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Mental health case study

Katherine Looney

Youngstown State University

November 29th 2022

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Abstract

Psychiatric Nursing is a field of study that you will run into many different

diagnoses and people may present these diseases differently. Many of these diagnoses

could relate to each other or be caused by the other. Today in this case study we will be

discussing major depressive disorder and bipolar 2 disorder. My specific patient

presented with depressive symptoms and suicidal ideation. In this case study i will break

down major depressive disorder, bipolar 2 disorder, the patients stay on the unit and plans

for discharge.
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Objective Data

Patient Identifier: K.G

Age: 20

Sex: Female

Date of admission: 11/24/22

Date of care: 11/29/22

Psychiatric diagnosis: Major depressive disorder and Bipolar 2 disorder

Other diagnosis: Intellectual disability and GAD

Patient K.G. presented to the emergency room on 11/24/22 brought by her friend.

The patient stated that she was under an abundant amount of stress and had a recent fight

with a romantic partner who threatened her in a way that was undisclosed to me at this

time. This then led to her claiming she was having suicidal thoughts and was going to

drive herself off the road. Due to past mental illness diagnoses (major depressive disorder

and bipolar 2) her friend thought it was safer for her at the hospital. She has had suicidal

ideations before as she was admitted to Saint Elizabeths Hospital in 2020 and Belmont

Pines as a juvenile. While at home the patient takes Valtrex, Latuda and Fluoxetine. She

has also experienced great losses in her life recently. Her birth father passed away in

august due to an overdose from his EPI pen and her grandfather then died a few weeks

after that. It was also disclosed to us that one of her closest friends tried to kill himself

two weeks ago.

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During her time on the unit the patient will also be taking Celexa, Halodol,

acetaminophen, as well as all her home meds which are Valtrex, Latuda, Fluoxetine and

Acyclovir. The labs we need to closely monitor while she is staying on the unit are QTC,

WBC,, blood glucose and sodium.

The patient's QTC level was 399 which is in normal range. This lab is VERY important

to check because she is taking Haldol and Latuda, which are both antipsychotics, which

both can raise the QTC level. Her white blood cell count was 8.3 which is in normal

limits. We need to monitor this because she is on the antipsychotics which are known to

raise WBC count. Her blood glucose was 100, also in normal range. Antipsychotics can

raise blood sugar as well as her acyclovir that she takes for her genital herpes. Her

sodium was also within normal range being 140, we need to closely monitor this because

of her being o n multiple antipsychotics.

The patient came onto the unit on 11/24 as mentioned previously in this case

study. She has per unit privileges. The patient does not have any homicidal ideations but

is experiencing acute suicidal ideations. Although this was her stated reason for coming

to the hospital emergency room, she expressed to us that she is “not actually suicidal and

she only came her for safety purposes”. She does not and has not ever wanted to commit

suicide, except for the fact that “she wants to die, just like everyone else in the world”.

This is obviously not true considering she has been hospitlized before for suicidal

ideation back in 2020 at saint elizabeths hospital and possibly at belmont pines as a

juvenile. She states that she has been going to group therapy sessions and they have been
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helpful. During our time at group therapy today she seemed enthusiastic and willing to

participate during it, although became distracted easily at times. As mentioned multiple

times previously the patient has been taking Halodol and Latuda for agitation and

psychotic symptoms while on the unit, as well as celexa and prozac for depressive

symptoms.

Summarize psychiatric diagnosis

As mentioned many times previously the patient has been diagnosed with major

depressive disorder and Bipolar 2 disorder. First I will touch on Major Depressive

