A Case Study in Nursing

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Written Assignment of Case
Mrs. Lee, a 45 year-old-woman who was diagnosed with generalized anxiety disorder (GAD), recently admitted to mental hospital. She was depressed with auditory hallucination. In this essay, the contributing factors of Mrs. Lee’s GAD condition will be explained first, followed by a discussion on her current health conditions. Then, appropriate nursing diagnoses are made in priority according to their significance. Furthermore, implementation of nursing care to her will be illustrated. Finally, a conclusion will be drawn to summarize the ideas.

Factors Contributing to Generalized Anxiety Disorder of Mrs. Lee Mrs. Lee was diagnosed to have GAD. Biological, psychological and social influences may lead to development of GAD (Hazlett-Stevens, 2008).

Biological influence
Being a middle-aged woman can be one of the risk factors. Feminist theorists and researchers suggested that women were having a higher chance in getting GAD because they are more dependent, passive and submissive than man (Hazlett-Stevens, 2008). Several researches also revealed middle aged women (45-49) had a higher prevalence rates (Wittchen, Zhao, Kessler, & Eaton, 1994; Kessler et al., 2005).

Psychological influence
Cloninger (1986) proposed a model that certain personality traits such as introvert contributed to the development of GAD. Mrs. Lee is prone to have GAD as being an introvert woman. Negative life events happened can lead to development of GAD in those people with predisposition because of the neurobiological reaction happened inside the brain (Barlow, 2000). Since changing of a living environment and cultural was a big event for her, it increases her likelihood to develop GAD.

Social influence
Poor relationship with family is another contributing factor. Sullivan (1952) viewed that problem in interpersonal relationships can generate anxiety. Mrs. Lee had poor relationship with her husband. Anxiety was aroused to reflect the insecure response generated by the damaged relationship. Prolonged marital problem was the stressor that makes Mrs. Lee prone to have GAD. Social theorists and researchers revealed that one’s socioeconomic status (SES) can influence the development of anxiety (Portman, 2009). Mrs. Lee’s family is receiving Comprehensive Social Security Assistance which implied that she had relatively low SES. People like her from lower SES encounter more problems and stressors in living, thus more vulnerable to experience GAD (Corcoran & Walsh, 2006).

Nursing diagnoses and interventions
Apart from her diagnosis of GAD, she is currently suffering from depressed mood and auditory hallucination. Nursing diagnoses and corresponding interventions are made during hospitalization. The following nursing diagnoses are prioritized according to the urgent needs of Mrs. Lee.

Risk of suicide
Mrs. Lee has increased suicidal risk. According to Roy (2000), middle- aged people, who have chronic physical pain, history of suicide attempts and low socioeconomic status, have increased suicidal risk. In addition, Mrs. Lee experienced auditory hallucination which is also recognized to be high suicidal risk (Schultz & Videbeck, 2009). Nursing interventions of risk of suicide

Nursing assessment including comprehensive physical and mental status examinations should be conducted to Mrs. Lee on admission. The suicidal history should be recorded in details. Good nurse- client relationship is the basic requirement during hospitalization. Developing a supportive therapeutic relationship to Mrs. Lee through frequent, brief contacts and an accepting attitude with active listening and being empathy can build up the rapport (Schultz & Videbeck, 2009). It is beneficial to assign a name nurse who is responsible for her at all times. Safety environment is also crucial. In this scenario, nurses should be particularly alert and keep all potentially dangerous items away from her such as sharps. In...
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