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10 Page Paper For Mental Health

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Mental Health Nursing: Case Study

Hayden Turk

NURS 4842 Mental Health Nursing

Dr. Teresa Peck

April 01, 2023


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Abstract

This paper will be an overview of the case of B.C. a 29 year old male who presented to

ED in a manic state. The patient states he was making a suicide attempt by taking heroin and

trying to crash his motor vehicle. He crashed his car and was bought in by police and EMS and

pink slipped and placed on suicide precautions. Once in the psychiatric unit he was given the

diagnosis of bipolar 2, PTSD, and substance abuse disorder. Upon interviewing the patient his

affect was flat and didn't seem to have much to say initially. After some basic questions he was

able to open up and started to make eye contact more as well as engage with the conversation.

We were able to learn that he lost custody of his son recently and has yet to find a healthy coping

mechanism. He takes heroin and smokes marijuana while maintaining a job as a pizza delivery

driver prior to his accident.


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Mental Health Nursing: Case Study

Objective Data

Patient Identifier: B.C.

Age: 29

Sex: Male

Psychiatric Diagnosis: Bipolar 2, PTSD, and Substance Abuse Disorder

Other Diagnosis: Trauma (MVC)

Behaviors on Day of Care: B.C. was pink slipped on admission due to his suicide

attempt and SI. Patient exhibited a depressed, anxious, and sad mood with a flat affect. Little eye

contact was made during the interview even after he was well acquainted with the two

interviewers. He was restless, slouched, and appeared nervous.

Safety and Security Measures: Pink slip, suicide precautions

Laboratory Results

Lab Values Results

Glucose 68
TSH 1.62
T4 1.08
RBC 4.26
Hbg 12.3
Hct 36.8
WBC 16.8
BUN 17
Creat. 1.15
QTc 419
Toxicology Anphetam
ines,
+THC
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Psychiatric Medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Sodium Depakote Anti-convulsant 200mg, PO, x4 Helps to


valproate per day stabilize mood
and control
bipolar episodes.

Haloperidol Haldol Antipsychotic 10mg, PO, Nonpsychotic


PRN behavior
disorder. PRN

Risperidone Risperdal Antipsychotic 3mg, PO, BID Treatment of


Bipolar 2
disorder

Summary of Psychiatric Diagnosis

Bipolar 2 Disorder

A type of bipolar disorder characterized by depressive and hypomanic episodes.

It involves at least one depressive episode lasting at least two weeks and at least one hypomanic

episode lasting at least four days. Depressive symptoms include sadness or hopelessness.

Hypomanic symptoms include a persistently elevated or irritable mood (Carmina, 2022).

Post Traumatic Stress Disorder

A disorder in which a person has difficulty recovering after experiencing or witnessing a

terrifying event. The condition may last months or years, with triggers that can bring back

memories of the trauma accompanied by intense emotional and physical reactions. Symptoms

may include nightmares or unwanted memories of the trauma, avoidance of situations that bring

back memories of the trauma, heightened reactions, anxiety, or depressed mood. These
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symptoms go along with the diagnosis of Bipolar 2 as well and may be difficult to distinguish

between the two.

Substance Abuse Disorder

Treatable and chronic diseases characterized by a problematic pattern of use of a

substance or substances leading to impairments in health, social function, and control over

substance use. It is a cluster of cognitive, behavioral, and physiological symptoms indicating that

the individual continues using the substance despite harmful consequences. Patterns of

symptoms resulting from substance use can help a doctor diagnose a person with a substance

abuse disorder. Substance abuse disorders can range in severity from mild to severe and can

affect people of any race, gender, income level, or social class.

Identification of Stressors and Behaviors Precipitating Current Hospitalization

Through our interview with BC we were able to identify multiple stressors and behaviors

that lead up to his admission to the hospital. His first complaint was the loss of custody of his

baby boy to the mother of the mother of his child. His second complaint was of his baby's mom

and her use of drugs that also precipitated the loss of custody from both parents. These stressors

coupled with his ineffective coping habits of the use of many drugs, not having a proper support

system at home, and recent financial hardships for him from the loss of his job made the feeling

of hopelessness unbearable for BC.

Evidence Based Nursing Care

Bipolar 2 Disorder
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Treatment includes counseling and medications, such as mood stabilizers which this patient is

taking in the form of Sodium valproate or Depakote. You'll typically need mood-stabilizing

medication to control manic or hypomanic episodes. Examples of mood stabilizers include

lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine

(Tegretol, Equetro, others) and lamotrigine (Lamictal). These medications will help to lessen the

swing of moods and allow for the patient to maintain a more regular and stable mood. (Carmina,

2022) Therapies and counseling can be used to evaluate effectiveness of medications as well as

development of health coping strategies in order to become more effective at self reversing the

swings when they happen.

Post Traumatic Stress Disorder

The main treatments for post-traumatic stress disorder are talking therapies and medicine.

