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.

Findings related to the possible cognitive decline and depression in Mr. Palo would be related to the passing of
his wife of 65 years, 3 years ago and the recent passing of his dog Max. I asked Mr. Palo if he could tell me
more about what was going on with him today. He responded “sometimes I’m not sure where I am or what is
happening. It scares me.” When asked about when he felt the best over the last year,Mr.Palo responded, “Max
gave me a reason to live and now he’s gone too.” Mr. Palo stated he does not have the energy to do ADL’s. It
does not feel as good as it was, and now I don’t have Max to nudge me along, so I find myself sitting on the
sofa most of the day.” I asked Mr. Palo if he had lost or gained weight over the past month and he stated, “I
think I have lost weight, but I don’t really weigh myself.” He also mentioned he thinks his belt fits looser. I
asked Mr. Palo about his eating habits/ change in appetite over the last month he stated If I try and eat or
shower, I get so tired that I give up.” I explained to Mr. Palo the physical symptoms are a part of grief and
acknowledged that he must miss his wife and Max a great deal. When I acquired about any changes in his sleep
habits, Mr. Palo shared “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 .” Mr. Palo displays signs of
depression through his lack of participating in activities he used to enjoy, he stated “I would like to go on walks
like I used to, but I don’t do it much anymore. He also doesn’t watch hunting shows like he used to.

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.

After completing the Geriatric Depression Scale, Mr. Palo received a score of 10/15, this is indicative of
depression. Any number >5 on this scale is indicative of depression. Below are the responses to his questions

Are you basically satisfied with your life? No

Have you dropped many of your activities in interest? Yes
Do you feel your life is empty? Yes
Do you get bored? Yes
Are you in good spirits most of the time? No
Are you afraid that something bad is going to happen today? No
Do you feel happy most of the time? No
Do you often feel helpless? No
Do you prefer to stay at home, rather than going out and doing new things? Yes
Do you tell you have more problems with memory than most? No
Do you think it is wonderful to be alive now? No
Do you feel pretty worthless the way you are now? No
Do you feel full of energy? No
Do you feel that your situation is hopeless? No
Do you think that most people are better off than you are? Yes

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

Mr. Palo is not satisfied with his life and has dropped many of the activities he used to enjoy doing. He feels
his life is empty and he stays in a state of boredom due to lack of activity. But he is in good spirits most of the
time. Feelings of helplessness occur most of the time, and he prefers to stay at home rather than going out and
doing new things. He does not feel that he has more of a problem with his memory than most. He does not think
it is wonderful to be alive, but he does not believe that his situation is hopeless either; however, he does feel
other people are way better off than he is.

3. Referring to your feedback log, document all nursing care provided and Mr. Palo’s response to this care.

Mr. Palo gave permission for his daughter to be present during the assessment. A cognitive/depression
assessment on Mr. Palo. I checked the scene for safety, washed my hands, introduced myself, Identified Mr.
Palo. I took his vital signs and they were B/P 140/88, R 16, P78, T 98.6 F and O2 was 96% on room air. Heart
sounds were good, Lungs were clear and equal bilaterally. His appearance, attention, motor skills and activity
and speech were also accessed. A safety check was done of the surroundings and a hunting gun was found
hanging on the wall. The gun was removed and given to his daughter Maggie for safe keeping. A mini-cog
assessment was also completed at this time. Mr. Palo scored a 4 which is the same he achieved seven months
ago. He could only recall 2 of the 3 words, but was able to complete the clock feature of the test. Mr. Palo did
not like all the questions being asked, he however did answer them. He seemed be ok with the nursing care.

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

Mr. Palo was educated on the local grief share support group that he could attend. At first, he was resistant to it
because he didn’t want to get up and speak in front of people, he was informed that he didn’t have to speak in
the group until he was comfortable with the group. He seemed to show some interest in the group after he was
told this. He was also told that there was a possibility of finding a walking partner within the community that
could walk with him on a regular basis. He showed some interest in going to the humane society and
volunteering with the animals, they assured him that he would have transportation if this is something he
wanted to do. His spirits seemed to be higher because of this. He was also educated on how grief can cause
physical symptoms, such as loss of energy and appetite, sleep disturbances, lack of motivation to complete task
and having the inability to do Adl’s. Palo’s gun was removed from the apartment.

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

S: Mr. George Palo is a 90 Y/O African American Male who lives in a retirement home assisted living
apartment. He currently lives in the apartment by himself. He has been living there for the last 3 years since the
death of his wife Anna. Mr. Palo has been diagnosed with minor neurocognitive decline, Alzheimer’s type, 6
months prior he was prescribed Galantamine. He also has mild hypertension and receives atenolol. Mr. Palo
was doing ok until his dog Max passed away about 2 months ago. Since then there has been a noticeable
change in Mr. Palo. He has become forgetful, weaker, his clothes seem to hang off of him. He expresses a lack
of motivation and has stated “I have nothing to live for.”

B: Mr. Palo’s daughter, Maggie, has noticed the changes in her father and she contacted the nurse to tell them
that her father’s signs of depression and confusion had gotten worse since the death of Max. About 7 months
ago a Mini Cog Test was completed and it showed some impairment in his memory at that time. The nurse
From vSim for Nursing | Mental Health. © Wolters Kluwer.
after the first test recommended some memory aides and resources to help maintain his independence. He is
also suffering from weight loss. Feels he has nothing left to live for and doesn’t want to be a bother to his
family.

A: My assessment of Mr. Palo is that he is grieving for his wife and dog. He does appear to be depressed. His
current vitals are B/P 140/88, P78, R16,T 98.6F and O2 was 96% on room air. Mr. Palo was A&O X2 he stated
his name and birthdate but did not know the name of the place where he was at. He states he is allergic to
penicillin. Heart sounds were good and lung were clear and equal bilaterally. He received a score of 4 on his
Mini Cog Test he did today. He was only able to recall 2/3 words. This is no change from the test he received
7 months ago. The patient has not been active since his dog Max passed away 2 months ago. He does not appear
to be in any physical distress at this time. When the support group grief share, finding a walking partner in the
community and volunteering at the Humane society was brought up Mr. Palo responded positively to these
ideals.

R: Mr. Palo should be encouraged to participate in some form of grief therapy. He should also be encouraged
to participate in activities whether it is volunteering, walking or just socializing in the community. Mr. Palo will
be encouraged to begin eating , performing his ADL’s and taking his medication as prescribed. Mr. Palo will
not harm himself. A follow up appointment with the doctor was made to discuss his over-all well-being and
management of his depression and hypertension . Will need to continue to monitor depression and hypertension.

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