Running head: COMPREHENSIVE CASE STUDY 1

Comprehensive Case Study

Michael Bryant
Nursing Department, Youngstown State University
4842L: Mental Health Nursing Lab
Mrs. Peck, Mrs. DeFiore-Golden
March 11th, 2020
COMPREHENSIVE CASE STUDY 2

Abstract

M.M. is a 42-year-old African American Male who presented to the Emergency Department on

February 17th for multiple self-inflicted stab wounds to the neck and chest. The self-inflicted stab

wounds were a result of a domestic dispute between M.M. and his spouse. After attempting to stab his

spouse, he turned the knife on himself in an apparent suicidal act. His medical diagnosis is Acute Blood

Loss Anemia related to Multiple Stab Wounds. Due to the nature of his self-inflicted wounds, he was

also given a psychiatric diagnosis of Major Depressive Episode and was consequently admitted to the

inpatient psychiatric unit at St. Elizabeth’s Hospital in Youngstown. The patient is currently on a police

hold.
COMPREHENSIVE CASE STUDY 3

Objective Data

M.M. is a 42-year-old African American Male who presented to the Emergency Department on

February 17th for multiple self-inflicted stab wounds to the neck and chest. His psychiatric diagnosis is

Major Depressive Episode. The Day of care is February 21 st. The Patient’s facial expressions are calm and

appropriate. His posture is erect, and he appears to be comfortable and relaxed. He is dressed neatly in

a casual outfit from home that consists of clean sweatpants and a t-shirt. He does appear to be in good

hygiene. He lacks any restlessness or hand/body tremors. He remains seated and engaged during the

entire patient interview. He is friendly and open during the entire meeting. His laboratory values are as

follows:

Valproic Acid- 31
Ha1C- 4.8%
BMP- within defined limits
RBC- 3.05
Hgl- 9.6
Hmt- 29.6%
Platelets- 202
WBC- 7.7
Urine Drug Screen- (+) Cocaine
He speaks softly and clearly in an appropriate manner. His affect is normal. When asked how his

mood has been lately, he states, “Anxious. My mind has been racing.” When asked if his moods have

been more or less emotional than usual, he states, “No, not really. I’m usually not an overly emotional

person. I’m pretty relaxed.” He is oriented to person, time, place, and situation. His judgement appears

appropriate.

He is currently prescribed 5 psychiatric medications. Depakote for mood stabilization, Haldol for

any agitation, Vistaril for anxiety, Zoloft for depression, and Desyrel to promote sleep and rest.
COMPREHENSIVE CASE STUDY 4

Summarize the psychiatric diagnosis

M.M.’s psychiatric diagnosis is Major depressive Episode. According to Mirela Topan, author of

Cognitive Behavioral Intervention in the Major Depressive Episode, “The states of irritability, sadness,

melancholy, sleep-wake cycle disturbances, fatigue, and pronounced impairment of social and personal

life are present and represent signs and symptoms of major depressive episodes.” (p. 1) Mary C.

Townsend and Karyn I. Morgan, authors of Essentials of Psychiatric Mental Health Nursing (7 th Edition),

define depression as, “An alteration in mood that is expressed by feelings of sadness, despair, and

pessimism. There is a loss of interest in usual activities, and somatic symptoms may be evident. Changes

in appetite, sleep patterns, and cognition are common.” (p. 378)

Identify the Stressors and Behaviors

The self-inflicted stab wounds were a result of a domestic dispute between M.M. and his

spouse. After attempting to stab his spouse, he turned the knife on himself in an apparent suicidal act.

He and his spouse had been using and were under the influence of crack cocaine at the time.

Discuss Patient and Family History of Mental Illness

M.M. had no prior history of mental illness leading up to this current hospitalization. It is

possible that M.M. has had Major Depressive Disorder for some time and remained undiagnosed due to

a number of possible factors. His gender, race, socioeconomic status, and drug abuse could be

responsible for M.M. to not seek mental health treatment. According to Beth Han, Mark Olfson, and

Ramin Mojtabai, authors of Depression Care Among depressed Adults With and Without Comorbid

Substance Use Disorders in the United States, “Among depressed adults in the United States, comorbid

SUD modestly but significantly decreases the likelihood of receiving past-year depression care.

