Mental

Health Nursing 1

Mental Health Nursing Case Study

Turner Curry

Youngstown State University

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Abstract

In this case study, it will be focusing on a patient that was diagnosed with

depression and anxiety. The case study will discuss several important topics such

as: patient history and data, psychiatric diagnoses, milieu therapy provided,

outcomes and discharge instructions and much more. For confidentiality of the

patient he will be referred to as E.M. The following pages will discuss how all the

factors in his life relate and develop the state of depression and the suicide attempts

that came with it. With the information provided from doctors and nurses on the

staff unit, E.M can continue to progress and become closer to his release from the

unit. Mental disorders affect mood, thinking and behavior and in this case, E.M

presents all three of these changes.

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Objective Data:

E.M. was involuntarily admitted on March 12, 2019 and the information

provided for the study was received on March 14, 2019. Using the DSM-5, E.M. was

diagnosed with depression and anxiety. On the 14th I introduced myself to E.M. and

sat down with him. We discussed his past history and the reason for his admission

onto the floor. Sitting down the patient, I instantly recognized several behaviors. He

was open to a discussion verbally and talked for some quite time, however his

nonverbal cues were telling me otherwise. He was slouched in his chair, he made

little to no eye contact and didn’t provide much emotion throughout the

conversation. At our table was an older gentleman as well that E.M. seemed to bond

and become friends with during his admission. Throughout our conversation I

made sure to keep it light at first and incorporate E.M.’s friend into the conversation.

“When assessing for suicidal ideation, nurses should convey a non-judgmental and

empathetic style” (Blair, 2012). This is important because it makes the patient feel

more comfortable around you. Eventually E.M. did open up to me and his nonverbal

cues started to match his verbal cues. E.M did have a history of a previous suicide

attempt but only agreed to talk about his most recent attempt with me. Because E.M.

was involuntarily admitted for suicidal ideation due to depression, he must be

checked on every 15 minutes due to suicidal precautions.

Psychiatric Medications:

E.M was prescribed several medications. The medications in the MAR

currently being used by E.M. were Aripiprazole 10mg BID, Aristada 662mg IM

injection 1x a month, and Gabapentin 900mg daily. PRN medications included

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Trazodone and Vistaril. These medications are used to help E.M. with his

depression and anxiety problems.

Psychiatric Diagnoses:

E.M. was diagnosed with depression and anxiety. These two disorders tend to

run hand in hand and are commonly together. Depression is considered a mental

health disorder with daily-depressed mood and sadness along with a loss of interest

in activities. According to Blair suicidal thoughts are a very common symptom of

depression and these suicidal symptoms are huge risks to the patient (2012). With

E.M. already having a past history of suicidal attempts and being pink slipped due to

that reason, suicide is a huge concern for him. According to Blair, when meds are

introduced, it may take several weeks for the meds to help with the depression but

they will feel more energized, so suicide is at risk until the medications work fully

(2012). The majority of people that commit suicide have a type of mental issue,

however the correlation between depression and suicide is interesting. In another

study, Shengnan Weil, Haiyan Li, Jinglin Hou, Wei Chen, Xu Chen and Xianoxia Qin

discuss that correlation. They look at the suicide ideations between patients with

major depressive disorders and the patients that do not. Within 127 patients 54

patients had major depressive disorder while 73 didn’t. Using the Hamilton

Depression rating scale which determines the intensity of suicide ideation, the

results were determined that the group with major depressive disorder were 8

points higher and more likely to have suicidal ideations than the non depressive

group (2017).

Stressors and Behaviors

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During the sit down with E.M. it was evident of the stressors and behaviors

that affected him to be admitted. He has a past history of depression and also has a

diagnosis of anxiety. He told me that his depression and anxiety had gotten bad

recently due to his relationship status. Recently he had gotten broken up with by

his girlfriend and has struggled to accept it. He stated that he felt like he wasn’t good

enough and had a sense of loneliness. With the breakup, not only was he single now,

but he had to find a way to cope with getting kicked out of her apartment with no

where to go. He stated to me how much of a financial burden this would be for him.

He then continued to talk about being a store manager at a Dollar General and how

it is very stressful and not the job he expected it to be. Between all the current

stressors in E.M.’s life and the addition of anxiety and a history of depression had

made it hard for him to cope. This is where he decided to start cutting himself in a

suicide attempt. The Hamilton depression rating scale also takes the patients quality

of life rating by looking at physical health, psychological health, economic

circumstances, work, family relationships and relationships with no family

associations (Wei, et al, 2017). As stated above you can see how E.M. relates to have

problems in a lot of these categories.

Patient and Family History

E.M. was very private about his psych history and his family’s psych history.

