Running Head: MENTAL HEALTH FALL SEMESTER 2019, CASE STUDY

Mental Health Fall Semester 2019, Case Study

Haley Davis
10/3/19
Youngstown State University
MENTAL HEALTH FALL SEMESTER 2019, CASE STUDY 2

Abstract
K.B. is a 23-year-old female who was voluntarily admitted to the seventh floor at St. Elizabeth’s

hospital in Youngstown Ohio. K.B. has a psych history and overdosed 4 years ago. She also has

other medical conditions that put her at risk. This time she is stable and does not have suicidal

ideations, however, she is depressed. She has postpartum depression on top of her depression and

was seeking care to be prescribed medicine to help her. She is currently breast feeding her almost

eleven-month old son which limits the medications she can use. She was on Zoloft, prescribed to

her from her obstetrician, but she dumped out her prescription because she did not like the side

effects. She put on a lot of weight and claimed they made her feel worse. She hoped to get a new

prescription, now that her son is older, she would rather get herself help then to continue breast

feeding.
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Mental Health Fall Semester 2019, Case Study

During my Mental Health clinical on Thursday October 3, 2019 I encountered patient,

K.B. She agreed to talk to me about her current situation and give me a little of her background.

It was through direct conversation with K.B and looking at her chart that I was able to gather the

following information about this case.

Objective Data

K.B. was admitted on 10/2/19 in the late afternoon. She voluntarily came in for help with

her depression. She had an episode of anger due to the buildup of stress and lack of support at

home. Her diagnoses is Major Depressive Disorder, Single episode. In her chart it states that last

week she said she had suicidal ideation (reported by her boyfriend), however, open admittance

she denied this. K.B.’s medical history includes: bipolar disorder, panic disorder, post-traumatic

stress disorder, attention deficit disorder, anxiety, post-partum depression, herpes simplex virus

type 2, and bacterial vaginitis (BV). Her surgical history includes a caesarean birth for her two-

year-old twins and a dilation and curettage. She has been on the psych floor one other time, four

years ago. She overdosed on Seroquel. K.B. currently has no prescribed safety or security

measures. Her current medications while on the floor are all PRN and include: Cogentin 2mg IM

2 times daily PRN, Vistaril capsule 50mg PO 3 times daily PRN, Zyprexa 10mg IM q4h PRN or

5mg PO q4h PRN, and Desyrel 50mg PO nightly PRN. Her orders include a general diet, full

code and inpatient to social work.

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Psychiatric Diagnosis Summary

K.B.’s psychiatric diagnosis was Major Depressive Disorder, Single episode.

Mayo Clinic explains Major Depressive Order:

Depression is a mood disorder that causes a persistent feeling of sadness and loss of

interest. Also called major depressive disorder or clinical depression, it affects how you

feel, think and behave and can lead to a variety of emotional and physical problems. You

may have trouble doing normal day-to-day activities, and sometimes you may feel as if

life isn't worth living. More than just a bout of the blues, depression isn't a weakness and

you can't simply "snap out" of it. Depression may require long-term treatment.

[ CITATION May18 \l 1033 ]

K.B. also has bipolar disease. This disease has mood swings from very lows to mania.

Her depression episodes would be present when she is experiencing the lows. Along with Major

Depressive Disorder, new mom K.B. has postpartum depression as well. She cannot handle her

postpartum depression anymore, so she is seeking treatment.

Patient Stressors and Behaviors

K.B.’s mother does not support her. She gets looked down upon for her mental illness.

Her boyfriend’s family doesn’t support her either. He has two dads and they do not understand

what postpartum depression is. Both families do not want K.B. to have her children. K.B.’s

boyfriend is the only support she has. He understands her she said. He is also the only one with

an income right now. She stopped working five months ago. She is working on applications for

Dollar General and Family Video.

K.B used to work as a stripper near Rogers, Ohio. She said she knows how to play it

smart and which gentlemen to take. However, in need of the money, she took a guy who seemed
MENTAL HEALTH FALL SEMESTER 2019, CASE STUDY 5

sketchy. He took it too far with her and she was raped five months ago. Her boss hid any proof

and the case was dropped. She now suffers from post-traumatic stress disorder because of the

rape.

K.B.’s 3-year-old daughter is from a man, other than her current boyfriend. She recently

saw her daughter’s father in town, and she fears running into him again. He tried to kill the

daughter twice, according to K.B. and eventually walked out and did not want anything to do

with them. Seeing him raised her stress level recently.

K.B. has 4 children: a 3-year-old, 2-year-old twins, and an 11-month-old infant. Her

boyfriend just started a new job and she has less help at home. On top of taking care of the

children all day when her boyfriend is working, they are all sick and fussy. She has not been

getting much sleep because the children aren’t sleeping since they are sick. Also, since she is

breastfeeding her youngest, she has been getting up every 2-3 hours for the past 11 months to

feed him. The sick children and lack of sleep eventually caused her to snap.

K.B. was cooperative and easy to talk to. Her goal for the day of care was to work on

herself to be a better mother. She was asking a lot of questions as to when she was going to be

released; and if it was up to her since she was voluntarily admitted. She was nervous to go home

and did not want to be left homeless for the rest of the week if she was discharged after a three

day stay. She said her boyfriend’s dad took off work to watch the children for the week. He did

not approve of her getting help at the floor and did not understand her postpartum depression.

