Running Header: CASE STUDY 1

Major Depressive Disorder: Case Study

Makayla Violette

Nursing Department, Youngstown State University

NURS: 4842 Mental Health Nursing

Professor Teresa Peck

October 7, 2022
CASE STUDY 2

Abstract

The following case study discusses the disease process of Major depressive disorder

along with treatments and care provided for the patient. B.M. is a 33 year old female who was

admitted to the hospital due to increased thoughts of self harm and wanting to harm others. B.M.

has a history of abuse in previous relationships and molestation from best friend's father when

she was 5. She has a history of alcohol abuse and is currently a patient at Meridian for treatments

of methadone. The research information found in this study was completed using the MayoClinic

website, the National Library of Medicine website, and the textbook: Psychiatric Mental Health

Nursing. This case study educates among the topic of Major Depressive Disorder and how it’s

manifestations lead to suicidal thoughts and idealations.

CASE STUDY 3

Major Depressive Disorder: Case Study

Objective Data:

B.M. is a 33 year old caucasian female admitted to St.Elizabeth MercyHealth

Youngstown on October 6, 2022 for suicidal thoughts and idealations. Patient claims she had

“thoughts of crashing her car to hurt herself.” Patient is currently taking a 72 hour stay at the

psych unit to seek help following her thoughts. She is allergic to biaxin and codeine. She is

currently engaged and lives with fiance and 3 children. She is not religious and she is currently

unemployed and on disability. The patient graduated high school with her GED and attended one

year of college, however, she claimed “it wasn’t a fit for her.” She also attended half a year of

hair school but she reported dropping out due to her mental health affecting her education. She

has had a good support system including her mother, fiance, and counselor.

Throughout the interview performed on October 7th 2022, the client showed signs of

anxiety such as constant fidgeting with hands and messing with her lip piercing. She stated that

she was currently feeling guilt and anxiety in relation to her fiances’ recent diagnosis of COPD.

She stated that she has had a manic episode 2 weeks ago and has not been taking her

medications. She reported that the diagnosis of her fiance caused her to become very stressed

and overwhelmed resulting in the thoughts of suicide and harm to herself and others. Upon

admission, the client has been calm, cooperative, collective and friendly. She is no longer

suicidal and she reports that she no longer has any thoughts of hurting herself or others.

Through observation, while waiting for the order for her methadone, she was becoming

very anxious and shaky. Due to the need for confirmation and order from the doctor and

methadone clinic it had taken about 30 minutes for the order to be put in and sent up from the

pharmacy. While waiting, she started to be aggravated and restless. Patient was very persistent
CASE STUDY 4

on receiving her dose and very consistent with asking for the methadone. After medicating the

patient with methadone, she was calm and cooperative. She was no longer aggravated and no

longer anxious. She was more interactive with the group meeting and with one-on-one

conversation.

The client has a history of manic episodes, major bipolar disorder, depression,

post-traumatic stress disorder (PTSD), and psychosis. It was noted that her most recent manic

episode was 2 weeks prior to admission and she received treatment from her counselor. She has a

history of alcohol abuse and she has been sober for 14 years. She is currently receiving treatment

at Meridian Healthcare for methadone treatment. The patient has a history of abuse throughout

different intimate relationships that have resulted in a development of post-traumatic stress

(PTSD.) There is no known mental health illness from her mothers side and she does not have

any history from her birth fathers side.

The patient’s medications given while at the hospital are as follows: acetaminophen

(Tylenol) 650mg every 6 hours for pain; haloperidol (Haldol) 5mg every 6 hours or as needed

(PRN) for agitation; hydroxyzine pamoate (Vistaril) 50 mg three times daily for anxiety;

magnesium hydroxide (milk of magnesia) 30mL daily, as needed for constipation (due to other

medications); methadone 67 mg daily for opioid maintenance; melatonin 3mg nightly to help

with sleep. The patient has been non-compliant with medications recently, she states that “she

would forget them and by time she’d remember it would be too late.” However, the client

remains up to date with her methadone treatments.

The patient is remaining within suicidal percautions for 72 hours. She is under suicidal

percautions including no strings, sharp objects, or electronics. There are different forms of

therapy to attend throughout the day to talk and cope with the situation including group meetings
CASE STUDY 5

and psychosocial therapy. The patient is encouraged to share her feelings and thoughts. The

patient also receives care from numerous therapists and doctors during their stay to help improve

her health. Through the interview the patient had confirmed her thoughts of harming herself but

said she did not have a complete plan as to what she would do to herself. She stated that she

shared her intrusive thoughts with her husband and agreed to come into the emergency

department.

