Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY 1

Psychiatric Mental Health Comprehensive Case Study

Maci Musolino

November 9th, 2023

Dr. Teresa Peck, DNP, RN

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

MENTAL HEALTH COMPREHENSIVE CASE STUDY 2

Abstract

CS is a 55 year-old female patient admitted to the inpatient psychiatric unit on November 6th,

2023 following involuntary admission after a neurologist sent her to the ER due to being a

danger to herself. CS has a mental health diagnosis of major depressive disorder and she recently

has been experiencing severe mood changes and thoughts of wanting to hurt herself. She also has

a diagnosis of anxiety and seizures. With medication treatments including haldol, vistaril, and

trazodone, the symptoms have become more manageable and CS has resumed a normal level of

mood changes and decreased thoughts of wanting to harm herself. The main priority for this

patient is safety and constant observation. She is on both suicide and seizure precautions and is

being monitored closely. Nursing care provided on the unit is focused on symptom management

through pharmacologic methods, as well as therapeutic groups and individual therapy sessions.
MENTAL HEALTH COMPREHENSIVE CASE STUDY 3

Objective Data

Patient identifier: CS

Age: 55

Sex: Female

Date of admission: November 6th, 2023

Date of care: November 9th, 2023

Psychiatric diagnosis Major Depressive Disorder

Other diagnoses: Anxiety, Suicidal Ideation, Seizures

Behaviors on admission: CS went to her neurologist for a follow up appointment for her new

onset of seizures. She had severe changes in her mood and stated thoughts about suicide. The

doctor sent her to the ER where she was pink slipped.

Behaviors on day of care: CS facial expressions were sad and worried. Her affect was

congruent to these. She stated that her mood was depressed, anxious, and sad. She states that she

had feelings of hopelessness and worthlessness. She also stated that she had a low self esteem

and felt ashamed to be on the unit. CS’s behavior was fearful, but she was also cooperative with

all the questions and care. CS also had a very friendly approach to the nurses and spoke up

openly about her diagnosis. She participated in 1 group session throughout the day and she was

put on a schedule for self care and eating.

Safety and security measures: The patient was on suicidal and seizure precautions. The nurse

performed rounding on this patient every 15 minutes. All hazardous items such as shoelaces,

razors, and pens were not permitted on the unit, and only crayons were used for writing.

Medications were administered to the patient by the nurse, and the nurse verified all medications

were taken at the time of administration.

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Laboratory results

Lab Value Result

Glucose 84
TSH 0.32
T4 0.87
RBC 4.53
Hbg/Hct 12.9/ 43.0
WBC 6.5
BUN/Crea. 12 / 0.9
QTc 423
Toxicology Positive for
cannabis

Psychiatric medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Atorvastatin Lipitor Statin 40 mg High
Cholesterol
Hydrochlorothi Microzide Diuretic 125 mg High Blood
azide Pressure
Lisinopril Zestril ACE Inhibitor 20 mg High Blood
Pressure
Mirtazapine Remeron Antidepressant 7.5 mg Depression

Divalproex Sodium Anticonvulsant 500 mg Seizures

Valproate
Citalopram Celexa SSRI 20 mg Depression
Antidepressant
Haloperidol Haldol Antipsychotic 1 mg PRN Psychosis

Hydroxyzine Vistaril Antihistamine 50 mg Anxiety

Trazodone Trazodone SSRI 50 mg QHS PRN Sleep

Antidepressant
MENTAL HEALTH COMPREHENSIVE CASE STUDY 5

Summarize the psychiatric diagnoses and expected/common behaviors, with citations

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest in

things that they were once interested in. It can also be called major depressive disorder. This

disorder effects how you feel, think and behave. It can lead to many emotional and physical

problems. Some patients have trouble doing normal day-to-day activities and may feel that they

do not want to live anymore. Depression can be misunderstood in today's society. Many people

have the “blues” or feel sadness due to a tragic event or stressor in their life. These “blue”

feelings are considered normal to feel at times throughout life when disappointed. However,

depression is much more than that. Depression is a chronic disease that requires long term

treatment to manage. Treatment for depression includes antidepressants, ECT, and therapy

sessions. Therapy can be individual, family, group, behavioral, or cognitive. Symptom of

depression include:

