1

Mental Health Comprehensive Case Study

Chloe Simmerman

Nursing Department, Youngstown State University

NURS 4842: Mental Health Nursing

Dr. Teresa Peck

November 22, 2022

 2

Abstract

This case study follows a patient experiencing brief psychotic disorder and details the diagnosis

along with the nursing care provided and patient outcomes. KT is a 43-year-old male patient on

the inpatient psychiatric unit, brought in and pink-slipped by the Warren police department for

paranoia and delusions. The patient has a history of depression and was on medication, which he

stopped taking at this time. The patient is currently discharge-focused and believes that he does

not belong on the unit. Nursing care is focused on medication stabilization and re-orientation.

Information on the psychiatric diagnosis was found using CINAHL and the Nursing and Allied

Health (Gale OneFile) database.

 3

Objective Data

Patient Identifier: KT

Age: 43

Sex: Male

Date of Admission: November 21, 2022

Date of Care: November 22, 2022

Psychiatric Diagnosis: Brief psychotic disorder

Other Diagnoses: Depression

Behaviors on Admission: KT was brought in by the Warren police department after he had

called them to his home with the intent of having them remove his wife from the home. KT

believes his wife has been cheating on him. He was pink-slipped for paranoia and delusions. It

was noted that KT had labile moods, rapid speech, tangentiality, delusions, and was tearful.

Behaviors on day of care: KT was willing and open to talk, only after asking why he was

chosen to talk to and stating that there was nothing wrong with him mentally. KT looked

unkempt, had messy hair, and was sweating through his tank top. While talking, he was

expressive with his hands, had a loud volume, and had a rapid pattern. Throughout the interview,

he seemed sad, irritable, and anxious and his affect was congruent with his mood and

appropriate. KT demonstrated flight of ideas by jumping from one topic to the next with no

prompting, as well as tangentiality and perseveration by stating multiple times that he “did not

belong here”. KT also displayed grandiose delusions when talking about how he can read people

and always knows when people are lying. He was discharge focused and was also showing

paranoia when talking about how the staff at the hospital had ulterior motives. KT was oriented

to time, person, place, and situation, and his memory is intact. His judgment and insight are
 4

impaired, evidenced by the fact that he called the police because he believes his wife cheated,

and that he believes he does not need to be on the unit.

Medical Conditions: KT has medical diagnoses of type II diabetes, stage 3 chronic kidney

disease, left below knee amputation, iron-deficiency anemia, hypertension, obesity, and heart

failure. Most of these conditions are being treated with medication.

Safety Measures: KT is not allowed off of the unit, and safety checks are done every 15

minutes. All objects that can be used as weapons are removed, and only markers are given as

writing utensils. The nurse gives all medications after doing the appropriate safety checks and

verifications.

Laboratory Results:

Lab Value

Potassium 4.3

Sodium 141

Glucose/A1C 101/8.7

BUN 22

Creatinine 1.73

RBC 4.99

Hgb/Hct 11.8/38.4

WBC 10.8

AST/ALT 19/20

TSH/T4 2.75/0.76

Drug Positive for

Toxicology methadone and
cannabis

QTC/ECG Not Done

KT has high glucose and A1C due to his diagnosis of diabetes. His PRN medication

Haldol can also cause blood sugar to be raised. His BUN and creatinine are high due to his stage
 5

3 chronic kidney disease. The patient also has iron deficiency anemia, which is why his

hemoglobin and hematocrit are low. His increased white blood cell count is indicative of an

infection, and he was positive for methadone and cannabis, which can also cause psychiatric

symptoms.

Psychiatric Medications:

Drug Dose/Frequency Route Classification Reason

Amlodipine/ 10 mg Daily PO Calcium Channel Hypertension

Norvasc Blocker

Atorvastatin/ 4 mg QHS PO Anti-lipemic High Cholesterol

Lipitor

Ferrous Sulfate 325 mg Daily PO Iron supplement Iron-deficiency

anemia

Gabapentin/ 600 mg t.i.d PO Anti-convulsant Diabetic

Neurontin Neuropathy

Haloperidol/ 5 mg q6h PRN PO Anti-psychotic Psychosis

Haldol

Insulin Glargine/ 25 Units q12h SC Insulin Diabetes

Semglee

Sertraline/ 50 mg Daily PO SSRI Depression

Zoloft

Metoprolol/ 25 mg Daily PO Beta Blocker Hypertension

Toprol

Summarize the Psychiatric Diagnoses

KT has an admitting diagnosis of brief psychotic disorder which is defined as “​​…

according to DSM-5 is the sudden onset of psychotic behavior that lasts less than 1 month

followed by complete remission with possible future relapses” (Stephen et al., 2022). The onset

of psychotic symptoms cannot be related to any medical conditions, mood disorders, or other

schizophrenic disorders for the diagnosis to be brief psychotic disorder. The diagnosis of brief

psychotic disorder is also an anticipatory diagnosis until it is known how long the symptoms last.
 6

At least one psychotic symptom must be present to get the brief psychotic disorder diagnosis,

including hallucinations, delusions, disorganized speech, or disorganized behavior (Stephen et

al., 2022). In the case of KT, he was experiencing delusions with some disorganized speech.

