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Kimberly Muccio
Abstract
of people of all ages in psychiatric hospitals all across the country. The purpose of this case study
was to collect subjective and objective data regarding a patient’s diagnosis and reason for
hospitalization. The case study focuses on one patient at the psychiatric unit at St. Elizabeth
Mercy Hospital in Youngstown, Ohio. Topics related to this patient such as signs and symptoms
of the illness, stressors and behaviors that precipitated this hospitalization, patient and family
history of mental illness, care provided, outcomes related to care, and plans for discharge are
discussed in this case study. Nursing diagnoses related to this patient and a list of potential
Objective Data
S.M. is a 25 year old female who was admitted to the psychiatric unit at St. Elizabeth’s
Hospital in Youngstown on February 19, 2019. I cared for her two days later on February 21,
2019. She has allergies to latex, penicillin, and fish oil. Her psychiatric diagnosis is depression.
Her other medical conditions include suicidal ideation and chronic post-traumatic stress disorder.
Her chief complaints were mood problems, anxiety problems, and suicidal and homicidal
ideations.
The patient presented to the emergency room by ambulance with superficial lacerations
on her left wrist. She stated that she moved to Youngstown a couple of weeks ago to be with her
boyfriend. They got into a fight and he told her to go home so she took out a razor and cut her
wrist, but the blade was not sharp enough to cut very deep. She described to me that she was not
trying to kill herself but she was simply trying to relieve the pain that she was experiencing
mentally by cutting and experiencing that pain physically. She was understanding that she
needed help, so she voluntary agreed to go to the psychiatric unit. She attends group activities
while she is at the hospital and sees a social worker who has set her up with a therapist for
treatment outside of the hospital setting. She sees a nurse practitioner on the psychiatric floor
who has prescribed her a medication regimen that she will follow when discharged from the
hospital. She does not have any extra self-harm precautions and is compliant with the rules of the
hospital. She maintains safety to herself and others and is not at a high risk for harm, but is
During our discussion, S.M. had an animated facial expression and seemed relaxed
throughout the conversation. She maintained good eye contact while talking to me. She was
dressed neatly and her hair was pulled back into a neat pony tail. She acted appropriate for the
situation and spoke very friendly. She did not have any irregular muscle or motor movement
DEPRESSION AND MENTAL ILLNESS 4
such as akathisia, akinesia, or tardive dyskinesia. She had a pleasurable affect and did not seem
to have any disturbances in cognition or thought. She told me that she has three kids at home and
she was looking forward to getting out and seeing them. It seemed as though her kids motivated
her in life and they are the reason she wanted to get better. She seemed excited that she was
The patient’s psychiatric medications include Abilify 5mg twice a day for suicidal
ideation, Haldol 10mg every six hours as needed for agitation, Vistaril 50mg as needed for
anxiety, Remeron 15mg at bed time for depression, and Desyrel 50mg at bed time for depression.
Summary
Depression is one of the most common psychiatric mental health disorders. Depression is
defined as “an alteration in mood that is expressed by feelings of sadness, despair, and
pessimism” (Townsend, 2017). Individuals diagnosed with this psychiatric condition often
experience symptoms such as change in appetite, sleep patterns, and cognition (Townsend,
2017). They also may lose interest in activities that they once enjoyed. Although these are the
most common, “patients’ description of their symptoms are likely to be affected by their beliefs
about their illness and to what they attribute symptoms” (Katona, 2005). This patient also had
to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as
natural or man-made disasters, combat, serious accidents, witness the violent death of others,
being the victim of torture, terrorism, rape, or other crimes” (Townsend, 2017). S.M. described
that at night she sees shadows because at a very young age she was molested by several family
members. Child sexual abuse is not uncommon and girls are at “about 2.5 to 3 times higher risk
than boys” (Putnam, 2003). She has flashbacks about these incidents. When she was 17 years
old, she was raped by one of these family members and this rape resulted in her diagnosis of
DEPRESSION AND MENTAL ILLNESS 5
herpes and a miscarriage of the baby. In a study conducted by Putnam (2003), it was determined
that “a variety of psychiatric disorders are clinically associated with childhood sexual abuse such
substance abuse disorders, posttraumatic stress disorder (PTSD), dissociative identity disorder,
and bulimia nervosa”. Since she experienced such traumatic events in her life, she now suffers
from posttraumatic stress disorder and depression over these events on top of the stress of her
Identification of Stressors
S.M. was voluntarily admitted to the inpatient psychiatric unit after being taken by
admission, she presented with superficial lacerations to her left wrist. She states that the stress of
moving and the stress about fighting with her boyfriend just became too much for her to handle.
She described that she knew she needed help and knew that she should go to the hospital once
she determined that her three children had somewhere safe to go for the time being. Although
she denied a suicidal attempt, in the doctors and nurses notes it was declared that the reason she
was admitted was an attempted suicide. Self-cutting injuries have “the potential of leading to
devastating disability and repeated suicide attempts” (Carroll, 2016). Though it has a low
mortality rate, cutting is a type of injury that is commonly seen in patients who attempt suicide.