-Feelings of sadness, tearfulness, emptiness or hopelessness worthlessness or guilt, fixating on

past failures or self-blame

-Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

-Sleep disturbances, including insomnia or sleeping too much

-Tiredness and lack of energy, so even small tasks take extra effort

-Reduced appetite and weight loss or increased cravings for food and weight gain

-Anxiety, agitation or restlessness

-Slowed thinking, trouble concentrating, making decisions, loss of memory

-Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

MENTAL HEALTH COMPREHENSIVE CASE STUDY 6

Identify the stressors and behaviors that precipitated current hospitalization

This patient has had multiple stressors that led up to her mood changes and depressive thoughts.

CS has a lengthy medical history including primary hypertension, hyperlipidemia, hypokalemia,

lactic acidosis, obesity, fibromyalgia, and sleep apnea. The one diagnosis that is stressing CS out

the most is her new onset of seizures that started in October of 2023. CS states that she had to

adjust her seizure medications that consisted of depakote and keppra. She thinks that this

adjustment is what is causing the increase in mood changes and suicidal thoughts. The doctor

took her off these medications and put her on a new medication regimen that will treat her new

onset of seizure, but will also not increase symptoms of depression. Another stressor that

precipitated the current hospitalization is her living alone. CS is living by herself in a house and

has to pay for her bills independently with only one income. She feels that she does not make

enough money and does not have enough support with her family to do so. She stresses about

financial issues especially with the holidays coming up. Another huge stressor CS’s states that is

currently going on in her life that is a possible contributor to her being hospitalized is her

relationship with her kids. She does not get to see them a lot or spend time with them. She wants

to be close with them but does not know how exactly to go about it. All of these stressors have

contributed to the increase in depression and suicidal thoughts that led her to being hospitalized.

CS expressed thoughts of not wanting to be alive anymore with a flat affect. CS is working

through these stressors with individualized therapy. She is learning healthy coping mechanisms

to deal with the stressors going on in her life.

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Discuss patient and family history of mental illness

CS grew up with her two parents in Helena. She graduated high school then went on to Kent

State to get her college degree. CS’s husband died in 2011 of cancer, and she now lives by

herself. She has 1 sister and 1 brother that she does not talk to very much. She has a son that

lives in the area and a daughter who lives in Florida. CS states that she keeps mostly to herself

and doesn't get much social interaction. CS does not have much family or friend support in her

life. CS states that her family has no history of serious mental health. CS states that was abused

by her grandfather when she was younger. This is a traumatic event that is a constant stressor in

her life. Despite this, CS states that she has no other history of physical, emotional, or sexual

abuse.

Describe the psychiatric evidence based nursing care provided and milieu activities
attended

CS was put on suicide precautions and on close observation for every 15 minutes. Vitals signs

and assessments were performed per unit policy. Medications were administered as prescribed

and the nurse watched CS to make sure they were properly taken. Education and health

promotion were given throughout her admission. CS was put on a schedule for self care

including showers, eating, and therapy. CS only attended one group therapy session but felt she

benefited from individual therapy.. Positive praise was given to CS when she achieved

something little to increase self esteem. Respect and professional boundaries were maintained

throughout care. All care and treatment were charted in a precise and correct manner. HIPPA was

also maintained throughout the stay of this patient.

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Analyze ethnic, spiritual and cultural influences that impact the patient

CS is a caucasian woman from a lower middle-class family. She is widowed and has been since

2011. She is employed at a credit union company. She struggles financially due to only having

one source of income. CS states that grew up practicing Christianity as her religion and used to

regularly pray and go to church. She states that since she has been struggling with her

depression, she has lost some of her faith. She doesn't pray as much as she used to and no longer

goes to church. She believes in karma and thinks whatever you put into the world is what you get

back. CS’s ethnicity is Italian. She enjoys Italian culture such as dancing and spending time with

fm daily. She also practices the culture by cooking her favorite Italian food such as pasta and

pizza. These cultural influences impact CS by cheering her up when she is feeling depressed.

These things bring her back to her childhood and give her comfort in the good things she

experienced as a child with her family.

Evaluate the patient outcomes related to care

One of the patients' outcomes related to her care were to comply with the prescribed medication.

The patient was hesitant with this at first due to her being paranoid. She was afraid of the

negative side effects that may come from these medications. The nurse educated CS on these

medications and signs to look for that are considered adverse reactions. With therapeutic

communication and a good nurse- patient relationship, the nurses were able to get compliance

from CS. It is very important that CS is a part of her treatment plan to help with her paranoia.

Another intervention that was placed for the care of CS was attending group therapy sessions. CS

stated that she only attended one group therapy session and would rather be in her room doing

her own thing. This intervention was not met but is still being worked on.
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Summarize the plans for discharge

While in the hospital, new meds that have been started for CS are halaodl, vitaril, and trazodone.

Before discharge. CS will collaborate with her doctor and healthcare team to change her at home

medication. She will return to her home where she lives alone. The doctor felt that CS did not

need transitional or long-term placement after discharge from the inpatient unit. CS will

continue to be active in her plan of care with her health care team. CS will be instructed to see

her psychiatrist within a week after being discharged. CS will be encouraged to schedule regular

appointments with her psychiatrist and be compliant with the new medication regimen. CS will

also be provided with resources of support groups she can attend in her community. Education

material will be provided on her medications, possible side-effects, and adverse reactions that

can occur.

Prioritized list of all actual diagnoses using individualized NANDA format

1. Imbalanced Nutrition: Less Than Body Requirements related to an unwillingness to eat

secondary to depression as evidenced by loss of appetite and weight loss

2. Self care deficit related to perceptual impairment secondary to depression as evidenced by

unwashed hair, foul body odor, and inability to bathe or get dressed

3. Anxiety related to situational crisis of new onset of seizures as evidenced by restlessness,

disorganized thought process, and decreased attention span.

4. Risk for suicide related to psychiatric illness and hopelessness

5. Risk for self directed violence related to biochemical imbalances

6. Risk for ineffective coping related to depression in response to stressors

MENTAL HEALTH COMPREHENSIVE CASE STUDY 10

List of Potential nursing diagnoses

1. Ineffective Health Maintenance

2. Stress Overload

3. Hopelessness

4. Social Isolation

5. Knowledge Deficit

6. Disturbed Body Image

7. Low Self Esteem

8. Ineffective Sexuality Patterns

9. Spiritual Distress

10. Fear

Conclusion

In conclusion, CS was a great patient to do this case study on. She was very kind, cooperative,

and answered all my questions thoroughly. I really enjoyed talking to her and getting to know

her. I gave her information about my life as well to make her feel comfortable and get a good

rapport. I saw moderate improvement in her symptoms after treatments and prescribed

medications were administered. I think if she is compliant with her medications and reaches out

to her family and friends for more support and company upon discharge, this will maintain her

depression and keep her out of the hospital. CS waa very thankful for my time with her and

expressed her thanks several times. I wish her luck in her mental health journey and hope she

stays healthy.
MENTAL HEALTH COMPREHENSIVE CASE STUDY 11

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2022). Depression (Nursing). PubMed;

StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568733/

National Institute of Mental Health. (2023). Depression. National Institute of Mental

Health. https://www.nimh.nih.gov/health/topics/depression

Sawchuk, C. (2022, October 14). Depression (major depressive disorder). Mayo Clinic;

Mayo Foundation for Medical Education and Research.

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc

-20356007

Torres, F. (2020, October). What Is Depression? Www.psychiatry.org.

https://www.psychiatry.org/patients-families/depression/what-is-depression#:~:tex

t=Depression%20(major%20depressive%20disorder)%20is

Wagner, M. (2022, March 20). Major Depression Nursing Diagnosis & Care Plan.

NurseTogether.

https://www.nursetogether.com/major-depression-nursing-diagnosis-care-plan/
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