Running head: Psychiatric Case Study 1

Ella Simcox

Nursing Department, Youngstown State University

NURS 4842L: Mental Health Nursing Lab

Mrs. Defiore-Golden

March 19, 2021

Abstract

This case study will show a patient that was diagnosed with major depressive disorder without

psychosis, alongn with: anxiety, mood disorder, and a suicide attempt. The patient is referred to

as S.S in this case study. An objective data, summaries of the psychiatric diagnoses, identifying

stressors and behaviors that precipitated the current hospitalization, discussion of the patient and

family history of mental illness, describing the psychiatric evidence based nursing care provided

and milieu activities attended, analysis of ethnic, spiritual and cultural influences, evaluation of

the patient outcomes, summarization of discharge plans, prioritization of all actual diagnoses, list

of potential nursing diagnoses and a conclusion will be included in this case study. References

will also be used throughout the case study and will be listed at the end.
Psychiatric Case Study 3

Objective data

The patient I cared for on February 26, 2021 is S.S, who is a 19 year old female that was

brought into the emergency department on February 22, 2021 by police. She was brought in from

her home due to an accidental drug overdose of Xanax as well as slitting her wrists. She has

psychiatric diagnoses of major depressive disorder without psychosis features, anxiety, mood

disorder, and suicide attempt. The patient’s lab values were listed in her chart as: positive for

benzodiazepines in a urine drug screen, positive for cannabinoid in a urine drug screen, and

negative for a urine pregnancy test. A complete blood count was listed as: red blood cell count of

4.83 trillion cells/L, hemoglobin of 13, hematocrit of 38.2%, white blood cell count of 5.7

billion/L and platelet count of 264 billion/L. There were no thyroid stimulating hormone levels

or a T4 level that were drawn on this patient. It is important to know what this patient’s lab

values are so they can be treated accordingly after knowing if they are on any other drugs. It is

also crucial to rule out any physical illnesses first before treating for mental illnesses. Her

medical diagnoses only included gastroenteritis in the chart. S.S was placed on self-harm

precautions due to her history of suicidal behavior and had a history of being emotionally and

mentally abused by family.

S.S reacted friendly to the nursing staff and students during the day of care but appeared

anxious, sad and depressed at times. She had sad or depressed facial expressions during parts of

our conversation when she was discussing her life at home, particularly with her mother. Her

posture was relaxed and she was engaged in our conversations during the day. She was

communicating to me verbally with her words and nonverbally with her body language by using

eye contact and leaning towards me when she was talking. S.S was dressed carelessly by having

unkempt, greasy hair that was noticeably unbrushed and unwashed. S.S did not exhibit any
Psychiatric Case Study 4

motor activity such as agitation, restlessness, hand or body tremors, or any motor retardation.

She also did not show akathisia, akinesia, tardive dyskinesia or acute dystonic reaction. The

patient was displaying feelings of depression and anxiety and stated she has been “feeling

anxious and overwhelmed” lately. When I asked if she has felt more emotional than usual, she

said, “My mood has been more emotional lately. My mother is toxic and narcissistic and does not

believe that mental health is a real thing. I am ready to be in a positive environment instead of

the negative one that is at home.” She did not display any disturbances in thought process,

thought content or perceptual disturbances. S.S was oriented to person, place, time and situation

and was able to recall events that had happened.

S.S was prescribed a few medications to help with her diagnoses. She was taking Celexa,

or citalopram, which is a selective serotonin reuptake inhibitor, 10 mg by mouth everyday for

depression. She was also taking Vistaril, or hydroxyzine, which is an antihistamine, 50 mg by

mouth everyday for anxiety. The patient was also prescribed Haldol, or haloperidol, which is an

antipsychotic, 5 mg by mouth as needed for agitation.

