Provide an assessment of a differential mental health diagnosis Describe the strengths and barriers you observed in this vignette Describe the initial steps for intervention that you would recommend
Read the case and arrived at a diagnosis possibility, including potential rule-outs.
- Provide an assessment of a differential mental health diagnosis
- Describe the strengths and barriers you observed in this vignette
- Describe the initial steps for intervention that you would recommend
What are the strengths and barriers, and the initial steps you will recommend for treatment.
Intake Information
You are a social worker at a hospital located in a small town in the mountains of Tennessee. The nurse on the medical floor has asked you to evaluate a woman who was admitted to the hospital for possible nursing home placement. The nurse stated that Della Corbin was admitted 2 days ago. Her husband died a year ago, and she has a son who lives out of state. Her daughter lives in Memphis—a 6-hour drive from her mother’s home. Mrs. Corbin apparently has many friends from her church, and several of them have been inquiring about her health. One close friend told the nurse that Mrs. Corbin was in good health until she moved into an apartment house following her husband’s death.
Initial Interview
As you enter Mrs. Corbin’s room, you immediately observe a very petite, fragile woman lying in bed with a white sheet and two green blankets covering her bed. She appears to be enveloped in the bedding. Upon closer examination, you notice that Mrs. Corbin has been restrained in her bed. Her arms are loosely tied to the bed railings, which are fully extended on each side of the bed. Mrs. Corbin appears alert but very agitated. Misty Wells, the nursing assistant, is feeding her applesauce, and Mrs. Corbin is spitting and yelling obscenities at her. The situation is much more chaotic than you expected.
The nursing assistant is so intent on feeding Mrs. Corbin that she doesn’t notice you entering the room. You quietly approach the bedside and ask the assistant why Mrs. Corbin is restrained. Misty jumps and appears surprised at your presence. She tells you that Mrs. Corbin has been “out of her head” since she was admitted to the hospital.
“I don’t think she even knows where she’s at,” Misty tells you. “I think she believes she’s at home. She’s confused about who I am. Sometimes, she thinks I’m her daughter and that she’s at home. This morning she was telling me to get her bathrobe out of the closet in the other bedroom, so I think she believes she’s at her home.”
“Okay. Is it all right if I try to talk with her for a few minutes?” you ask Misty.
“Oh yes, please do. She’s not making much sense though,” Misty replies.
You tell Mrs. Corbin your name and that you are the social worker at the hospital. She glares at you and asks you where her Coca-Cola is.
“Mrs. Corbin, I don’t have your Coke. Would you like me to see if the nurse can get you a Coke?” you ask.
“Well, I wouldn’t really need it if I had my bathrobe. Where the hell is my doctor? He needs to find my bathrobe. If I had that bathrobe, I could go and get those philodendron plants that I love. Then I could finish decorating the living room for the holidays. That angel up top of the tree looks like Barbra Streisand.”
You repeat, “Would you still like me to get you a Coke?”
“I hate those goddamned commercials with the polar bears in ’em. Like that’ll make someone want a soda, goddamn it! Those commercials just bug the crap out of me! I can’t even believe you brought that up . . . look at my arms! Get these things off my arms! I’ll call the cops if you don’t get these damned things off my arms. And you keep asking about that soda? C’mere and I’ll show you what I think of that Coke of yours.” She bares her teeth and spit flies.
You back up a few feet since Mrs. Corbin is gnashing her teeth and spitting as she threatens you. You wonder what is wrong with this elderly woman. You have never observed this type of be- behavior in an older person even though you have worked with many dementia patients.
Mrs. Corbin has been writhing restlessly in bed and pulling at her blankets since you entered the room. Suddenly, she bolts upright and says that she is going home. You attempt to calm her down by going to her side, but she then tries to bite you.
She struggles to free herself from the bed. And suddenly she bursts into tears, crying, “I’m so tired. Why don’t they let me out of here?”
You explain to Mrs. Corbin that the doctors are trying to help her feel better and that you are going to help her find a good place to stay when she leaves. She looks wide-eyed and responds, “I can’t move all my things. And what about my birds?”
“Right now, you just need to rest and get better. Don’t worry about your birds. Your son told me that he was taking care of them,” you attempt to reassure her.
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