Corns

Caylin Corns

Mental Health Case Study

Youngstown State University

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Abstract

The paper at hand will be informative on a patient admitted to Trumbull Memorial Hospital.

With a discussion held with the patient and chart reviewing, I will be sharing the patient’s

background. In regards to the patient’s admission, the precipitating events will be told. Nursing

diagnoses will be determined based on the patient’s medical diagnoses. Lastly, other

information that will be stated includes: a patient health history, support systems and family

members involved in the patient’s life, problems at hand in the patient’s life currently, and

personal statements made by the patient.

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Objective Data

A.S. is a thirty-one-year-old Caucasian female admitted to Trumbull Memorial Hospital

on October 27th, 2017. The date of care provided was on October 31st, 2017. According to the

DSM-IV-TR, the patient’s diagnoses presented in Axis I are Bipolar I Disorder and Substance-

Induced Mood Disorder due to the use of Cocaine. The patient’s diagnosis existing in Axis II is

Borderline Personality Disorder. The unemployment of the patient can be reported as an Axis IV

diagnosis. On top of the diagnosis mentioned, A.S. is currently going through withdrawal from

Cocaine due to the admission to the hospital, and not having her daily drug fix. During the

interview process, she stated, “I love Cocaine. I use it every day.” The current opiate withdrawal

can be considered an Axis III diagnoses. A journal article considering Cocaine abuse noted that

there are several consequences for one’s health. Treatment of compulsive users is challenging,

but behavioral treatments have attained success with about half of those cocaine addicts

requesting treatment (Cornish and O’Brien, pg. 12). With A.S. mentioning that she wanted to

overcome her drug addiction and better her life, maybe she will seek treatment and be successful.

A.S. was currently in a state of mania during the date of care. She had a flight of ideas,

was extremely talkative, and had rapid changes in emotions. She was very personable and easy

to talk to. I felt as if she was honest with me during the interview after comparing with the chart.

The patient was involuntarily admitted to the hospital by the cops due to stating suicidal

ideations after facing assault charges. She denied truly having any suicidal thoughts during our

interview by making the comment, “I just said I was suicidal to the cops so I didn’t have to go to

jail. I am really not suicidal at all.” A.S. was on police hold, unit restrictions, and had patient

self-harm precautions enforced. She was prescribed Depakote, an anticonvulsant, for bipolar

disorder. The dose and frequency for Depakote was 500 mg twice a day. Additionally, she was
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prescribed Synthroid, a synthetic T4 replacement, used to treat hypothyroidism. She was

prescribed 125 mcg daily. The PRN medications that were ordered included Haldol for

agitation, Vistaril for anxiety, and Desyrel for insomnia.

Expected and Common Behaviors of the Client with Bipolar I Disorder

In reference to the textbook, Bipolar Disorder is characterized by mood swings from

profound depression to extreme euphoria, with intervening periods of normalcy. Psychotic

symptoms may or may not be present in the patient with the disorder (Townsend, pg. 899). In

regards to this specific patient, the manic episode was very evident. This is when the mood of

the individual is elevated, expansive, or irritable. The disturbance is sufficiently severe to cause

marked impairment in occupational functioning or in usual social activities or relationships with

others or to require hospitalization to prevent harm to self or others. Motor activity is excessive

and frenzied (Townsend, pg. 500). Bipolar I disorder is deemed when the person is undergoing a

manic episode or has a history or one or more manic episodes. This diagnosis is indicated by the

current or latest behavioral episode experienced which is mania (Townsend, pg. 501).

A.S. was exhibiting a very noticeable manic episode. She presented with a range of

emotions. For example, she would laugh and tell a joke about her love life one moment then cry

and become sad about her mother the next. She also presented with a flight of ideas. It was as if

she had a timer running and had to fit in all her thoughts and ideas very quickly. As mentioned

early, she denied all suicidal ideations at the time of the interview.

Expected and Common Behaviors of the Client with Borderline Personality Disorder

According to the textbook, Borderline Personality Disorder is a disorder characterized by

a pattern of intense and chaotic relationships, with affective instability, fluctuating and extreme

attitudes regarding other people, impulsivity, direct and indirect self-destructive behavior, and
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lack of a clear or certain sense of identity, life plan, or values (Townsend, pg. 900). This

disorder is seen more in females than males (Townsend, pg. 675).

A.S. displayed a couple of signs of Borderline Personality Disorder during the day of

care. In regards to “values,” the patient held values that were different than those of most

people. During the interview, she shared that she is taking place in sexual activities with a

married man. When sharing this information with me, she preceded to laugh and make a joke

about the entire situation. She did not see anything wrong with the situation, and felt as if it was

a normal occurrence. In regards to “lack of clear life plan,” the patient held a very unrealistic

goal with thoughts of immediate gratification. For example, she informed me that instantly after

discharge she is going to get an apartment, a new job, and her son’s custody back even though

she is currently unemployed, has a drug-addiction, and no current home.

Expected and Common Behaviors of the Client with Substance-Induced Mood Disorder

In the textbook, Substance Abuse is defined as the use of psychoactive drugs that poses

significant hazards to health and interferes with social, occupational, psychological, or physical

functioning (Townsend, pg. 914). Individuals are said to have a substance use disorder when the

use of substance interferes with their ability to fulfill normal life functions. There is a crave for

the substance, and excessive amounts of time spent trying to get more and more of the substance.

Addiction can become evident when tolerance develops, and the amount of substance required to

achieve the desired affect continues to increase (Townsend, pg. 366).

A.S. is addicted to the substance known as Cocaine. She informed me that she uses the

drug every day because she loves it. She even shared with me that when she is babysitting her

friend’s children, she puts the children in a safe place before doing the drug. She did not see any

problem with that, and insisted she was doing what was right.
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One journal article I read examined whether certain medical disorders are more prevalent

among adults with severe mental illness and if a comorbid substance use disorder increase

prevalence beyond the effect of severe mental illness alone. In the article, the group of patients

with a psychotic disorder and a comorbid substance use disorder had the highest likelihood for

five of the eight disorders: heart disease, asthma, gastrointestinal disorders, skin infections, and

acute respiratory disorders (Medical Morbidity, Mental Illness, and Substance Use Disorders, pg.

5). Due to the comorbidity of severe illnesses, A.S. has a higher risk of developing more

medical illnesses than those with less illnesses.

Precipitators to the Current Hospitalization

Before becoming hospitalized, A.S. was unemployed and would partake in babysitting

the children of some of her friends. For as long as A.S. could remember, she did Cocaine daily.

The drug abuse resulted in her unemployment, losing custody of her child, and the loss of her

family. The precipitating event that lead the patient to hospitalization was the act of assault

towards one of her friends. A.S. had also been noncompliant with her medicines for over a

month. The cops were called to the scene and on the way to the jail, the patient made suicidal

remarks resulting in the admission at the hospital. In the ER, the patient was very uncooperative

and causing a scene. A.S. is currently admitted to become medically stable, and begin the use of

medication treatments necessary for her diagnoses.

Another journal article that I looked at was informative about compliance with

medications. The authors looked at medication compliance in psychiatric treatment while

comparing compliance rates with compliances rates in treatment of physical disorders. The

article noted that the use of certain prompts such as a specific time of day, meal, or other daily

routine assists with the behavior of taking a dose of medication as part of a regular routine
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(Compliance With Medication Regimens for Mental and Physical Disorders, pg. 5). For A.S. to

become more compliant with her medications, integrating use of a certain cue may help.

Patient and Family History of Mental Illness

When looking at the family history of A.S.’s case, her father, sister and brother all have

Bipolar Disorder. The patient did not share this information with me during the interview;

however, it was discovered during the chart review. Additionally, the chart also showed the

patient having a history of sexual abuse, but A.S. did not bring this up in conversation.