Depressed young adults, men, racial/ethnic minorities, less educated individuals, uninsured adults, and

never married adults are also at increased risk for not receiving depression care.” (p. 291)
COMPREHENSIVE CASE STUDY 5

Evidence Based Nursing Care Provided

M.M. is receiving a combination of pharmacological therapy and psychotherapy to treat his

depression. The medications he is currently taking are Depakote 500 mg, Vistaril 50 mg, and Zoloft 50

mg. From a nursing perspective, we are using a number of interventions while he remains hospitalized.

These interventions include encouraging him to verbalize his feelings, using open ended questions,

maintain a therapeutic distance with open posture, being calm and supportive, assisting with hygiene

needs as necessary, providing activities that stimulate the mind as well as the body, providing behavior

modification techniques, and appraising his strengths. According to Holly Victoria Rose Sugg , Julia Frost,

and David A. Richards, authors of Personalizing Psychotherapies for Depression using a Novel Mixed

Methods Approach: an Example From Morita Therapy, “Evidence indicates that antidepressant

medication (ADM) and several psychotherapies such as cognitive behavioral therapy (CBT) are, on

average, equally effective in treating depression.” Therefore, M.M.’s treatment regimen is appropriate

and indicated by evidence-based practice.

Analyze ethnic, Spiritual, and Cultural Influences that Impact the Patient

As I mentioned before, I believe that ethnic and cultural influences have impacted M.M. in

regard to not seeking care for his depression. He is a low income, African American male, whose highest

level of education is a high school diploma. “Although women are twice as likely as men to be diagnosed

with depression, men experience markedly elevated rates of morbidity, disability, and mortality from

depression than females, and African-American men fare worse in comparison with their Caucasian

counterparts.” (Rich & Roo 2002) It is essential to take his ethnic and gender identity into context when

planning his care.

Evaluate Patient Outcomes Related to Care

COMPREHENSIVE CASE STUDY 6

Care has been successful thus far. Additional self-harm has been avoided. Suicidal ideations

have subsided. M.M. has set realistic goals for himself. He can identify areas of life over which he has

control. M.M. is seeking out interactions with others on the unit in an appropriate manor. He is able to

make decisions concerning his own self-care. He is able to sleep without difficulty and wakes feeling fully

rested.

Plans for Discharge

He is expected to be discharged and released into police custody tomorrow, following the

removal of his staples and sutures.

Actual Diagnosis

Acute Blood loss anemia, Multiple Stab wounds, Major Depressive Episode, Substance abuse

disorder.

Nursing Diagnosis

Pain r/t stab wounds to neck and chest as evident by subjective patient data.

Depressive behavior r/t suicidal intentions as evident by self-inflicted stab wounds.

Impaired skin integrity r/t multiple stab wounds.

Conclusion

To conclude, I believe M.M. is improving and on the way to a better self. He understands how

important his mental health is and is determined to take the corrective actions required to heal himself.

I believe he is no longer at risk to harming himself, and he only attempted suicide due to being under the

influence of a heavy narcotic. He was not in his right mind, and now that he is getting clean, expresses

regret and remorse for his actions. I personally enjoyed meeting and talking with M.M. He was polite
COMPREHENSIVE CASE STUDY 7

and respectable. I was impressed by how well he has been able to stay positive and motivated. He is

nervous about his future but plans to “maintain his faith in god because he’ll get me through it.”
COMPREHENSIVE CASE STUDY 8

References

Han, B., Olfson, M., & Mojtabai, R. (2017). Depression care among depressed adults with and without

comorbid substance use disorders in the United States. Depression & Anxiety (1091-4269),

34(3), 291– 300.

Rich, J. A., & Ro, M. A. (2002). Poor man’s plight: Uncovering the disparity in men’s health. Battle Creek,

MI: W. K. Kellogg Foundation.

Sugg, H. V. R., Frost, J., & Richards, D. A. (2020). Personalizing psychotherapies for depression using a

novel mixed methods approach: an example from Morita therapy. Trials, 21(1), 1–12.

Topan, M. (2018). Cognitive Behavioral Intervention in the Major Depressive Episode. Romanian Journal

of Cognitive-Behavioral Therapy & Hypnosis, 5(1/2), 1–6.

Townsend, M. C., & Morgan, K. I. (2020). Essentials of psychiatric mental health nursing: concepts of

care in evidence-based practice (7th ed.). Philadelphia: F.A. Davis Company.

COMPREHENSIVE CASE STUDY 9

Case Study Comment Sheet 4842

Student Name_____________________________________
Pt Identifier______________
Date(s) of Care_____________

__________ Objective Data presentation the patient, treatments, medications

_ _________ Discuss patient / family history of mental illness

___________ Identify stressors and behaviors that precipitated current hospitalization

___________ Summarize the psychiatric nursing interventions with rationales

___________ Evaluate patient outcomes for nursing care provided

___________ Analyze ethnic, spiritual and cultural influences that impact care of the patient

__________ Summarize discharge plans and community care

__________ Actual nursing diagnoses, prioritized, using R/T and a.e.b.

___________ List of potential nursing diagnoses

___________ Conclusion paragraph

____________ Style, spelling, grammar, clarity, organization, APA format

COMPREHENSIVE CASE STUDY 10

Criteria 1
10 % Constructs a unique patient
Poor Basic Proficient Distinguished
case study and determines an
Does not construct a Discusses a unique Constructs a Creates and correlates a unique patient
appropriate description for patient
unique patient case patient case study unique patient case study with previous clinical
and setting
study and determine and properly case study and experience and provides a thorough
an appropriate generalizes an determines an description for patient and setting
description for appropriate appropriate
patient and setting description for description for
patient and setting patient and setting
from experience

Criteria 2
30 % Summarizes a detailed
Poor Basic Proficient Distinguished
patient history and a complete
Does not summarize Describes a basic Summarizes a Constructs a detailed patient history and
physical assessment
a detailed patient patient history and detailed patient determines a probable complete physical
history and complete lists physical history and a assessment description
physical assessment assessment findings complete physical
assessment

Criteria 3 Poor Basic Proficient Distinguished

25 % Identifies and Does not identify or Identifies and Identifies and Identifies and describes nursing theory
describes nursing theory describe nursing describes nursing describes nursing and correctly correlates and defends
theory and does not theory and discusses theory and nursing interventions with theory
and correctly correlates correlate interventions’ correctly
interventions with correlation with correlates nursing
nursing interventions with theory theory interventions with
theory
theory

Criteria 4
20 % Determines discharge
Poor Basic Proficient Distinguished
needs
Does not determine Identifies and Discusses and Distinguishes and prioritizes discharge
discharge needs describes discharge explains discharge needs
needs needs

Criteria 5
10 % Communicate through
Poor Basic Proficient Distinguished
writing that is concise, balanced,
Does not Communicates Communicates Consistently communicates through
and logically organized
communicate through writing that through writing writing that is concise, balanced,
through writing that is inconsistent in its that is concise, organized, flows with smooth transitions
is concise, balanced, concision, balance, balanced, and between ideas
and logically and logic logically
organized organized

Criteria 6 Poor Basic Proficient Distinguished

5 % Communicate through
Does not Communicates Communicates Consistently communicates through
writing that applies APA 6th
communicate through writing that through writing writing that demonstrates level
Edition style and formatting and
through writing that is inconsistent in its that applies APA appropriate mastery of APA 6th Edition
conforms to all assignment
applies APA 6th use of correct APA 6th Edition style style and formatting and follows all
instructions.
Edition style and 6th Edition style and and formatting assignment instructions
formatting and/or formatting and/or and conforms to
does not conform to inconsistently follows all assignment
assignment assignment instructions
instructions instructions

Case Study Rubric