Running Head: Psychiatric Mental Health Comprehensive Case Study 1

Psychiatric Mental Health Comprehensive Case Study

Courtney Unger

October 1, 2020

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

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Abstract

J.H. is 47-year-old male patient who was involuntary admitted to the inpatient

psychiatric unit following a suicide attempt prior to calling the suicide hotline. He has mental

diagnosis’ with anxiety, depression, bipolar disorder, and schizoaffective disorder. Other than

those mental diagnosis’, J.H. also is being treated for Diabetes. The medication regimen for J.H.

includes medications such as antimanics, antipsychotics, antiemetic, and antidepressants.

Throughout stay, J.H. has maintained medication regimen compliance and has shown improved

mood and decreased suicidal thoughts. J.H. has also been able to remain free from any

delusions and hallucinations while on the floor. Nursing care was focused on reducing anxiety

and depression, increasing mood and ways to manage times of exacerbations. All methods of

health care were implemented and met throughout day of care. The goal while day of care, was

to have a good day and J.H. verbalized that goal as being met while also showing it within his

mood and behavior.

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Objective Data

J.H was admitted to the behavioral health unit at Mercy- Youngstown on September 9,

2020. Patient was observed on September 10, 2020. J.H was also on patient self-harm

precautions during their stay on the behavioral health unit. J.H. appeared to be animated with

their facial expressions, but very tense with their gestures and posture. My patient was very

restlessness during the day of care and should signs of Akathisia, which is extreme restlessness

urgent need to move, which could also be a side effect of some antipsychotic medication. J.H.

also exhibited an unpleasant affect with their depression and anxiety. My patient stated that

lately their mood had been down and they have been more paranoid, which ultimately

“landed” them into the hospital. When it comes to their cognition, my patient had disturbances

in thought content as well as perceptual disturbances. J.H. experienced delusions as well as

hallucinations. J.H. stated that they get paranoid a lot and thinks people are out to get them.

They even shared that sometimes they believe that there are snipers in the trees by their

house. This would be considered a visual hallucination. J.H. was alert and oriented to person,

place, time, and situation. Overall, my patients’ judgment was poor due to the delusions and

the paranoia that they feel quite frequently. J.H. has psychiatric diagnosis which are; anxiety,

depression, schizoaffective disorder, bipolar disorder, and PTSD. J.H. has a non-psychiatric

diagnosis which is type 2 Diabetes. Previous visits to the behavioral health unit, other than their

current stay, dealt with; severe depressed bipolar 1 disorder with psychotic features,

depression with suicidal ideation, anxiety, bipolar, and medication overdose. During my day of

care, the only abnormal lab value for my patient was their glucose, with was 136 and the

normal range is from 74-99. This was important to know since my patient has hyperglycemia.
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J.H. was ordered several different medications during their stay, which included; Neurontin

which is an anticonvulsant (for anxiety), Haldol which is an antipsychotic (for their bipolar

disorder), Vistaril which is an antiemetic (for anxiety), and Desyrel which is an antidepressant

(used as a sleep aid due to insomnia which is a symptom of depression).

Summary of Psychiatric Diagnosis

Per the Psychiatric Mental Health Nursing book by Mary Townsend and Karyn Morgan,

anxiety can be defined as a feeling of discomfort, apprehension, or dread related to anticipation

of danger, the source of which is often nonspecific or unknown (Townsend & Morgan, 2017).

Anxiety is considered a disorder when fears and anxieties are excessive and there are

associated behavioral disturbances such as an interference with social and occupational

functioning (APA, 20123Along with this definition they go on to list common signs and

symptoms which include; muscle tension, restlessness, or feeling keyed up or on edge.

While J.H. suffered from severe anxiety, the main diagnosis treated would be his

depression and schizoaffective disorder. In order to diagnosis schizophrenia, at least two or

more of the following symptoms have to be present for at least a one month period;

hallucinations, delusions, disorganized speech, catatonic or grossly disorganized behavior, or

negative symptoms (diminished emotional expression). When talking with J.H., I learned that he

did exhibit hallucinations and delusions regularly as well as disorganized behaviors. Not only did

he think people were out to get him, but he also believed people were hiding in the trees with

guns in order to kill him.

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With schizoaffective disorder, a common occurrence is suicidal ideation and suicidal

behavior. During our conversation, J.H. discussed how he had tried to commit suicide over his

entire life, and has made multiple attempts. Studies within the U.S. suggest that more than 90%

of victims of suicide have a psychiatric disorder. The most frequent psychiatric illnesses or

disorders are mood and psychotic disorders. Another important fact is that suicide is the largest

contributor to the decreased life expectancy in individuals with schizophrenia. In order to treat

one’s disorder, discussing their suicidal risk factors is crucial.

Identification of stressors and behaviors precipitating current hospitalization

Prior to admission, J.H. stated that he was compliant with his medications. He said that

there are still times where he sees things and thinks people are out to get him. He stated that

since he lives out in the country, surrounded by woods, he believes, at time, that there are

snipers in the trees watching him. While discussing his living situation, he stated that he and his

family get along fine. He doesn’t see his family as a stressor but mentioned one of his neighbors

stressed him out. He explained how this neighbor keeps asking for money in order to do drugs

and he gives them the money. J.H. went on to say how it’s hard for him, at times, especially

living out in the country. He enjoys interactions with others and it’s hard for him to find people.