Nursing Care and Milieu Activities

The psychiatric unit at Trumbull Memorial Hospital provides an excellent milieu. The

floor is very clean and organized which limits distractions to the patients. There is a schedule

posted on the wall of when the groups are, meal times, and visiting hours.

The floor is an elongated horse shoe shape with rooms on each side (one side being

restricted) and a common room in the middle in front of the nurse station with tables. The group

room is found on the left of the common room. Most of the patients can be found sitting in the

common area watching television, coloring, talking to other patients, or playing a game. The

common area allows the staff to have eyes on all the patients. If the patient decides to stay in

their rooms, there will be a staff member that does a check on that room every 15 minutes.

A.S. was initially placed on suicide precautions based on her suicidal ideations. Even

though the patient stated that she was not suicidal, it was still important to keep close attention to

her and not allow her to be alone for certain periods of time. This decreases the risk of any self-

harm activities.

Ethical, Spiritual and Cultural Influences

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The patient did not discuss any cultural or spiritual influences that impacted herself. The

patient did attend the religion group therapy session on the day of care, and was interested in

what the pastor had to say based on her contribution to the group session.

Patient Outcomes Related to Care

A.S. did not seem to express any current signs of withdrawal besides being in a manic

mood. The patient realized why she was admitted, and knew that she did something unlawful.

She mentioned not being suicidal at all, but just making the comments to get herself out of going

to jail. When having our interview, the patient talked as if this entire admission was a life lesson,

and she needed to get her life back on track. It was hard to determine if she was genuine when

making the comments of a better lifestyle due to being in a manic episode. It was challenging

because she was expressing signs of grandeur when mentioning what her intentions were once

discharged. For example, she said “I already have an appointment set up to go look at a new

apartment on North River Road once I leave here,” but five minutes later she would state, “I

have an appointment to go look at a house I want to rent after I am discharged.” I found that her

comments ended up overlapping one another, and it seemed as if she was trying to say the things

she thought I wanted to here, rather than saying the feelings/thoughts that she honestly felt.

Discharge Plans

A.S. is going to continue go to Valley Counseling. She is also very interested in seeking

help to beat her current drug addiction with intentions to come clean. On the day of care, there

was not a plan to go home anytime soon that I was aware of. The law enforcement team may

also have some criteria for her to meet before being discharged anywhere.

Nursing Diagnoses
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1. Ineffective coping related to substance abuse as evidence by patient stating, “I love Cocaine. I

do it every day.”

2. Absence of acute withdrawal symptoms related to substance abuse as evidence by coming into

the emergency department with a positive drug screen

3. Withdrawal precautions related to drug abuse as evidence by signs of mania

Potential Nursing Diagnoses

1. Knowledge deficient related to substance abuse as evidence by not knowing about community

resources

2. Risk for self-harm related to suicidal ideations

3. Encourage patient to verbalize positive coping patterns post discharge related to poor coping

strategies as evidence by positive drug screen

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Works Citied

Cornish, J. W. (1996). Crack Cocaine Abuse: An Epidemic with Many Public Health

Consequences. Annual Review of Public Health, 17(1), 259-273.

doi:10.1146/annurev.publhealth.17.1.259

Cramer, J. A., & Rosenheck, R. (1998). Compliance With Medication Regimens for Mental and

Physical Disorders. Psychiatric Services, 49(2), 196-201. doi:10.1176/ps.49.2.196

DeepDiveAdmin, W. D. (n.d.). Axis I-V. Retrieved November 14, 2017, from

http://www.psyweb.com/DSM_IV/jsp/Axis_I-V.jsp

Part 2C Women and Substance Abuse. (2010). Oxford Textbook of Women and Mental Health.

doi:10.1093/med/9780199214365.010.0005

Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: concepts of care

in evidence-based practice. Philadelphia, PA: F.A. Davis Company.