Summarize the psychiatric diagnoses

Major depressive disorder is a mental health disorder that is characterized by persistently

depressed mood or having a loss of interest in activities. It is one of the most commonly

diagnosed mental health illnesses in the country (Potter, 2019, p. 1936). This can cause

significant impairment in a person's daily life. Major depressive disorder is categorized as having

two weeks or more of lack of interest in activities with a sad mood and including four other

symptoms of depression. Those symptoms comprise of: changes in weight, sleep, appetite,

energy level, concentrating, having issues with decision making, self-esteem and having goals
Psychiatric Case Study 5

(Videbeck, 2020, p. 288). This mental illness does not have to have a specific trigger to occur in

an individual (Zalar, Blatnik, Maver, Klemenc-Ketis, Peterlin, 2019, p. 5). Depression can also

be linked to thoughts and actions of suicide. Mood disorders are alterations in a mood and

emotions by depression and mania. Major depressive disorder is the main mood disorder,

followed by bipolar disorder. Anxiety is a body response from an external or internal stimuli that

causes a feeling of dread, fear and worryness (Videbeck, 2020, p. 222).

Identify the stressors and behaviors

S.S stated “I got into an argument with my mom at home. After the argument I went into

a panic attack and took two Xanax. I then slit my wrists because I was so overwhelmed and

eventually passed out, and when I woke up I was in the emergency department.” The patient’s

mother called the police after her daughter passed out and they brought her in and admitted her

for a psychiatric hold due to harm to self. She had negative current coping strategies like taking

an unprescripted amount of benzodiazepines, and cutting herself when she felt stressed,

overwhelmed and anxious. The actions to her behaviors led her to being admitted to the hospital.

S.S also explained that her mother is the main stressor in her life, and constantly puts her down

by saying harsh words. S.S has two children of her own and said that she had to drop out of high

school during her senior year to care for them because she was too anxious and scared to leave

them at home with her mother during the day. She exclaimed that she knows she needs to be

using better coping techniques and said she feels ready to explore more positive ones. She listed

some different positive coping strategies that she wants to try such as reading, journaling,

stepping away from the situation and taking deep breaths and playing with her two young

children and taking them on walks.

Discuss the patient and family history of mental illness

S.S told me in our discussions that she has a family history of mental illness. She first

started out by telling me that her mother does not believe in mental illness and that mental health

is not a real thing. She did not say if her mother had a diagnosed mental illness, but said she does

not have a good relationship with her mother. S.S currently lives with her mother along with her

two children. The patient has a boyfriend who is the father of her children and was waiting for

him to graduate high school and get a job so they can get a place together as a family. The patient

knows that her mental health is important and has a goal in mind of what she wants to

accomplish to improve her mental health. She also discussed how she does not have a close

relationship with her father who has paranoia schizophrenia. Schizophrenia is a mental illness

that causes disturbances in thought process and changes affect and mood. It can have biological

influences such as genetics, biochemical influences and physiological influences. Genetically it

is increased in siblings and especially identical twins. Biochemical influences are associated with

an excess of dopamine and a decrease in serotonin and norepinephrine. Physiological influences

are seen with enlarged ventricles in the brain and cerebellar atrophy.

Describe the psychiatric evidence based nursing care provided and milieu activities

attended

The patient had a safe environment during her hospital stay. When she was admitted all

her belongings that could cause harm were removed like her shoe lace strings and her belt. The

patient had to be in self harm precautions on the unit and everything had to be removed that

could cause harm. It is important for the nurses to frequently round on the patients for safety and
Psychiatric Case Study 7

to help promote positive healing. Having a nursing staff that is there for the patients has been

shown to lead to better outcomes for psychiatric patients (Donald, Duff, Lee, Kroschel, Kulkarni,

2015, p. 65). The nurses have to check on the patients often to make sure they are safe and out of

danger. S.S was sitting at a table in the milieu talking and laughing with other patients when I

first met her. They seemed to have formed a bond over their stay and S.S said she had made

friends since she had been there. We talked at a table in the milieu away from others until it was

time to go to the treatment team. Her nurse said I was able to attend with them and during my

experience in the room where the treatment team was held, it seemed like a positive

environment. The social worker and nurse practitioner discussed discharge plans for S.S and she

became very excited that she was going to be leaving soon.

During the rest of the day, S.S attended the group therapy sessions where she played

bingo during the one session that the students held. She even won a journal as a prize for

winning the game. This helped boost her confidence and mood, by being able to be with other

people around her age and participating in the sessions. After the group therapy session was over

and after winning bingo, she came over to me and explained how the journal she won would help

her exhibit positive coping strategies when she gets upset, stressed and anxious in the future. I

provided positive feedback on how journaling would be a great way to cope during times of

stress and she planned on doing that for now on instead of hurting herself.

