MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Cassidy Kimbrough

February 25, 2023

Mrs. D

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

MENTAL HEALTH COMPREHENSIVE CASE STUDY

Abstract

RB is a 23-year-old female patient admitted to the inpatient psychiatric unit following threat of

suicide. She has a mental health diagnosis of depressed and she experiences mixed features. She

also has cluster B personality disorder. With medication treatments including antianxiety and

antidepressants, the symptoms have become more manageable, and RB has resumed functioning

level of daily communication and hygiene. Nursing care provided on the unit is focused on

symptom management through pharmacologic methods, as well as therapeutic groups and

individual therapy sessions.

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Objective Data

Patient identifier LL

Age 23

Sex Female

Date of admission February 6, 2023

Date of care February 10, 2023

Psychiatric diagnosis Major depressive disorder

Other diagnosis Intellectual disability, cluster B personality disorder

Behaviors on admission RB voluntarily came to the ED to discuss treatment options related to

her mental health. After explaining how the fight with her brother was a trigger and made her

want to commit suicide, RB was pink slipped and admitted to the floor

Behaviors on day of care RB was calm and cooperative and willing to speak openly. She was

hesitant to participate in group therapy and sat far away from the rest of the group. She attended

other activities throughout the day and showered before them in the morning. RB was

experiencing slight anxiety but more so happiness with the thought of being discharged. RB was

having suicidal ideations upon admission but is no longer experiencing those thoughts. RB had a

positive outlook and a plan for the future where she plans to move to Las Vegas. RB had clear,

slow, and intentional speech patterns and answered orientation questions appropriately. Her

posture was hunched but comfortable.

Safety and security measures Throughout the inpatient admission there were safety checks that

implemented. Staff is present at all times in the nurse’s station, and patients are not allowed off

the unit. All hazardous items such as razors, shoelaces, pens, and pencils are not permitted on the
MENTAL HEALTH COMPREHENSIVE CASE STUDY

unit. Only pencils under supervision. Medications were administered to the patient by the nurse

prior to my arrival. The nurse verified all medications were taken at the time of administration.

Laboratory Results

Lab Value Result

Glucose 103

Na 137

K 4.1

BUN 15

RBC 5.11

Hgb 14.8

WBC 7.3

Toxicology Negative

ECG NSR with sinus arrhythmia

Psychiatric medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Acetaminophen Tylenol CNS agent 650mg/q6h Pain

Alum&Mag.hydroxid MAALOX Antacid 30ml/PRN Indigestion

e Simethicone

Citalopram Celexa SSRI 10mg/daily Depression

Hydroxyzine Vistaril Antihistamine 50mg/PRN 3x Anxiety

daily

Olanzapine Zyprexa Bipolar 5mg/nightly Bipolar

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Nicotine Patch NicoDerm CQ Nicotine 14mg patch daily Tabaco

Replacement dependence

Melatonin CNS agent 3mg nightly Sleep

Summary of psychiatric diagnosis

Depression is a common yet serious disorder the negatively affects how you feel, the way

you act, and how you think. However, it is treatable. Depression can lead to a variety of physical

and emotional problems that can decrease the ability to function. It causes feelings of sadness

and loss of interest in activities you once enjoyed. Depression can occur at any time, but on

average, first appears during the late teens to mid-20s. Women are more likely to experience

depression. Depression affects an estimated one in 15 adults every year. (Torres, 2020).

Depression is diagnosis when a combination of the following symptoms are present for at

least two week, presenting a change in your previous level of functioning: changes in appetite,

feeling sad, loss of interest in activities you once enjoyed, trouble sleeping, sleeping too much,

loss of energy, feeling worthless, difficulty thinking, or thoughts of suicide or death (Torres,

2020). RB exhibits sleeping too much, feeling sad, loss of interest in activities she once enjoyed,

and previous feeling of suicide.

Persistent sadness is a hallmark symptom of depression. There are several factors that can

play a role in depression including biochemistry, genetics, personality, and environmental

factors. For RB, environmental factors play a big role into her depression. Her rough upbringing

and continuous bad relationship with her parents and siblings are one of the factors that led her to

her diagnosis.
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In addition to environmental factors RB’s personality also puts her at a risk factor for

depression. She is a person with low-self-esteem and is easily overwhelmed by stress (Torres,

2020).

Identification of stressors and behaviors precipitating current hospitalization

Prior to admission, RB, was compliant with her medications. She lives with a roommate

who has three kids also living there. RB states there are no stressors within their relationship, and

they all get along well. RB stated that her stressors come from her family. Her father and mother

do not have a good relationship; however, it is manageable. The real issues come from her

siblings. She states that they all hate her “because she is slow” and they have arguments quite

often. An argument with her younger brother is what caused the hospitalization. RB stated that

the argument put her on edge and it was “just too much to deal with” and caused her suicidal

ideations. RB knew she wanted help so she came to the emergency department, where she was

then admitted onto the psychiatric floor.

Patient and family history of mental illness

RB states that she was diagnosed with Depression and Bipolar when she was a teenager

and a learning disability when she was “younger”, but cannot recall the exact ages. She is not

aware of any other family members that experience mental health disorders. RB has six siblings,

a combination of both younger and older.

RB grew up in a two parent household. RB and her father have an estranged relationship,

and when asked for details about it she just states that he did not like her. RB and her mother

were close. RB felt like her mother was the only one who would stand up for her between her

siblings and father.

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Psychiatric evidence-based nursing care provided

During her stay on the inpatient unit, RB received nursing care from the mental health

nursing staff. RB was assigned a nurse each shift that she would bring up concerns about her

care, and build a relationship. Her nurse would diagnose, plan, implement, and evaluate RB

using the nursing process on a daily basis. The nurse would also administer daily medications

and ensure that RB took all the pills when they were given to her. RB was placed on an SSRI

antidepressant, along with some CNS agents to help with anxiety, her bipolar disorder, and pain

when needed. The nurses that provide care RB are aware of what the medications are used for,

typical side effects, and with the SSRI they are aware of different important nursing implications.

A nonpharmacologic approach to RB’s depression and others to help their symptoms is

psychotherapy. This entails talking through things with different staff members like social

workers, nurses, and therapists. This is a form of therapy that helps problem solving in the

present and responding to challenges in a more positive manner (Torres, 2023).

Another aspect of the treatment while RB was inpatient was a daily group session that

she attends. The unit provided a structured schedule that included mealtimes for personal care or

phone calls. And structed groups run by social workers, nurses, or psychiatrists on the unit. RB

regularly attended as many group sessions were available each day, but admits she is still

nervous to participate in it. RB stated that she learned new coping skills, and about new

resources that were available to her in her community.

Ethnic, spiritual, and cultural influences

RB is a Caucasian, single woman from a lower-class family. She is not gainfully

employed and gets a government disability check as her form of income. RB does not practice

any religion and does not have any opinions related to spirituality.
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Evaluation of patient outcomes

Some of the outcomes that are desired for a patient with depression include self-

administered measures of functional status and well-being, role functioning, social functioning,

and well-being measures (Hentoff et Al, 2019). On the day of care for RB, she was performing

self care activities for herself and showering, combing her hair, and eating appropriately. She

also had remained from any harm while she was on the inpatient unit and was taking her

medications appropriately.

Some other outcomes were partially met on the day of care, such as RB’s ability to state

healthy coping mechanisms. RB was no longer having any suicidal ideations. She stated that her

depression also felt like it was under control. RB knows that conversations with her family

members may be a trigger for her, so she is learning how to better manage her emotions.

RB also had her anxiety and bipolar disorder better managed on the day of care compared

to when she was admitted. When asked to rank her anxiety and bipolar on a scare of 1 to 10 she

with one being the lowest and ten the highest, and she ranked her it a 3. RB credited the

medications and the tools she learned in group sessions with helping her to manage both

depression, anxiety, and her bipolar disorder symptoms.

Plans for discharge

When RB is discharged, she will return to her home where she resides with her

roommate, and her roommate’s three kids. Staff felt that RB did not need transitional or long-

term placement after discharge from the inpatient unit. RB will be discharged with her

medications. And will have an outpatient appointment in place with a mental health agency in

her community within a week. RB will be encouraged to regularly attend sessions with a
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psychiatrist, and to stay compliant with her medications. Education material will be provided

with her medications, possible side-effects, and adverse reactions that can occur.

Prioritized nursing diagnoses

The following a prioritized nursing diagnoses for RB:

1. Risk for self-directed violence

2. Impaired social interaction

3. Chronic low self esteem

4. Disturbed though processes

5. Hopelessness

6. Deficient knowledge

Potential nursing diagnoses

1. Spiritual distress

2. Grieving

3. Body dysmorphic disorder

Conclusion

Depression is a common yet serious disorder the negatively affects how you feel, the way

you act, and how you think. However, it is treatable. Depression can lead to a variety of physical

and emotional problems that can decrease the ability to function. It causes feelings of sadness

and loss of interest in activities you once enjoyed

RB exhibited suicidal ideations and is at increased risk of suicide because of her history

with depression. With education prior to discharge, it is the goal for RB to remain compliant with

her medications and therapy schedules to avoid another self-harm situation. With regular and
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consistent treatment, the exacerbation should be able to be controlled before it comes to the point

of RB seriously harming herself.

MENTAL HEALTH COMPREHENSIVE CASE STUDY

Abstract

Insititue of Medicine (US) Division of Health Care Services, Hentoff, K. A., & Lohr, K.

(2012). Studying Outcomes for Patients with Depression: Initial Findings From the

Medical Outcomes Study. Nih.gov; National Academics Press (US).

https://www.ncbi.nlm.nih.gov/books/NBK233979/

Martin, P. (2022, March 18). 6 Major Depression Nursing Care Plans. Nurselabs.

https://nurseslabs.com/major-depression-nursing-care-plans/

Torres, F. (2020, October). What Is Depression? American Psychiatric Association.

https://www.psychiatry.org/patients-families/depression/what-is-depression\