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Cody Wohlgemuth

Mental Health Case Study

Youngstown State University


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Abstract

There is a large population within the United States with mental illness. Family members of the

ill may not even realize that a loved one could be diagnosed with a mental illness. The patient is

diagnosed with Major Depression Disorder. There were stressors leading up to the admission to

the psychiatric health floor. The symptoms of this disorder can be shrugged off as just having a

bad day or feeling blue. Education is a huge role in understanding the disease process. As time

progresses mental illness is taken more seriously, but there is still a stigma on mental illness.

With education society will understand that the people diagnosed with mental illness are not just

crazy, but they need help.


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Objective Data

The patient is a twenty-five-year-old female that presented to the emergency room on

Friday the sixth of October which stab wounds to the lower left quadrant of her abdomen. The

patient stated that she “has been drinking and does stupid things when she drinks.” The father

was contacted and came to the emergency department and questioned the patient who did this to

her. This lead to the patient saying she was alone and neither her fiancé or current boyfriend

were in the house when this occurred. With the concern of the father it would lead to further

questions regarding domestic violence. The patient was becoming agitated with the staff who

were trying to help and take care of her. She was using profanity and telling the staff to quit

touching her and she was going to leave.

The patient was admitted to the hospital for the stab wounds and spent five days on the

floor before coming to the mental health floor on October eleventh. We started with small talk to

develop a relationship. She told me how she went to a university in Pennsylvania and she has

three kids already. Talking to her about her school and her outside life a person would not realize

that she was diagnosed with major depressive disorder. During our conversation the patient told

me she came to the mental health floor voluntarily, because she knew she would be forced to

come and it looks better if she voluntarily came. This lead to more questioning about her past.

She said she has attempted suicide before, but has not been admitted onto the mental health floor.

The medical diagnosis would be the stab wounds on her abdomen. There are six different

wounds. Wound care would be a top treatment for her medical diagnosis. Proper wound care

would prevent infection. There was no major organ damage with the stab wounds.
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When I talked to the patient the morning after being admitted to the psychiatric floor she

was not prescribed any psychiatric medication. I asked if she has seen the psychiatric doctor on

the floor and she said no. the doctor was making rounds later that morning. The patient also had

a positive pregnancy test. Most psychiatric medications need to be withheld while being pregnant

so this will limit the doctor on which medications if any are prescribed. There were as needed

medications prescribed per the hospital policy. The two medications that are prescribed on the

floor is Cogentin and Haldol. Cogentin can develop tardive dyskinesia and if this occurs the

nurse must discontinue the drug and contact the health care provider. Haldol is prescribed for

agitation and aggression. If the patient terminates the pregnancy I would look for some common

antidepressants to be prescribed such as Zoloft or Prozac.

The DSM IV is not used at our facility. Axis I would be the psychiatrist diagnosis of

major depressive disorder. Axis III is the medical diagnosis which would be the stab wounds

located on the patients lower left abdomen.

Summarize

According to Mayo Clinic, major depression disorder is very common and there about 3

million cases in the United States. Major depression disorder is defined as: the persistent feeling

of sadness or loss of interest that characterizes. This feeling has to be for two weeks all day every

day without any changes. Depression can affect any age group, but predominantly starts in the

twenties or thirties (Mayo Clinic, 2017). This patient was right in the middle of the age range.

There were probably signs of depression earlier, but family members and friends do not

recognize these signs as depression. Most people will think it is just one of those days and before

they know it’s been a month.


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Signs and symptoms are different for everyone. According the National Institute of Mental

Health, these are some of the symptoms of a person dealing with depression: persistent sad,

anxious, or “empty” mood, feelings of hopelessness, or pessimism, irritability, feelings of guilt,

worthlessness, or helplessness, loss of interests, weight changes, and suicidal ideations (NIH,

2016).

