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Case Study
Case Study
Cambrie Campbell
Abstract
J.M. is a 35 year old admitted to the acute inpatient psychiatric unit at Generations following a
suicide attempt. He has a medical diagnosis of Major Depressive Disorder and Generalized
Anxiety Disorder. J.M. also has William-Beuren’s Syndrome. He experiences frequently suicidal
ideations and depression on a daily basis. Symptoms have been managed with medical treatment
Objective Data
Age 35
Sex Male
Behaviors on admission J.M. had held a knife to his throat and threatened to slice it. J.M. had
also written and left a suicide note to his mother. The patient states “I’m just in so much pain”
Behaviors on date of care J.M. was interacting with another patient prior to the conversation.
When approached, he was calm and willing to speak. It is noted his general appearance was poor.
He had poor hygiene, unkempt grooming, a slouched posture, and greasy/unwashed hair. His
speech patterns were slow and dysphoric. J.M.’s general attitude was cooperative, friendly,
attentive, and only slightly guarded. His mood was sad, depressed, anxious, fearful, and
despairing. J.M.'s affect was congruent with mood and appropriate for someone working through
the grieving process. His affect could be described as slightly blunted, flat, and dysphoric.
Evaluating his thought process, it was found he was able to think abstractly and concretely. He
was not experiencing delusions and/or hallucinations. It was the content of his thought where
issues were arising. He reported suicidal ideations, intent, and a plan, as well as some
obsessive/compulsive ideas and phobias. Treatment for J.M. includes suicidal floor safety
CASE STUDY 4
measures, psychiatric medications for stabilization, group therapy, one on one therapy, social
Patients were not permitted off the unit, staff badges were required to enter and pass
various sections of the facility, staff was present within patient sight at all times (excluding
bedrooms), hazardous items were removed prior to admission, pencils and pens were accounted
for on the unit and taken when not in use, markers were used for coloring, suicidal fixations such
as flat doorknobs and box beds were in place, aggressive patients were moved to a different part
of the unit, the nurse’s station had clear plastic windows enclosing it from the common area,
medications were locked behind a metal garage door, a nurse verified all medications before
Laboratory Results
Patient Medications
doses (max
100 mg/d)
Psychiatric Diagnoses
J.M. received two psychiatric diagnoses and one genetic diagnosis that are to be defined
and elaborated on to follow. The psychiatric diagnosis being Major Depressive Disorder and
at a younger age.
The Mayo Clinic states that “Depression is a mood disorder that causes a persistent
feeling of sadness and loss of interest. Also called major depressive disorder or clinical
depression, it affects how you feel, think and behave and can lead to a variety of emotional and
physical problems. You may have trouble doing normal day-to-day activities, and sometimes you
may feel as if life isn't worth living” (Mayo Clinic Staff, 2018). Major Depressive Disorder lasts
CASE STUDY 7
at least two weeks. The patient can experience symptoms such as unexplained weight loss or
thoughts, and feelings of hopelessness, despair, and/or distress. These symptoms can affect the
and anxiety felt by the individual at least 50% of the time within a 6 month frame or longer. Due
to a lack of control over the constant worrying the person may exhibit symptoms such as
“uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations”
genetic disorder. This syndrome is caused by the deletion of the Williams–Beuren syndrome
Deletion of this gene shows increased risk for diabetes, hypertension, and anxiety in these
individuals. William’s Syndrome presents in various ways. One presentation, which J.M. seems
to present as, “is characterized by hypercalcemia plus persistent growth failure, characteristic
facial appearance, “mental retardation,” heart murmur, and hypertension, while the other was
reflecting similarly to those with growth retardation and mental retardation (Pober, 2010).
J.M. presents to the emergency room on October 31st, 2021 with anxiety, agitation, and
suicidal ideations. When asked if he has a suicidal plan, he answers by stating “I was going to
CASE STUDY 8
slice my throat” to the nurse. He also expresses “I’m just in so much pain” to the staff. His
After investigating further, his mother informs staff of important information pertinent to
J.M.’s psychiatric exacerbations. His mother reveals that the father had recently passed away in
August and J.M. had not had these psychiatric experiences prior to the incident. She reports that
she has been in the process of obtaining guardianship of J.M. since the father’s death, and has
been watching for J.M. and administering his medications. Additionally, she hands staff the
suicide note J.M. had written. She also informs the nurse that the patient’s father had diabetic
neuropathy, which J.M. now believes is what causes his own pain and this pain causes him to
have increased anxiety consistently. J.M. made the suicide attempt in front of her.
While talking with J.M., he shares some factors that uncover potential contributing
compliant with his medications or not. He expressed a dependency on someone to organize and
remind him of his medications. He also shares he is unaware of important information pertaining
to his medications. When asked, he did not know what medications he was on, how many he
should have been taking, when he should have been taking them, why he was taking them, or the
side effects of his medications. Moreover, he fails to express any information relating to the
recent passing of his father. He also fails to mention that this is his third psychiatric admission
within the past two months. When asked about any potential triggers to his anxiety/sadness he
blames neuropathic pain. The way he describes the onset of anxiety in relation to the nerve pain
seems to resemble that of an anxiety attack. He does express a fear of the recurrence of this pain.
The patient is partially aware of all his diagnosis. Pertaining to his psychiatric diagnosis,
he is aware that he should not be feeling this way, that he knows something is wrong. He was
only recently diagnosed with them (within the past two months). The passing of his father seems
to have triggered these onsets. He is more aware of his genetic diagnosis of William-Beuren’s
cardiac and facial formation problems. There is no family history of mental illness listed in his
chart. The only time the patient shares information pertaining to his family is during the group
session. Even here he only briefly mentions his mother and brother, listing them as his support
system.
precautions, assisting through the grief process, encouraging self-control over life situations, and
ensuring that his needs related to nutrition, elimination, activity, rest, and personal hygiene are
met. Additional nursing intervention, related to J.M.’s medications, would be reminding him
when to go to the medication station to receive his prescriptions, and educating him on their
J.M. is a white/caucasian single male. He had lived with his father up until his death. He
now lives with his mother. Their economic class is unknown. J.M. does not mention a
CASE STUDY 10
job/employment. His source of income is unknown. He does not express any religious
beliefs/practices.
3. Does J.M. know where to seek assistance outside of the hospital if suicidal thoughts
4. Has the client discussed the recent loss with the staff and/or family members? No.
5. Is J.M. able to verbalize feelings and behaviors associated with each stage of the grieving
6. Is the client able to verbalize positive aspects about self, past accomplishments, and
7. Can the client identify areas of the life situation over which he has control over? No.
J.M. actively seems to have responded to some of the interventions and therapy however,
there are many areas where J.M. could improve with the continuation of care. For instance, J.M.
has refrained from self-harm while under acute care but he states he is still experiencing suicidal
ideations “around 10-15 times a day”. Also, J.M. is unsure of where to seek assistance aside from
a hospital and his mother if suicidal ideations were to recur upon discharge. Additionally, J.M.
has not discussed the recent loss with the staff and has not verbalized feelings/behaviors
CASE STUDY 11
associated with the stages of the grieving process. It is not known if J.M. is even aware of the
stages of the grieving process. J.M. recognizing his own position in the process appears
unachievable at this current time due to the lack of previous knowledge and difficulty with
denial. Moreover, it is evaluated that J.M. is unable to gain control over his anxiety exhibited by
restlessness, fidgeting, and stuttering during the group when exposed to stimuli (stimuli being
Discharge
When J.M. is discharged, he will be returning home where he resides with his mother.
J.M. may be probated to stay longer at Generations due to the lack of cessation of suicidal
ideations. J.M. would benefit from medication education, establishing an everyday home
self-care, having an activity or hobby to instill responsibility, motivation, and purpose (such as
having a support animal, joining a club, starting a career, extending schooling). Support services
that he may benefit from include support groups, group therapy sessions, and/or one-on-one
therapy sessions.
Nursing Diagnosis
1. Risk for suicide related to depressed mood as evidence by recent statements of suicidal
2. Ineffective coping related to recent death of father as evidence by recent suicide attempt
1. Panic anxiety
2. Powerlessness
4. Self-care deficit
Conclusion
These neurotransmitters are responsible for feelings of pleasure, happiness, movement, and
motivation. These all may become diminished or absent with Major Depressive Disorder. The
mood disorder can be life-long, meaning the client may never stop experiencing fluctuating
J.M. is currently still working through the grieving process, and trying to do so with his
recent diagnosis of Major Depressive Disorder. J.M. is at risk for suicide ideations and another
suicidal attempt. Goals for J.M. are cessation of suicidal ideations and plans, practicing positive
With encouragement, compliance, supportive services, and consistent treatment, J.M. may
hopefully prevent further suicidal ideations/self-harm and obtain his optimal quality of life.
CASE STUDY 14
References
Mayo Clinic Staff. (2018, February 3). Depression (major depressive disorder). Mayo Clinic.
Retrieved from
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356
007
https://challengesandinitiatives.trubox.ca/wp-content/uploads/sites/601/2018/12/Nanda-N
ursing-diagnosis-list-2018-2020.pdf
https://williams-syndrome.org/resource/NEJM-williams-beuren-syndrome