She did not want to return to her home while he was there for the remainder of the week. The

social worker, who was also talking to K.B., told her that she would probably be discharged in

three days, so she needed to communicate that to her boyfriend and work out the situation.
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Patient and Family Mental Illness History

K.B.’s mother also has a diagnosis of depression. Additionally, her aunt, the mother’s

sister, committed suicide ten years ago. K.B. is not currently getting along with her mother. Her

mother does not think that K.B. is stable enough to have custody of her children and is trying to

take them. Children services is not involved with the family. The mother is also pregnant

currently and is due next month, November 2019.

K.B reported that in her past she was sexually abused by her grandfather until age 16.

The abuse ended when her grandfather passed away of a heart attack. In addition to being

sexually abused, she was physically abused by her mother and stepfather as a child. K.B. used to

cut herself however she has not been doing that. Four years ago K.B. attempted suicide by

overdosing on Seroquel 1700mg. She reported being in coma for four days on a medical floor at

St. Elizabeth’s Main then they moved her to the adult psychiatric floor when she was stable. That

was her only other time on a psychiatric floor. She has two counselors to help her.

Psychiatric Based Nursing Care

K.B. has attended and participated in wellness group on the floor. The nurses are to form

a therapeutic relationship with the patient and see how they can equip her to fulfill her roles in

life. They should talk to her about coping strategies she has used in the past and teach her new

ones she should try. The nurses should allow the patient to ventilate feelings and use active

listening. The nurses can provide positive feedback to K.B. The nurses will make sure she takes

her newly prescribed medications and observe how she responds to them. The nurses should also

provide K.B. with other resources she can use in the future.
MENTAL HEALTH FALL SEMESTER 2019, CASE STUDY 7

Influences

The patient reported not being spiritual. She reported to being very open minded and no

significant traditions or culture influences. She showed off her newest tattoo, a bisexual flag on

her forearm. She also reported having gay in-laws. K.B. said her mother was spiritual, at least

claimed to be. She disapproved of the tattoo. K.B. said her mother is a hypocrite though because

she has had three different husbands and has their names tattooed all over her.

Patient Outcome Evaluation

K.B. was not even on the floor 24 hours when this data was collected on her case. She

seemed stable. She was willing to share a lot about what brought her to the floor. She seemed to

have a good grasp on her situation. K.B. currently has a clinic counselor who she has not seen in

a while. The nurses were going to make sure she set an appointment with that counselor before

discharging her from the floor. K.B. also said she has a counselor who visits her house. She

reported having good relationships with both counselors, so keeping up with her appointments

with them should better her outcome.

Nursing Diagnosis

1. Risk for self-directed violence related to depression as evidenced by previous suicidal

attempt, suicidal ideation, cutting history, and punching her house the day of admittance (bruised

hand). Some expected outcomes to for the client are:

 Patient will have satisfaction with social circumstances and achievements of life goals.

 Patient will identify at least two-three people he/she can seek out for support and

emotional guidance when he/she is feeling self-destructive before discharge.

 Patient will not inflict any harm to self or others.

 Will demonstrate alternative ways of dealing with negative feelings and emotional stress.
MENTAL HEALTH FALL SEMESTER 2019, CASE STUDY 8

2. Ineffective coping related to reaching her breaking point as evidenced by suicidal

ideation, feelings of worthlessness, guilt, sleep disturbances, and anger episode. Some expected

outcomes to for the client are:

 Express feelings directly with congruent verbal and nonverbal messages

 Be free from psychotic symptoms

 Demonstrate functional level of psychomotor activity

 Demonstrate compliance with and knowledge of medications, if any

 Demonstrate an increased ability to cope with anxiety, stress, or frustration

 Identify a support system in the community

3. Chronic low self-esteem related to ability to be a mother as evidenced by her daily goal

“work on myself to be a better mother” and her family trying to take her children because they

tell her she is not good enough. Some expected outcomes to for the client are:

 Evaluate own strengths realistically

 Verbalize increased feelings of self-worth within 2 to 5 days

 Make plans for the future consistent with personal strengths

 Express satisfaction with self and personal qualities

Potential Nursing Diagnosis

 Impaired Social Interaction related to lack of support

 Bathing self-care deficit related to depression

 Dressing self-care deficit related to depression

 Feeding self-care deficit related to depression

MENTAL HEALTH FALL SEMESTER 2019, CASE STUDY 9

 Impaired parenting related to inability to preform activities of daily living secondary to

postpartum depression

Conclusion

K.B. is aware of her diagnosis and can see how it is negatively affecting her currently.

She is seeking help and seems ready to follow a treatment regimen. The doctors will prescribe

medication that she will need to routinely take in order to decrease the symptoms of her

disorders. The nurses will be able to assess, while K.B. is admitted, if the medications are

helping or further harming her. Her stay on the adult psychiatric floor should only be three days

then she will return home. The goal is that K.B. returns home with better coping skills and has

learned ways to respond to the negative stressors in her life at the time being.
MENTAL HEALTH FALL SEMESTER 2019, CASE STUDY 10

References

Staff, Mayo Clinic. 2018. Depression (Major Depressive Disorder). February 3.