Psychiatric Mental Health Comprehensive Case Study

Emily Kurnot

Youngstown State University: Mental Health Nursing 4842

Mike Criscione

10/15/2020
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Abstract

This case study depicts the experience of a patient who presents with anxiety, depression,

and alcohol use disorder. It includes what the disorders are, factors influencing the development

of these disorders, medication interventions, and nursing care. My patient is a 26-year-old

Caucasian male that was transferred to St Elizabeth’s from St Joseph’s following an overdose. A

multitude of resources were used to help me gather information for this case study and they

include the patient, the patient’s chart, and 3 research articles. These research articles provide

evidence and insight about how these disorders relate to one another and how they affect the

patient’s life. This study gives an in-depth overview as to how these disorders can be identified

and treated to help the patient achieve the main outcome of living a functional and optimal life.
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Objective Data

C.M. is a 26 year old male and was originally admitted to St Joseph’s on September 24rd.

He had lost visitation rights to his three-year-old daughter due to a failed home inspection that

morning. C.M. overdosed on pills he had lying around his house. He took and unknown amount

of Tylenol, about 8 pills of Norco 5/325, 9 pills of Benadryl, and consumed 4 large beers leading

to an ETOH of 211. He felt remorseful and called 911 for help. In the ICU at St Joseph’s, he

received a bicarb drip for alkalized urine and received twenty hours of acetylcysteine to treat

acetaminophen overdose. He was on continuous observation in the ICU due to the nature of the

injury. C.M. doesn’t recall the entire evening that any of this occurred and only remembers

waking up in the ICU. He was then transferred to St Elizabeth’s on September 27th for inpatient

care. On date of admission the nurse stated his main complaint was frustration related to loss of

visitation of daughter and a bad baby mother. He denied any suicidal ideation and stated he just

wanted to numb that pain away. According to Watkins (2020), “Some people drink alcohol in an

attempt to cope with their depression. People can be drawn to the sedative effects of alcohol as a

kind of medication, helping to distract from persistent feelings of sadness.” On September 29th,

C.M. stated he was experiencing very high anxiety as his chief complaint. I cared for him on

October 1st. When I first began talking with him, he was very quiet and seemed nervous. He was

fidgeting in his chair and with his hands and answered questions very quickly. After a while,

C.M. opened up to me about his situation with his daughter and his love for his STNA job on an

Alzheimer’s unit. He also verbalized his frustration with his baby’s mother and sadness over not

seeing his daughter. He seemed to change the topic quickly after bringing up his daughter though

and often referred to her as “my kid.” C.M. seemed very pleasant and calm after about ten

minutes of us talking and even eventually stated the goal of getting his RN license and other
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plans for his future. He stated he is disappointed he stopped his college education after 1 year at

YSU. C.M. was diagnosed based on the DSM-5 with major depressive disorder, generalized

anxiety disorder, and severe dependency alcohol use disorder. He was prescribed Zoloft

(sertraline) 25 mg daily for his depression and anxiety. Vistaril (hydroxyzine) 50 mg 3 times

daily prn to help with anxiety and resting. And lastly, Desyrel (trazodone) 50 mg once nightly for

depression. This medication also helps with anxiety and insomnia related to depression. The only

abnormal laboratory value was a BUN level of 3. The normal BUN level is 6-20. C.M. was not

on any suicidal precautions because he did not state suicidal ideation at any point during his

hospitalization. He was allowed facetime calls with his daughter every morning but was still

afraid to tell his daughter’s mother that he was admitted to the hospital but planned on doing it

later in the day that I saw him. C.M. was also reading books from the library and recalling his

days as a musician to try and help ease his anxiety while staying there.