According to Michael Kerr, the treatments for major depression disorder are medications,

psychotherapy, and life style changes. Selective Serotonin Reuptake Inhibitors are first line

defense this includes Celexa and Prozac. Psychotherapy can help some people, but it may not

help everyone. Sometimes the patient needs somebody to talk to and have somebody that is

willing to listen. The professional can help the patient by teaching them positive coping

strategies. Life style changes can help depression. Most people turn to alcohol when they are

feeling down, but as a central nervous depressant alcohol can make the depression symptoms

worst. Exercising, eating right, and getting enough sleep at night has a huge effect on mood

(Kerr, 2017)

Identify

The current hospitalization precipitated from alcohol intoxication and stab wounds to the

abdomen. The stab wounds are considered self-inflicted which lead to the admission on the

psychiatric floor. The stressor that could have led to the self-harm but not limited to is finding

out the patient was pregnant and not knowing who the father is. Already engage with three

children and having a new-found love interest can be stressful by itself. The patient described the

new pregnancy and an unwanted surprise and planned on termination. The patient is also

attending online classes through a university. College can be very stressful trying to maintain a

social life, working, and in this case a family.


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Discuss

The patient has had a history of alcohol abuse and depression in the past. The depression

lead to previous suicide attempts. The patient knows that she has a substance abuse problems and

quit drinking for a while. When new stressors developed mentioned above she went back to her

old habits and began drinking again. The father has been supportive of the patient and worries

that the patient will commit suicide one day. The patient said there was nobody in her family that

has a history of depression that she knows of.

Describe

The psychiatric unit at Saint Elizabeth downtown Youngstown 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. Around nine

in the morning a staff member comes out and asks each patient a goal of the day and talks about

the schedule of the day emphasizing the first group that starts in an hour.

The floor is a horse shoe shape with rooms on each side and a common room in the

middle in front of the nurse station with exercising equipment. The group rooms are found on the

backside in two private rooms. Most of the patients can be found sitting in the common area

watching television, coloring talking to other patients or using the equipment. The common area

allows the staff to have eyes on all the patients. If the patient decides to stay in their room there

will be a staff member that does a check on that room every 15 minutes.

The rooms are not like the typical hospital room. Everything is heavy on the floor or

bolted. This prevents the patients from throwing these items. The bathroom door is thickened and

slanted so the patient cannot attempt to hang themselves. The mirror is not glass so the patient
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cannot break it and inflict harm to themselves or another person on the floor. The patients are not

permitted to have strings in their clothing or shoe laces.

Analyze

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

The patient could explore spiritual influences and this may help with the depression. Religion

can be a positive coping mechanism with prayer and being a part of something.

Evaluate

When I had the conversation with the patient she was only on the floor for about twelve

hours. She met the goal of meeting the staff and being able to recognize them. Another goal she

met was having a good night sleep. One of the goals she planned on meeting was going to the

groups throughout the day. The goal for the day of care that she came up with was to be more

patient. This is an excellent goal for the first full day of care, because there is a lot of changes

that she will have to encounter. The patient stated that she was going to do certain activities to

ensure she would get out of there quick enough to not miss any class work. This is concerning

because she should be focused on herself and getting better. This could be related to lack of

education on mental illness.

Summarize

The patient should attend an outpatient facility after discharge. Instead of having two love

lives the patient needs to break it off with one of the two men or end the relationship with both.

The patient stated that she wanted to get help with her alcohol problem. The patient will be

educated to alcoholic anonymous prior to discharge. This is a great first step in recovery. Weekly

psychiatric visits will be implemented. If the patient decides to terminate the pregnancy
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medication regimen will be addressed. Patient will find a positive coping strategy that will deter

from drinking. The patients father was involved in her life and was a great support system.

Prioritized Nursing Diagnosis

1. Self-harm related to unexpected pregnancy as evidence by stab wounds to lower left

quadrant abdomen.

2. Ineffective coping related to substance abuse as evidence by patient stating, “I have a

drinking problem.”

3. Absence of acute withdrawal symptoms related to substance abuse as evidence by

coming into the emergency department intoxicated.

Potential Nursing Diagnosis

1. Knowledge deficient related to substance abuse as evidence by not knowing about

community resources.

2. Risk for self-harm related to self-inflicted stab wounds

3. Encourage patient to verbalize positive coping patterns post discharge related to poor

coping strategies as evidence by self-inflicting wounds while intoxicated.


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Works Cited

Depression (major depressive disorder). (2017, August 16). Retrieved October 18, 2017, from

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-

20356007

Depression. (n.d.). Retrieved October 18, 2017, from

https://www.nimh.nih.gov/health/topics/depression/index.shtml

Kerr, M. (2017, June 27). Major Depressive Disorder (Clinical Depression). Retrieved October

18, 2017, from https://www.healthline.com/health/clinical-depression#Overview1