Disorder. According to the Mayo Clinic depression is a mood disorder that causes severe

persistent feelings of sadness and loss of interest in daily living. It affects how you think,

feel and behave. It can also cause a variety of physical and emotional problems. It is the

oldest and most commonly diagnosed psychiatric disorder. The patient exhibited many of

these traits especially upon how she acts and makes decisions in her daily life. The

second disorder that this patient was diagnosed with was Bipolar 2 disorder. As defined

by the mayo clinic bipolar 2 disorder used to be defined as manic depression. It is a

mental health condition that causes extreme mood swings such as emotional highs (mania

or hypomania) and extreme lows (depression). Episodes of this mood disorder may only

come multiple times a year or hardly at all. Another definition worth mentioning comes

from the DSM5 which states that Bipolar 2 disorder is when you have had at least one

major depressive episode and at least one hypomanic episode. The patient happened to be

in a depressive episode upon arriving at the Emergency room. The signs and symptoms of
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a depressive episode are: feelings of hopelessness, sadness and tearfulness, loss of

interest in activities, slowed thinking and movement, anxiety or agitation, frequent or

recurrent thoughts of suicide or death etc. This patient happened to be experiencing most

of these symptoms when she was brought to the hospital. She claims to have not actually

been suicidal but according to her chart, she has had suicidal ideations for quite some

time. As previously mentioned before she was hospitalized for her major depressive

disorder/ bipolar disorder back in 2020 at St Elizabeths hospital in Youngstown.

Identify Stressors and behaviors

K.G discussed many of her stressors and things that have previously been a

stressor in her life to me and another student. We first started talking about previous

romantic relationships, specifically her most recent one. The patient described to me that

she was seeing a man for about a week or so and they were romantic together but not

dating. She said that when she did not listen to him he became very aggressive with her

and even choked her outside a bar. Even though she still went home with him later that

night, she decided after that, they would be ending their “relationship”. He then became

very verbally aggressive towards her and threatened to come and hurt her and her entire

family. K.G. found this to be very triggering and sent her into wanting to drive her car off

the road. Her suicidal ideations had her close friend concerned and brought her to the

hospital. She also mentioned that she recently ended a long term relationship with her

fiance who has also “moved on to another girl” which the client got very emotional
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about. The client expressed that she is not that bothered by this but this is what had led

her to her “psychotic break”.

Another stressor in her life is her living situation. K.G currently lives with her

mother and step father. The patient expressed to us that her step father has always been

extremely mentally, emotionally and physically abusive. When asked if she told her

mother about this, she claimed that her mother does not care and ignores her fears about

her step father. It was also found in her chart that this past August her father had died

from an overdose of his epi pen. She claims she is glad her father is dead and that he got

his karma. Her grandfather then died a few weeks later, which she did not mention to us.

Also within the last two weeks a close friend of hers tried to commit suicide, which could

contribute to her having suicidal ideations.

Discuss patient and family history of mental illness

K.G stated that she was diagnosed with major depressive disorder as a child but

did not give me a specific age. As mentioned before, she truly downplays her mental

illness and acts if it does not play a huge role in her life. She states that there is no family

history of mental illness, she would not elaborate too much on that topic. K.G has 4

siblings, she states that none of them have a history of mental illness but it could be

possible that some of them do. She states that her siblings left her alone with her abusive

step father and mother and have not returned to Ohio since leaving. K.G still currently

lives with her step father and mother in Boardman, Ohio, along with her beloved cat.
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K.G states that her biological father had recently passed away, but she was not close with

him at the time of his passing. As previously mentioned in this case study the patient

states that she is glad her father is dead and he got what was coming to him. K.G

explained to me that her biological father was mentally, emotionally and physically

abusive to her as a child. When asked to further elaborate on the abuse, she states that she

cannot remember much about it since she was so young.

Psychiatric evidence-based nursing care provided

During her stay in the inpatient unit K.G. received nursing care from the mental

health staff. K.G. was assigned a nurse each shift that she could build a therapeutic

relationship with and she could bring any concerns she had to. Her nurse then would use

the nursing process to assess, diagnose, plan, implement and evaluate care for her on a

daily basis. The nurse would then administer her daily medications and ensure that K.G

would not pocket her pills or not take them. Upon her stay on the unit she was put on a

typical antipsychotic, as well as her usual medications such as Valtrex, Latuda,

Fluoxetine and Acyclovir. The nurses who provide care for K.G. are aware of each

medication's purpose, typical side effects etc. Another very important thing that each

nurse must watch out for with a person taking an antipsychotic is neuroleptic malignant

syndrome, a rare but life threatening condition. Some signs and symptoms of neuroleptic

malignant syndrome are: high heart rate, respiratory rate, high blood pressure, muscle

rigidity and inc leukocytes. Another important aspect of treatment for K.G while she is

inpatient is for her to attend group therapy. The unit provides a structured schedule for the

patients that includes meal times, snack time, personal calls, and structured groups run by
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the therapist, nurses and other staff members. While I was in the unit, K.G attended the

group session led by my instructor and participated in it as well. She stated that they were

helpful to her recovery and gave her a purpose each day. She shared that it gave her new

coping skills, grounding exercises and also helped her socialize with the other patients.

Ethinic, cultural and spiritual influences

K.G. is a caucasian, single woman from a middle to lower class family. She is

employed part time as a dietary aid at a nursing home in boardman ohio. She states that

they plan to pay for her to go back to school to become an LPN. From what I gathered,

K.G. supports herself financially. K.G. practices christianity, regularly pays and has

several cross tattoos dedicated to her faith in god. When asked about her spiritual beliefs

she wants her faith to become stronger throughout the next year and she will turn to God

during the times she struggles.

Evaluation of patient outcomes

Some of the desired outcomes for a patient with major depressive disorder is for

them to participate in self care activities, attend group therapy, participate in cognitive

therapy and plan realistic outcomes for themselves. On the day of care K.G participated

in self care activities such as showering, getting dressed for the day and participating in

group therapy. She also is taking her medications as ordered. Some other outcomes that

were not achieved during the day of care was getting K.G to be realistic about her

situation and not be in denial about. Like previously mentioned, K.G was downplaying

the situation and stated that she was not actually suicidal and only said that to be admitted

to the unit. Getting a patient to admit to their problems and wanting to get better is one of
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the biggest steps to recovery. When asked to rate her anxiety and depression on a scale

from 0-10, she rated them both a zero. K.G credited attending group therapy and her

overall stay on the unit for managing her anxiety and depression.

Plans for discharge

When K.G. is discharged she will be returning home to her step father and mothers

house where she currently resides. While this does not seem like the best situation for her

mental and emotional needs, this is what was presented to me on the day of care. She

states that she is going to continue to see her therapist weekly, whom she trusts a great

deal. She states that she is going to be compliant with her medications. I educated her on

her new medication Celexa about the side effects and that she may not see a true effect

until 4-6 weeks after the first dose.

Prioritized Nursing Diagnosis:

1. Risk for suicide related to hoplessness and past SI

2. Fatigue related to psychological demands

3. Self care deficit related to cognitive impairment and depression

4. Hopelessness related to feeling of abandonment and long term stress

5. Ineffective health maintenance related to lack of ability to make good judgements

Potential nursing diagnosis:

1. Ineffective coping

2. Ineffective activity planning

3. Impaired mood regulation

4. Risk for spiritual distress

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5. Risk prone health behavior

6. Fear

7. Impaired social interaction

8. Social isolation

9. Impaired individual resilience

10. constipation

Conclusion:

Major depressive disorder is a complex and ever changing mental health disorder.

K.G exhibited the worse of this disease by having suicidal ideations and being admitted

to the hospital. K.G is at even more high risk for suicidal ideation since this has occurred

multiple times in the past. With education prior to discharge, it is the goal for K.G to

remain compliant with medication and individual therapy sessions in order to stay on the

path to avoid another suicidal ideation situation. With regular and consistent treatment

K.G should be able to function in everyday life and avoid hospitalization.

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References

Major depression. Major Depression | Johns Hopkins Medicine. (2021, August 8).

Retrieved December 9, 2022, from

https://www.hopkinsmedicine.org/health/conditions-and-diseases/major-depression

Mayo Foundation for Medical Education and Research. (2021, February 16).

Bipolar disorder. Mayo Clinic. Retrieved December 9, 2022, from

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/

syc-20355955

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

Depression (major depressive disorder). Mayo Clinic. Retrieved December 9, 2022, from

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356

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WebMD. (n.d.). Bipolar II disorder: Symptoms, treatments, causes, and more.

WebMD. Retrieved December 9, 2022, from

https://www.webmd.com/bipolar-disorder/guide/bipolar-2-disorder
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