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Running Head: Psychiatric Mental Health Comprehensive Case Study

Psychiatric Mental Health Comprehensive Case Study

Chaylee Bentley

Youngstown State University

NURS 4248L

Mrs. DeFiore-Golden
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Running Head: Psychiatric Mental Health Comprehensive Case Study

Abstract:

C.J. is a 38-year-old female that arrived at the St. Elizabeth’s downtown emergency room on

9/11/2020. She came to the emergency room seeking a psychiatric evaluation and stating that she

felt “like she was losing control” and hadn’t been taking he medications as prescribed. She also

wanted to receive a trauma consult related to a domestic violence injury she had endured earlier

in the month. On admission it was noted that she was able to rapidly change her moods,

thoughts, feelings, and behaviors. It was also noted that she has an extensive mental health

history with the focus diagnosis of this particular stay being Severe Manic Bipolar I Disorder

with Psychotic Behavior. After the evaluation she was later pink slipped and voluntarily

committed to the behavioral health unit. The date of care of this case study was performed on

September 17th, 2020. She was later discharged on the day of care and was sent to the Rescue

Mission of Mahoning County. In this case study I plan to discuss the patients background,

behaviors witnessed, plan of care for stay and upon discharge, diagnoses, nursing diagnoses,

stressors related to admission, nursing care provided, patient outcomes, and spiritual, ethical, and

cultural influences on the patient.

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Running Head: Psychiatric Mental Health Comprehensive Case Study

Objective Data:

C.J. is a 38-year-old caucasion female who was voluntarily committed to the Behavioral Health

Unit at St. Elizabeth’s Belmont Campus on 09/11/2020. C.J. was oriented times four. She had

arrived at the emergency department in the middle of the night on 09/11/2020 for a psychiatric

evaluation and stated that she felt like she was losing control and hasn’t been taking her

medications as prescribed. It was noted that she was experiencing auditory hallucinations and she

was able to switch from multiple moods, feelings, and personalities spontaneously. She was then

pink slipped. I cared for this patient on 09/17/2020. She has an extensive mental health history

including all of the following diagnoses; Bipolar Disorder, Obsessive Compulsive Disorder

(OCD), Anxiety, Post Traumatic Stress Disorder (PTSD), Borderline Personality Disorder,

Schizophrenia, and Cannabis and Alcohol Abuse. The psychiatric diagnoses for this particular

stay was Severe Manic Bipolar I Disorder with Psychotic Behavior. 

Some of the important lab results that were flagged include a BUN level of 21 where the normal

range is (6-20). This can be due to the fact that psychiatric medications can cause kidney related

issues, along with her also experiencing depression symptoms. Her Lithium level was low

reading at 0.30 and the normal range for that is (0.50-1.50). This is due to the fact that the patient

wasn’t taking her medication properly prior to admission. The patient also had an RDW Glucose

reading of 110 and the normal range is (74-99). This patient suffers from anxiety and that causes

an increase in your cortisol levels which is why her glucose was high. 

On 09/17/2020 I provided care for this patient. She had very animated facial expressions. She

was smiling, happy, and seemed energized. Her posture was relaxed. She was neat and

appropriately dressed and groomed. Her motor activity exemplified a lot of restlessness and she
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Running Head: Psychiatric Mental Health Comprehensive Case Study

had increased movements. She was witnessed pacing near the nurse’s station when she was

getting ready to be discharged. C.J. presented very friendly, open to talk, cooperative with

treatment. When talking with this patient she presented a lot of tangentiality jumping around

from topic to topic during discussion. Along with flight of ideas with rapid speaking and quick

changes from one thought to another. 

Most of her treatment is medication related along with setting up outside resources to maintain

her medication regimen upon discharge from the hospital. She was able to receive a trauma

consult during her visit as well. This is related to an incident that took place at her sisters’

residence where her significant other had pushed her down 6 stairs and was punched in the face,

head, and neck. This was not the first time she had been a victim of domestic violence. She

sustained a right orbital fracture from the trauma. The perpetrator of the abuse is currently

serving time in jail. This is keeping her safe and away from him. The patient also wanted to work

on getting housing with the help of the social worker on the unit. She currently only receives

disability due to her mental health condition. Some safety concerns with the patient included her

being discharged and having a place to go. She ended up going to the Rescue Mission since she

did not want to go back to her sister’s residence where she was living in her backyard in a tent

prior to admission. It was important that she had a bed to sleep in and a roof over her head; along

with food and water. So, the Rescue Mission was a good place for her to go. Some other

security/safety measures on the unit for this patient included a private room that was known as

her safe space. The unit is a locked unit at all times. The staff also removes any potentially

hazardous or dangerous items from the patient. 

