Mental Health Clinical Case Study 1 PDF

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HESI Evolve, Nurse THINK Clinical Case studies....

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Clinical Case Study: Emotion (Mood, Anxiety, & Grief)

Case: Bipolar Disorder with Depression Related Concepts: Adaptation, Coping, Wellness, Self-Management, Medication management & Suicide attempt

Luis Chaves is a 22-year-old who migrated to Miami at the age of 2 years with his parents. He is unemployed and lives with his sister. He is actively involved with an intercity gang and depressed. Today he intentionally overdosed with paroxetine, zolpidem, oxycodone and alcohol. He goes to his sister’s apartment to say goodbye after taking the drugs and alcohol and confesses to overdosing. His sister immediately calls 911 as he became unconscious. On the way to the emergency department Luis was treated with naloxone, which produces a rapid improvement in his level of consciousness. He becomes agitated and starts yelling that he “doesn’t want to live anymore.”

Pre-Hospital Note October 26 2300

Paramedics responded to the residence at 2204. Upon arrival to the scene found a 22-year-old male unconscious. Sister reports that the client stated overdosing with paroxetine, zolpidem, oxycodone, ibuprofen, and alcohol. Patent airway and breathing spontaneously at 8 respirations per minute, pulse 60 beats per minute, blood pressure 90/58 (69) mmHg. Naloxone administered during transport and client’s consciousness level increased. Began yelling, “I don’t want to live anymore.” Respirations 20 breaths per minute, pulse 90, blood pressure 148/98 (115) mmHg. Handoff report to the emergency department nurse.

1. The nurse receives the above handoff from emergency medical personnel that brought Luis into the emergency department. What are the 3 priority concerns or cues? 1. Suicide risk assessment. 2. Medical assessments, he has risk of respiratory depression as the medication wears off. 3. At risk for injury to self or others

2. As the triage nurse in the E.D., what is the priority focused assessment? A. Cultural preferences B. Respiratory status C. Suicide risk D. Substance use history 3. The client responded to the naloxone on the way to the E.D. Which substance(s) would not react to naloxone? Select all that apply. A. Paroxetine B. Zolpidem C. Oxycodone D. Ibuprofen E. Alcohol

Luis is stabilized in the emergency department. He reports feeling “desperate” over being estranged from his 4-year-old son and the negative consequences of his current life decisions. He goes on to discuss conflicts that he has with his mother, his inability to find employment, the recent death of several close friends murdered in gang violence, and feelings of self-loathing, helplessness, hopelessness and depression. Luis shares that his biological father is an alcoholic and has a drug abuse problem. However, the client denies that he has any problems with alcohol because he “doesn’t like the taste,” and only drinks one to two times per month. He also doesn’t take drugs because he doesn’t “like the way they make him feel.” Luis states that his family history is positive for depression, schizophrenia, and bipolar disorder. At age 14 he tried to commit suicide for the first time and has made three attempts since then with a previous psychiatric admission. He says “I wish I hadn’t gone to my sister and told her what I did; then this would be over.” Client denies current suicidal ideation.

4. What is the best predictor of a suicide attempt? A. A family history of suicide attempts. B. Previous suicide attempts. C. Stating suicide intent. D. Having a friend who had a suicide completion. 5. The nurse reviews suicide risk factors and mentally compares them to Luis’s situation. Mark each box appropriately. Suicide Risk Factors

Factors that place Luis

at a Higher risk for suicide Defined plan, means and intent Previous attempts A family history of alcohol use. A family history of suicide. Being in a committed relationship. Lack of social support system. The recent loss of a close relationship. Male gender Employment status Mental illness

x x

x

x

x x

x

x x x

x x x

Luis denies chronic illnesses in his family besides his mother having bone marrow cancer. He is currently taking oxycodone for leg pain. Three months ago, he was climbing a spiked fence when he slipped, and his leg was caught on one of the spikes, where he was left dangling. He now walks with a slight limp but states that it only hurts if he tries to walk without the limp.

6. The nurse continues the assessment. What question(s) should the nurse ask? Select all that apply. A. What medications are you currently prescribed besides oxycodone? B. Tell me about any illicit drugs you have taken? C. How do you feel about your attempt being unsuccessful? D. What is your relationship with your sister? E. Tell me more about your family history of mental illness. F. How has your mood been lately? 7. What are the criteria for a diagnosis of major depressive disorder? Select all that apply. *Use the National Institute of Mental Health to help answer this question. www.nimh.nih.gov/health/topics/depression/index.shtml

A. B. C. D. E. F. G. H. I. J.

Depressed mood. Lack of interest in activities that used to be enjoyable. Manic mood. Change in appetite. Fatigue or loss of energy. Feelings of elation. Feelings of worthlessness. Inability to concentrate. Thoughts of death. Increase in goal-focused activity.

8. The nurse discovered that Luis takes paroxetine for a major depressive disorder. Which statement is correct about this medication? A. Paroxetine is a monoamine oxidase inhibitor that works by blocking the breakdown of tyramine, a precursor to dopamine. B. Paroxetine a tricyclic antidepressant that works by altering norepinephrine and serotonin levels at the synapse. C. Paroxetine is a selective serotonin reuptake inhibitor that works by helping serotonin get to the synapse where it is needed. D. Paroxetine is a heterocyclic that works by inhibiting neuronal uptake of norepinephrine and dopamine. Laboratory Report Lab WBC Hemoglobin Hematocrit % RBC Platelets Calcium Chloride Magnesium Phosphorus Potassium Sodium Glucose, fasting BUN Creatinine CPK LDH AST ALT

Normal (Fill in values) Admit values (highlight abnormal values) 4500-11000 5.6 12-15.5 11.2 36-44 32 4.2-5.4 4.0 150,000-450,000 156,000 8.5-10.5 9.0 96-106 103 1.7-2.2 1.4 2.5-4.5 4.5 3.6-5.2 3.4 135-145 136...