RUNNING HEAD: Mental Health Case Study 1

Kayla Boyer

Mental Health Case Study

Youngstown State University

RUNNING HEAD: Mental Health Case Study 2

Abstract

The paper at hand will be informative on a patient admitted to Trumbull Memorial Hospital.

With a discussion held with the patient and chart reviewing, I will be sharing the patient’s

background. In regards to the patient’s admission, the precipitating events will be told. Nursing

diagnoses will be determined based on the patient’s medical diagnoses. Lastly, other

information that will be stated includes: a patient health history, support systems and family

members involved in the patient’s life, problems at hand in the patient’s life currently, and

personal statements made by the patient.

RUNNING HEAD: Mental Health Case Study 3

Objective Data

S.F. is a fifty-eight-year-old Caucasian female admitted to Trumbull Memorial Hospital

on February 27th,2018. The date of care provided was on March 2nd, 2018. According to an

article written by Tandon the DSM-V has six different criteria to meet to be diagnosed with

schizophrenia. The first is criteria A: characteristic symptoms two (or more) of the following

each present for a significant portion of time during a 1-month period (or less if successfully

treated). The characteristic symptoms are delusions, hallucinations, disorganized speech, grossly

disorganized or catatonic behavior, and negative symptoms. The next is criteria B:

social/dysfunctional dysfunction. Followed by criteria C: duration: continuous signs of

disturbance persist for at least 6 months. This 6-month period must include at least one month of

symptoms to meet criteria A. Then criteria D: Schizoaffective and major mood disorder

exclusion. Next is criteria E: Substance/general mood condition exclusion. Lastly is criteria F:

Relation to Global Development Delay or Autism Spectrum. (Tandon pg. 3).

S.F. was currently in a state of mania during the date of care. She had a flight of ideas,

was extremely talkative, and had rapid changes in emotions. She would spontaneously laugh for

no reason. The patient had a difficult time answering questions and forming ideas. The patient

was involuntarily admitted to the hospital by the group home she was staying in. S.F. hit her

roommate because she was talking about her. However, the patient’s roommate was not talking

about her she was hearing voices. Per the group home the patient had been having worsen

hallucinations for 2 days before hitting the roommate. S.F. denied attacking roommate stated the

roommate started the fight by hitting her first. According to an article by Smith the patient was

experiencing disorganized behaviors. The patient had unpredictable or inappropriate emotional

responses, behaviors that had no purpose, and lack of impulse control. (Smith pg.1).
RUNNING HEAD: Mental Health Case Study 4

S.F. was on unit restrictions and patient self-harm precautions were in place and

followed. She was prescribed Depakote, an anticonvulsant, for schizophrenia. The dose and

frequency for Depakote was 750 mg twice a day. Additionally, she was prescribed Synthroid, a

synthetic T4 replacement, used to treat hypothyroidism. She was prescribed 100 mcg daily. She

was also prescribed Cogentin, an anticholinergic, for EPS at 1mg twice a day. Additionally, she

was prescribed Buspar for anxiety at 10mg twice a day. Lastly, she was prescribed Haldol, an

antipsychotic, for agitation at 10mg twice a day. The PRN medications that were ordered

included Haldol for agitation, Vistaril for anxiety, and Bisacodyl for constipation.

Expected and Common Behaviors of the Client with Schizophrenia

According to the textbook, Schizophrenia is characterized by a breakdown in relation

between thought, emotion, and behavior leading to faulty perception, inappropriate actions, and

feelings, withdraw from reality and personal relationships into fantasy and delusion and a sense

of mental fragmentation. (Townsend). Regarding this specific patient, she had a breakdown

between her thoughts, emotions, and behaviors. Patient experienced delusions and fantasies

throughout the interview., however, denied them all.

S.F. was exhibiting classic signs of her disorder. For example, she would laugh out of

nowhere and for no reason. As if she heard someone telling a joke. However, the patient denied

hearing voices when interviewed. She also presented with a flight of ideas. It was as if she had a

timer running and had to fit in all her thoughts and ideas very quickly. She also repeated some of

the same ideas several times. She told me that it was snowing multiple times and discussed a cat

named Izzy.
RUNNING HEAD: Mental Health Case Study 5

Precipitators to the Current Hospitalization

Before becoming hospitalized, S.F. was unemployed and on SSDI. S.F. was first

diagnosed with schizophrenia when she 19 years old. S.F. was last hospitalized 15 years ago and

upon discharge then was sent to a group home in Niles, Ohio. In this group home there are

twelve other residents. The precipitating event that lead the patient to hospitalization was the act

of assault towards one of her roommates. An ambulance was called to the group home and the

patient was transported to the ED for increased psychiatric issues and hallucinations. In the ED,

the patient was very uncooperative and stating that the roommate was talking about her and

trying to harm her. The patient stated that the roommate attacked her first. S.F. is currently

medically stable and denying hallucinations currently.

In the textbook I looked at information about medical issues that can trigger an increase

in schizophrenia manifestations. The authors stated that medical issues such as hypothyroidism,

hypoglycemia, hyponatremia, and hypocalcemia can trigger an increase in the manifestations of

the patient’s disorder. (Townsend, pg. 462). Upon reviewing the patient’s lab work I was able to

determine that S.F. had a blood sugar level of 66, a sodium level of 131, a calcium level of 0.6,

TSH level of 0.77, and a T4 level of 1.08. Although, most of the patient’s level were only

slightly decreased it could be an explanation on why the patient had a sudden increase in

agitation and paranoia

Patient and Family History of Mental Illness

When looking at the family history of S.F.’s case, no report of anyone in her family

having a mental illness. I found this information to be interesting since the patient has is a twin.

The patient’s mother and father were divorced. S.F. refused to talk about her father. S.F. has a

twin brother and three sisters. S.F. talks a lot about her twin brother stating that they are very
RUNNING HEAD: Mental Health Case Study 6

close. However, S.F. did not mention having any sisters during the interview. However, after

reviewing the chart I was able to determine that the patient called her roommates the same name

as her sisters. I am not sure if they share the same name or if the patient has delusions about her

sisters being her roommates at the group home. The patient also stated that her mother rarely

comes to see her. According to the hospital documents the patient rarely has visitors and if often

alone.

Nursing Care and Milieu Activities

The psychiatric unit at Trumbull Memorial Hospital provides an excellent milieu. The

floor is very clean and organized which limits distractions to the patients. There is a schedule

posted on the wall of when the groups are, meal times, and visiting hours. The staff does an

excellent job interacting with the patients.

The floor is an elongated horse shoe shape with rooms on each side (one side being

restricted) and a common room in the middle in front of the nurse station with tables. The group

room is found on the left of the common room. Most of the patients can be found sitting in the

common area watching television, coloring, talking to other patients, or playing a game. The

common area allows the staff to have eyes on all the patients. If the patient decides to stay in

their rooms, there will be a staff member that does a check on that room every 15 minutes.

S.F. was initially placed on self-harm precautions based on her assault attack towards her

roommate. Even though the patient stated that she would harm anyone, it was still important to

keep close attention to her and not allow her to be alone for certain periods of time. This

decreases the risk of any self-harm activities. The patient was also assigned to a room by herself

to avoid the patient being paranoid and trying to harm someone else.
RUNNING HEAD: Mental Health Case Study 7

Ethical, Spiritual and Cultural Influences

The patient did not discuss any cultural or spiritual influences that impacted herself. The

patient did attend the religion group therapy session on the day of care and was interested in

what the pastor had to say based on her contribution to the group session. However, the patient

did not mention any religious views during the interview or mention going to church outside of

the hospital or attending religious groups there.

Patient Outcomes Related to Care

S.F. did not seem to express any current signs of paranoia just seemed to be in a manic

mood. The patient realized why she was admitted to an extent and knew that she did something

wrong but blamed it on the roommate. When having our interview, the patient talked as if she

missed the group home and all her friends in it including her roommate. It was hard to determine

if she was genuine when making the comments of about the group home, due to the flight of

ideas the patient was experiencing. The patient seemed to have a good time during group therapy

and did not have any issues with other patients. The patient participated in bingo with the help

of a student. She seemed to enjoy herself and joined in the group therapy discussion. The patient

shared with the group her coping skills and what she enjoys to watch on TV.

Discharge Plans

S.F. is going to going back to her group home in Niles, Ohio. She is

also very excited to get back to her friends and pet cat Izzy. On the day of care, there was not a

plan to go home anytime soon that I was aware of. Patient’s medication level was not at

therapeutic level and S.F. would be staying at S.F. until reaching therapeutic level.
RUNNING HEAD: Mental Health Case Study 8

Nursing Diagnoses

1. Impaired verbal communication related to disordered evidenced by loose associations,

neologisms.

2. Self-care deficit related to cognitive impairment evidenced by difficulty carrying out

tasks associated with hygiene, dressing, grooming, eating, and toileting.

3. Disturbed sensory perception auditory and visual related to loneliness evidenced by

inappropriate responses, disordered thought, poor concentration, and disorientation.

4. Risk for loneliness.

5. Risk for post-trauma syndrome.

6. Risk for other-directed violence.

Potential Nursing Diagnoses

1. Ineffective Activity Planning related to compromised ability to process information.

2. Anxiety related to unconscious conflict with reality.

3. Ineffective coping related to inadequate support systems, unrealistic perceptions,

inadequate coping skills, disturbed thought processes, impaired communication.

4. Deficient diversional activity related to social isolation, possible regression.

5. Interrupted family process related to inability to express feelings, impaired

communication

6. Fear related to altered contact with reality.

7. Ineffective health maintenance related to cognitive impairment, ineffective individual and

family coping, lack of material resources.

8. Hopelessness related to long-term stress from chronic mental illness.

9. Disturbed personal identity related to psychiatric disorder.

RUNNING HEAD: Mental Health Case Study 9

10. Insomnia related to sensory alterations contributing to fear and anxiety.

11. Impaired memory related to psychosocial condition.

12. Self-neglect related to psychosis.

13. Imbalanced nutrition: less than body requirements related to fear of eating, lack of

awareness of hunger, disinterest toward food.

14. Sleep deprivation related to intrusive thoughts, nightmares

15. Impaired social interaction related to impaired communication patterns, self-concept

disturbances, disturbed thought process.

16. Social isolation related to lack of trust, regression, delusional thinking, repressed fear.

Conclusion

In conclusion, S.F. displayed classic symptoms of schizophrenia based

on the DSM-V criteria. After interviewing and spending the day with the patient I was able to

observe several of these symptoms displayed. The patient had flight of ideas, hallucinations,

delusions, disorganized behaviors and was manic. The patient would laugh for no reason and was

easily distracted. For most of the interview process she just looked at me in confusion on how to

answer my questions. The patient was obsessed with talking about her brother and pet cat Izzy.

During group therapy I observed S.F. enjoying interacting with other clients. I was able to learn a

lot about schizophrenia from observing S.F. and found the articles and textbook to be very

interesting. I find schizophrenia to be very interesting since it does not seem to have an actual

cause.
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Works Citied

https://www.helpguide.org/articles/mental-disorders/schizophrenia-signs-and-symptoms.htm

Ackley, B. J., Ladwig, G. B., & Makic, M. B. (2017). Nursing diagnosis handbook: An evidence-

based guide to planning care (10th ed.). St. Louis: Elsevier.

Segal, J., Ph.D. (2018, March). Schizophrenia Symptoms, Signs, and Coping Tips. Retrieved

March 22, 2018, from https://www.helpguide.org/articles/mental-

disorders/schizophrenia-signs-and-symptoms.htm

Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., . . . Carpenter, W.

(2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia

Research, 150(1), 3-10. doi:10.1016/j.schres.2013.05.028

Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: concepts of care

in evidence-based practice. Philadelphia, PA: F.A. Davis Company.

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