Traumatic events can be very difficult to come to terms with, but confronting your feelings and

getting professional help is often the only way of effectively treating PTSD. Cognitive Behavior

Therapy is a type of psychotherapy that has consistently been found to be the most effective

treatment of PTSD both in the short term and the long term. Cognitive Behavior Therapy for

PTSD is trauma-focused, meaning the trauma events are the center of the treatment (Sten, 2020).

For this patient the focus of therapy would be on the loss of custody of his son. Sessions would

be spent on diving into the details of what happened and how that trauma has affected his life.

Medications that may be utilized in treatment of PTSD would be antidepressants, particularly

selective serotonin reuptake inhibitors which would help reduce symptoms of depression or

anxiety in people with PTSD. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), and

sertraline (Zoloft).
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Substance Abuse Disorder

Depending on the type of SUD, treatment may include:

- Medications for opioid use disorder– Specific conditions like opioid use disorder may

require medication as the first course of treatment. Medications for opioid use disorder

can help with cravings and withdrawal symptoms. These medications include Naltrexone

or Vivitrol, Buprenorphine, Suboxone, and Methadone.

- Outpatient counseling– Helps people understand addiction, their triggers, and their

reasons for using drugs. This form of treatment can be done at a doctor’s office or via

telehealth appointment.

- Inpatient rehabilitation – A full-time facility provides a supportive environment to help

people recover without distractions or temptations.

- Behavioral health care – Trained providers who help with mental health concerns as well

development of coping strategies.

Ethical, Spiritual and Cultural Influences

BC wasn't able to identify very many influences on him from spiritual or cultural sources.

When asked if he practices religion he stated that he was raised in a christian household but

wasn't ever in the place or mindset to follow the religion after he left his parents house. As far as

ethical principles that BC follows he stated in the interview that following discharge from the

psychiatric unit he plans on admitting himself into rehab and getting clean to be able to start the

path of getting custody back of his son. We were able to listen to him and give encouragement
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that rehab was a good first step when he gets out of the hospital and getting clean from drugs was

the best first option.

Patient Outcomes

The outcomes for patients struggling with bipolar disorder are adherence to medication

regimens which in turn will help to manage symptoms of mania and depression alike. It is most

important for patients like BC to also develop a support system to help with remembering

medications, offering emotional support, and helping with ADLs and other such chores which

may become difficult during times of mania and depression.

For substance abuse disorder it is most important to seek treatment to initially get off of

the drugs they are using due to the potential harmful effects of detoxing. Being overseen

medically will help to manage symptoms of withdrawal and allow for further help to be given as

needed from the medical community. After withdrawal symptoms have gone the next step would

be counseling and even medications to prevent further drug use and development of healthy

coping strategies.

Discharge Plan

The discharge plan for BC following the expiration of his pink slip is to assist him in

finding a rehab facility that will take him to facilitate his journey to stop using drugs. The

expiration of his pink slip will happen 72 hours after his admission or once the psychiatrist

deems he is safe to be on his own as he had previously attempted suicide.

Prioritized List of Actual Diagnoses

Prioritized nursing diagnosis for BC:


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- Risk For Suicide related to Alcohol and substance abuse/use, legal or disciplinary

problems, grief, bereavement/loss of an important relationship.

- Risk for Self-Harm/Injury related to suicidal thoughts, manic episode and hopelessness.

- Imbalanced Nutrition: Less Than Body Requirements related to symptoms of

withdrawal and mania phase of Bipolar 2 disorder.

- Ineffective Coping related to alcohol and substance abuse/use and lack of eternal support

systems

Potential Nursing Diagnoses

- Powerlessness

- Imbalanced Nutrition: Less Than Body Requirements

- Low Self-Esteem

- Altered Family Process

- Deficient Knowledge

- Risk For Injury

- Risk For Violence: Self-Directed or Other Directed

- Impaired Social Interaction

- Ineffective Individual Coping

- Interrupted Family Processes

- Total Self-Care Deficit


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Conclusion

Throughout the interview process BC seemed to have a genuine regret for how he has

conducted his life so far and seemed remorseful about his actions. Although he attempted suicide

in a time of mania and hopelessness, he now seemed to want to get better and quit using drugs.

There is a long road ahead of him with a DUI charge now and loss and custody of his son he will

need a strong support system in place to get through the upcoming steps in his life. Through

counseling and medication management it is possible that he gets better. BC experienced a manic

episode related to a situational crisis exacerbated by the fact that his family kicked him out when

he was younger, which he is still dealing with the PTSD from lack of family support, and he lost

custody of his child and current unemployment. Due to a previous suicide attempt he is now at

increased risk for that to happen again. There will need to be careful medication management

and counseling as well as setting up an external support system for BC to be able to overcome

the coming obstacles.


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References

Carmina, Ashur (2022). “Treatment - Bipolar Disorder.” NHS Choices, NHS,

https://www.nhs.uk/mental-health/conditions/bipolar-disorder/treatment/.

Lester, Marco (2019). “Mental Health and Substance Use Disorders.” SAMHSA,

https://www.samhsa.gov/find-help/disorders.

Sten, Wolfram (2020). “Treatments for PTSD.” American Psychological Association,

American Psychological Association,

https://www.apa.org/ptsd-guideline/treatments.

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