Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY 1

Psychiatric Mental Health Comprehensive Case Study

Samantha DiTosti

November 2, 2022

Ms. Elizabeth Sanford, MSN, RN

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

MENTAL HEALTH COMPREHENSIVE CASE STUDY 2

Objective Data

Patient identifier DS

Age 39

Sex Male

Date of admission October 24, 2022

Date of care October 27, 2022

Psychiatric diagnosis Suicidal Ideation

Other diagnoses gunshot wound, rib fracture, depression, suicide attempt, bipolar 1 disorder

Behaviors on admission DS had been hearing auditory hallucinations while being at home.

Patient stated that he drinks 24/7 and hears sex on the television. Patient stated he was sexually

assaulted as a child and is now addicted to sex. Patient stated he had been trying to kill himself

for a while now.

Behaviors on day of care DS was openly willing to speak to my partner and I during our

clinical day. DS was calm however he seemed anxious when discussing his life story. The

patient expressed several times throughout the conversation his frustrations on how he wishes he

could go back in time and not be who he was today. DS had been experiencing non-bizarre

delusions and persecutory delusions. Regarding the non-bizarre delusions, DS had convinced us

that he had been living with his girlfriend who was his ex-girlfriend referenced from the charting.

The patient lives at his parents’ home rather than his shared home with his girlfriend with his two

daughters. DS participated in group therapy with both the guest group therapy leader and my

group during our group therapy session. DS did not have any deviations to his speech patterns.

DS was cooperative and friendly when answering questions. DS had seemed sad, anxious,
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depressed, fearful and guilty however he was interested in getting rehabilitation for his drug

addiction of heroin.

Safety and security measures While being on the inpatient behavioral health unit, several safety

and security measures were implemented. All doors that were opened by a staff member must

have been checked to make sure that it was closed behind you after entering. All doors were

locked entering the unit and entering the nurses’ station. Patients were required to remain on the

unit and were never allowed to leave the unit. Visitors were limited depending on the current

patient illness. The counters that surround the nurse’s station are wide while the inner table is set

at a low level to provide a barrier between the patient and nurses. Glass windows surround the

nurse’s station near the entrance of the unit where patients enter. Staplers, pens, paperclips,

scissors, and notebooks with wires were not permitted to be set anywhere on the nurse’s station

desk. Within the patient’s rooms, the doors are at a slant to be able to always see the patient’s

head and feet. The patients are unable to have any belongings that can cause harm to self or

others. For example, are cellphones, any type of jewelry, belts, and no pens. The milieu area has

chairs that are extremely heavy to prevent from throwing them at others. The aids or nurses do a

patient check every hour to make sure to document where the patient is and what the patient is

doing at that time. The nurses would do vital signs and assessments prior to mealtimes to see

how the patient was positively progressing in their care in addition to administering medications

while supervising.

Laboratory results

Lab Value Result

Glucose 117

TSH 2.720
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T4 1.04

RBC 5.0

Hgb/Hct 15.9 / 43.2

WBC 5.2

BUN/Creatinine 10 / 0.5

QTc 448

Toxicology Negative

Potassium 4.2

Sodium 135

WBC 5.2

Psychiatric medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Nicotine patch NicoDerm CQ Stimulant 21 mg patch Pt addicted to
daily cigarettes
Melatonin Circadian Hypnotic 3 mg PO daily Sleep
disturbances
Quetiapine Seroquel Antipsychotic 400 mg PO Bipolar 1
nightly disorder
Valproic Acid Depakene Anti-convulsant 500 mg PO 2x Bipolar 1
daily disorder

Summary of psychiatric diagnosis

Suicidal Ideation is also known as suicidal thoughts or ideas. Suicidal ideation is when an

individual has a fixation with death and suicide (Harmer et al., 2022). Many challenges are faced

with physicians because there are not consistent definitions regarding suicide which make it

difficult to understand observations in relation to suicide. With this, it is important to use an

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appropriate assessment suicidal tool to allow for early identification of suicide and provide early

intervention to prevent an individual from dying.

Suicidal ideation contains two types. The first suicidal ideation is active. With active, a

person has present suicidal ideas. The person will inflict self-harm by trying to result in death.

The focus is not on how destructive the harm may be rather the person is trying to cause death as

a final result. An example of this type of suicidal ideation includes asking the patient if recently

they have had thoughts of killing themselves in addition to how frequent they think of this. The

second type of suicidal ideation is passive. With passive, the person has suicidal ideation but

does not have a plan to carry it out. The person would have an accidental death rather than a

plan. An example of this would be to use an assessment tool. The scale includes a rating of 0-2. 0

indicated that the person would take appropriate actions to remain form dying while 1 indicated

that the person would not be bothered if they would die by chance. 2 indicated that the person

would not doing anything to keep themselves alive and would rather let themselves die. To

follow this assessment tool, a depression scale and modified suicidal ideation tool are used. With

the depression scale, the person would be asked if they felt the desire to die within the last

month. The modified suicidal ideation tool would ask the patient if they purposely tried to not

care for themselves in addition to trying to kill themself by not eating or drinking enough. To

follow this, the patient would be asked if they had stopped taking the appropriate medications

daily as prescribed. (Harmer et al., 2022).

Within the emergency department, during triage, a suicidal ideation tool is used to early

identify individuals who are having suicidal thoughts. Those screened within the emergency

department for suicidal ideation and not meeting the criteria had a 3% increase of being

readmitted within six months meeting the criteria for suicidal ideation. (Harmer et al., 2022). DS
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had this similar incidence when he had been admitted for his fall from his job. Once he was

cured, he had been readmitted to the emergency department a year later for suicidal ideation.

With suicidal ideation, psychosis symptoms occur. DS was experiencing auditory

hallucinations by hearing people having sex on the TV related to his childhood sexual abuse.

Those who experience psychosis symptoms had a double chance of having suicidal ideation.

(Harmer et al., 2022).

Auditory hallucinations are when a sensory experience of hearing voices occurs without

the actual external source present. Auditory hallucinations can occur with several diagnoses

including depression and drug abuse. DS experienced both illnesses. With auditory

hallucinations, negative comments are being heard subconsciously that cause impaired reality

and occurrence of a psychotic breakdown. DS was experiencing suicidal ideation due to his

depression and hearing inner voices that reflect an emotional past event of sexual abuse

(Hugdahl, 2017).

Overall, suicidal ideation can stem from depression and auditory hallucinations in which

DS had been experiencing. Suicidal ideation can stem from an active or passive point of view.

Both can be degrading for a person causing further injury to self.

Identification of stressors and behaviors precipitating current hospitalization

Prior to admission, DS had been drinking throughout the entire day, every day, in

addition to finding different ways to kill oneself. The patient stated that he had been creating a

bomb to kill himself. The patient was addicted to heroin and would try to kill himself by having

it laced with fentanyl. DS was disturbed because he felt as if his girlfriend had secret cameras to

spy on him because each time he would overdose he would always be revived. DS lives at home

with his three daughters and claims to be living with his girlfriend as well. DS explained that he
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and his girlfriend had been going through a rough patch because he has erectile dysfunction from

his medications in addition to his addictions. DS expressed his strong love for his children. DS

had tried to kill himself multiple times by drowning himself in sink water. DS had expressed

frustrations that he had been on disability for years after he fell off a roof building within his

construction job. Patient explained that when he fell it caused a concussion leading to a stroke

which led to traumatic brain injury and aphasia. Pt stated he had felt depressed ever since this

event because he currently is still unable to function normally due to lingering effects of back

pain. Patients’ discs had been misplaced. Ds recently had been admitted for low sodium levels

(hyponatremia) from the high alcohol content. Patient was then involuntarily admitted into the

behavioral health unit due to expression of suicidal ideation in addition to putting those he lives

with in harm from his attempt of bomb creation.

Patient and family history of mental illness

DS explains that he has been depressed for many years and has had suicidal ideations

after his accident at work. DS does not have any family history of mental illness however DS had

explained a time in which when DS was at the hospital at Cleveland Clinic his mother had called

the doctor to tell him that he was trying to put him in a coffin. DS followed up with that his mom

was crazy. The patient did not express any feelings about his father or other family members.

DS claims to be living with his girlfriend in a house with his three daughters. During

crisis, ED had documented that patient was living with his parents after recent break up with

girlfriend.

Psychiatric evidence-based nursing care provided

During DS stay in the behavioral health unit, many different nurses had cared for him

during his stay. The patient had expressed frustration in which he would be going to jail for ten
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years after expressing that he was suicidal. The patient felt as if the nursing staff was wrong in

doing this. The nurse begins care by taking his vital signs to evaluate internal and external

factors. Regarding internal factors, the nurse is making sure that medications are not causing any

harm to the patient’s vital organs. To follow, the patient is given his medication to keep him

stabilized. The nurse will ask his name and birth date verification followed by the medication

given and potential side effects that may occur. The patient is also taught when to report adverse

side effects. Each day, the patient would be evaluated by a nurse by doing a complete assessment

focused on his suicidal thoughts, how he is overcoming these thoughts, what he is doing to

overcome these thoughts and being evaluated by nursing staff to see if improvements are

occurring. Each day the patient is to attend group therapy sessions to learn how to overcome

challenging times by learning coping mechanisms. With this, other individuals are to attend

group therapy sessions to express their way of overcoming challenges that may be like DS. DS

can learn proper coping mechanisms through his peers experiencing similar situations. Each

activity had a set time and set structure that everyone was to follow. It began by breakfast,

medication, group therapy session, lunch, afternoon down time, dinner, and group therapy

session to end the day. DS expressed that group therapy sessions have helped him work through

his thought processes in a meaningful and positive way. The patient felt that rehabilitation would

be similar and that he would be less nervous and more willing to fully go through the

rehabilitation process. The patient is currently taking an antipsychotic such as Seroquel and an

anti-convulsant such as Depakene for his bipolar disorder. Overall, the patient had stated that he

had felt more controlled and in a better state of mind to getting rehabilitation services for his

drug and alcohol addiction.

