Write a summary on Summer Fields who identifies as a 31-year-old female was admitted to the Accident and Emergency department (AED) with extensive wrist, arm and upper thigh injuries. Summer was unaccompanied on arrival as her partner was unable to travel with her to the hospital. Their six-month-old twin girls are being cared for by relatives.On admission, following assessment by the AED consultant, it is apparent that Summer has self-harmed and requires wound management and an immediate referral to psychiatry services.Whilst in the AED Summer was subdued and relatively non-communicative making it difficult to obtain an accurate and complete medical history and examination. During the assessment Summer appeared to be in pain scoring 8 on a pain scale, but this was masked by the possibility of recent consumption of alcohol. After taking baseline blood samples, the results showed that Summer did have high blood alcohol levels confirming the suspicion that she recently consumed an excessive volume of alcohol prior to admission. In addition, the paramedic handover included information that suggested that Summer may have ingested a higher dose of the drug Sertraline.Summer currently lives with her partner of 6 years, Siobhan, in a modest three-bedroom semi-detached house. They both have family living close by, but Siobhan suggests that their relationship can be strained at times. Summer recently suffered a family bereavement – her mother Rhianna died by suicide a few months after the twins were born pre-term. From the assessment it is known that Summer was recently diagnosed with depression and had been commenced on 50mg daily of Sertraline. She also has a history of bulimia and is allergic to penicillin. Summer is currently on maternity leave from her work in Human Resources at a local High School. Summer is physically active and spends excessive amounts of time exercising each day – often exceeding the recommended guidelines of 150 minutes of moderate intensity exercise per week, this, along with caring for the twins, leaves very little free time to socialise or participate in other hobbies. Summer has a current BMI of 18, she consumes a minimum of 4 units of alcohol each week, usually over a three-day period, but does not smoke. Previous admissions to hospital include an emergency caesarean section at 31 weeks gestation with the twins.Summer’s wrist, arm and thigh wounds were sutured, and dressings applied. Analgesia and oxygen therapy were prescribed and given in the AED, before Summer was transferred to an observation ward for further monitoring and referral to the psychiatry team. Discharge to primary care services has been planned for the day after next.On transfer to the ward Summer was initially settled and pain free but is now becoming increasingly agitated. Still reluctant to communicate, she has declined any offer of food or fluids (loss of appetite) stating that she is feeling sad and anxious (depressed) about ‘life’. After completing some recent observations there are also signs that Summer is dehydrated.The nurse in charge of the ward has asked you to conduct a bio psychosocial holistic assessment for Summer using the information from the scenario above and then co-ordinate a plan of care for her that focusses on one problem identified during that assessment. The identified problems are:• wound management• loss of appetite• pain• depression• dehydration
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