Self-cutting has the function to “terminate the dissociation precipitated by a strong emotion, such
as anger” (Carroll, 2016). This is why she told me that she was trying to stop the emotional pain
by causing physical pain. Even though it is hard for people who do not experience mental illness
to understand, there are a lot of instances where individuals believe that this action will take the
pain away.
DEPRESSION AND MENTAL ILLNESS 6
Family History
S.M. talked to me for a short period of time about her history and her family history of
mental illness, but I found most of it in her chart on the computer. She told me that she had only
been to a psychiatric institution one other time. When she was seventeen years old she went to
Belmont Pines. We talked about Belmont Pines for a little because I just had an offsite rotation
there. She said that Belmont Pines helped her a lot when she was there eight years ago. When I
read a bit more in depth into her chart I realized that she was acting suicidal and homicidal
toward her mother, so her mother took her to Belmont Pines. In her chart I also found that her
father experiences bipolar disorder. It is not uncommon for mental illness to run in families, so I
Nursing Care
The purpose of milieu therapy is to provide a healing and therapeutic environment for
patients to be open about their illness and to discuss alternative and healthier coping mechanisms
to deal with the feelings that they are facing. Milieu therapy is an important part of psychiatric
treatment program on the unit. Patients are encouraged to attend these group sessions and be an
open participant in them. S.M. attended all of the group therapy sessions that were offered at the
hospital. She described to me that she thought they were very helpful to her because she realized
that she was not alone in her illness. Peer pressure is a powerful tool that is used in the
psychiatric setting to encourage discussion. To her, talking with the others who go through the
same situations was eye opening and beneficial. When she is in the outside world, especially
with social media, it’s hard to understand that some people are also going through difficult times
just like you. She appreciated that I was empathetic and that we could just talk about her
Analyze
The patient did not discuss any ethical, spiritual, or cultural influences that impacted her
decision making. She denies any spirituality and states that prayer is not a coping mechanism of
Patient Outcomes
On the psychiatric unit, there are numerous patient outcomes and goals set in place for
each individual. Every outcome and goal is specific to each patient since everyone presents with
different symptoms for every diagnosis. Safety, as always, is of utmost importance on the
psychiatric unit, so the outcome that the patient will remain safe and free of harm throughout
hospitalization is a desired outcome for every patient on the floor. Some other desired outcomes
specific to S.M. include: patient will seek help when experiencing self-harm impulses, patient
will identify community support groups that she will be in contact with in the next month, patient
will demonstrate compliance with any medication or treatment plan within the next three weeks,
and patient will express feeling accompanied by practicing alternative coping strategies. These
desired outcomes will discussed with discharge planning and followed up on in later therapy
Discharge Plans
S.M. was discharged on the day that I cared for her. She will receive instructions on how
to take her new medications and the importance of compliance to her medication regimen.
Education about alternative coping strategies will also be discussed at discharge. Social work and
case management are involved in her case and have set her up with a psychiatrist so that she can
self-harm. She told me that she plans to go back to her hometown with her children to be close to
DEPRESSION AND MENTAL ILLNESS 8
her family until she can get everything together and feel better. She seems excited about
Nursing diagnoses are important because they serve the basis of the selection of
interventions and procedures that will occur with the care of the patients. They are specific to
each and every patient, even those with the same illness. This specific patient’s actual nursing
diagnoses in order of importance are as follows: Risk for self-harm related to feelings of
depression as evidenced by cutting of wrists and suicidal thoughts, ineffective coping related to
wrist, and chronic low self-esteem related to traumatic childhood experiences as evidenced by
Potential nursing diagnoses are important to keep in mind in case the patient exhibits new
signs and symptoms that indicate a new problem. Potential nursing diagnoses for depression
include: impaired social interaction, risk for self-care deficit, disturbed thought processes, and
Conclusion
The diagnosis of depression is a very common but serious disorder of all age groups of
individuals. The individual discussed in this case study was diagnosed with depression with
suicidal ideation and posttraumatic stress disorder. Subjective and objective data was collected
and presented in this case study regarding a specific patient’ medical diagnosis. The diagnosis of
depression was defined and common behaviors associated with this psychiatric illness were
discussed. The patient’s current stressors and family history were discussed to determine the root
of the problem that led to this hospitalization. Patient outcomes and plans for discharge were also
DEPRESSION AND MENTAL ILLNESS 9
discussed as well as a list of diagnoses and potential diagnoses were determined. Safety was
maintained for this patient throughout her entire hospitalization. A therapeutic milieu
environment was promoted and group therapy was encouraged. The multidisciplinary approach
on this psychiatric unit yields a beneficial healing environment for individuals diagnosed with
References
Carroll, R., Thomas, K. H., Bramley, K., Williams, S., Griffin, L., Potokar, J., & Gunnell, D.
(2016). Self-cutting and risk of subsequent suicide. Journal of Affective Disorders, 192,
8-10.
Katona, C., Peveler, R., Dowrick, C., Wessely, S., Feinmann, C., Gask, L., ... & Wager, E.
Putnam, F. W. (2003). Ten-year research update review: Child sexual abuse. Journal of the
Townsend, M. C., & Morgan, K. I. (2017). Essentials of Psychiatric Mental Health Nursing: