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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Mackenzie Kravec

December 8th, 2022

Mrs. Teresa Peck, MSN, RN

NURS 4842L Mental Health Nursing Laboratory

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Abstract

JY is a 63-year-old male patient admitted to the behavioral health unit following suicidal

ideations. He has a mental health diagnosis of severe mixed bipolar disorder. With attendance of

various group therapies and a combination of a new medication regimen, JY has resumed a

functioning level of daily living with healthier coping mechanisms and communication. On the

unit, nursing care that is provided is directed to stabilize mental wellness by pharmacologic and

non-pharmacological methods such as 1:1 counseling and group therapy.

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Objective Data

Patient Identifier JY

Age 63

Sex Male

Date of admission September 26, 2022

Date of care September 29, 2022

Psychiatric diagnosis Mixed bipolar disorder

Other diagnoses Alcoholism, prior drug use, suicidal ideations

Behaviors on admission JY was experiencing depression after being pink-slipped by police for

wanting to drown himself in Lake Milton. He was feeling hopeless and desperate after learning

he had financial issues with his ex-partner then dropping his phone into the lake.

Behaviors on day of care JY was shy yet still willing to speak on behalf of his experience. He

was honest to all questions asked and participated in psychotherapy as well as various group

therapies throughout the day. He was poorly-groomed and appeared to have poor hygiene as well

with gray shaggy hair and a long gray beard. While he spoke clear, he had a flat affect except

when speaking about his prior cocaine and alcohol addiction then became tearful. JY expressed

worry about his discharge date due to stressors in his home-setting and begged staff to let him

stay inpatient over the weekend to ensure his own safety.

Safety and security measures Staff was required to do safety checks every 15-minutes

indicated by where the patient was on the unit at all times. Patient was given hospital gown as
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

clothing while staff washed their appropriate clothing per unit. Contraband checks were enabled

to ensure a safe environment for the patient and staff members. The nurse administered the

patient’s medications and ensured that all pills were taken.

Laboratory results

Lab Value Results

Glucose 118

TSH 1.2

T4 1.0

RBC 4.54

Hbg/Hct 13.7 / 39.1%

WBC 12.3

BUN/Crea. 20 / 1.1

QTc 447 ms

Toxicology Negative

Psychiatric medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

aripiprazole Abilify atypical 10 mg daily Bipolar

antipsychotic Disorder
divalproex Depakote anticonvulsant 250 mg daily Bipolar
Disorder
divalproex Depakote anticonvulsant 500 mg HS Bipolar
Disorder
gabapentin Neurontin anticonvulsant 300 mg BID Bipolar
Disorder
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

haloperidol Haldol typical 3 mg PRN to treat

antipsychotic agitation on the
unit

Summary of psychiatric diagnosis

Bipolar disorder is a disorder that is characterized by periods of mania to episodes of

depression. During times of mania, patients can feel euphoric, restless, and energetic. This

contributes to poor judgment. During times of depression, patients can feel hopeless, worthless,

and in total despair. They may not take proper care of themselves and have thoughts of harming

themselves or suicidal ideations. Bipolar disorder occurs equally in men and women and is more

common among highly-educated people (Videbeck, 2020, p.305). There are two major

categories of bipolar disorder. Bipolar I disorder is described by the person having at least one

episode of mania, while Bipolar II disorder is depicted by one episode of hypomania and

depression. The main difference between mania and hypomania is how severe the manic

symptoms are. Mania can result in interfering with functioning, which would require

hospitalization. However, hypomania does not completely interfere with functioning

(McCormick et. al, 2015, para. 9). Furthermore, a person may experience Cyclothymic Disorder,

which is known as “Bipolar Light.” This is a mood disturbance that lasts as least 2 years with

alternating periods of hypomania and mild depression. A person experiencing this disorder

would not have a loss of social or occupational functioning (Videbeck, 2020, p. 286).
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Identifications of stressors and behaviors precipitating current hospitalization

JY experienced multiple stressors leading to precipitating current hospitalization. He has

been a recovering addict for the past 18-months. He has four children, none of which he has

custody to. He thoroughly believes that the fourth child is not his own. He has no local family or

social support. He was on the phone with ex-partner when he learned he will be experiencing

financial issues in the future with social security. His wages are currently being garnished due to

not paying child support. Prior to his hospitalization, he was sitting by Lake Milton when he

received the phone call from his ex. He was so angry that he dropped his phone into the lake and

thought, “What if I jumped in after it?” Police happened to be patrolling nearby when they

stopped and questioned him. He was then pink-slipped and taken to our emergency department

then later transferred onto the unit. All of these stressors and behaviors are what led to his

involuntary stay at the Behavioral Health Institute.

Patient and family history of mental illness

When interviewed, patient had a flat affect but became tearful when speaking of his

family. He no longer has contact with them. He has four children but is unsure of the last child

being his or not. Because of no family support, this really added a negative stressor to his life and

financial burden to himself as he faces retirement with no source of income besides social

security.

Psychiatric evidence-based nursing care provided

Compliancy within bipolar disorder starts with staying on medication provided by

the psychiatrist or NP. For example, JY was prescribed Depakote for maintenance of his

disorder. The problem with compliancy and drugs such as this one is that it requires monitoring
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

of labs constantly when some may have liver impairment, and simply cannot take Depakote.

Alternate treatment plans for this could include a variety of different prescriptions such as

Lithium. More alternative methods for treatment could be electroconvulsive therapy (ECT), as

well as intravenous ketamine as an extra treatment to mood stabilizers (Harrison et. al, 2016).

Another way to stay on top of the disease and remain successful in treating the signs and

symptoms is to be involved in family therapy. It is proven that when support is given to a

problem or situation then it is easier to deal with that problem or situation. In JY’s situation,

though he does not have any family support now, it is never too late to get the support of his

children especially because they are still younger. In the sessions, JY and his children would

learn about the nature of his illness, the causes and management of his disorder. Together, they

could establish a treatment plan that would be beneficial for JY and beneficial to the family

overall.

Ethnic, spiritual and cultural influences

Patient is a Caucasian male of Sabbath belief. He explained that he worships his higher

power on Saturday where he rests and worships. He is a Judaist who does not believe in any

other God except one God. He explains how it is important to be kind and compassionate

towards others and how it is important to always help one in need. Even though he was

experiencing stressors in his personal life, he showed his ethnic, spiritual and cultural influences

by trying to help other patients within their journey of healing too.

Evaluation of patient outcomes

Patient remained safe throughout the duration of his stay with reinforcement of the Q-15

minute safety checks as well as contraband checks. He showed a decrease risk for violence
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

towards himself as well staff members and other patients. He remained calm and adhere to his

medication regimen and even attended various types of therapies such as psychotherapy. With

medication getting into a therapeutic range, he began to gain his appetite back and obtain a

healthier sleep schedule.

Plans for discharge

Pt. discharge is planned for two days. However, patient is concerned about being

discharged due to stressors within his home-setting. He states he “would like to stay inpatient

over the weekend to ensure his own safety.” Patient is currently living in a trailer park with no

family or social support. He has prior barbiturate usage and was previously living at the Rescue

Mission. He is also unemployed due to early retirement.

Prioritized nursing diagnoses

The following are prioritized nursing diagnoses for JY:

1. Impaired Social Interaction related to patient’s depressive state as evidenced by poor

interactions when interviewing, inability to maintain social support, and poor

attention span.

2. Disturbed Sleep Pattern related to hypomanic episode as evidenced by JY not

sleeping at night.

3. Total Self-Care Deficit related to JY’s impaired perception and cognition as

evidenced by the observation of inability to do self-hygiene.

4. Disturbed Thought Process related to biochemical imbalance as evidenced by

impaired judgment, poor-decision making skills, and inability to complete activities

of daily living as needed.

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

5. Risk for Self-directed Violence related to social isolation, hopelessness, and

hypomania as evidenced by suicidal ideation, and having the energy to carry out plans

of suicide when depression fades.

Potential nursing diagnoses

 Risk for spiritual distress

 Risk for loneliness

 Risk for suicide

 Self-care deficit

 Ineffective health maintenance

 Fatigue r/t psychological demands

 Ineffective impulse control

 Care giver role strain

Conclusion

To conclude, JY was experiencing a hypomanic phase of mixed bipolar disorder. There

were many stressors that led to this both internally and externally in his environment. Upon

discharge, if JY follows his medication regimen, attends individual therapy, and uses the

resources that staff provided on the unit, he will be successful in treatment of this disorder.

Bipolar disorder can be tough to deal with but with medication compliance and therapy, it is

manageable to those it victimizes.

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

References

Harrison, P. J., Cipriani, A., Harmer, C. J., Nobre, A. C., Saunders, K., Goodwin, G. M., &

Geddes, J. R. (2016). Innovative approaches to bipolar disorder and its treatment. Annals

of the New York Academy of Sciences, 1366(1), 76–89.

McCormick, U., Murray, B., & McNew, B. (2015). Diagnosis and treatment of patients with

bipolar disorder: A review for advanced practice nurses. Journal of the American

Association of Nurse Practitioners, 27(9), 530–542.

Videbeck, S. L, Miller, C. J. (2020). Psychiatric-Mental Health Nursing (8th).

Philadelphia: Wolters Kluwer.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY