Mental Health Case Study 1

Mental Health Case Study

Sarah Patrick
Youngstown State University
Mental Health Case Study 2

Abstract

This case study contains subjective and objective data that was important to collect on the

patient regarding her diagnoses and reason for hospitalization. The recognition of the patient’s

medications was significant to gather to see how they related to her psychiatric diagnoses. The

knowledge of each psychiatric diagnosis and how to recognize them is a vital tool in dealing with

mental health patients. In this case study, the patient was admitted after he was assaulted and was

making statements about suicidal ideation. The patient has a past history of depression that he

has been facing for many years. Information in this case study will include patient health history,

personal statements made by patient, nursing diagnosis’, and problems the patient is currently

facing.
Mental Health Case Study 3

Objective Data

K.C. is a 49-year-old male that was involuntarily admitted to the behavioral health unit at

St. Elizabeth’s Youngstown hospital on March 23rd, 2018. The date of care for this patient was

March 27th, 2018. Prior to his psychiatric inpatient admission, K.C. was brought to the ED by

police for assault. Patient’s ex-girlfriend’s boyfriend assaulted him. Pt stated in ED he had

suicidal ideation and planned to use carbon monoxide in car or jump off a bridge. Patient is on

YPD police hold. After being cared for in ED following assault, patient was admitted to

behavioral health unit. K.C. was admitted with the following psychiatric diagnosis: depression,

alcohol abuse, and suicidal thoughts. Patient had visible eye lacerations from assault.

Since the patient initially came into the ED from an assault, it was important to check if

any drugs were involved. Patient’s drug screen urinalysis came back negative with no detections

in urine of any street drugs. Checking the thyroid panel, K.C.’s TSH level was 0.923, which is

within normal limits. It was important to check, as it may be indicative of depression. In the

research article The Link Between Thyroid Function and Depression, it is well recognized that

disturbances in thyroid function may significantly affect mental status including emotion and

cognition. Both excess and insufficient thyroid hormones can cause mood abnormalities

including depression.

During our conversation, K.C. was relaxed, friendly, and maintained good eye contact

with me; however, initially K.C. wasn’t so inclined to want to talk but did open up as he saw

many other patients speaking to students on the unit. For appearance, K.C.’s outfit was careless,

and he had dirt under his fingernails and greasy hair. He didn’t have any abnormal muscle or
Mental Health Case Study 4

motor movement, such as akathisia, akinesia, or tardive dyskinesia. On the other hand, his affect

while talking to me was flat and had a depressed tone which could be due to his history of

depression and recent suicidal ideations. When asked about his mood on this day he told me, “I

feel content, but I’m going to jail when I leave here”. During our time talking, D.M. used

blocking, and loose associations throughout our conversation.

K.C. initially came in for an assault but had underlying psychiatric illnesses as well.

When I asked K.C. why he feels depressed he stated it was because he abused alcohol in the past

and has an addictive behavior. He moves from one addiction to the next. In the article

Introduction to Behavioral Addictions, the essential feature of behavioral addictions is the failure

to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to

others. Each behavioral addiction is characterized by a recurrent pattern of behavior that has this

essential feature within a specific domain. The repetitive engagement in these behaviors

ultimately interferes with functioning in other domains.

The patient blames his addictive behavior as to why he feels like a failure in life. He

moves from one addiction to the next and when he thinks he is clean he becomes addicted to

something else. This is heavily influencing his depression.

Something that really stood out to me while talking to this patient was the fact that he had

a great life growing up. He moved all over the United States but lived in Hawaii for most of his

life. His dad owned a boat company there which he then worked for, for a short time before his

father past away. When I asked how he ended up in Youngstown, he stated “It’s cheap to live

here”. To me, it appeared his past life growing up was a trigger for him. I never got a straight

answer out of him about how he ended up living here. K.C. became very depressed when his
Mental Health Case Study 5

father past away and bringing up his past life in Hawaii triggered this for him. He quickly

changed the subject when I addressed his family, and at one point even got up out of his chair

and walked for a couple minutes. In the article The Burden of Loss: Unexpected death of a loved

one and psychiatric disorders across the life course in a national study, Throughout the lifespan,

unexpected death of a loved one is associated with the development of depression and anxiety

symptoms, substance use, as well as other psychiatric disorders and heightened risk for

prolonged grief reactions. Furthermore, the death of K.C. ‘s father, did heavily influence his

depression. From then on, he abused alcohol and many different types of drugs.

The patient’s daily medication includes Effexor XR 37.5mg PO, daily. The patient also

has PRN Cogentin 2 mg IM prescribed for agitation, Haldol 5 mg IM for agitation, Vistaril 50

mg PO for anxiety, and Desyrel 50 mg PO for sleep. These medications were listed and

prescribed to the patient by his physician.

Summarize

K.C. has a diagnosis of depression, which is a mental disorder characterized by at least

two weeks of low mood that is present across most situations. It is often accompanied by low

self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear

cause. (Townsend, 2015). The patient was also diagnosed with alcohol abuse and suicidal

ideation. K.C. abused alcohol off and on for periods of his life. He presented to the ED with

suicidal ideation and planned to use carbon monoxide in a car at the autobody shop he works at.
Mental Health Case Study 6

Identify

Patient was involuntary admitted to the behavioral health floor, after being assaulted and

taken to the ED. There he made statements of suicidal ideation and was pink slipped to the

behavioral health floor for safety purposes. Patient was on a police hold due to assault. K.C. did

not go into any detail on the assault but just stated that his ex-girlfriend’s boyfriend wanted to

fight. Patient has a past psychiatric history and has had prior suicidal behavior. K.C. has had 3

previous hospitalizations related to his depression and alcohol abuse.

Discuss

The patient talked to me for quite some time about his depression. When I asked him to

tell me a little bit about himself he stated, “You don’t want to know about me”. The patient did

open up with time but was closed off for the first few minutes of our conversation. It wasn’t until

he heard other people talking to students that he then started speaking to me. While discussing

his depression, I asked K.C. if he had any support system or family or friends in his life. He told

me he has one sister who lives in Seattle, whom he never sees. He states that she does not know

about his depression or alcohol/drug abuse. When asked when he last saw his sister he stated,

“It’s been awhile”. K.C. also did say he has no friends in Youngstown because he didn’t grow up

here. He only talks to the workers at the autobody shop where he works.

Describe

The behavioral health floor at St. Elizabeth’s Youngstown provides a great milieu. The

floor is very new, clean, and provides limited distractions for patients. There is a schedule posted

on the wall which provides, meal times, group therapy times, and visiting hours. The floor is a
Mental Health Case Study 7

long U shape with rooms on the outside of the U with a big common space in the middle. It is

very open with the nurse’s station in view. This area allows the staff to constantly monitor the

patients on the unit. In the common area, there is a tv, many tables and chairs, a few exercise

machines and phones where patients can speak to their families. If the patient does decide to stay

in their room, a staff member rounds on them every 15 minutes for safety. While K.C. was being

constantly monitored due to suicidal ideation, he was able to freely walk around the unit and talk

to other patients. The unit is also very well managed as safety is a top priority. They have mirrors

that don’t break, windows that can’t be broken or opened, beds that are low to the ground,

bathroom doors that are not full-length doors, so patients can be monitored, and special screws,

etc. for patient safety.

Analyze

My patient did not go into too much detail regarding any spiritual or cultural

influences. K.C. stated he does not believe in any religion because they won’t “help him feel

better”. He stated he would like to go back to Hawaii one day because life was “simple” there

and he enjoyed the culture. His biggest coping technique is listening to music. He used to play

the guitar before he started abusing alcohol and now only listens to music as he can no longer

afford to buy a guitar. K.C. said “I love music, I played the guitar all the time. But then I decided

meth was more important, so I sold it to buy drugs”.

Evaluate

Beginning upon admission, there are many nursing outcomes put in place for the care of

each patient on a psychiatric unit. These outcomes are specific to each patient and are

individualized based upon their needs, and psychiatric diagnosis. The following are the outcomes
Mental Health Case Study 8

nursing staff would want a patient diagnosed with depression by the time of discharge. The

patient will show no self-directed violence physically, emotionally or sexually to self. Patient

will interact with friends, other patients on the floor, staff, and family and show no signs of

impaired social interaction. Patient will express belief in self and maintain self-esteem. Patient

will practice alternative coping skill mechanisms. Patient will express feelings related to stress

and tension. Patient will participate in therapeutic regimen. The patient will groom and dress

appropriately with the help of staff. The patient will exhibit organized thought process and will

identify 2 goals he would life to achieve from therapy. The patient will remain safe during

hospitalization.

Summarize

For discharge, the patient will be receiving instructions from an RN on medication

compliance for his depression. This would include his daily Effexor XR. He will not be receiving

any refills until he has a follow up appointment with his psychiatrist. K.C. does have social work

involved on his case as he is currently homeless, and they will be caring for his needs after he is

discharged. However, K.C. is on a YPD police hold, and will be going to jail upon admission for

assault charges. There a judge will decide how to further process his case. K.C. still has social

work and case management on his case throughout his hospitalization.

Prioritize

Nursing diagnosis are vital to patient care and allow the staff to identify current problems

the patient is facing and potential problems that may rise. K.C had many different nursing

diagnoses for depression. His most important ones in order include: Risk for self-harm related to

current suicide plan as evidenced by previous psychiatric hospitalization for suicide attempts,
Mental Health Case Study 9

Risk for social isolation related to moving away from home as evidenced by patient stating “I

have no family or friends here, I have no support system”, and Risk for self-care deficit related to

being homeless and living in his car as evidenced by patient appearing unkept and unwilling to

shower.

List

Potential nursing diagnosis for a patient diagnosed with depression include: Risk for

self-directed violence, impaired social interaction, risk for chronic low self-esteem, fatigue

related to anxiety and stress, disturbed thought process, ineffective coping, hopelessness, risk for

self-care deficit and poor personal hygiene.

Conclusion

K.C.’s personal health history, reason for admission, medications, personal statements,

and past psychiatric hospitalizations, were all obtained through subjective and objective data.

Upon entering the ED, patient was assaulted and brought in by the police. In emergency, K.C.

made suicidal statements about killing himself with more than one plan. Patient was pink slipped

for safety where he began his stay on the behavioral health unit. The patient has a history of

abusing alcohol and drugs and has a past history of suicidal ideation and attempts. K.C. suffers

from depression as well. The main goal was patient safety which was met by the precautions set

in place per the unit policy. Patient was kept safe with multiple daily checks and was kept in a

non-distracting, therapeutic environment. After admission, nursing diagnosis and care plans were

created and individualized to K.C.’s needs. Each nurse caring for K.C. reviewed these and

worked towards meeting each of these diagnoses. This overall allowed goals to be created and

focus to be emphasized on certain areas of concern to improve the condition of this patient.
Mental Health Case Study 10

References

Grant, J., Potenza, M., Weinstein, A. and Gorelick, D. (2018). Introduction to Behavioral

Addictions. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164585/

[Accessed 3 Apr. 2018].

Hage, M. and Azar, S. (2018). The Link between Thyroid Function and Depression. [online]

Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246784/ [Accessed 3 Apr.

2018].

Keyes, K., Pratt, C., Galea, S., McLaughlin, K., Koenen, K. and Shear, M. (2018). The Burden of

Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course

in a National Study. [online] Available at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119479/ [Accessed 3 Apr. 2018].

Townsend, M.C. (2015). Psychiatric Mental Health Nursing: Concepts of Care in

Evidence-Based Practice. Philadelphia, PA: F.A. Davis Company.