A Case Study On:

DEPRESSION/DEPRESSIVE DISORDER

Student: Ma. Charis Anne M. Indanan

Section: BSN 3A
Clinical Instructor: Mr. Anthony Joseph C. Mercado
Subject Code: NUR 220
Date Submitted: June 3, 2021
 CASE STUDY ON DEPRESSION/DEPRESSIVE DISORDER

A. Case
Patient J.B, 76 years old, male who was admitted for mitral valve repair in inpatient unit.
Nurse Ivan is discussing for his discharge instructions. It was revealed that his serum blood
glucose had been averaging 250mg/dL or higher for the past several months. During his
admission, his dosage of insulin was adjusted, and he was given additional education in managing
his diet.
While giving his discharge instructions, J.B. tells the nurse that his wife died 9 months
ago. He becomes tearful when telling the nurse about that loss and the loneliness he has been
feeling. He also verbalized that he just doesn't feel good lately, feels sad much of the time,
and hasn't been involved in his normal activities. J.M. states, “I'll be so glad to get out of
this place. I'm so fat and ugly. I need to lose 10 pounds. I bet I can do it in just a couple
of days. Otherwise, I don't want to live anymore.”
It was revealed that he has few friends left in the community because most of them
have passed away. He also stated that he has a daughter in town, but she is busy with her
work and with his grandchildren. He also tells Nurse Ivan that he has been feeling so down
the past few months that he has had thoughts about suicide.
Nurse Ivan, use the SAD PERSONS scale to assess J.B.'s potential for suicide and find that he
is at a 4 on the 10-point scale. Nurse was concerned about his statements.
Nurse Ivan, decide to notify J.B.'s physician about his verbalization. The attending physician
calls in a psychiatrist to evaluate J.B.’s situation.
The psychiatrist on call comes in to evaluate J.B. After meeting with J.B., the psychiatrist
writes an order for escitalopram (Lexapro) 10mg daily at bedtime. J.B. is scheduled to see the
psychiatrist the day after he is discharged from the hospital.
J.B.'s daughter visits him in the hospital, and they have a long talk. She is shocked when she
realizes that her father is lonely to the point of considering suicide and tells you that she will do all
she can to help him when he goes home.

B. MENTAL HEALTH ASSESSMENT FINDINGS

ASSESSMENT FINDINGS DISCUSSION
His wife died 9 months ago. He also verbalized that
he just doesn't feel good lately, feels sad much of
the time, and hasn't been involved in his normal
activities.

J.M. states, “I'll be so glad to get out of this place.

I'm so fat and ugly. I need to lose 10 pounds. I bet
I can do it in just a couple of days. Otherwise, I
don't want to live anymore.”
He also tells Nurse Ivan that he has been feeling so
down the past few months that he has had
thoughts about suicide.

He has few friends left in the community because

most of them have passed away. he has a
daughter in town, but she is busy with her work
and with his grandchildren.

C. PSYCHOSOCIAL THEORY

Psychosocial Stage: Ego Integrity vs. Despair Age Range: 65+

Discussion:

Ego integrity versus despair is the eighth and final stage of Erik Erikson’s stage theory of
psychosocial development. This stage begins at approximately age 65 and ends at death. It is
during this time that we contemplate our accomplishments and can develop integrity if we see
ourselves as leading a successful life.

Individuals who reflect on their life and regret not achieving their goals will experience feelings of
bitterness and despair.

Erik Erikson believed if we see our lives as unproductive, feel guilty about our past, or feel that
we did not accomplish our life goals, we become dissatisfied with life and develop despair, often
leading to depression and hopelessness.

Success in this stage will lead to the virtue of wisdom. Wisdom enables a person to look back on
their life with a sense of closure and completeness, and also accept death without fear.

Wise people are not characterized by a continuous state of ego integrity, but they experience
both ego integrity and despair. Thus, late life is characterized by both integrity and despair as
alternating states that need to be balanced.

Source: Mcleod, S. (2018, May 3). Erik Erikson’s Stages of Psychosocial Development. Simply
Psychology. https://www.simplypsychology.org/Erik-Erikson.html

D. DIAGNOSIS
Diagnosis: Depression/Depressive Disorder

The pathophysiology of depression is complex. Several risk factors are associated with depression, such as
childhood adversity and socioeconomic disadvantage, sedentary lifestyle, smoking, poor diet, and poor self-
care. Hence, an individual who is depressed might develop a sedentary lifestyle, poor diet, and poor self-
care, might start smoking—which is more common in people who are depressed vs the general population—
and might also start engaging in substance abuse and misuse, often as part of a self-medication approach.

