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MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Ashley Veneroso

February 27, 2022

Mrs. Beth Sandford

NURS 4842L Mental Health Nursing Laboratory

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MENTAL HEALTH COMPREHENSIVE CASE STUDY

Abstract

GV is a 20- year- old female patient admitted to the inpatient psychiatric unit for suicidal

ideations. This case study will describe the disease process of depression and the treatment used

for the patient. GV has a mental health diagnosis of depression, catatonic schizophrenia, and

cluster b personality traits. The patient has a history of suicide attempts so nursing care on the

unit will focus on suicide prevention The care will also focus on helping the client return to

normal communication with peers and daily hygiene. This paper will dig into the causes of

depression and how it can manifest in patients.

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Objective Data

Patient Identifier: GV

Age: 20 Years old

Sex: Female

Date of admission: February 18, 2022

Date of Care: February 24, 2022

Psychiatric Diagnosis: Depression

Other diagnoses: Cationic Schizophrenia, Cluster B Personality Trait

Behaviors on Admission: GV came into the ER by her father following suicidal ideations. The

patient was having suicidal thoughts stating, “I do not feel like life is worth living”.

Behaviors on day of care: GV was quiet and shy on the day of care, it took some time to get any

words out of her. She expressed to me that she liked being on the unit and that she felt it gave her

“structure”. She told me that on the day of care it was her first time attending a group session.

She was also walking around the unit, whispering, and talking to herself. She had a quiet tone

and often was laughing to herself at times.

Safety and security measures: During the time of care there were many safety and security

measures put in place. Safety checks of all the patients are completed every 15 minutes, the

rounder checks off each patient’s safety. All items that could cause harm were locked away and

out of reach of the patient. The only things accessible to the patient were setiform cups and

markers. The unit is all set up so that no patient can hang anything from the doors and other

compartments. The beds are all nailed to the ground along with having very heavy chairs and

tables which makes It very hard for a patient to throw.

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Laboratory Results

Lab Value Result

Potassium 4.2

Sodium 143

Glucose 97

Blood Urea Nitrogen 16

Creatine 16

Red Blood Cells 4.57

Hgb/Hct 12.4/41

WBC 10.1

AST/ALT 16/21

TSH 1.910

Toxicology/Alcohol Negative

Psychiatric Medications

Generic Name Trade Name Class/Category Dose/frequency Reasoning

Apriprozaole Abilify Antipsychotic 15mg/ 1x Daily Bipolar, schizophrenia,

depression
Keppra Levetiracetam Anticonvulsant 750mg/1x Daily Off label use for
bipolar
Lorazepam Ativan Benzodiazepine 0.5mg/ 1x Daily Anxiety

Propranolol Inderal Anti-Arrhythmic 20mg/ 1x Daily Tremors, Cardiac

arrhythmias
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Summary of Psychiatric Diagnosis

Depression is a very common disorder that affects many people throughout our world.

Depression can have many different causes along with different symptoms that go with it. In the

article used, depression is described as:

“Depression (major depressive disorder) is a common and serious medical illness that

negatively affects how you feel, the way you think, and how you act. Fortunately, it is

also treatable. Depression causes feelings of sadness and/or a loss of interest in activities

you once enjoyed. It can lead to a variety of emotional and physical problems and can

decrease your ability to function at work and at home” (Torres, 2020).

When a person is experiencing depression, it often can cause them to not be able to go to their

jobs and complete self-care. Depression can be very debilitating for someone who is suffering

from the disorder and can lead to many issues of being able to function in daily life.

Those suffering from depression may experience a variety of symptoms, either having

many symptoms of depression or just a few symptoms. The symptoms experienced also depend

on the severity ranging from mild to severe symptoms. The text states many symptoms that

people with depression experience and they are listed below (Torres,2020):

 Feeling sad or having a depressed mood

 Loss of interest or pleasure in activities once enjoyed

 Changes in appetite — weight loss or gain unrelated to dieting

 Trouble sleeping or sleeping too much

 Loss of energy or increased fatigue

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 Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing)

or slowed movements or speech (these actions must be severe enough to be observable by

others)

 Feeling worthless or guilty

 Difficulty thinking, concentrating or making decisions

 Thoughts of death or suicide

The list of symptoms above GV had experienced more than just one of the symptoms and some

to the more severe side of it as well. GV was experiencing not being able to complete self-care

daily. She was laying in pee and not showering or changing her clothes for many days. She

stated she felt very depressed and that voices were telling her “It is okay to die”. In regard to

speech she had a very slow speech with some side laughing as well. As far as thoughts of suicide

GV had a plan for suicide and she stated she was going to “drink bleach”.

When talking about what can cause depression a variety of reasons can contribute to the

disorder. There typically is not one single cause and often a combination of factors that

contribute to depression. One main reason that can cause depression can be how the brain’s

physical structure is. A lot of people don’t realize that depression can occur due to the physical

structure and is not necessarily a contributing factor. In this cause of depression, this article

states that “the brain scans can indicate a smaller hippocampus which plays a role in long term

memory” (Soriano, 2022). Along with the brain structure, people can often have a serotonin

imbalance in their brain which can connect to being a cause of depression. When these levels are

out of balance “the serotonin receptors can act differently than in someone without depression”
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(Soriano, 2022). That is why when we are treating depression certain drugs work with the

serotonin receptors.

When diagnosing depression we use the DSM-5 scale to help diagnose a patient

correctly. As stated, “Major depressive episode is characterized by the combination of depressed

mood or loss of interest or pleasure lasting for most of the day, nearly every day for 2 weeks or

more” (Bose, 2016, pg. 24). A person will answer a set of questions and must meet at least 5

diagnostic criteria for them to be diagnosed with depression. Depression is very common today

and often most people go undiagnosed due to shame of the disorder.