Analyze ethnic, spiritual and cultural influences

S.S dropped out of high school during her senior year to raise and protect her children.

She stated she does not have many friends and cannot rely on her family for support. She is not

married but is in a relationship with her boyfriend of three years who is the father to both of her
Psychiatric Case Study 8

children. They have two boys, ages two and ten months old. She is working through Door Dash

with her boyfriend to try to make enough money to get their own apartment. She said her

boyfriend also works for a roofing company to help save to be able to provide for them in the

future. S.S did not say if she planned to get her general education development or GED to

receive her high school diploma, or if she had plans to try to find other work. She did tell me that

her boyfriend is teaching her to drive, and she is going to apply for her drivers license. She said

she hopes to be able to take the test soon and pass. S.S is not religious so she does not have any

spiritual influences nor did she state any ethnic or cultural influences.

Evaluate the patient outcomes

During my time on the unit, S.S participated in group activities and socialized with the

other patients. She did appear to be anxious, sad and depressed at times, but was happy to have

people sound her that were not calling her names or saying harsh statements while talking to her.

She said she was grateful that I took time to talk to her during the day and she said she would

start using coping strategies that would be beneficial to her and her future health.

Summarize the plans for discharge

S.S discharge plans were discussed during the treatment team. The different health care

workers on her case all discussed her progress and asked if she was ready to go home. S.S stated

she felt ready to go and be able to be with her children and boyfriend. The nurse practitioner said

they made a call to her boyfriend and that he was going to come to the hospital and pick her up

once he got off of work that day. She explained to me that after discharge she was going to go

with her boyfriend along with their two children and get an apartment in the Struthers area. She

had positive goals for herself and her children by getting out of the negative environment that

they were living in with the patient’s mother.

Prioritized list of all actual diagnoses

● Self-directed violence, related to depression, as evidenced by suicidal behavior

● Impaired social interaction, related to lack of support system, as evidenced by

dysfunctional interactions with family

● Chronic low self-esteem, related to feelings of shame and guilt, as evidenced by negative

view on self and abilities

● Self care deficit, related to anxiety, as evidenced by unkempt hair and appearance

● Deficient knowledge, related to unfamiliarity with signs and symptoms of depression, as

evidenced by inappropriate behaviors

List of potential nursing diagnoses

● Risk for injury

● Risk for suicide

● Powerlessness

● Altered family process

● Disturbed sleep pattern

Conclusion

In conclusion, S.S suffers from different mental illnesses such as major depressive

disorder without psychotic features that affects her mood and mental health the most. I enjoyed

my time talking with S.S and being there for her in a time of need. She is a very nice person who

just needs a little help going in the right direction with learning how to cope and deal with her

mental illnesses. I enjoyed going to treatment team with her and seeing her participate and

socially interact with other patients during group therapy and throughout the day. I hope she
Psychiatric Case Study 10

starts to use more positive coping techniques and finds a place where her mental health is not

negatively affected all the time.

References

Donald, F., Duff, C., Lee, S., Kroschel, J., Kulkarni, J. (2015). Consumer perspectives on the

therapeutic value of a psychiatric environment. Journal of Mental Health. Retrieved

from:https://web-a-ebscohost-com.eps.cc.ysu.edu/ehost/pdfviewer/pdfviewer?vid=9&sid

=ac25daee-2832-4c9a-8318-8084240b64cb%40sdc-v-sessmgr02

Potter, D. (2019). Major depression in adults: a review of antidepressants. International Journal

of Caring Sciences. Retrieved from: www.internationaljournalofcaringsciences.org

Videbeck, S. (2020). Psychiatric-mental health nursing. In Psychiatric-mental health nursing (pp.

222-288). Philadelphia, PA: Wolters Kluwer.

Zalar, B., Blatnik, A., Maver, A., Klemenc-Ketis, Z., Peterlin, B. (2018). Family history as an

important factor for stratifying participants in genetic studies of major depression.

Sciendo. Retrieved from: DOI: 10.2478/bjmg-2018-0010