Case Study

MENTAL HEALTH COMPREHENSIVE CASE STUDY 1
Psychiatric Mental Health Comprehensive Case Study
Brock Grundy
November 16, 2023
Mrs. Teresa Peck, MSN, RN
NURS 4842L Mental Health Nursing Laboratory
Youngstown State University

Abstract
NW is a 22-year old female patient admitted to the inpatient psychiatric unit who was originally
admitted to the hospital for chest pain. A series of events follows as she is soon to experience
what it seems to be her first psychotic episode. She was eventually admitted to the psychiatric
unit and was given a diagnosis of acute psychosis. Throughout this case study I am going to
discuss the events that occurred during her time in and around the unit. I will be covering
medications administered to the patient, plans of care, objective data, psychiatric evidence based
on the nursing care provided, and a list of nursing diagnoses for the patient. The patient's signs
and symptoms leading to this diagnosis include hallucinations and delusions.

Objective Data
Patient Identifier - NW
Age - 22
Sex - Female
Date of admission - October 25th, 2023
Date of Care - November 2, 2023
Psychiatric Diagnosis - Acute Psychosis
Other Diagnoses - History of autism (Chest pain but troponin levels were normal)
Behaviors on admission -NW was brought into the emergency room due to calling 911 and
complaining of chest pain. Upon assessment at the hospital they found that her troponin levels
were totally normal so they ruled out anything cardiac related. She was diagnosed with a UTI
and was placed on medications to treat this. While at home not long after this visit to the hospital
she proceeded to lock herself in the bathroom and began calling 911 for a second time. Her
mother and sister observed this and stated to the paramedics that “she started trippin’. The
ambulance soon arrives at their home and checks out the patient and finds that nothing is wrong
with her so they leave. She continues to call them shortly after they leave and they come back,
the family intervenes and says that they just want her gone and that she is going crazy. They
requested that she be admitted to a psychiatric unit. Her father even tried to bribe the paramedics
with $20 just to get her out of the house and away from them. Originally NW would not make
any sort of eye contact with anyone and only shake her head yes and no. She was admitted to the
ER in boardman and was acting very erratic. She jumped over the rail of her bed and began to
run freely throughout the department. The nurses were trying to deescalate the situation as much
as possible and ended up needing back-up so their only option was to call the police. The police
arrive and calm the situation down as much as possible and she was placed in a room with a one
on one sitter to keep eyes on her at all times. She requested to talk to someone and stated to them
that she “was not ok”. She told this person that her mother and sister have been trying to poison
her and kill her. At some point she stated that they tried to kill her because of the baby that she
was supposedly pregnant with. She also stated that her mother and sister were both in jail so it
was ok, this was obviously found to be a delusion. A doctor came in to talk with her and he pink
slipped her due to these delusions, she also stated that she wanted some sort of revenge on her
mother and sister that had the intent of poisoning them back. She was then transferred from
boardman to St. Elizabeth downtown and placed into the psychiatric unit.
Behaviors on day of care - Patient is withdrawn in her bed and refuses to sit and and also
refuses to make any sort of eye contact. She denies all psychiatric symptoms when assessed by
the nurse. She was also questioned how she ended up on the psychiatric unit and stated “I do not
know”. She appeared to be preoccupied and internally stimulated. She was also appearing very
disorganized. She also stated “I do not want to poison my mom and sister, they tried to poison
me”. Patient was having delusions saying that her mom poisoned her because she wanted to kill
the baby that she was pregnant with. On my day of care she was also very short with her
responses and struggled to maintain eye contact. She was also speaking of stories involving her
multiple boyfriends and how they were also trying to harm her in some way. She stated that he
cannot come into the house and when I asked how she ended up on the unit she said that it was
his fault. Nowhere in the chart or in doctors notes did it mention anything about a boyfriend.
Patient seemed to be confused at times during the interview but was able to cooperate to the best
of her ability.
Safety and security measures - Throughout my patients stay on the unit she was not permitted
to leave at any time besides when she gets discharged which was happening soon after I was on
the unit. Staff was also present at all times on the unit. All possibly hazardous items are not
permitted on the unit like shoelaces, knives, razors, writing utensils including pens and pencils.
The unit provided color pencils and markers to use mainly for group therapy. Chairs were
designed to be heavy so they are hard to move and or throw at someone. Also doors were very
secure at all times and there was a double door at the main entrance so patients would have to get
through both sets in order to leave. Medications were administered by the nurse and they were
also verified that the correct dose was given at the right time.
Laboratory results
Lab Value Result
Glucose 114
Potassium 3.7
Sodium 137
BUN 9
Creatinine 0.8
RBC/WBC 4.4/6.6
Hbg/Hct 13.5/38.8
AST/ALT N/A
TSH/T4 N/A
Depakote 49 (50-100)
Toxicology Negative
QTc 423
HcG Negative
Platelets 236
Psychiatric Medications
Generic Name Trade Name Class/Category Dose/Frequency Reasoning
Haloperidol Haldol Antipsychotic 5mg Q6 PRN Agitation
Risperidone Risperdal Antipsychotic 2mg tablet BID Can work with

autism
symptoms
(Negative
schizophrenia
symptoms
Valproic acid Depakote Anticonvulsant 250mg BID Psych symptom

management
Melatonin Circadin Sleep aid 3mg PRN Sleep

nightly disturbances
Summary of psychiatric diagnosis
Acute psychosis is a diagnosis given to patients who are experiencing their first psychotic
event. This can be a one time occurrence and never happen again or there can be recurring
episodes that can be a symptom of developing chronic psychosis. This usually occurs after a
traumatic life event, including severe stress, loss of a loved one, loss of a job, or anything else
can be considered traumatic to the person. This usually occurs within the time span of a month or
less. Psychosis is a symptom complex that may include hallucinations, delusions, disorder of
thought, and disorganized speech and behavior (Stephen & Lui, 2020).
There are two types of psychosis and they are separated into primary and secondary
psychosis. Acute psychosis is primary if it is symptomatic by a psychiatric disorder and
secondary if it is caused by a specific medical condition (Griswold et al., 2015). In NW’s case it
was not specifically stated in the chart so I am not entirely sure if it is primary or secondary acute
psychosis. Acute psychotic episodes are mainly caused by illicit drug use, this was not seen in
NW’s situation considering her drug and alcohol screen was negative. Clinicians should ask
patients about any recent head injury or trauma, seizures, cerebrovascular disease, or new or
worsening headaches. When someone is diagnosed with acute psychosis certain labs and test
should be drawn to see the etiology of this occurrence. These include a CBC, metabolic profile,
thyroid function tests, urine toxicology, parathyroid hormone test, calcium, vitamin B12, and
folic acid. Sexual transmitted disease tests should also be considered in the initial testing
(Griswold et al., 2015).
There is no single cause of acute psychosis but there are several factors that lead to this
happening. Psychosis appears to result from a complex combination of genetic risk, differences
in brain development, and exposures to stressors or severe trauma (Understanding Psychosis,
n.d.). NW had delusions of her mother and sister trying to poison her and also genuine thoughts
that the world was going to end. NW also stated and told stories of multiple boyfriends that were
never brought up anywhere in the patient's chart or in conversation with the nurses. As stated by
NW’s mother she has an overbearing obsession with Tik Toc and also is hallucinating talking to
people that are not there. These examples alone are enough to diagnose NW with acute
psychosis.
NW has a history of an autism diagnosis which can somewhat explain the way she was
acting on my day of care. According to recent research, “There is strong evidence for the
existence of a high comorbidity between autism and psychosis with percentages reaching up to
34. 8% and several significant implications for treatment and prognosis of these patients.”
(Ribolsi et al., 2022). NW was for the most part, responding only yes or no to any question
asked, she did not make much eye contact, had a very flat affect, and speech was very slow and
mumbled. She also had alterations in her thinking and speech. She also had a crazy obsession
with Tik Tok which was stated by her and also her mother in the charts. These observations are
closely related to the negative symptoms of schizophrenia and autism so sometimes it can be
hard to differentiate. The main thing that tells the two apart is the hallucinations and delusions
that are present with NW.
Identification of stressors and behaviors precipitating current hospitalization
Prior to admission, NW seemed to be living as a normal 22 year old would. She
graduated from High School in Warren Ohio and stated that she enjoys baking. She stated that
she got along with her family very well and that they were close. The mother stated that NW has
had previous issues that were manageable but now it has gotten to a point where they are no
longer able to take care of her. It appears that her family slowly was moving towards trying to
get her a psychiatric evaluation when it was the correct time. This may have been due to her
acute psychotic episodes; it was not very clear. During an interaction with the paramedics they
stated that the father was very overbearing and derogatory towards the patient and would not let
her be seen without him present. There is no proof but this type of behavior is often seen in abuse
cases. She does have another older sister that is a ward of the state due to a similar psychotic
episode, her mother stated “I am worried that the same thing is happening to NW”. A couple
stressors that NW faces is her family relationships, personal relationships, and loneliness. These
stressors may have been part of the reason for why she had a psychotic event. Some behaviors
that also led to her hospitalization were her locking herself in the bathroom, stating that she
wanted to poison her mother and sister for “payback”, and jumping over the rail of the bed in the
emergency department and running around. Prior to all of this she would repeatedly call 911 over
and over and say that she is not ok.
Patient and family history of mental illness
NW believes that she has no sort of mental disorder but she was diagnosed with acute
psychosis and autism. There was no significant family history of mental illness other than her
older sister. She is currently a ward of the state and her mother noted that she was worried the
same thing is going to happen to NW. Patient denies any sort of suicidal ideation and also denies
being diagnosed with autism. She has no substance abuse herself. I am not aware of the rest of
the family. There was no family history recorded in the chart besides what is already stated. The
family does come from a lower socioeconomic status which can lead to an increased risk for
developing any sort of mental illness which may have something to do with this case.
“According to a study that examined a database of 34,000 patients with two or more psychiatric
hospitalizations in Massachusetts during 1994-2000, unemployment, poverty and housing
unaffordability were correlated with a risk of mental illness.” (Hudson, 2005). NW was never
employed after high school so she may have been struggling financially without the help of her
parents. On the chart it was noted that she was worried if she will be able to collect social
security when she leaves.

