Running Head: MENTAL HEALTH CASE STUDY 1

Augusta Fronzaglio

Mental Health Case Study

Mrs. Peck

Youngstown State University

MENTAL HEALTH CASE STUDY 2

Abstract

My case study will inform the reader on a patient admitted to Trumbull Memorial

Hospital on February 23, 2018. Upon looking at the patient’s chart and having discussion I will

share the background information. Along with the patients the precipitating events leading to

admission to Trumbull Memorial Hospital will also be told. Reviewing the patients’ medical

diagnoses, then nursing diagnoses will be formulated. To finish, other information that will be

indicated includes: a patient health history, support systems including family members,

problems the patient is currently dealing with in life, and personal words shared by the patient.
MENTAL HEALTH CASE STUDY 3

Objective Data

M.C. is a seventy-seven year old Caucasian female admitted to Trumbull Memorial

Hospital on February 23rd, 2018. M.C. was admitted to Trumbull Memorial Hospital involuntary

but stated” I know I need to be here to get better and talk about what happened.” March 2nd,

2018 was the date that I provided care to M.C. When reviewing the patient’s diagnoses of

Major Depression with psychotic features the DSM-IV-TR, states M.C. diagnoses is present in

Axis 1. According to Correll, Detraux, Lepeleire, and Hert “People with severe mental illness,

particularly schizophrenia, bipolar disorder and major depressive disorder, have an average

mortality rate that is 2-3 times higher than the general population, corresponding to a 10-25

year shortened life expectancy” the statement made is mind blowing that due to a mental

illness someone’s life can be shortened. Patients with severe mental illness usually die from

physical diseases such as obesity, diabetes, thyroid disorders, cardiovascular diseases,

pneumonia, GI diseases, neoplasms, musculoskeletal, and other diseases (Correll & et al. pg.

120). When reviewing M.C. chart she had some other medical diagnoses such as anemia,

bursitis, thalassemia, skin cancer, macular degeneration, and bladder incontinence. M.C was on

four medications two daily, the other BID and other medication PRN. One of the medications

was Buspar (Buspirone) 5 mg BID for her anxiety. The second medication was Abilify

(Apriprazole) 5mg daily for her depression. The third medication was Trazodone (Desyrel) 25

mg daily at bedtime to help M.C. sleep at night. M.C. PRN medications are Tylenol for fever or

pain, Ducodyl for constipation, Haldol for mild agitation, and Vistaril for agitation/anxiety. M.C.

stated during our discussion “I feel like the medication is helping me and my mood is less

emotional, I’m feeling good.”

MENTAL HEALTH CASE STUDY 4

When meeting with M.C. to have our discussion she presented with animated facial

expressions, relaxed gesture/posture, she was dressed neat, hair was combed and she was

friendly to the people around her including staff and other patients on the floor. During my

time with the patient she seemed to answer everything very honestly and was open to

answering all my questions. We talked for about thirty minutes or so and I was able to gain a

lot of information from her. Information that I didn’t get I was able to get from her chart and

during the groups. Some safety and security measures that were used during my day of care

were 15 minute checks made by the nurse or aid, the locked down unit only people being

buzzed in or out could enter, patients rooms used steel for mirrors instead of glass, and the

phone is kept at nursing station at all times.

Expected and Common Behaviors of the Client with Major Depressive Disorder

In the textbook major depressive disorder is characterized by depressed mood or loss of

interest or pleasure in usual activities. Townsend said “evidence will show impaired social and

occupational functioning that has existed for at least two weeks, no history of manic behavior,

and symptoms that cannot be attributed to use of substances or a general medical condition”

my patient has no previous history of manic behavior. The diagnosis of MDD is specified

according to whether it is a single or recurrent episode. An individual’s first encounter with a

major depressive episode is single and the individual who has a history of previous major

depressive episodes is recurrent (Townsend, pg. 461). M.C. would be considered to be having a

recurrent episode. Along with the diagnosis of MDD it also will identify the degree of severity of

symptoms (mild, moderate, or severe) and whether there is evidence of psychotic, catatonic, or

melancholic features, M.C. had the presence of psychotic features but didn’t state the severity
MENTAL HEALTH CASE STUDY 5

of the symptoms (Townsend, pg. 461). Also something to look at is the presence of anxiety and

severity of suicide risk, M.C. also has the presence of anxiety.

Expected and Common Behaviors of the Client with Delusions

M.C. also was admitted with delusions because she has the beliefs that people are

coming into her when she is sleeping and stealing things out of her apartment. Delusions are

false personal beliefs that are inconsistent with the person’s intelligence or cultural

background. The individual continues tot have the belief in spite of obvious proof that it is false

or irrational (Townsend, pg. 430). Throughout the day M.C. told me about how she knows the

residents are stealing things but she has to realize there not because if she doesn’t they will kick

her out of the apartment complex.

Precipitators to the Current Hospitalization

M.C. was referred to the ED by Adult Protective Services then which the ambulance

brought her in due to her increase in paranoia. ADS reports she is on the verge of being evicted

from her apartment if her behavior continues. M.C. reports that after New Year’s, the residents

at her apartment complex have been stealing from her. M.C. states “They are coming into my

apartment when I’m sleeping, taking my things and when I wake up things are missing from my

apartment.” M.C. also says “I go door to door knocking on them, yelling at the residents

because she knows they took her things.” M.C. also complains to the office manager but they

are on the verge of having her removed from the apartment complex for good because she is

disturbing other residents and causing problems.

The patient back in 2017 was admitted to St. Elizabeth’s for being non-complaint with

her medication at the time and in her chart it stated her medication need to be adjusted
MENTAL HEALTH CASE STUDY 6

because they believe she was non-complaint again. According to Kane, Kishimoto, and Correll

“Patients are described as “adherent”, if they are taking at least 70 to 80% of their medication”

and studies show that roughly 50% of patients after 6 months patients stop taking their

medications as prescribed. The cost of non-compliance in the United States alone could be up

to $300 billions dollars per year and with knowing that researchers are trying many methods to

make compliance something all patients can do 100% (Kane, et al. pg. 216). Some methods that

could be done to help with compliance and could help M.C. are taking medication at a set time

like with meals, waking up, or at bedtime, having a pill case for the week, having family

members help, and set self timers on their phones.

Patient and Family History of Mental Illness

The patients family has no history of mental illness the father did have Alzheimer’s and

the mother did have colon cancer. The patient graduated from Niles high school where she

went to work as a meat packer for a year, then a telephone operator for about 5 years and then

retired from Packard after 35 years. She has two sons, along with 2 grandchildren and 3 great

grandchildren. She is also a widow of 21 years. The patients told me the information about her

history but I had to look up her family history. I verified what M.C. told me in her chart and it

was correct.

Nursing Care and Milieu Activities

The geriatric psychiatric unit at Trumbull Memorial Hospital provides an exceptional

milieu for its patients. The floor may be a little outdated but it is kept very clean and organized,

which is great for the patients to be less preoccupied. A nice positive addition they have on

their floor is a schedule posted on the wall with date, when groups are, and meal times.
MENTAL HEALTH CASE STUDY 7

The floor is one straight hallway when being buzzed in you walk passed the locked staff

lounge and then into the common area where the patients eat or hang out. Across from the

common area is the activities and social workers office. Next to that office is the group room

with a television and some chairs from the patients to hang out in there as well. As you keep

walking down you’ll ran into the nurses station on the right hand side and passed the nurses

station is rooms along both sides of the hallway. Most of the patients will be either in the

common area or group room. The nurses do 15-minute checks where they have to lay eyes on

each patient every 15 minutes. If patients want to be in there room they are aloud too.

M.C. was not on any restrictions or precautions while she was on the unit the day I was

there. She just had the basic rules of being locked in, not able to leave as she pleases because

she is there involuntary, and has the same phone restrictions. M.C. also participated in both

group activities. During the first group she participated in bingo giving three coping skills she

uses such as a walk, reading novels especially mystery and listening to music. In the second

group she talked about how when she is going home she will avoid the people and change her

thoughts because she can only control herself and not control other people around her.

Ethical, Spiritual and Cultural Influences

When asking M.C. about her spiritual and cultural influences, that she was catholic,

would go to church on Sunday’s and was 100% Italian very proud to say so. She did not get into

anything ethical and simply left her spiritual and cultural beliefs at that.

Patient Outcomes Related to Care

During the time I had with M.C. she seemed to be doing fine throughout the day and

was not having any delusions. She was aware that for her to get better and go back to her
MENTAL HEALTH CASE STUDY 8

apartment complex that she needs to understand she was making up the people coming into

her apartment stealing things from her. M.C. stated, “She was in the wrong for going up to the

residents doors, yelling and accusing them of stealing her things” she understands that if she

continues to do that her apartment complex with evict her. M.C. also told me that she feels like

her medication is working because her mood has been improving throughout her stay at

hospital. M.C. is feeling less emotional and having a good day. Upon going back to her

apartment complex she will avoid the other people living there because she doesn’t get along

with them. She said, “I will be civil with them but will not go out of my way to talk with them.” I

felt that at the end of my day with M.C. she still had some work to do because I don’t think she

is quit ready to return to the apartment complex because while making her statements she kind

of had a giggle and I believe she just started to agree with the social worker when making her

statements.

Discharge Plans

M.C. as far as I understood would be discharged back to her apartment complex but I

believe with no tolerance of what happened. If she continues to disturb the residents of the

apartment complex she will be evicted. M.C. talked about once she returns home going to

different groups in the community making friends that way and becoming involved because she

said, “I still drive.” She is also going to look into getting some type of meals delivered to her

home because she thinks that will be easier for her. Upon me leaving that day she didn’t have

discharge date yet but I could assume potentially soon but also could be a couple weeks before

M.C. leaves.
MENTAL HEALTH CASE STUDY 9

Nursing Diagnoses

1. Disturbed Thought Processes related to perceptual and cognitive distortions, as

demonstrated by suspiciousness, defensive behavior, and disruptions in thought.

2. Ineffective Coping related to misinterpretation of environment and impaired

communication ability.

3. Social Isolation related to an inability to trust

Potential Nursing Diagnoses

1. Risk for Self-directed or Other-directed Violence related to delusional thinking and

hallucinatory experiences.

2. Hopelessness related to long-term stress.

3. Fatigue related to anxiety.

Conclusion

In conclusion, my overall experience with M.C. was a great one and I really learned a lot

of March 2, 2018 with my patient. By being able to pick through the chart and ask more in-

depth questions from M.C. I was able to formulate this mental health case study. I learned a lot

my doing this case study and researching articles that went with it. Overall it was very

informative and by one reading this Mental Health Case Study I hope they can better

understand M.C. and her diagnoses.

MENTAL HEALTH CASE STUDY 10

References

A. (Ed.). (2000). APA Diagnostic Classification DSM-IV-TR. Retrieved March 12, 2018, from

https://behavenet.com/apa-diagnostic-classification-dsm-iv-tr

Correll, C. U., Detraux, J., Lepeleire, J. D., & Hert, M. D. (2015). Effects of antipsychotics,

antidepressants and mood stabilizers on risk for physical diseases in people with

schizophrenia, depression and bipolar disorder. World Psychiatry, 14(2), 119-136.

doi:10.1002/wps.20204

Kane, J. M., Kishimoto, T., & Correll, C. U. (2013). Assessing the comparative effectiveness of

long-acting injectable vs. oral antipsychotic medications in the prevention of relapse

provides a case study in comparative effectiveness research in psychiatry. Journal of

Clinical Epidemiology, 66(8). doi:10.1016/j.jclinepi.2013.01.012

Kane, J. M., Kishimoto, T., & Correll, C. U. (2013). Non-adherence to medication in patients

with psychotic disorders: Epidemiology, contributing factors and management

strategies. World Psychiatry, 12(3), 216-226. doi:10.1002/wps.20060

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

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