J.H. stated that there are a lot of times where he feels a lone and that gets him in a bad mental

state with his depression. While feeling this way previously, he ended up calling the suicide

hotline, who then contacted local first responders. J.H. was then involuntary sent into the

behavioral health unit at St. Elizabeth’s- Youngstown.

Patient and family history of Mental Illness

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J.H stated that they suffered for years with depression. They recall having it at a young

age, starting when they were molested. Since then, they have had countless visits to the

behavioral health floor as well as increased disorders such as bipolar 1 disorder and

schizoaffective disorder. No other family history was known in regards to mental health history.

J.H. is divorced and lives with his mother, sister, and niece in a single- family home. No

conversation was brought up about the father and stories only included the mother and

daughter.

Psychiatric evidence-based nursing care provided

While being admitted to the behavioral health unit at Mercy Health- Youngstown, J.H.

received care from a variety of health professionals. The nurses who were assigned to J.H. were

very supportive and there whenever he had a question or a concern. They also were there to

talk whenever needed. Throughout each day, the nurse would assess J.H.’s status and plan care

appropriately. The nurses would set the schedule for the day and have a goal for each of their

patient’s. During their shifts, the nurses also made sure to do medication passes while following

the medication administration process. When needed additional help, the nurses were able to

direct J.H. into people who would talk to him such as social workers or physicians in order to

further his plan of care and answer additional concerns he had. Not only did J.H. talk about

discharge, but him and his nurse discussed planning after care in the hospital. He stated that he

was interested in therapy in which the hospital held in an outpatient setting and they discussed

setting him up for those group therapy sessions.

Ethnic, Spiritual, and Cultural Influences

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J.H. is a Caucasian, single male who is from a lower middle- class family. He is currently

on disability for his mental health conditions and relies on his mother for a place to live. J.H.

stated that he is very religious and even plans on attending college to get a degree in religious

studies. During the day of care, J.H. took part in spiritual group therapy and enjoyed talking

about his beliefs.

Evaluation of patient outcomes

When dealing with a patient who is depressed along with a psychotic disorder such as

schizophrenia, desired outcomes could be to recognize the distortions in which they are

experiencing, have the patient remain free from harm or free from thoughts of harming one

selves, and improving and ultimately have the patient perceive themselves in a realistic manner

by performing self-care activities for himself.

During the day of care, J.H. was able to discuss his hallucinations and recognized how it

wasn’t real but his brain made him think like that. J.H. also stated that he wasn’t experiencing

any hallucinations at this time and hadn’t for several days. J.H. was also compliant with his

medication and had no thoughts of harming himself or others. J.H. stated that his thoughts and

perceptions of himself improved when talking with people and being involved more within his

group therapy sessions.

Plans for discharge

Once J.H. is discharged, he plans on returning home and staying compliant with his

medication regimen. He plans on attending group sessions as well as attending his therapy

sessions weekly. Resources will be given to J.H. on outpatient group sessions in which he can
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attend. Education and teaching about medication compliance and reasoning for such

compliance will be given.

Prioritized nursing diagnosis

1. Risk for self-directed violence related to depression and current mental state

2. Anxiety related to actual/ perceived threat to biologic integrity as evidenced by extreme

restlessness, hyperactivity, delusions, and paranoia.

3. Risk for suicide related to previous suicidal ideation and attempt, and hallucinations.

4. Risk for self-harm related to delusions and hallucinations

5. Ineffective individual coping related to situational crisis as evidenced by verbalization of

inability to cope with past traumas that occurred in childhood, reported life stress, and

alteration in social participation.

Potential nursing diagnosis

Potential Nursing diagnosis include:

1. Ineffective coping

2. Ineffective activity planning

3. Impaired verbal communication

4. Self- care deficit

5. Impaired social interaction

6. Social isolation

7. Fear

8. Hopelessness
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Conclusion

Schizoaffective disorder as well as others such as depression, anxiety, and bipolar

disorder have remissions and times of exacerbations. This can happen for several different

reasons, and can be reduced with medication compliance and extensive therapy. Not only can

these exacerbations but the patient at risk for harming themselves, but it puts them at risk for

harming others, especially when delusions and hallucinations are being experienced. These

exacerbations make it critical for patients to seek help in order to prevent serious

consequences, the most important being suicide.

During the day of care, J.H had no further complications with his delusions or

hallucinations and was able to openly discuss them. During the day of care, J.H. discussed how

these hallucinations were wrong and found interest in ways in which to treat them. The desired

outcome prior to discharge was to have J.H. remain free from hallucinations and also to remain

free from thoughts of harming himself, which he exhibited. He also exhibited interest in his plan

of care and found interest in seeking help with group therapy.

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References

1. Bornheimer, L. A., & Jaccard, J. (2017). Symptoms of Depression, Positive Symptoms of

Psychosis, and Suicidal Ideation Among Adults Diagnosed with Schizophrenia Within the

Clinical Antipsychotic Trials of Intervention Effectiveness. Archives of Suicide Research,

21(4), 633–645. https://doi.org/10.1080/13811118.2016.1224990

2. Sher, L., & Kahn, R. (2019, July 10). Suicide in Schizophrenia: An Educational Overview.

Retrieved October 08, 2020, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681260/

3. Townsend, M. C., & Morgan, K. I. (2017). Essentials of psychiatric mental health

nursing: concepts of care in evidence-based practice (7th ed.). Philadelphia, PA: F.A.

Davis Company