Summarize the Psychiatric Diagnoses

I retrieved this section from our textbook, Videbeck (2020). Major depressive disorder is

characterized by 2 weeks or more of a sad mood or lack of interest in life activities, with at least

four other symptoms of depression such as anhedonia and changes in weight, sleep, energy,

concentration, decision-making, self-esteem, and goals. Generalized anxiety disorder is

characterized by patient worries excessively and feels highly anxious at least 50% of the time for

6 months or more. Common behaviors include inability to focus on anything other than worry,

irritability, muscle tension, fatigue, difficulty sleeping. According to Kalin (2020), “…a

worldwide survey reported that 45.7% of individuals with lifetime major depressive disorder had

a lifetime history of one or more anxiety disorder.” Alcohol use disorder is characterized by a

chronic disease characterized by uncontrolled drinking and preoccupation with alcohol. Common
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behaviors are agitation, need to drink to calm down, inability to limit amount of alcohol intake,

craving alcohol, and experiencing withdrawal if you don’t drink.

Identify the Stressors and Behaviors

The major stressor was the loss of visitation rights of his three-year-old daughter due to a

failed home inspection. He has many other stressors as well. C.M. had 7 jobs in 5 years and is an

STNA in an Alzheimer’s wing of a nursing home. He stated with covid regulations his job got

harder because the residents are more upset. With all the stress of work, he stated he was happier

there and all the bad things happen when he is home. He has a bad habit of drinking and listening

to father daughter songs to cope with the inadequate relationship he has with his daughter. C.M.

also has trouble sleeping so he takes Tylenol PM and mixes it with alcohol to help him fall

asleep.

Discuss Patient and Family History of Mental Illness

C.M. has struggled with anxiety and depression since high school but was never

hospitalized. He was prescribed medications in high school but stopped taking them briefly after

starting them and stated he just copes with it. The only family history he knows is that his father

was diagnosed with depression. According to Monroe, Slavich, and Gotlib (2014), family history

is the strongest indicator of a depression diagnosis. Whether or not the patient delt with major

life stress or not didn’t significantly affect the development of depression.

Describe Nursing Care Provided

C.M. has been given the opportunity to facetime his daughter every morning at nine

o’clock. He has also been talking regularly to his grandmother on the phone. His chart stated he

attended groups and participated actively in them. I asked if he finds them helpful and he stated

that it is nice to be around people who are going through the same things as you, but he likes to
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figure things out by himself. He stated he hadn’t slept in days and had been working a lot prior to

his hospitalization. He believes this was a blessing in disguise to allow him to get the rest he

needed and to get back on track with his life. C.M. told me that he has had a lot of time for self-

reflection while being here. He realized he does have an alcohol problem and decided the first

step of making his life better was to go to inpatient rehab. He found that many of his problems

stemmed from his excessive alcohol use. He also stated to a nurse that since being here, he has

felt less depressed.

Analyze Ethnic, Spiritual, and Cultural Influences

C.M. stated that the biggest impact on him was his baby’s mother. He stated she makes

things very hard on him and makes it impossible to see his daughter regularly which leads to

high stress and anxiety in his life. He stated that when he does see his daughter, they get along

great and he loves her very much. C.M. has a good relationship with his mom, sister, and

grandmother. Other than mentioning his father’s history of depression, he didn’t state any type of

relationship good or bad. He stated to the nurse that he lives with his cousin and his cousin’s

daughter. They had a pretty good relationship prior to the night he overdosed. The cousin got so

angry that she moved out because he overdosed in front of her daughter. That is now a strained

relationship for him which will add more stress and anxiety to his life.

Evaluate Patient Outcomes

The main patient outcome would be to reduce frustration, anxiety, and depression.

Another patient outcome would be for C.M. to see his daughter more because that seems to be a

strong source of stress and sadness for him. He stated he wants to facetime his daughter 3 times a

day while he is here and in inpatient rehab. Another outcome could be to have more positive

thoughts throughout the day and decrease catastrophic thinking. He said he usually thinks of the
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worst case scenario so that he isn’t constantly disappointed. A good outcome is to allow himself

to feel emotions and be aware of them. Also, he could be educated on knowing when to seek

help as to not let his mental health get so out of hand that it leads to a life-threatening situation

like he was in recently.

Summarize the Plans for Discharge

C.M. plans to attend inpatient rehab for his alcohol problems. When I left, no place was

finalized because he was still in the process of discussing different options with his case

manager. He also wanted to tell his baby’s mother he was in the hospital and hear what she had

to say as well. C.M. stated he needs to figure out what he will do for rent and utilities now that

his cousin moved out because she used to pay for half. He said it may be difficult for him to live

on his own because he is afraid it will make him even more lonely than he already was.

Prioritized List of all Actual Diagnoses

C.M. was diagnosed with 3 different mental illnesses: major depressive disorder,

generalized anxiety disorder, and alcohol use disorder. The priority diagnosis in my opinion is

major depressive disorder. He was very sad due to the loss of visitation of his daughter. He also

complained of the inability to sleep and once he did sleep, he slept for days and missed work.

That is a characteristic of depression. He also stated he overdosed on pills and alcohol so he

didn’t have to feel the sadness anymore. This overwhelming sadness all the time is also a

characteristic of major depressive disorder. Secondly is the diagnosis of alcohol use disorder. It

seems he uses alcohol as a way to self-medicate the side effects of depression away. The use of

alcohol can also worsen those feelings of depression after you sober up since alcohol is actually

considered a depressant. It may also be contributing to his monetary bind that is causing him

increased stress. Lastly is the diagnosis of anxiety. His chart only mentioned anxiety a few times.
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Anxiety may increase the alcohol use disorder because he may use it to help ease the anxiety.

Anxiety is very commonly associated with depression. In one study, the correlation was close to

50% of people with depression also have some form of anxiety.

Potential Nursing Diagnoses

Nursing diagnoses are formulated based on looking at how the patient presents and to

what extent their mental disorder has impaired their functioning. The main nursing diagnoses

would be ineffective coping related to use of forms of coping that impede adaptive behavior as

evidenced by use of pills and alcohol to deal with stress and sadness. This inability to cope is

C.M. greatest problem. Instead of seeking help or adaptively attempting to deal with these

stressors he resorted to self-medicating which eventually lead to an alcohol use disorder and an

overdose. Another nursing diagnosis is hopelessness related to losses, stressors, and symptom of

depression as evidenced by impaired decision making, sleep disorders, and loss of interest in life.

This describes how his major depressive disorder is affecting his life all around. It also displays

how stressors and losses can increase this feeling of hopelessness. Even though his daughter

didn’t pass away, he can still be experiencing a feeling of loss because he can no longer see her

face to face. Lastly, a nursing diagnosis could be altered family process related to abuse of

substances and inadequate coping skills as evidenced by disturbed family dynamic, anxiety, and

isolation/loneliness. This nursing diagnosis could apply to his relationship with his baby’s

mother, his daughter, or his cousin he used to live with.

Conclusion

Mental health comes with many stigmas and it is important that we are able to

distinguish movies and media from real life. This case study allowed me to really understand

mental health in a real-life perspective. I enhanced my therapeutic communication skills while

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talking with C.M. and gathering information. The fact that he was an STNA also made me

realize that people with mental health disorders are just normal people. This case study has

allowed me to gain a plethora of knowledge about how the nursing process works when applied

to the mental health setting. I gained knowledge about how major depressive disorder,

generalized anxiety disorder, and alcohol use disorder manifests on actual people. Using C.M.,

his chart, my textbook, and outside research articles, it helped me to write a well informed and

all-inclusive case study. I grasped a better understanding on how to identify disorders, use

nursing interventions, and pair those interventions with medication treatment. It is critical that

medication treatment is paired with therapy such as group for the best patient outcomes. Overall,

I gained a more holistic view on all the aspects that goes into being a mental health nurse.
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References

Kalin, N., RC, K., Al., E., . . . DG, G. (2020, May 01). The Critical Relationship Between

Anxiety and Depression. Retrieved October 13, 2020, from

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030305

Monroe, S., Slavich, G., & Gotlib, I. (2014, February). Life stress and family history for

depression: The moderating role of past depressive episodes. Retrieved October

13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918432/

Videbeck, Sheila L. (2020). Psychiatric-mental health nursing (8th ed). Philadelphia, PA:

Wolters Kluwer.

Watkins, M. (2020, February 3). Alcohol and Depression: What is the Connection? Retrieved

October 13, 2020, from https://americanaddictioncenters.org/alcoholism-

treatment/depression