He was open to talk about his most recent admission, which was stated above, but

was hesitant about his past mental health history. In the chart, it did show a history

of past suicidal attempts but with no significant details. With E.M. just starting to

open up to me, I didn’t want to put him on the defensive and risk him shutting down
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on me and losing a quality patient for my case study. I eased up on the past history

and started a less serious conversation with E.M. and his friend that had been sitting

with us. To make E.M feel more comfortable I made sure to ask about his friends

reason for admission and his history as well.

Psychiatric Evidenced Based Nursing Care

The mental health floor at St. Elizabeth’s on Belmont provides great patient

care. They have rooms that are for individual patients and rooms that provide a

roommate. The staff does a good job of picking which patients can handle a

roommate and which can’t. They are open to patients’ requests with roommates and

resolve any issues quickly. The floor also offers several group therapy’s throughout

the day where they have open discussion and also talk about goals that they had for

the day. The patients can also participate in a morning stretch session to help them

feel less uptight and confined. The floor provides good milieu therapy by having all

neutral colors and making sure it’s not too bright in the room to lower stimuli and

relax the patients. The unit also has a large community room that patients can eat,

play games, or watch TV in. The unit also has a library that patients can go in.

They’re free to roam in and out of their room for most of the day.

Ethnical, Spiritual and Cultural Influences

E.M did not state about his religious influences except for the fact that he was

not following his parent’s religion of Christianity. He stated that he didn’t get along

with his parents due to this and practically got kicked out of his house because of

that. E.M was really adamant about this and actually had gotten triggered. He

started to raise his voice and become upset so the subject wasn’t explored any
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further. Getting kicked out of his house due to religious believes is a traumatic

experience that is hard for E.M. to talk about and this issue still effects him because

his parents play a limited role in his life.

Patient Outcomes

While on the unit, E.M. had a very active role. He participated in the majority

of the groups and stated that they really helped. Before arriving to the floor, he felt

isolated and felt that he was the only person with a diagnosis of depression and

anxiety. Group made him feel that he was not alone and was able to relate to the

other patients. When first talking to E.M he talked about being an introvert but

when assessing he seemed very extroverted. He cooperated in group and

participated in many conversations.

Plans for Discharge

E.M expected to get out within the day and he seemed excited. The doctor

corrected some of his medications and E.M. seemed to be accepting and willing of

his new medication dosages. He was in sad spirits to see that his friend in the group

was being discharged before him and they exchanged numbers. When E.M. leaves

he plans on finding a new place to live and to move on from his ex girlfriend.

Although his job stresses him out, it does provide an income for him and he plans on

staying there but searching for other jobs in the meantime. With his parents and

now his past girlfriend out of the picture, hopefully E.M. can stay in contact with his

friend from group and keep a connection. E.M. must find better coping skills when

his life becomes stressful and find relief in another ways than trying to harm himself

or one of these times he will be successful with his suicide plan.

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Nursing Diagonoses

• Ineffective coping skills r/t suicidal attempt due to cutting

• Risk for self injury r/t loneliness and past history of suicidal ideation

• Chronic low self esteem r/t family members kicking him out of house and

girlfriend leaving him

Conclusion

E.M. was kind enough to let me talk to him and was a pleasure to talk to. He

was very withdrawn at first but quickly opened up to me. Although he did have

some topics that he didn’t want to discuss or further talk about, he was a great

candidate for this case study. He had a tough life having to deal with the idea of

loneliness from his parents and his girlfriend. He knows that he must find a better

way to handle his stressor and must continue his medication regiment. E.M. has a

good plan ahead of him once he leaves the hospital and hopefully he can work

against his depression and anxiety to prevent his past history of suicidal ideation

and attempts.

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Reference Page

Blair, E. W. (2012). Understanding Depression: Awareness, Assessment, and Nursing

Intervention. Clinical Journal of Oncology Nursing, 16(5), 463–465.
https://doi.org/10.1188/12.CJON.463-465


Shengnan Wei, Haiyan Li, Jinglin Hou, Wei Chen, Xu Chen, & Xiaoxia Qiu. (2017).
Comparison of the characteristics of suicide attempters with major
depressive disorder and those with no psychiatric diagnosis in emergency
departments of general hospitals in China. Annals of General Psychiatry, 16,
1–9. https://doi.org/10.1186/s12991-017-0167-x


Svenningsson, I., Udo, C., Westman, J., Nejati, S., Hange, D., Björkelund, C., &
Petersson, E.-L. (2018). Creating a safety net for patients with depression in
primary care; a qualitative study of care managers’
experiences. Scandinavian Journal of Primary Health Care, 36(4), 355–362.
https://doi.org/10.1080/02813432.2018.1529018