Running head: MENTAL HEALTH CASE STUDY 1

Psychiatric Mental Health Comprehensive Case Study

Hannah Shafer

Youngstown State University

MENTAL HEALTH CASE STUDY 2

Abstract

This case study will discuss the various psychiatric and mental diagnoses that impacted the

patient’s (K.C.) condition. The information is conveyed through a summary of the objective data,

psychiatric diagnoses, stressors and behaviors, patient and family history of mental illness,

nursing care and planning provided, and ethnic, spiritual, and cultural influences. According to a

study conducted by PLOS titled “Depressive Symptoms in People with and without Alcohol

Abuse: Factor Structure and Measure Invariance of the Beck Depression Inventory (BDI-II)

Across Group” it was concluded that overall, those struggling with alcohol use were reported to

have a higher degree of depressive symptoms when compared to others who did not have a

comorbid alcoholic condition. The combination of Depression and Alcohol Abuse Disorder lead

to many physical ailments including liver cirrhosis and cancer, multiple broken ribs, a subdural

hematoma, and many soft tissue injuries. Many times, people struggling with depression or other

mental illnesses will attempt to self-medicate with various substances. Unfortunately, these

substances can have tremendous ramifications on one’s physical and mental well-being.

Objective Data

Patient was a fifty-one-year-old male with a history of depression, suicidal ideations, alcohol

abuse disorder, mood disorder, anxiety, and issues with aggression. On September 30th, he was

admitted to the hospital following a traumatic fall down stairs while intoxicated. He suffered a

few broken ribs, soft tissue injuries, nondisplaced fractures, and a subdural hematoma. He was

then discharged that same day after receiving medical treatment for those injuries and returned to

his home. He was living with his girlfriend and landlord at that time who were also alcoholics.

During the time of getting discharged and then readmitted on October 9th, he continued to heavily
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drink. On October 9th, he was brought into the emergency department by the police with soft

tissue injuries and suicidal ideations. After being heavily intoxicated, he fell through a glass table

at this home and was then kicked out and forced to live in his car. Police found him unresponsive

and unclothed laying in his car while holding a bottle of alcohol. On October 10th, I provided care

this patient and was able to find out a lot more about his history of mental illness and life overall.

He explained to me that he had three falls within ten days related to his chronic and excessive

use of alcohol which eventually led him to his hospital admissions. He has been suffering with

depression for many years and has felt as if alcohol was the only way for him to cope with the

stressors of everyday life since he was about seventeen years old. This chronic use of alcohol has

led him to have many health complications such as liver cancer, a subdural hematoma, multiple

rib fractures, several hematomas, broken facial bones, missing teeth, and chronic body pains. He

was diagnosed with liver cancer a few months ago and plans to receive treatment at the

Cleveland Clinic. According to himself and his nurse, he needs to be alcohol free for a few

months before they will begin treating the cancer. This tragic diagnosis has given him motivation

to work towards sobriety at the Neil Kennedy recovery center.

The patient suffered from many physical illnesses that presented in his blood work including a

low CO2 level, high protein, high phosphate, high ALT and AST, and high ammonia level. These

lab values are all related to chronic alcohol use and are manifesting through poor kidney and

liver function.

Medications

Name of Medication Category Dose/Frequency Reason for Reception

Ibuprofen (Advil) NSAID 400mg q4hr prn Pain

Pantoprazole PPI 200 mg daily GERD

(Protonix)
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Lidocaine Anesthetic 4% patch Pain

Levetiracetam Anticonvulsant 500 mg BID Alcohol withdrawal

(Keppra)

