefore, he does not wish to make

any changes to his medication at this time. Post-traumatic stress disorder (PTSD) is a mental

health disorder triggered by witnessing or experiencing terrifying events (Fishbain et al., 2017).

The major symptoms associated with PTSD include severity anxiety, flashbacks, uncontrolled

thoughts, and nightmares. Ryan reported he is sleeping alright but has had flashbacks every day

since last week, and he would need support with some medications urgently as this causes him

stress as his sleep is disturbed, especially at night. The hallmark symptoms of PTSD involve

cognitive and emotive alteration processes such as problem-solving, attention, planning, and
LEARNING DISABILITY NURSING: MENTAL HEALTH 3

memory. The patient was taken referred to MHLD Psychology Team to assess PSTD and was

encouraged to participate in charity as he is provided with social care.

Mental State Examination

Observing for: At present On admission

Appearance Ryan was properly dressed

and appropriate appearance.

Ryan appeared very well-

kempt. He presented

cheerful, engaged with us

lots of humor.

His nutritional status looked

adequate, and he has

registered at True-gym and

has lost 16pounds of weight

in 2 weeks.

Behaviour Initially, Ryan was shy, but

over time he became amiable

and shy.

During the interaction, at

times, he looked tense, but

LEARNING DISABILITY NURSING: MENTAL HEALTH 4

later, he felt relaxed.

Ryan presented various

behavioural changes during

the mental health assessment

Speech Soft tone and normal rate Had difficulty responding to specific

He was answering questions questions

posed appropriately

Mood (and affect) He felt happy and loved Anxious and irritable

because of the care given by

staffs

Thought Thought of anger, fear, and

processes/thought restlessness

content

Orientation Ryan was oriented to

location, time, place, names,

and even person

Attention/ Full concentration

concentration He could remember his

names

Shared all necessary details

LEARNING DISABILITY NURSING: MENTAL HEALTH 5

Memory Memory and recall were

intact

No record of memory loss,

and he could remember all

events

Judgment Thoughtful with logical

thinking

Insight Good insight and

understands of the reason

why he was brought to the

care center

Understanding when told by

the Care staff on the effects

of rage

Psychiatric Diagnosis and DSM 5 Diagnostic Criterion of PSTD

Axis: I (Post-traumatic stress disorder)

A: Witnessing trauma

B: History of alcohol abuse, flashbacks

Axis II (Trauma-related feelings and thoughts): 0 Diagnosis

Axis III (General medical conditions): No acute medical complains

LEARNING DISABILITY NURSING: MENTAL HEALTH 6

Axis IV (Environmental and Psychological problems): 0 Diagnosis

Axis V (Multiaxial assessment): Global-scale number

20/50

According to the American Psychiatric Association, PSTD is a trauma and stressor-

related disorder (Aaron et al., 2019). This disorder negatively affects an individual mood and

thinking, thus bringing change in the emotional and physical reactions.

Physical Health Presentation and Well-Being

Ryan was properly dressed and appropriate appearance. He was wearing jeans and a shirt.

Ryan appeared very well-kempt, cheerful and engaged with us with lots of humor. His nutritional

status looked adequate, and he has registered at True-gym and has lost 16pounds of weight in 2

weeks. Ryan has continued to use Vape daily to reduce nicotine from cigarette use. The patient

has a neurology follow-up appointment in the next three weeks in regards to previous telemetry

testing. The patient possessed a steady gait with an erect posture while he was walking around.

He did not maintain eye contact during the interaction, and he experienced unintentional

movements during the assessment.

Ryan has continued to keep up with his care plan on energy drinks and is now alternating

replacing with freshly self-made but very strong coffee bean using a coffee machine, although

Care staff has advised him to reduce the quantity to reduce episodes of palpitations. But Ryan

explained this initiative helps him calm down and has had caffeine from when he was much

younger. According to the patient, he had another rage last week, and he threw and smashed a

cup on the wall. After the incident, Ryan talked to the care staff, who advised him to divert his

rage in doing something positive like using the bike in the home or going to the gym. The care

staff explained to Ryan that such rage could accidentally harm someone else, which will become
LEARNING DISABILITY NURSING: MENTAL HEALTH 7

an even bigger issue. After the interaction, Ryan understood this and was encouraged to continue

talking about his feelings to someone in the future.

While seeking Mental Health of Learning Disability (MHLD) services, Ryan was seen as

incapable of following instructions and easily distracted. In the common room, Ryan was unable

to interact with other patients. He was just focused on watching television and not interacting

with fellow patients but only talked to caregivers. The patient did not present any physical

deformities. The physical actions of Ryan could be a result of traumatic events; hence the patient

might experience difficulties in coping and adjusting. According to Saraiya and Lopez-Castro

(2016), PTSD is not a permanent condition. With the right interventions and self-care, then Ryan

still has a chance to get better.

Social and Environmental Issues

The patient appeared friendly and cooperative. The care staff at Waterstone helped Ryan

to clean his house and laundry. The patient feels happy and supported and has promised the care

staff to maintain keeping it clean. Ryan has reported that he is very pleased with living at

Waterstones. He feels loved and is happy to continue living at Waterstones. Generally, Ryan had

appropriate speech, and he was very open and eager to communicate.

LEARNING DISABILITY NURSING: MENTAL HEALTH 8

References

Aron, C. M., Harvey, S., Hainline, B., Hitchcock, M. E., & Reardon, C. L. (2019). Post-

Traumatic stress disorder (PTSD) and other trauma-related mental disorders in elite

athletes: a narrative review. British journal of sports medicine, 53(12), 779-784.

Fishbain, D. A., Pulikal, A., Lewis, J. E., & Gao, J. (2017). Chronic pain types differ in their

reported prevalence of post-traumatic stress disorder (PTSD), and there is consistent

evidence that chronic pain is associated with PTSD: an evidence-based structured,

systematic review. Pain medicine, 18(4), 711-735.

Saraiya, T., & Lopez-Castro, T. (2016). Ashamed and afraid: A scoping review of the role of

shame in post-traumatic stress disorder (PTSD). Journal of clinical medicine, 5(11), 94.