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Natalie Laurence
Major Depression Case Study: J.G. 2
Abstract
This paper explores a case study that looks into the effects that Major depression can have on an
individual. The individual discussed is J.G. who had her first admit to the hospital on the psych
floor. The paper discusses objective data retrieved from the patient and looks into the individual
behaviors and events that led to the patient’s hospitalization. Treatments and therapies are looked
at to help explain the situation and status of J.G. throughout her hospitalization. Causative factors
are addressed ranging from ethnic, cultural and spiritual influences. This paper also explains the
intended discharge plans for J.G. and dives into the holes in the health care system that exist in
today’s day in age. This case study will explain how major depression greatly affects and took
Major Depression Case Study: J.G. 3
Major Depression Case Study: J.G.
Objective Data
J.G. was admitted to the psychiatric unit on 3/15/19. The date of care took place on
3/19/19. J.G. has a primary mental health diagnosis of Major Depression. She is also diagnosed
with bipolar disorder as well as anxiety. She had her first admit to this unit on 3/15/19. Previous
visits to the hospital were due to pregnancies and injuries. This admission was due to her being
picked up by the police and brought to the ED because of her state due to alcohol and marijuana.
She stated multiple times “my family would be better off without me” in the ED therefore she
was then pink slipped and admitted to the unit a few hours later. At the beginning of the patient’s
admission she displayed a very flat and emotionless affect. She negated attempts of conversation
and appeared to be very depressed in her mood and physical presentation. She presented feelings
and thoughts of hopelessness. Patients facial expressions started with sad, angry and even
depressed with slouched posture. However, two days after admission her expressions changed to
that of friendly, animated and one that contained more expression. Her gestures and posture
appeared to be relaxed, with calm and deliberate movements. J.G. presented at first disheveled
and very unkempt in appearance and seemed to not have much care for her personal hygiene.
However, a few days into her stay, her clothing was more straightened, appropriate and more
care seemed to be given into her personal hygiene. Her hair was combed and clothes very neat.
No abnormal movements, tics or tremors were observed. J.G. also has other medical conditions
including noncompliance to medications and history of drug/alcohol abuse. Treatments for these
conditions unit protocols and medications to help stabilize the depression and control the
withdrawals from alcohol/nicotine. Unit protocells help ensure patients safety of self and safety
of others on the unit. Upon admission, patient’s belongings were taken and locked up to ensure
Major Depression Case Study: J.G. 4
safety of herself and others on the unit. Medications prescribed are used to treat both of her
psychiatric and medical diagnoses. J.G. is prescribed Abilify, an antipsychotic to help her
depression. Haldol, an antipsychotic to help control agitation. Cogentin, to help treat her acute
dystonia. Vistaril, an anxiolytic to help control her anxiety. Lastly, Nicotine gum is prescribed to
Summarize
The following information under this heading is according to Psych Notes Clinical
Pocket Guide by Darlene D. Pedersen. Major depressive disorder requires at least 2 weeks of
depression/loss of interest and four additional depressive symptoms with one or more major
depressive episodes. Common signs and symptoms to expect in a client with major depression, is
that they will be in a depressed mood or have a loss of interest for 2 weeks or more, and a
Generalized anxiety can be defined as excessive anxiety that is difficult to control and
presence of persistent worry about future events. These need to be present for at least 6
consecutive months. Patients with generalized anxiety will often present behaviors such as:
Bipolar II disorder is defined as a disorder that includes one or two major depressive
episodes (as defined above) and at least one hypomanic episode. With hypomania a patient may
Major Depression Case Study: J.G. 5
exhibit signs and symptoms such as grandiosity, decreased need for sleep, excessive talking,
racing thoughts, buying sprees, increased activity, foolish business investments, and excessive
involvement in sex. Most of these are found to be presented in a very low intensity as opposed to
full-blown mania.
Identity
The stressors, events and behaviors that precipitated J.G.s hospitalization range back to
her excessive use of alcohol and marijuana along with occurring suicidal thoughts. She was
using alcohol and marijuana during the night while watching a series which contained the story
line of how to kill yourself. There was also a major storm that night. Between the storm and the
Netflix series she was watching, those events trigged her to begin to have anxiety. Her sister
called the police due to J.G.’s behavior. The police picked her up, took her to the St. E’s ED, she
was admitted due to excessive intoxication and marijuana use. During her admit to the ED she
began to state statements such as, “my family would be better off without me.” Due to those
statements, she was pink slipped for direct admittance to the psychiatric unit. This was her first
Discuss
J.G. exhibits a history of depression that originates from her relationships with her family
members. Multiple other events exacerbated her depressive states and led to her suicidal
ideations. She had never attempted suicide before, yet admitted to having suicidal thoughts
frequently. In conclusion from conversations I had with J.G. and charted data there was no
Major Depression Case Study: J.G. 6
indication of any mental illness within the family. No questions were specifically asked
Describe
The care that J.G. received involves a combination of therapeutic care and environmental
R.L. Osborn as, “addressing social issues that are causing the patients depression”. During this
visit however it was completed in the form of daily group therapies. Also in addition, problem
solving therapy is addressed in the group therapy setting. This type of therapy is used to help
define personal problems that have multiple solutions and which solutions will most benefit the
patient in her daily life. Both of these therapies can be performed by the nurse without the need
for a trained therapist. The care also includes administration of medications from antidepressants
and antianxiety medications mentioned prior. The administration of these medications helps to
maintain medication compliance and build of a therapeutic level of stabilization while J.G. is
admitted.
Along with traditional therapy use, J.G. attended multiple milieu therapy
opportunities/experiences. She was given many choices with open communication in her daily
care so she could be in control of her care and daily activities. This therapeutic interaction is very
important in this patient’s case due to helping her gain independence and regain confidence in
herself and improve depressive factors. One of the biggest factors of J.G.s milieu therapy
includes the containment aspect. This promotes a safe environment that discourages any harm to
the patient, especially to herself. Each patient on the floor is not permitted any potential
weapons, shoe laces, belts, or any substances that can cause harm. This helps to ensure that J.G.
Major Depression Case Study: J.G. 7
does not have any means to attempt to harm herself during her stay. Validation is also a critical
part in care for J.G. Validation ensures respect to the patient and promotion of her human rights.
This ensures that she retains a sense of self-worth and reduces depressive thoughts. Lastly,
structured interaction is implemented in the milieu for the client. It not only helps to enforce the
rules and regulations of the unit, but it greatly helps to improve the patient’s social interaction
with other patients. As J.G. even stated herself, she enjoys the fellowship she has and feels while
Analyze
There are multiple societal influences that have great impact on J.G. and her mental
health. The largest cultural influence is that of her family. The lack of support of her pregnancies
with her family put a lot of stress on her. After her pregnancies, her parents neglected to accept
J.G. in their lives which added to the unavailability of support in her life influencing a furthering
of his depression. Also within the community in which J.G. lives she has trouble to find
employment due to the lack of opportunities, without having employment J.G. lacks an income
and sense of independence which once again leads to a furthering of her depressive state.
Spirituality or lack thereof may also impact J.G. in her ability to cope with her depression and
feel a sense of belonging within a spiritual community. Lastly, the negative stigma associated to
mental health may pose a negative effect on J.G. and the bettering of her mental state. Mental
illness is culturally frowned upon in our society and not widely accepted which may deter her
Major Depression Case Study: J.G. 8
Evaluate
Throughout the first days of care, there was not much improvement or positive outcomes
with care toward J.G. Medication compliance was maintained however finding placement and
acquiring a discharge date promoted ineffective outcomes for the patient. The lack of positive
outcomes led J.G. to continue to display depressive actions/emotions with lack of motivation,
monotone voice and statements indicating no presence of hope. However, after the first couple
days J.G. received news that progression was being made towards her discharge plans, her
medications approached a therapeutic level and her mood greatly was improved. J.G. presented
herself with a very well kept manner and showered. Her mood was that of cheerful and she
expressed much interest in conversation. She expressed thoughts of excitement and hope for her
placement and stated that she is excited to finally begin to make changes within her life. Based
upon these observations and thoughts expressed by J.G. outcomes were that of a positive and
effective result.
Summarize
On this current admission J.G. has a stay due to suicidal ideations and this was her first
admit to this unit. The plans for discharge are to get J.G. into therapy groups and return home to
her children with a stable mood. More discharge plans include attempts to maintain medication
therapy compliance. Her caseworker is also working on assisting her in receiving social security
benefits. J.G. has a case that demonstrates the holes and cracks within the mental health care
system that prevent some people from acquiring the care they need. She has a home under her
name so she does not apply for qualification with group home placement. Along with this, if she
sells her home she will no longer be eligible to receive any form of social security funding. J.G.
Major Depression Case Study: J.G. 9
also has had trouble in being eligible for unemployment/disability benefits. With her being a
single mom, having psychotic disorders, and no income is not enough to categorize her as being
disabled. Due to all of these complications the patient has a very complicated discharge plan.
Getting her placed in the programs she requires/needs requires an increased amount of work and
labor in helping her to fall into the categories she needs in order to receive such cares/benefits.
Prioritize
History of drug and alcohol abuse as evidence by increased elevated BAC upon admission.
List
According to Linda Carpenito, potential nursing diagnoses for major depression include
the following. Risk for self-directed violence. Risk for Suicide. Ineffective coping. Hopelessness.
Social isolation. Impaired social interaction. Chronic low self-esteem. Disturbed thought process.
Self-care deficit.
Conclusion
In conclusion it is evident that a diagnosis such as major depression can have a major
impact on one’s life. With multiple admissions to a psychiatric unit there is still a presence of a
mental illness that is debilitating to the clients everyday functioning. With treatment such as
medications and therapies, improvement was made in the patient’s status. However, with this
Major Depression Case Study: J.G. 10
particular case half the battle is to get J.G. the care she needs in terms of financial assistance and
living placement to truly provide a therapeutic environment to help better her mental health.
Major Depression Case Study: J.G. 11
Sources Cited
Osborn, R. L., Demoncada, A. C., & Feuerstein, M. (2006). Psychosocial Interventions for
34. https://doi.org/10.2190/EUFN-RV1K-Y3TR-FK0L
Pedersen, D. D. (2018). Psych notes: Clinical pocket guide (5th ed.). Philadelphia: F.A. Davis
Company.