Mental Health Comprehensive Case Study

Mental Health Comprehensive Case Study

Alyssa Streb

Youngstown State University

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Mental Health Comprehensive Case Study

Abstract
This case study was done on R.D, a 28-year-old Caucasian female who suffers from

depression as her psychiatric diagnosis and asthma and diabetes as her medical diagnosis. She is

in here due to several stressors and precipitating events. Some of the precipitating events that led

her to being in here were that both of her parents had passed away within a couple month span

from each other, she lost two of her uncles due to suicide, and she kept losing close family

members and friends to death and she didn’t know how to grieve accordingly. The main reason

she is in here today is that she had a suicidal plan to overdose on her antidepressants and she was

cutting herself, especially in her left shoulder and stomach area. Another reason she is in here

today is that she had a medication change and she stated that it made her feel different so that is

part of the reason she wanted to kill herself. There are many treatment options for this patient

such as medications including SSRIS, SNRIS, MAOIS, and then counseling. The discharge

planning for this patient would be to discuss referral options such as further counseling with

mental health services or something as far as community health services.

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Objective Data

This patient is a 28-year-old Caucasian female with the initials R.D that was admitted on

October 13, 2017 and the day I provided care was October 19, 2017. The psychiatric diagnosis

that I have for this patient is that she suffers from depression. When she first arrived at the unit

she did not want company and did not want to talk to anyone. She would just sit there by herself

and keep to herself most of the time and did not attend group. On the day of care, she talked to

me till it was time to go and she started to attend group sessions. She said that this session I

provided her with really helped her and it was the first time she laughed in a while which was

great. Earlier that week the safety measures were not maintained because she was able to cut

herself on her stomach with the ends of a toothpaste bottle that they had to confiscate recently.

While I was on the unit, the safety and security measures were maintained, and she had nothing

that she could cut herself with. There are many psychiatric medications she is on such as

Cogentin 2mg 2xdaily prn for agitation, Haldol 5mg IM q4hrs for agitation, Vistaril PO 50mg

3xdaily prn for anxiety, Paxil 60mg PO daily for depression, and lastly Desyrel 150mg oral

nightly for sleep.

Summarize

Depression is one of the most common mental illnesses and it is also a serious mood

disorder. It causes many severe symptoms that affect how you feel, think, and handle daily

activities, such as sleeping, eating, or working. If you are going to be diagnosed with depression,

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the symptoms must be present nearly every day, most of the day, for at least two weeks (National

Institute of Mental Health, 2016). There are many different expected and common behaviors

with depression such as feelings of hopelessness, loss of interest or pleasure in hobbies and

activities, persistent sad or “empty” mood, decreased energy or fatigue, difficulty concentrating,

appetite and/or weight changes, and thoughts of death or suicide (National Institute of Mental

Health, 2016). Everyone who has a diagnosis of depression does not experience every symptom I

listed. Some people may experience many symptoms while others only experience a select few.

“Several persistent symptoms in addition to low mood are required for a diagnosis of major

depression, but people with only a few – but distressing – symptoms may benefit from treatment

of their “subsyndromal” depression” (National Institute of Mental Health, 2016). Depending on

the person and the type of illness they have, the number of symptoms and how long they last will

vary because every person is different. There are many risk factors that lead to a person being

depressed. These risk factors include personal or family history of being depressed, major life

changes, trauma, stress, and certain physical illnesses and medications. Depression can be treated

and the earlier that the treatment can begin, the more effective it is. One way depression can be

treated is through medications such as antidepressants. These medications help improve the way

the brain uses certain chemicals that control mood or stress. The person that is going to be put on

antidepressants may need to try a couple medications before they find the one that works just for

them and it can be stressful. These medications usually take two to four weeks to work and

symptoms such as sleep, appetite, and concentration problems improve before mood lifts

(National Institute of Mental Health, 2016). Another way you can treat depression is by going to

counseling and using talk therapy to work out the problem.

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Mental Health Comprehensive Case Study

Identify

There were many stressors that led to my patient’s current hospitalization. My patient had

lost her father and mother within a couple month span of each other and she had also lost both of

her uncles to suicide. She also lost a lot of friends and acquaintances due to drunk driving and

suicide. These precipitating events led to her being depressed and hospitalized. My patient had

also been cutting herself on her stomach and her left shoulder, which had a superficial cut on it

that also led to her being hospitalized. She had left a suicide note that her wife had found, and

her wife took all the guns out of their house. She had voluntary came to the hospital because she

wanted to get better and live a healthier life.

Discuss

The patient has a history of being depressed and seeing a psychiatrist and counselor. She

has been on her medicine, Paxil, for a while now because she has been depressed. She had told

me that her mother when she was alive had suffered from bipolar disorder and so did her sister.

Mental illness therefore runs in the family, but she said her mother and sister have it under

control.

Describe

I believe I provided the patient with great nursing care related to her problem. There were

many nursing interventions that I did for the patient. I made sure to establish a therapeutic

relationship with the client, so she felt that she trusted me and could talk to me about what has

been going on. I was being alert for warning signs of suicide such as becoming depressed or

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withdrawn, suffering from a major loss or change, and her showing a marked changed in

behavior, attitude, or appearance. I also encouraged and listened to the patient about the reasons

why she wants to harm herself. There are many milieu activities attended to on the unit. The staff

keeps the patients in a very safe environment when they arrive such as getting rid of anything on

the patient that may do them or anyone else harm. They can call their family members at certain

times and I believe that provides a safe environment because they are allowing them to be able to

talk to their loved ones. They do group therapy and I believe that is very helpful in the patient’s

treatment plan to get better because they learn skills such as personal triggers, communication

skills, confidence, how to lead a group, and understanding/empathy. With milieu therapy, it

focuses on the person rather than the problem. “The benefit of milieu therapy is that many

therapeutic styles can be implemented during group or individual sessions, as long as they foster

an environment that promotes personal and social growth for the individual” (Carmstrong, 2015).

Analyze

There were no ethical or cultural influences that impacted the patient on the day of care.

There was a spiritual concern that affected the patient and that was that she is homosexual and

Christian. She had gotten kicked out of her church for it and I believe this affected her to being

here today in many ways because she didn’t feel wanted in her own church for being who she is.

She talked about it only for a little bit, and I could tell she was hiding it in a way and she didn’t

want to continue talking about it.

Evaluate
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Mental Health Comprehensive Case Study

After I performed my nursing interventions on the patient, I came up with a couple

outcomes that I wanted the patient to complete on the day of care. The first one was that the

patient does not harm self on the day of care and she overcame that and met the outcome. The

second outcome was that the patient talks about feelings and expresses anger appropriately and

she did a very good job at doing both and met that outcome. The third outcome was that she

obtains no access to harmful objects and on the day of care she did not come across any harmful

objects because the unit is safe. The last outcome I had for the patient was that she would express

decreased anxiety and she did on the day of care and met that outcome.

Summarize

On the day of admission to the unit, the patient should have established a discharge goal and a

discharge plan. During the patients stay at the unit, the treatment team makes recommendations

for aftercare services to ensure that needed services are in place for when the patient transitions

back home. The discharge planning includes the patient and family with the therapeutic supports

needed to ensure that the patient maintains the gains they made while on the unit. It is important

these supports, and services are established prior to discharge to ensure a smooth transition.

Some of these services include psychiatrist appointments, medication regimens, counseling, or

some type of community based program to help the patient. In my discharge planning, I would

include medication teaching such as the effects, side effects, drug-drug and drug-food

interactions. I would also teach coping skills such as relaxation and deep breathing exercises. I

would ask the client if they had a support system to call before being discharged and make sure

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they have follow-up care after their visit such as outpatient services or even a crisis number to

call.

Prioritized

 Risk for suicide related to grieving as evidenced by constant crying

 Risk for self-harm related to feelings of helplessness, loneliness, or hopelessness

as evidenced by depression

 Powerlessness related to institutional environment as evidenced by

nonparticipation in care

 Disturbed sleep pattern related to depression as evidenced by change in normal

sleep pattern

 Sedentary lifestyle related to lack of motivation as evidenced by verbalizes

preference for activities low in physical activity

List

 Powerlessness related to institutional environment as evidenced by nonparticipation in

care

 Sedentary lifestyle related to lack of motivation as evidenced by verbalizes preference for

activities low in physical activity

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Mental Health Comprehensive Case Study

 Disturbed sleep pattern related to depression as evidenced by change in normal sleep

pattern

 Risk for suicide related to grieving as evidenced by constant crying

 Risk for self-harm related to feelings of helplessness, loneliness, or hopelessness as

evidenced by depression

References

Carmstrong. “Milieu Therapy Activities Boost Confidence and Social Skills.” Teen Mental

Health Hospital, 4 Mar. 2015, www.viewpointcenter.com/2015/03/04/milieu-therapy-activities-

boost-confidence/.

Depression: Do You Know the Symptoms?” WebMD, WebMD,

www.webmd.com/depression/understanding-depression-symptoms.

“Depression.” National Institute of Mental Health, U.S. Department of Health and Human

Services, www.nimh.nih.gov/health/topics/depression/index.shtml#part_145396.

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