The laboratory results that can be related to possible mental illness’ is shown in the table below.

Lab Normal Value Patient’s Value

Potassium 3.5-4.0 4.0

Sodium 132-146 139

Glucose 74-99 105

Blood Urea Nitrogen 6-20 6

Creatinine 0.5-1 0.7

Red Blood Cells 3.50-5.50 5.0

Hemoglobin 11.5-15.5 15.5

Hematocrit 34.0-48.0 37.0

White Blood Cells 4.5-11.5 11.3

AST 0-31 17

ALT 0-32 19

Drug Toxicology None Positive for methadone

Positive for cannabinoid

UA Alcohol level Negative Negative

QTC 350-450 463

Chart results were found within the results review tab in the patient’s chart. The normal values

were provided by the Epic system.

CASE STUDY 6

The following results in the chart above are important for this patient because she is currently

taking methadone and it is important for us to be aware if the methadone was laced with

anything that can result in an increase in normal lab levels.

Psychiatric Diagnoses: Major Depressive Disorder

The textbook Psychiatric Mental Health Nursing identifies major depression disorder as a

mood disorder. Within the text major depressive disorder is defined as:

2 weeks or more of sad mood or lack of interest in life activities, with at least 4

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

energy, concentration, decision-making, self-esteem and goals (Wolters Kluwer,

2020 pg.670).

According to Mayoclinic, signs and symptoms of major depressive disorder includes: feelings of

sadness, tearfulness, emptiness, or hopelessness; the occurrence of angry outburst; lack of

interest with pleasures; tiredness and lack of energy; reduced appetite and weight loss or

increased cravings or weight gain; and anxiety, agitation, or restlessness (Mayo Clinic 2020.)

These behaviors are expected with patients who are suffering from major depressive disorder.

There is a tendency of exacerbation in symptoms when stressors come into play.

Stressors and Behaviors

Prior to hospitalization, B.M was not compliant in taking her medications. She claims she

would forget to take them and then by time she would remember it would be too late. She has her

typical stressors such as her own health and her three children. However, recently her fiance has

been diagnosed with COPD and his health has been declining rapidly. She reports that since the

diagnosis, she has been feeling very worthless and guilty that her husband has this diagnosis. She

stated that her husband’s father had died from COPD and she is fearful that he will die from the
CASE STUDY 7

same diagnosis as well. She began having suicidal thoughts of harming herself and/or others,

informed her husband of these thoughts and he encouraged her to go to the hospital. She agreed

and came to the emergency room with no difficulties.

The patient claims that she is feeling very betrayed by the hospital because within the

system it is noted that the patient came in “involuntarily,” however, she voluntarily came into the

hospital and accepted help. She said that she feels like she is being held there by force and that

makes her very uncomfortable and causes feelings of unjust.

Upon arriving the patient has been calm, collective, and cooperative. She is alert and

oriented to time, place, and self. She has, however, been very persistent on receiving her

methadone. While waiting for the pharmacy to receive the order and send it up, she was very

restless and irritable. She claimed that “she was not feeling well” and that she wanted her

medicine and to go lay down. During this time, the daily group meeting had been held and she

did not participate much but she sat in and listened quietly. After receiving her medication, she

was back to a calm and refrained state.

Patient and Family History

The patient’s family history of mental illness is unknown. Her birth father was not

present in her life and she is unaware if he had any mental illness’. While her mother’s family

has no known mental illness’ they are aware of. The patient had an adoptive father and a

step-father whose mental illness is also unknown. This is important because sometimes

someone's behaviors can be learned and that can cause an onset of illness or disorders to present.

The patient herself, however, currently is suffering from major depressive disorder,

bipolar Disorder, Post-traumatic stress disorder, psychosis, and mania. The patient reported being

physically abused in previous relationships resulting in post-traumatic stress. She had done drugs
CASE STUDY 8

and alcohol in the past, however, she has remained 14 years clean with the treatment of

methadone.

Psychiatric Evidence Based Nursing Care Provided

Throughout the day of care with this patient, she had attended numerous meetings with

the nurse practitioner, case managers, nurses, and other faculty members to gain information

about past history, reason for visiting hospital, and any current thoughts/emotions of hurting

herself or others. Within these meetings, the patient was encouraged to share her stressors,

thoughts and/or feelings and emotions about the situation, any concerns about the stay, and any

questions she had. She was very open and informative with her interview and she was calm and

collective. Her thoughts were concise and clear. She spoke in a normal tone and rate. She

answered all questions to the best of her abilities and she was able to feel comfortable with

sharing personal information.

She attended two therapy sessions. One being a group which had been led by nursing

students. The category of the group meeting was ways of coping. They had brought in journals to

write down any thoughts, feelings, emotions in any way they felt necessary. After the group

meeting, the topic was discussed with the patient and she shared that she has, in the past,

journaled and used to write poetry. When asked why she no longer writes, she stated that she had

“writers block.” The client had been encouraged to use healthy coping mechanisms to cope with

the stressors in her life. She was educated on the positive outcomes of journaling, meditation,

and deep breathing. Following shortly after, the patient attended psychotherapy and was able to

share her thoughts, feelings, and emotions with others while finding relations with her fellow

peers on the unit.

Ethical, Spiritual, and cultural influences

CASE STUDY 9

Throughout the interview, the client stated that she is not currently religious. She did not

have any religious tendencies throughout her childhood and into adult life. She is from the

Youngstown area and speaks English. She is a stay at home mom and tends to the cooking,

cleaning, and caring for the kids while her fiance works. The patient claims that she cannot work

due to her mental illness’ and therefore, she is on disability.

Patient outcomes in relations to care

Plans for Discharge

The patient is planned to be discharged from the hospital on October 8th, 2022. Her

fiance is actively involved with her discharge planning and he will be picking her up. She is

going to follow up with her psychiatrist and continue her medications. She will be educated on

the importance of compliance with medications, talking to someone/reaching for help if suicidal

thoughts or ideations occur again, and positive coping mechanisms when stressors exacerbate.

Prioritize List of Actual Diagnosis

According to the National Library of Medicine with addition to information from the

Mayoclinic, the following are diagnoses for an individual with major depressive disorder:

● Impaired mood regulation related to the off set of neurotransmitters within the brain

(national library of medicine, 2022).

● Feelings of worthlessness or guilt in relations to signs and symptoms of untreated major

depressive disorder (national library of medicine, 2022).

● Increased risk of suicidal thoughts and idelations in relations to the possibility of side

effects of medications taken to treat the disorder (mayoclinci, 2020).

● Risk of rebound effects of medications in relations to abruptly stopping psych medication

(mayoclinic, 2020).
CASE STUDY 10

Within the textbook: Nursing Diagnosis Handbook: An Evidence-Based Guide to

Planning Care, the following diagnoses are as follows:

● Death anxiety related to feelings of lack of self-worth

● Constipation related to inactivity and decreased fluid intake

● Fatigue in relations to psychological demands

● Ineffective health maintenance in relation to the lack of ability to make good judgements

regarding ways to obtain help.

● Chronic low self-esteem related to repeated unmet expectations

Prioritized List of Potential Nursing Diagnosis

Potential nursing diagnosis for this patient are as follows:

● Risk of suicidal thoughts and idelations

● Risk of loneliness

● Risk of feeling guilt and sorrow

● Risk of depletion in self-care

● Risk of feeling hopeless

● Risk of not reaching out to medical professionals in the future due to feeling betrayed

from this experience.

● Risk of having exacerbations and coping in unhealthy ways.

Conclusion

B.S. was a very interesting and informative patient for this case study. She was

cooperative with providing information and her case overall challenged me to critically think. I

have thoughts to believe that as long as she continues her medication regimen, use positive

coping mechanisms, and continue using available resources, such as her counselor, she will be
CASE STUDY 11

able to treat her major depressive disorder and proceed with her life with the ability to have some

control over her

CASE STUDY 12

References

Ackley, B. J., Ladwig, G. B., & Flynn, M. M. B. (2020). Nursing diagnosis handbook: An

evidence-based guide to planning care (Twelfth). Elsevier.

Mayo Foundation for Medical Education and Research. (2022, October 14). Depression (major

depressive disorder). Mayo Clinic. Retrieved October 19, 2022, from

https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-2035

6013

StatsPearls Publishing, LLC. (2022). Major depressive disorder (nursing) - statpearls - NCBI

bookshelf. Major Depressive Disorder (Nursing) . Retrieved October 19, 2022, from

https://www.ncbi.nlm.nih.gov/books/NBK570554/

Videbeck, S. L. (2020). Psychiatric-Mental Health Nursing (Eighth). Wolters Kluwer.