Docusate Sodium Laxative 100 mg BID prn Depression and

(Colace) decrease on ammonia
level

Dicyclomine (Bentyl) Gut Antispasmodic 200 mg QID GI related issues

Atorvastatin (Lipitor) Statin 10 mg nightly Lower cholesterol

levels

Lactulose Ammonia Reducer 10g/15mL TID Lower ammonia

(Chronulac) levels

Lorazepam (Ativan) Sedative 4mg tablet, 2 mg IM Anxiety and

injection Aggression

Nicotine (Nicoderm) Anti-Nicotine 21mg/24hr daily Reduce Nicotine use

Maalox Antacid 20mg/5mL Oral Care

Ondansetron (Zofran) Antiemetic 4mg injection q6hrs Nausea

prn

Milk of Mag Laxative 400 mg/15mL Depression and

decrease ammonia
levels

Trazadone (Dexyrel) Antidepressant 50 mg nightly prn Depression

Olanzapine (Zyprexa) Antipsychotic 10 mg IM injection, 5 Depression and

mg tablet q 4hrs changes in mood

Hydroxyzine Antihistamine 50 mg TID Decrease agitation

(Vistaril) and promote sedation

Folic Acid (Folvite) Vitamin 1 mg tablet daily Alcohol Use

Vitamin B1 Vitamin 100mh tablet daily Alcohol Use

(Thiamine)

Benztropine Mesylate Antitremor 2 mg injection BID Alcohol withdrawal

(Cogentin) prn and antipsychotic
medication potential
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EPS

Medications prescribed to this patient were aimed at treating alcohol withdrawal symptoms,

depression and anxiety, pain from various injuries, GI issues related to liver cancer, high

ammonia levels relating to impaired liver function, vitamin deficiencies relating to chronic

alcohol use with nutritional imbalances, and high cholesterol levels.

Summarize the psychiatric diagnoses

According to the Essentials of Psychiatric Mental Health Nursing;

Major Depressive Disorder is characterized by depressed mood or loss of interest or

pleasure in usual activities. Evidence will show impaired social and occupational

functioning that have existed for at least two weeks, no history of manic behavior, and

symptoms that cannot be attributed to use of substances or a general medical condition.

The National Institute on Alcohol Abuse and Alcoholism defines Alcohol Use Disorder as; “A

chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over

alcohol intake, and a negative emotional state when not using.” The DSM5 outlines diagnostic

criteria for those diagnosed with AUD. In order to be diagnosed, an individual must meet at least

two of the eleven criteria within a span of one year.

The criteria outlined by the DSM5 and National Institute on Alcohol Abuse and Alcoholism

include;

Times when you ended up drinking more or longer than intended, wanted to cut down or

back and could not, spent a lot of time drinking, experience a strong craving, felt that

drinking or the side effects from it made it difficult to care for your home or family,

continued to drink despite the negative repercussions, given up or quit activities that once

brought you joy, got into situations while or after drinking that increased your risk of
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getting hurt, continued to drink even though it made you feel depressed, had to drink

much more than you once did to get the same effect, and found that the effects of alcohol

were wearing off and you had withdrawal symptoms.

Identify the stressors and behaviors

The stressors and behaviors that precipitated this hospitalization were directly related to his use

of alcohol as a coping mechanism. Within the previous month of his hospital admission, he had

been diagnosed with cancer of the liver, suffered numerous falls in which he had accumulated

many injuries, and had been forced to leave his home. The injuries he had suffered included a

subdural hematoma, multiple rib fractures, multiple soft tissue injuries, and facial fractures.

This patient has been suffering with Major Depressive Disorder for many years and had

previously take Lexapro to treat this. During this ninety day period, he had achieved sobriety and

was attending AA meetings. Unfortunately, he then lost both of his parents of whom he was

extremely close to. This traumatic loss and chronic depression pushed him back into using

alcohol to cope with such a traumatic time. Since his time of relapse, he has been drinking

heavily every day and no longer attends AA meetings. However, he was able to maintain a job

working as a car mechanic. He expressed that it was difficulty work and at the end of the day he

continued to struggle to pay bills. The stress of his job was also a contributing factor to his

chronic alcohol use. In addition to these stressors, he had discovered that his daughter was

addicted to cocaine. He expressed that he was worried because he did not “want her to struggle

and be ill” like he is.

Discuss patient and family history of mental illness

Patient denied any history of mental illness, however he then went on to say that both of his

parents were chronic and heavy drinkers. His mother would attempt to hide her alcohol
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consumption where his dad was very open about it. His parents were able to maintain jobs and

care for their children to this best of their ability.

Describe the psychiatric evidence based nursing care provided

The nursing care was based around treating the underlying condition of depression and suicidal

ideations. The care included self-harm precautions, suicide precautions, encouragement to

express feelings, medication management and compliance, and frequent assessment to monitor

patient status. The patient was also encouraged to attend therapeutic groups. During my day of

care, he attended the addiction group in which he felt to be very beneficial. He stated that it made

him want to start attending AA meetings again so he could begin his treatment for liver cancer.

He was also placed on a two hour hold which meant that he must stay out of his room for that

time. This helped him to socialize with other patients throughout the day.

Analyze ethnic, spiritual, and cultural influences

The patient was an older male who expressed feeling isolated from other on the unit. Most of the

other patients were younger which made it difficult for him to relate to them. He would spend

most of his time watching TV and not interacting with other. This generational gap made it

difficult for him to interact and bond with others.

Evaluate the patient outcomes

The patient responded well to therapeutics groups and nursing care. Upon admission, the patient

had poor insight and judgment relating to his suicidal ideations and continuation of binge

drinking. After receiving nursing care and group therapy, he decided that he wanted to continue

his recovery at the Neil Kennedy Center. The psychiatric treatment that was provided and

planned for discharge will ultimately aid K.C. to reach for recovery.

Summarize the plans for discharge

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The plans for discharge were to continue the medication regimen and work towards sobriety. The

patient was to attend Neil Kennedy for help with recovery from alcohol use. Once the patient has

been sober for a month he will then attend Cleveland Clinic to receive chemotherapy on his liver.

He will also be following up with the neurologist regarding to the subdural hematoma he

acquired from a fall.

Prioritized list of all actual diagnoses

1. Depression

2. Alcohol Use Disorder

3. Cancer of the Liver

4. Hyperammonemia

5. Trauma

6. Subdural Hematoma

7. Multiple rib fractures

List of potential nursing diagnoses

Risk for suicide related to history of suicide attempt and psychiatric disorder

Risk for imbalanced nutrition: less than body requirements related to caloric intake from alcohol

consumption

Social Isolation related to depressed mood as manifested by increased time spent alone in room

Conclusion

A combination of patient history, preexisting conditions, and current stressors can all greatly

impact the condition and treatment of the patient. This patient had a history of depression and a

family history of substance abuse that contributed to his current state. Many times, those

suffering with mental health illness will begin to self-medicate in an attempt to mask the real
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problem. Unfortunately, at a young age he was exposed to his parents using alcohol as a coping

mechanism which lead him to begin using himself. The use of alcohol almost gave him break

away from the crippling illness of depression. He stated, “the only time I feel happy or relieved

is when I am loaded.” This patient isn’t the only one that feels this way when under the influence

or drugs or alcohol which is what makes treating the underlying illness and addiction so

challenging. The correct combination of medications, therapy, and support can nourish those

struggling to reach recovery to obtain a healthier tomorrow.

Works Cited

Townsend, M.C., and Morgan, K. I. (2017). Psychiatric Mental Health Nursing: Concepts of

Cae in Evidence-Based Practice. Philadelphia, PA: F.A. Davis Company.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder. Retrieved October

21, 2019, from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-

consumption/alcohol-use-disorders

Skule, C. Ulleberg, P., Dallavara Lending, H., Berge, T., Egeland, J., Brennen, T., & Landro, N. I.

(2014). Depressive Symptoms in People with and without Alcohol Abuse: Factor Structure and

Measurement Invariance of the Beck Depression Inventory (BDI-II) Across Groups. PLoS ONE,

9(2), 1-7. https://doi.org/10.1371/journal.pone.0088321

YALDIZLI,O., KUHL, H.C., GRAF, M., WIESBECK, G. A., & WURST, F. M. (2010). Risk

factors for suicide attempts in patients with alcohol dependence or abuse and a history of
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depressive symptoms: A subgroup analysis from the WHO/ISBRA study. Drug & Alcohol

Review, 29(1), 64-74. https://doi.org/10.1111/j.1465-3362.2009.00089.x

Olney, J. J., Marshall, S. A., & Thiele, T. E. (2018). Assessment of depression- like behavior and

anhedonia after repeated cycles of binge like ethanol drinking in male mice. Pharmacology,

Biochemistry, & Behavior, 168, 1-7. https://doi.org/10.1016/j.pbb.2018.03.006