Identification of stressors and behaviors precipitating current hospitalization

Prior to admission, GV was recently discharged from clear vista. GV has had medication

compliance issues in the past and was currently not compliant with her medications on this

admission. When asked about current stressors or triggers she denied both. When presented to

the ER she stated, “I do not feel like life is worth living anymore” and “I want to die”. GV was

brought by her father stating that she was laying in her own pee and not doing any daily hygiene

for herself the week prior to admission. GV does have a history of sexual trauma that required 3

previous hospitals prior. During this hospital stay, she did not talk about that past trauma at all.

During this stay, she was pink-slipped for being a danger to herself and was also not being able

to care for her own basic needs.

Patient and Family history of mental illness

GV has had mental illness since age 14 when the sexual trauma had occurred. She has been

diagnosed with depression, cationic schizophrenia with auditory hallucinations as well as cluster
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b personality traits. She does have a family history of mental illness from her mom and grandma.

Her grandma was diagnosed with bipolar, and her mother was diagnosed with anxiety. Other

than those two disorders she denied any other family history of mental illness.

Psychiatric evidence-based nursing care provided

Nursing care was adequately provided to help care and get GV back to a stable state.

There was a nurse who would check on GV every 15 minutes making sure she was safe and not

in any immediate need. There was a nurse assigned to GV to help with the process of coming up

with a plan. The nurse would use the nursing process to do this along with using her

interdisciplinary teams such as social workers, and doctors. There was a nurse who would give

GV her medications daily and watch her take them to make sure she is staying complaint. GV

was also placed on suicide precautions to ensure her safety while on the unit. When using suicide

precautions, the nurse would assess the patient for any current suicidal thoughts. On the day of

care, the patient told the nurse that “I do not feel suicidal anymore just depressed”. This

statement showed a progression in GV’s care that she is not feeling suicidal thoughts. There was

also group sessions that are provided for GV to attend. The group session is great for people to

interact with peers and be able to relate as well to how others are feeling. GV was encouraged to

attend group sessions but not attended group since admission. On the day of care, she went to her

first group session, and she stated to me that it helped a little. GV did state to me that “I like the

structure that I get here”. This showed that the structure of nursing care is helping this patient

gain more control of her feelings. Being on a structured schedule for mealtimes, group sessions,

interactions with medical professionals, and phone calls allowed her to feel more control.
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Ethical, Spiritual, and cultural influences

GV is unemployed currently and lives at home with her father, stepmom, and brother.

She is not employed but does have her high school diploma. She did express to me and the

nurses that she has a big spiritual influence. Her spiritual influence is her “Greek gods” as stated

by GV. GV told me that her “faith” talks to her, and she can talk back to them. She stated that

she believes a lot in her “faith” and enjoys talking to them.

Evaluation of Patient outcomes

The outcome evaluated for GV would be safety because of the suicidal ideations she

presented with. Another outcome to evaluate would be being able to perform self-care activities

because of how she presented to the ER. On the day of care, GV was clean had showered and

brushed her hair. She felt that she was caring for herself well and changing her clothes also.

Her safety outcome was met she did not show any signs of suicidal actions. She even

stated that she was not feeling suicidal anymore on the day of care. When previously she was

wanting to die but needed a plan. Although she stated still feeling some depressing thoughts.

This outcome of safety was completed, and she was in a stable state on the day of care.

One outcome not met would be her auditory and visual hallucinations. She was still

expressing that she can hear the voices talking to her just not telling her to kill herself now. She

also was pacing the unit walking in circles talking to herself and laughing. This behavior

expressed some of the hallucinations she was experiencing.

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Plan for Discharge

When GV is discharged she will go back to her home with her father, stepmother, and

brother. There was no set date put in place for GV’s discharge on the day of care. Her father was

trying to gain guardianship of GV. He was communicating with social workers to figure out how

to go to the courts to obtain this guardianship. That plan of guardianship was still in process on

the date of care.

Prioritized nursing diagnoses

1. Risk for suicide-related to suicidal ideation and attempt.

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

3. Risk for self-care deficit related to cognitive impairment.

4. Disturbed sensory perception related to psychological stress as evidenced by

hallucinations

Potential nursing diagnoses

1. Spiritual distress

2. Chronic low self-esteem

3. Deficient knowledge

4. Impaired social interaction

5. Ineffective health maintenance

6. Impaired verbal communication

7. Social isolation
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Conclusion

Depression is a disease that is very common and affects many people today. A lot of

people are either noncompliant with medication or do not seek care for depression. During the

depression state, GV had intense suicidal thoughts. With getting her back on her medications and

on a schedule, she was not having suicidal thoughts anymore. The patient has come along with

since admission and being able to state she no longer hears suicidal thoughts was a big step.

GV was still experiencing her hallucinations and her behavior of pacing. She still was

talking and laughing to herself but not expressing any states of self-harm. Her goal for discharge

was to get back to a compliant state along with being able to continue to care for her basic needs.

Her father was also working on establishing guardianship for GV to help her with her care.
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References

Article by: Krista Soriano, & Medically reviewed by: Dina Cagliostro. (2022, March 3).
Depression types, causes, symptoms, statistics, & treatment. Psycom.net - Mental Health
Treatment Resource Since 1996. Retrieved March 16, 2022, from
https://www.psycom.net/depression

Substance Abuse and Mental Health Services Administration. (n.d.). Table 9, DSM-IV to DSM-5
major depressive episode/disorder comparison - DSM-5 changes - NCBI bookshelf. DSM-
5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Retrieved
March 16, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/

What is depression? (n.d.). Retrieved March 16, 2022, from https://www.psychiatry.org/patients-

families/depression/what-is-depression