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Running Head: Psychiatric Mental Health Comprehensive Case Study

Her medications during her stay included:

Haloperidol (Haldol) - to help with agitation.

Hydroxyzine (Vistaril) - To treat anxiety. 

Trazodone (Desyrel) - To help her sleep.

Risperidone (Risperdal) - To treat her personality disorder.

Lithium - Used to treat her bipolar disorder and manic symptoms. 

Summarize the psychiatric diagnoses:

To begin according to a research article “Bipolar disorder is a common illness, affecting 2% to

3% of the population worldwide” (Swartz, 2019). Bipolar Disorder or formerly known as Manic

Depressive Disorder (MDD) “is diagnosed when a person’s mood fluctuates to extremes of

mania and/or depression” (Videbeck & Miller, 2020). So, as for the depression a depressive

episode can last up to 2 weeks in these patients. Symptoms of depression can include “changes in

eating habits, resulting in unplanned weight gain or loss; hypersomnia or insomnia; impaired

concentration, decision-making, or problem-solving abilities; inability to cope with daily life;

feelings of worthlessness, hopelessness, guilt, or despair; thoughts of death and/or suicide;

overwhelming fatigue; and rumination with pessimistic thinking with no hope of improvement.

These symptoms result in significant distress or impairment of social, occupational, or other

important areas of functioning” (Videbeck & Miller, 2020). This can then send the patient into

either a hypomania or mania state of being. During a manic state there is in increase in the

patient's activity level, they are easily distracted, they don’t see any problem with their behaviors

and want to blame someone else, they have increased irritability, pressured speech, flight of

ideas, risk taking behaviors, and some also experience hallucinations and or delusions also

known as psychotic features. While in a hypomania state these symptoms are lessened and they
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Running Head: Psychiatric Mental Health Comprehensive Case Study

don’t impact a patient's ability to function.  Specifically, Bipolar 1 disorder is classified by “one

or more manic or mixed episodes usually accompanied by major depressive episodes'' (Videbeck

& Miller, 2020). Bipolar disorder is a chronic condition that affects a patient's life in many ways.

As stated in one of my research articles “BD has a substantial lifetime prevalence in the

population at 4%. Because the manic or depressive symptoms of BD tend to be severe and

recurrent over a patient's lifetime, the condition is associated with significant burden to the

individual, caregivers, and society” (Mccormick, Murray, & Mcnew, 2015). It was mentioned in

another article that these patients are have an “Elevated risk for suicide and cardiovascular

diseases contribute to increased risk for premature mortality” (Swartz, 2019).

Identify the stressors and behaviors:

C.J. has experienced a lot throughout her lifetime from things like domestic violence, verbal

abuse, loss of loved ones, miscarriages, substance and alcohol abuse, family disowning her due

to her mental health conditions, and all of her mental health diagnoses. I believe that the main

stressor to this particular situation was due to the fact her significant other had thrown her down

6 stairs and punched her in the face, head, and neck earlier this month. He is currently serving

jail time according to her. She was also living at her sister’s residence in a tent in the backyard.

She stated she was there to help her sister get away from her own domestic violence situation;

but the sister wasn't cooperating and that frustrated her as well. She is also currently jobless; but

is receiving disability due to her mental health condition. 

Discuss the patient and family history of mental illness:

According to the patient's chart she has been suffering from her mental illnesses for quite some

time. As I mentioned above she has experienced a lot throughout her lifetime from things like
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Running Head: Psychiatric Mental Health Comprehensive Case Study

domestic violence, verbal abuse, loss of loved ones, miscarriages, substance and alcohol abuse,

family disowning her due to her mental health conditions, and all of her mental health diagnoses.

However, this was her first documented stay in the Behavioral Health Unit here in Youngstown,

Ohio. According to her she has had other admissions where she previously resided in Indiana.