Delusions are beliefs held by a person that are false and not based in reality (Videbeck,

2019). One of the main reasons KT was brought to the hospital was because of his delusional

thinking. He was paranoid and said his wife was cheating on him. He was also exhibiting

grandiose delusions which are when a person thinks they have a special talent or self-importance

that they do not actually have. KT insisted that he could read people and knew when people were

lying.

KT also showed disorganized speech during his interview. He exhibited flight of ideas by

moving quickly from one topic to the next, with no association between those topics. He also

showed perseverance when he insisted that he did not belong in the psychiatric unit several

times. He was tangential as well when asked about the situation with his wife. He would start

talking about his broken heart and then move on without giving an answer, despite guiding the

conversation back to the question multiple times.

Identification of Stressors and Behaviors Precipitating Current Hospitalization

One of the main stressors that caused this hospitalization is that KT believes his wife is

cheating on him. His three children also cause him stress as he worries for them, and he states

that his one son is lazy and just smokes weed. KT also stopped taking his methadone and Zoloft

several days ago and was positive for cannabis on admission. His sister has a heart condition and

had a heart attack which led to her getting open heart surgery that did not go well. She will pass

away in the next few days, and KT is stressed about going to see her before she dies. He found

this out from his nephew the night before he was admitted. KT was laid off during the pandemic
 7

and is currently still unemployed due to his multiple surgeries. He also went to jail for 48 days

for not paying a speeding ticket, though he claims that he did pay it. He believes that the showers

in jail are where he got the staph infection that caused him to get a below-knee amputation. KT

also got the diagnosis of heart failure one year ago, and he was told he only has a few years left

to live, which is also causing him a great amount of stress.

Patient and Family History of Mental Illness

KT became depressed after he had his below-knee amputation which was in July of 2022.

There is no family history of depression that KT is aware of. He has one sister and one brother,

each older than him and there is no history of other mental illnesses in his family that he is aware

of. Both his mother and brother are alive at this time, his father is deceased due to influenza and

his sister is actively dying due to heart failure. KT also has three children ages 18, 21, and 22,

and he is not aware of any mental illnesses that they have.

Psychiatric Evidence-Based Nursing Care Provided

While on the unit, KT was provided with evidence-based nursing care such as medication

administration and management. The staff would perform safe medication administration

techniques and watch as he took his medication to ensure that he swallowed the pills. They were

then able to document the administration and monitor the patient for any adverse effects. The

nursing staff that was assigned to KT formed a professional relationship with him that

established trust and good rapport. The staff used therapeutic communication techniques when

talking to the patient and avoided the use of non-therapeutic communication, which is important

since KT came in with distrust of the staff.

KT attended group therapy twice a day, where he learned new skills and techniques to

help with his mental health. Some of the topics for the group therapies include meditation,
 8

learning new coping skills, talking about stressors, and self-help techniques. The nurses use the

nursing process of assessment, diagnosis, planning, implementation, and evaluation to create

care plans that will best help the patient to achieve wellness and stabilization. Due to the brief

psychotic disorder, some interventions that are used include, monitoring vital signs and

neurological status, assessing thought processes, interacting gently with the patient, ensuring

patient safety, educating the family about the illness, ensuring the patient is not violent towards

others and ensuring the patient has no suicidal ideations (Calabrese et al., 2022).

An intervention that would be beneficial for KT would be to use cognitive behavioral

therapy. According to Lambert et al., cognitive behavioral therapy works by “... changing

maladaptive beliefs and teaching new information-processing skills” (2013). Cognitive

behavioral therapy focuses on the way people think, and to change the maladaptive behavior, the

thought process behind the behavior has to be changed first. KT would benefit from this, as it

would help with his delusions and paranoia, as well as his disorganized speech.

Ethnic, Spiritual, and Cultural Influences

KT is an African American male who has been married for 25 years to his wife. They

have recently bought a new house after his last child moved out. KT does not have any ways that

his ethnicity or culture influences his life that he is aware of. His religion is Christianity, and he

attends church as one of his coping techniques. He feels that his religious community is a part of

his support group. KT says that he often thinks about death, due to his diagnosis of heart failure,

the death of his father, and his actively dying sister. He believes that you should live your life as

well as you can because you never know when your time will come. Though KT often thinks

about death, he denies any thoughts about suicide.

Evaluation of Patient Outcomes

 9

One outcome for a brief psychotic disorder is that the patient maintains reality orientation

and communicates clearly with others. KT was able to communicate clearly, but he still had

disorganized thoughts and speech with delusions and paranoia on the day of care. It did not

improve since the day of admission.

Another outcome is that the patient will recognize a change in their thinking when it

comes to delusions or hallucinations, which KT did also not meet on the day of care. He does not

think that he has any delusions and denies everything, so he is not able to identify a change in

thinking.

For an outcome of patient participation in unit activities, KT went to one group session

and did participate. He often monopolized the group when given an opportunity to talk, and he

had to be redirected. He did achieve this outcome, but he could also participate more by

attending all group sessions each day.

One last outcome for a patient with a brief psychotic disorder is that the patient

appropriately interacts and cooperates with staff and peers in a therapeutic community setting

(Wayne, 2022). KT interacted appropriately with other patients on the unit and cooperated with a

few of the staff that he trusted. KT has been adamant that the staff are only working for a

paycheck and that they do not care about the wellbeing of the patients, so he does not easily trust

someone, but he did say that not all of the staff are like that. While KT did achieve this last

outcome, it is something that he can still work on.

Plans for Discharge

The plan for KT is to discharge home with his wife and to restart his home medications

of Zoloft, Methadone, Norvasc, Lipitor, Ferrous Sulfate, Neurontin, Insulin Glargine, and Toprol.

There is also a plan for psychoeducation and education regarding medication compliance and
 10

side effects. KT is on the second day of his psychiatric hold due to his pink slip and is eligible

for discharge in two days. KT states that he has a plane ticket to go see his sister before she dies,

and that is his plan as soon as he is discharged.

Prioritized List of Nursing Diagnoses

Prioritized nursing diagnoses for KT include:

1. Disturbed thought process related to overwhelming stressful life events as evidenced by

inappropriate non-reality-based thinking.

2. Defensive coping related to suspicions of the motives of others as evidenced by false

beliefs about the intention of others.

3. Interrupted family process related to a situational crisis or transition as evidenced by

changes in the expression of conflict in the family.

4. Impaired verbal communication related to altered perceptions as evidenced by

disturbances in cognitive associations.

List of Potential Nursing Diagnoses

Potential nursing diagnoses for KT include:

1. Impaired social interaction

2. Disturbed sleep pattern

3. Self-care deficit

4. Knowledge Deficit

5. Ineffective coping

6. Ineffective impulse control

7. Risk for Self/Other-Directed violence

8. Spiritual Distress
 11

Conclusion

KT, a 43-year-old African American male, was admitted to the psychiatric floor on

November 21st, 2022 with a diagnosis of brief psychotic disorder. The DSM-5 criteria for a brief

psychotic disorder require that the patient exhibit at least one psychotic symptom, such as

delusions, hallucinations, disorganized speech, or behavior, for longer than a day and less than

one month. The symptoms must not be caused by another disorder, medical condition,

medication, or substance use. KT has a recent history of depression from his below-knee

amputation in July of 2022, as well as type II diabetes, stage III chronic kidney disease, iron

deficiency anemia, hypertension, heart failure, and obesity. KT was brought in by the Warren

police department after he called the police to make his wife leave the home. He believes his

wife cheated on him and has had many stressors recently including his lack of employment, his

health, his sister's health, and his children's well-being. KT was exhibiting delusional thinking as

well as disorganized speech on the day of care. Psychiatric evidence-based nursing care was

provided to KT such as safe medication administration, and building a professional relationship

based on trust. Not all outcomes for KT were achieved on this day of care. KT will be eligible

for discharge in two days, and he will be discharged to home with his home medications and

psychoeducation. The prognosis for those with brief psychotic disorders is positive, and most are

able to return to pre-morbid functioning due to the sudden onset and short duration of symptoms.
 12

References

Calabrese J., Al Khalili Y., & Shaheen K. (2022). Psychosis (Nursing). In: StatPearls

[Internet]. Retrieved November 30, 2022, from

https://www.ncbi.nlm.nih.gov/books/NBK568796/

Hollon, S. D., & Beck, A. T. (2013). Cognitive And Cognitive-Behavioral Therapies. In M.

J. Lambert (Ed.), Bergin and Garfield's Handbook of psychotherapy and behavior

change (Sixth, pp. 393–394). chapter, J. Wiley & Sons. Retrieved November 30,

2022.

Stephen, A., & Lui, F. (2022). Brief Psychotic Disorder. In StatPearls [Internet]. section.

Retrieved November 29, 2022, from

https://www.ncbi.nlm.nih.gov/books/NBK539912/#:~:text=The%20presence%20of

%20at%20least,or%20more%20than%20one%20month.

Videbeck, S. L. (2019). Psychiatric-Mental Health Nursing (Eighth). Wolters Kluwer

Health.

Wayne, G. (2022, March 19). Disturbed Thought Processes – Nursing Diagnosis & Care

Plan. Nurseslabs. Retrieved November 30, 2022, from

https://nurseslabs.com/disturbed-thought-processes/