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Ethnic, spiritual, and cultural influences

DS is a Caucasian male. DS is currently on disability receiving two hundred dollars a

month while his girlfriend is receiving five hundred dollars a month. Patient expresses that he

cannot afford anything. DS stated that he is catholic and believes that God makes it so everything

happens for a reason. The patient expressed he has a true connection with God. Patient also

expressed that he prays daily before bedtime.

Evaluation of patient outcomes

Patient outcomes for this patient were positive ones. With suicidal ideation, the outcomes

included joining self help groups as the patient plans to do for his drug addiction, patient will

withhold from trying to commit suicide by reaching out to a nurse he trusts prior to trying to

attempt, patient was able to state a goal that he had for his future which was to be free of drugs

and be a better father figure for his three daughters. During the inpatient admission, DS was

providing self-care by eating his entire dinner meal and discussing his feelings to the students

and nurses to work through his problems. DS also stated that he wanted to live to be there for his

children. DS was able to accept his mistakes and find a way to cope with his thoughts by

expressing how he could be better in the future and to find someone to trust to talk to when he

feels hopeless. DS was able to take his medications at appropriate time intervals.

DS still was anxious and had a semi depressive mood when interviewing him however he

had a state of mind where he wanted to better himself to be appropriately present for others. DS

felt that group therapy had benefited him by allowing him to use appropriate coping skills for

frustrations when necessary.

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Plans for discharge

DS’s plan when discharged is to move into his home with his girlfriend and children to

fix what he has claim to have broken however admission charting stated that he and his girlfriend

had broken up. DS will then be in jail for ten years due to his attempt to create a bomb. DS will

remain compliant with his medication regimen and attend rehabilitation for his drug addiction

post jail time. DS will be educated on his medication, side effects, adverse effects and

complications that could arise.

Prioritized nursing diagnoses

The following are prioritized nursing diagnoses for DS:

1. Disturbed sensory perception related to sexual abuse as evidenced by auditory

hallucinations.

2. Disturbed thought processes related to persecutory delusions of patient’s thoughts of

living with his girlfriend.

3. Anxiety related to attending rehabilitation for patient’s drug addiction to heroin.

4. Depression related to inability to function normally due to dislocated discs within the

vertebrae.

5. Risk for suicide related to suicidal ideation of previous plans to kill oneself.

6. Risk for self-harm related to creating a bomb to kill oneself.

Potential nursing diagnoses

1. Disturbed sensory perception

2. Disturbed thought process

3. Anxiety

4. Depression
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5. Risk for suicide

6. Self-harm

Conclusion

Suicidal Ideation consists of feelings of suicide and death. Suicide includes a two-step

part including active and passive suicide. Active suicide includes wanting to self-harm in a result

of instant death while passive suicide includes accidental death due to not caring about one’s

own health. Suicidal ideation can stem from diseases including depression. With suicidal

ideation, auditory hallucinations can cause suicidal thoughts from the internal burden of hearing

negative voices.

DS experienced auditory hallucinations from childhood sexual abuse. From his work

injury, he felt depressed and had no desire to live due to having to start to learn how to function

properly from the beginning. DS became addicted to drugs resulting in a financial burden and

never wanting to live again. DS tried to commit suicide multiple times.

DS was admitted in the inpatient psychiatric unit due to suicidal ideation. DS was a male,

Caucasian who was catholic and believed in God. DS felt that God made it to be that everything

happens for a reason. Upon admission, DS had hyponatremia due to excess alcohol consumption

daily. DS tried killing himself by creating a bomb resulting in ten years jail time. DS expressed

that he had three daughters at home therefore he wanted to get rehabilitation services for his drug

addiction to be present for his children. DS regrets his choices however has a plan post discharge

to fix his addiction. DS had explained that there was not any history of mental health issues

within his family however he had stated that his mother was crazy due to her actions during his

admission at the Cleveland Clinic.

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DS was appropriately cared for during inpatient within the psychiatric unit by being

provided with ways to properly cope with frustrations he experiences to prevent thoughts of

suicide. DS had expressed that he had learned many skills from group therapy sessions and felt

he was not alone in his illness. Nurses have provided him with the appropriate medications while

DS had been compliant is his medication regimen. Post discharge it will be important for DS to

maintain his medication regimen and get the appropriate help needed to stop his drug addiction.
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References

Harmer, B., Lee, S., Duong, T., & Saadabadi, A. (2022). Suicidal Ideation. In StatPearls.

StatPearls Publishing.

Hugdahl K. (2017). Auditory Hallucinations as Translational Psychiatry: Evidence from

Magnetic Resonance Imaging. Balkan medical journal, 34(6), 504–513.

https://doi.org/10.4274/balkanmedj.2017.1226