Psychiatric evidence based on nursing care provided
During this patient's stay in the inpatient psych unit she received nursing care from the
mental health nursing staff in many ways. Everyday NW was assigned a nurse that is responsible
for caring for her and giving her anything she may need. For example, a shower, something as
little as a blanket, medications, discharge planning, and care plans. The nurses are also there to
build a therapeutic and non judgemental relationship with the patient so that trust can be built.
With trust, it enables the nurses to help the patient and discuss hard topics that can eventually
lead to greater outcomes for the patient in the future. The nurses also ensure that NW is taking
the medications on time and also the correct dose. She also may check that NW is not gumming
the medications or hiding them. The nurses are also there to teach about medications and benefits
of taking the medications and also the side effects of them. Antipsychotic medications are very
serious and have some complications that can cause a lot of issues if not taken with precautions.
NW is on the unit for the first time and it is important that she feels safe there and the nurses can
greatly help with this aspect.
Furthermore, the unit offers multiple sessions of therapy. These include psychotherapy
and group therapy. Group therapy is usually held by one of the nurses on the unit and it’s main
goal is to help the patients understand their emotions and offer techniques on ways they can
improve themselves. These groups are all voluntary but it looks good if they attend and
participate in as many as possible. Psychotherapy is similar but it opens the room for individuals
to share some things they might not in front of the whole group of people. NW did not attend
either session while I was present on the unit. If NW would attend more of these I feel like she
would be able to communicate better and develop better relationships with her peers. This is hard
for her because of her current state.
Ethic, spiritual and cultural influences
NW is a 22 year old female from a lower socioeconomic family. She stated that she used
to attend church all of the time but did not specify her religion. She stated that she loved to go
and wishes that she could continue to go. She stated that since covid she has not been able to
attend church at all and that it makes her sad. She also said that she believes in God. To my
knowledge there are no churches around the local area that are closed due to covid still, some
even stayed open throughout the duration of covid with limitations and precautions. This may be
a delusion or it could be a simple excuse for her not to attend church anymore but it seemed like
she still had a faith or belief in God.
Evaluation of patient outcomes
Some of the outcomes that could be desired for a patient like NW is to take medications
as prescribed when discharged. She also needs to understand and accept her condition and find
ways to cope when stressed. Patient stated that on discharge she would like to get back into
baking everyday for her family and friends which I believe would be beneficial because it is
something that she enjoys doing. Patient appeared to be calm and more positive towards life
when talking about going home. There was really no variety of expressions when talking with
her about leaving. She appears to be in better spirits and has better intentions with her life when
leaving. She may even plan on attending some sort of schooling if possible. I also believe that
the group therapy sessions she attended said that something was learned from it and she will use
it when discharged. Also the one on one sessions with nurses and doctors will encourage her.
NW’s symptoms were managed very well on the floor with a variety of antipsychotics,
sleep aids, and mood stabilizers. With the continuation of these medications I think that she will
be able to move on from her first psychotic episode and be able to function normally in a public
setting. It also appeared that does not have any more thoughts of harming herself or others and is
safe to go home.
Plans for discharge
When NW is discharged, she will be getting picked up from her sister and driven home to
where she lives with the rest of the family. The patient’s family has been contacted prior to
discharge. A nurse will review current medications with the patient and provide education on the
compliance with treatment. The nurse will also discuss and make sure NW understands the risks,
benefits, side effects, drug to drug interactions, and alternatives to treatment. NW was advised to
call the outpatient provider and visit the nearest emergency department if symptoms are not
manageable. She is being sent home with two medications which are risperidone and valproic
acid. NW was also advised to continue taking her current home medications.
Prioritized nursing diagnosis
The following are prioritized nursing diagnosis for NW:
1. Impaired verbal communication related to mental illness as evidenced by lack of eye
contact and yes or no answers to questions.

2. Disturbed thought processes related to mental illness as evidenced by non-realistic
thinking and delusions
3. Risk for violence related to delusions and hallucinations
4. Self-care deficiency is related to mental illness as evidenced by poor hygiene and
motivation overall.
5. Risk for dysfunctional family processes related to relationship with parents and home
living situation.
6. Risk for self harm related to delusions and hallucinations
Potential nursing diagnoses
1. Acute confusion
2. Impaired memory
3. Self care deficit
4. Social isolation
5. Impaired verbal communication
6. Depression
7. Risk for anxiety
8. Ineffective role performance
9. Interrupted family processes
10. Impaired social interaction
11. Stress overload

Conclusion
Acute psychosis can be the beginning of a lifelong disease that affects
relationships, communication skills, and thought processes just to name a few. In this
patient's case it appeared to be her first event of psychosis. In a patient like this, it is
important to keep track of any symptoms that relapse in the future so they can be taken
care of before serious complications occur.
NW experienced several different types of hallucinations and delusions during her
psychotic episode. Some of these included harming others which can be dangerous and
shows even more the importance of managing these symptoms. Treatment was given to
NW and her symptoms have mostly gone away and has been deemed safe to return back
home without the risk of harming herself or anyone else.

References
Griswold, K. S., Regno, P. a. D., & Berger, R. C. (2015). Recognition and Differential
Diagnosis of Psychosis in Primary Care. American Family Physician, 91(12),
856–863. https://www.aafp.org/pubs/afp/issues/2015/0615/p856.html
Hudson, C. G. (2005). Low Socioeconomic Status Is a Risk Factor for Mental Illness.
Https://Www.apa.org. https://www.apa.org/news/press/releases/2005/03/low-ses
Ribolsi, M., Fiori Nastro, F., Pelle, M., Medici, C., Sacchetto, S., Lisi, G., Riccioni, A.,
Siracusano, M., Mazzone, L., & Di Lorenzo, G. (2022). Recognizing Psychosis in
Autism Spectrum Disorder. Frontiers in Psychiatry, 13.
https://doi.org/10.3389/fpsyt.2022.768586
Stephen, A., & Lui, F. (2020). Brief Psychotic Disorder. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK539912/
Understanding Psychosis. (n.d.). National Institute of Mental Health (NIMH).
https://www.nimh.nih.gov/health/publications/understanding-
psychosis#:~:text=What%20causes%20psychosis%3F
Case Study Comment Sheet 4842 (Turn in with Case Study)

Student Name______Brock Grundy_______________________________
Pt Identifier_____NW_________
Date(s) of Care___11/2/2023__________
__________ Objective Data presentation the patient, treatments, medications

_ _________ Discuss patient / family history of mental illness
___________ Identify stressors and behaviors that precipitated current hospitalization
___________ Summarize the psychiatric nursing interventions with rationales
___________ Evaluate patient outcomes for nursing care provided
___________ Analyze ethnic, spiritual and cultural influences that impact care of the patient
___________ Patient education required (based on symptoms, diagnosis, medications, labs,
safety, etc.)
___________ Priority patient needs (day of care and discharge)
__________ Summarize discharge plans and community care
__________ Actual nursing diagnoses, prioritized, using R/T and a.e.b.
___________ List of potential nursing diagnoses
___________ Conclusion paragraph
____________ Style, spelling, grammar, clarity, organization, APA format

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MENTAL HEALTH COMPREHENSIVE CASE STUDY 1

Psychiatric Mental Health Comprehensive Case Study

November 16, 2023

Mrs. Teresa Peck, MSN, RN

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

and symptoms leading to this diagnosis include hallucinations and delusions.

Date of admission - October 25th, 2023

Date of Care - November 2, 2023

Psychiatric Diagnosis - Acute Psychosis

Lab Value Result

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Haloperidol Haldol Antipsychotic 5mg Q6 PRN Agitation

Risperidone Risperdal Antipsychotic 2mg tablet BID Can work with

Valproic acid Depakote Anticonvulsant 250mg BID Psych symptom

Melatonin Circadin Sleep aid 3mg PRN Sleep

Summary of psychiatric diagnosis

psychosis. Acute psychosis is primary if it is symptomatic by a psychiatric disorder and

(Griswold et al., 2015).

in brain development, and exposures to stressors or severe trauma (Understanding Psychosis,

that are present with NW.

Identification of stressors and behaviors precipitating current hospitalization

Prior to admission, NW seemed to be living as a normal 22 year old would. She

and over and say that she is not ok.

Patient and family history of mental illness

hospitalizations in Massachusetts during 1994-2000, unemployment, poverty and housing

security when she leaves.

Psychiatric evidence based on nursing care provided

greatly help with this aspect.

for her because of her current state.

Ethic, spiritual and cultural influences

she still had a faith or belief in God.

Evaluation of patient outcomes

Plans for discharge

Prioritized nursing diagnosis

The following are prioritized nursing diagnosis for NW:

1. Impaired verbal communication related to mental illness as evidenced by lack of eye

contact and yes or no answers to questions.

2. Disturbed thought processes related to mental illness as evidenced by non-realistic

thinking and delusions

3. Risk for violence related to delusions and hallucinations

4. Self-care deficiency is related to mental illness as evidenced by poor hygiene and

6. Risk for self harm related to delusions and hallucinations

Potential nursing diagnoses

3. Self care deficit

5. Impaired verbal communication

7. Risk for anxiety

8. Ineffective role performance

9. Interrupted family processes

10. Impaired social interaction

11. Stress overload

Acute psychosis can be the beginning of a lifelong disease that affects

care of before serious complications occur.

NW experienced several different types of hallucinations and delusions during her

home without the risk of harming herself or anyone else.

Diagnosis of Psychosis in Primary Care. American Family Physician, 91(12),

Siracusano, M., Mazzone, L., & Di Lorenzo, G. (2022). Recognizing Psychosis in

Autism Spectrum Disorder. Frontiers in Psychiatry, 13.

Understanding Psychosis. (n.d.). National Institute of Mental Health (NIMH).

Case Study Comment Sheet 4842 (Turn in with Case Study)

__________ Objective Data presentation the patient, treatments, medications

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