This information was not accessible to me. 

The patient did disclose some family history of mental illness. She had a father who abused

drugs and alcohol. He later committed suicide and she was never able to meet him. She also had

a sibling who used and abused drugs. She didn’t disclose anything further than those few details. 

Describe the psychiatric evidence-based nursing care provided:

Safety- Safety of the patients on the behavioral health unit is the number one priority on the

floor. There are many things in place to keep each and every patient safe. These include things

like heavy furniture to prevent anyone from picking up and throwing things and potentially

harming themselves or someone else. The unit is locked 24/7 and the staff can monitor visits and

phone calls for the patient's best interest. Nurses and staff are consistently checking on each

patient roughly every 15 minutes or so. When the patients are admitted their belongings are

stored safely away and anything that could be a potential danger that could harm either the

patient or someone on the floor is taken away as well. The patients are provided with different

activities and group sessions they can attend throughout the day as well. 

Proper medication administration and education- This provides the patient with a routine with

scheduled medication administration time. While also educating the patient on the importance of

staying on the medication, monitoring for signs and symptoms of any adverse reactions, and

teaching the patient about the medication they are taking and how it is treating their condition.
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Running Head: Psychiatric Mental Health Comprehensive Case Study

Group Therapy Sessions- Psychotherapy is a good outlet for the patient when admitted to a

mental health facility. This gives the patient the ability to communicate with others around her,

develop a sense of trust, support, and social relationships. While also providing the patient with a

sense of self awareness. Through the group sessions my patient attended she was able to develop

goals that she wanted to meet for herself after she was discharged from the hospital. Like

applying for housing through the government so she could get back on her feet. 

Social Interactions in the milieu- This again gives the patient the ability to meet others who can

sometimes better relate to their own situation. It gives them the chance to make friends and

interact with others on the floor along with the nursing staff. My patient said that she likes to

watch movies and was able to really point out anyone on the floor and knew their names. She

said this was because she was a talker and liked to get to know new people. 

There was a research study done titled Patient experiences with nursing care during

hospitalization on a closed ward due to a manic episode. Below I want to provide a list of direct

quotes from patients who participated in the study that stood out to me. 

 “The calmer they responded, the calmer I got.”

 “I was furious, thought my friend had betrayed me. Talking with a nurse gave me a
different viewpoint.”

 “I knew they wanted the best for me.”

 “You are very dependent on them and thus develop a form of love for them.”

Just based on these few quotes taken from patients in this study you can see just how important

and impactful nursing care really is on a behavioral health unit. As stated in the article “Nurses

clearly shape the experiences of patients with a diagnosis of BD and hospitalization on a closed
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Running Head: Psychiatric Mental Health Comprehensive Case Study

ward due to an acute episode of mania. Providing safety and a sense of security are vital to

enhance recovery. Perceptions of nursing care varied across the participants interviewed in the

present study but were mostly positive” (Lankeren, Testerink, Daggenvoorde, Poslawsky, &

Goossens, 2019).

Analyze ethic, spiritual, and cultural influences: 

The patient identified her religion/culture as Paganism. This religion has a lot to do with nature

and the natural world. She believes in gods and goddesses. There are many different spiritual

traditions she takes part in like tarot readings, crystal healings, palm readings, and pendulum

readings as well. 

This patient has a big family however she has lost contact with many of those family members

due to her mental health condition. She stated her family doesn't want anything to do with her

because of her mental health issues. They have a tendency to call her names and not help her out

when she needs it. She has a good heart and good intentions. No matter the hurt or trauma she

has experienced in her lifetime she still wants the best for those around her and would give

someone the shirt off of her back if they needed it. 

Regarding ethics the patient is aware of what is right and what is wrong. However, she admitted

to sometimes not following her moral compass and not choosing to do the right thing. For

example, she mentioned the fact that she wasn’t proud of her past drinking habits but has decided

to stop drinking excessively. However, she stated she doesn't want to quit smoking cigarettes

even though she knows they are not good for her health. 
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Running Head: Psychiatric Mental Health Comprehensive Case Study

Evaluate patient outcomes:

The patient stated that her main goal when choosing to seek help for issues related to this

admission was to get back on track with her medications. This was so that she could feel like she

gained back her control and stabilize her to give her the ability to be discharged and have plans

in order to obtain housing. When she was being discharged she had a very positive attitude. She

stated that she couldn't wait to get out there and get her life back on track for herself and her two

children she does not currently have custody of. She mentioned that she was proud of herself for

seeking help and getting it and being able to be discharged on 09/17/2020. She also made it a

point that she wants to be able to stay on her medications and take them as prescribed to prevent

this from happening again in the future.

Summarize plans for discharge:

Upon discharge it is important for this patient to maintain and follow her medication regimen so

that she doesn't end up back in this situation. I feel that she seemed very motivated to do this

upon being discharged. She was directed to the Rescue Mission for shelter until she is able to get

housing for herself. She also wants to look for some kind of employment or get back into school

and work towards a degree. She had plans to get back into things that used to make her happy

like DIY crafting, crocheting, and making art. She also wants to maintain doctor’s visits and

counseling sessions to help her continue to process past traumas.

Prioritized list of all actual diagnoses:

Risk for injury including self-harm and or suicide related to multiple psychiatric disorders, and

lack of a support system outside of hospital. Evidenced by extreme hyperactivity and poor

judgement.
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Running Head: Psychiatric Mental Health Comprehensive Case Study

Risk for ineffective health maintenance related to inability to make appropriate judgements and

insufficient resources as evidenced by the lack of financial resources and past history of not

taking medications as prescribed.

Risk for loneliness related to physical and social isolation as evidenced by the patient stating

that the hospitalization severed the relationship with her and her sister, and the patient being

from out of state with minimal connections here in Ohio. 

List of potential nursing diagnoses:

Risk for individual ineffective coping related to ineffective problem-solving abilities.

Risk for total self-care deficit related to racing thoughts and poor attention span.

Risk for fatigue related to psychological demands.

Risk for risk prone health behaviors related to a low state of optimism.

Risk for chronic low self-esteem related to repeated unmet expectations.

Risk for spiritual distress related to multiple mental health diagnoses.

Risk for ineffective activity planning related to unrealistic perception of events.

Conclusion:

To conclude this case study review. I would like to mention how helpful this was for me to take a

patient that I cared for and really delve into their diagnoses and each step of the process through

their treatment from admission to discharge from the hospital. I have thoroughly discussed my

patients experience with mental health and her plans for after discharge. C.J. was a 38-year-old

female that arrived at the St. Elizabeth’s downtown emergency room on 9/11/2020. She came to

the emergency room seeking a psychiatric evaluation and stating that she felt “like she was

losing control” and hadn’t been taking he medications as prescribed. She also wanted to receive a
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Running Head: Psychiatric Mental Health Comprehensive Case Study

trauma consult related to a domestic violence injury she had endured earlier in the month. I cared

for her on 9/17/2020. During her stay the staff was able to get her Lithium levels back to normal

before being discharged. The patient was successfully discharged on 9/17/2020 to the Mahoning

Valley Rescue Mission with plans to seek government aid for housing along with searching for a

job and finding ways to help others cope and understand their mental illnesses. She also plans to

maintain her strict medication regimen and seek help if she is unable to do so. Her stay at the

Behavioral Health unit gave her the boost she needed to get stabilized and get motivated to get

back on her feet for herself and her children.

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Running Head: Psychiatric Mental Health Comprehensive Case Study

References:

Lankeren, J. E., Testerink, A. E., Daggenvoorde, T. H., Poslawsky, I. E., & Goossens, P. J.
(2019). Patient experiences with nursing care during hospitalization on a closed ward due
to a manic episode: A qualitative study. Perspectives in Psychiatric Care,56(1), 37-45.
doi:10.1111/ppc.12370

(Lankeren, Testerink, Daggenvoorde, Poslawsky, & Goossens, 2019)

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. doi:10.1002/2327-6924.12275

(Mccormick, Murray, & Mcnew, 2015)

Swartz, H. A. (2019). Addressing Unmet Needs in Bipolar Disorder. Psychiatric Annals,49(9),

377-378. doi:10.3928/00485713-20190807-01

(Swartz, 2019)

Videbeck, S. L., & Miller, C. J. (2020). Psychiatric-mental health nursing. Philadelphia, PA:

Wolters Kluwer. Retrieved September 22, 2020.

(Videbeck & Miller, 2020)