Source: Corell, C. (2020, April 13). Pathophysiology of Depression - Comorbidities in MDD - Modules - Treatment
Augmentation in MDD. Neurology/Psychiatry - Clinical Care Options.
https://www.clinicaloptions.com/neurology-psychiatry/programs/mdd-augmentation/modules/clinical-focus-
2/page-2#

E. MEDICATION REVIEW (DRUG STUDY)

Medication Indication Mechanism of Contraindication Adverse Nursing
action Effects Responsibilities
Generic Treatment of It blocks uptake Hypersensitivity Overdose
Name: major of to escitalopram. manifested Intervention
escitalopram depressive neurotransmitte Use of MAOI as 1. Supervise suicidal-
disorder; r serotonin at intended to treat dizziness, risk pt closely
Brand generalized neuronal psychiatric drowsiness, during early
Name: anxiety presynaptic disorders tachycardia, therapy (as
Lexapro disorder membranes, (concurrent or confusion, depression lessens,
(GAD). increasing its within 14 days of seizure. energy level
Dosage availability at discontinuing improves, suicide
OFF-LABEL: postsynaptic either potential
Seasonal receptor sites. escitalopram or increases).
affective MAOI). Initiation 2. Assess appearance,
disorder Therapeutic in pts receiving behavior, speech
(SAD) in Effect: linezolid or IV pattern, level of
children and Antidepressant methylene blue. interest, mood.
adolescents, effect. Concurrent use 3. Monitor for suicidal
pervasive with pimozide. ideation (esp. at
developmental beginning of
disorders, therapy or when
 vasomotor doses are increased
symptoms or decreased),
associated social interaction,
with mania, panic
menopause. attacks.

Patient/family
teaching
• Do not stop taking
medication or increase
dosage.
• Avoid alcohol.
• Avoid tasks that
require alertness,
motor skills until
response to drug is
established.
• Report worsening
depression, suicidal
ideation, unusual
changes in behavior.

Source: Bs, R. K. J., & Hodgson, K. (n.d.). Saunders Nursing Drug Handbook 2019 (1st ed.). Saunders.

F. PROBLEM LIST
Problem Rationale

1. Risk for self-directed violence related to social
isolation and loneliness as evidenced by suicidal
behavior
It was revealed that he has few friends left in the
community because most of them have passed away.
He also stated that he has a daughter in town, but she
is busy with her work and with his grandchildren. He
also tells Nurse Ivan that he has been feeling so down
the past few months that he has had thoughts about
suicide.

2. Impaired social interaction related to lack of His wife died 9 months ago. He has few friends left in
support system as evidenced by verbalized feeling the community because most of them have passed
of loneliness away. he has a daughter in town, but she is busy with
her work and with his grandchildren.

3. Hopelessness related to loss and stressors as
evidenced by loss of interest in life
He also verbalized that he just doesn't feel good
lately, feels sad much of the time, and hasn't been
involved in his normal activities. J.M. states, “I'll be so
glad to get out of this place. I'm so fat and ugly. I
need to lose 10 pounds. I bet I can do it in just a
couple of days. Otherwise, I don't want to live
anymore.”

Source: Martin, P. B. (2019, November 4). 9 Major Depression Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/major-depression-nursing-care-plans/

G. NURSING CARE PLAN

 Defining Nursing Scientific Goals of Care Nursing Rationale
Characteristics Diagnosis Analysis Intervention

Subjective Risk for In manic SHORT TERM: Identify the level Client with a high-
Data: self- phase, the After 8 hours of of suicide  risk will require
directed negative, nursing precautions constant supervision
violence uncontrolled interventions, needed. and a safe
related to thoughts, the patient will environment.
social feeling and be able to:
Objective Data: isolation behaviors  demonstrate Encourage Clients can learn
and pose a threat alternative clients to alternative ways of
loneliness or danger to ways of express feelings dealing with
as harm self or dealing with (anger, overwhelming
evidenced others. They negative sadness, guilt) emotions and gain a
by suicidal are feelings and and come up sense of control over
behavior aggressive, emotional with alternative his/her life.
hostile and stress; and ways to handle
cannot  seek help feelings of
evaluate the when anger and
consequences experiencing frustration.
of their self-
behaviors. destructive Contact the Clients need a
impulses. family, arrange network of resources
for crisis to help diminish
counseling. personal feelings of
LONG-TERM: Activate links to helplessness,
After 2 weeks of self-help worthlessness, and
nursing groups. isolation.
interventions,
the patient will Reduce milieu A calm external 
be able to: noise and environment often
stimulation helped to promote a
 have or accompany relaxed internal
satisfaction client to a  state within the
with social calmer, quieter  client and may
circumstance environment at lessen agitation and
s and early signs of prevent
achievement anger, violence.
s of life frustration or
goals; and agitation.
Reference:  state that he
Fortinash,  wants to live. If, hospitalized, There are different
Psychiatric  follow unit measures for the
Nursing  protocols. suicidal client in
Care Plans  either the hospital,
5th ed. clinic, and
pp. 122 community.

Implement a Reinforces action the

written no- client can take when
suicide contract. feeling suicidal.

Defining Nursing Scientific Goals of Care Nursing Rationale

 Characteristics Diagnosis Analysis Intervention
Subjective
Data: Impaired Social
social isolation is 
Objective Data: interaction the condition Collaborative
related to of aloneness 
lack of experienced
support by the 
system as individual
evidenced and perceive
by d
verbalized as imposed
feeling of by
loneliness others and
as a
negative or
threatened
state; 
impaired
social 
interaction is
an 
insufficient
or excessive
quantity or
ineffective 
quality of
social exchan
ge.

Source:

Defining Nursing Scientific Goals of Nursing Rationale

Characteristics Diagnosis Analysis Care Intervention
Subjective
Data: Hopelessness
related to
Objective Data: loss and Collaborative
stressors as
evidenced by
loss of
interest in
life

Source: