Question

Mood Disorders Scenario

Scenario:

Ally is a 25 year old female who presents to the emergency department via an ambulance after an intentional overdose. Ally reports she took #25, 50mg Benadryl & #10, 100mg Lithium tablets. She reports feeling lightheaded, nauseated and having a constant ringing in her ears. She is unaware of how long ago the overdose occurred. She stated she had text a friend prior to taking the pills and the next thing she remembers is waking up in the emergency department.

Ally states she doesn’t want to live any longer after a recent break-up with her fiancé. She states they were supposed to get married next week and she cannot bear the thought of living without him. “Nobody will ever love me again, I can’t believe this is over”. Ally states she has no family in the area. She reports moving here 4 years ago to be with her fiancé. Ally reports currently living an apartment with a friend after the breakup. Ally and her friend agree to a safety contract and ask when Ally will be released from the emergency room?

PMH: Obesity, Hypertension, Type 2 Diabetes

Current Vitals: B/P- 175/98, P- 92, R- 18, T- 98.9, O2- 99% on room air.

Answer the following questions:

1. List potential nursing diagnosis in this situation? Please provide a minimum of 3
2. What, if any, medical danger(s), do you see or should you consider for either patient? Why?
3. What nursing interventions take priority?
4. What is an appropriate response for Ally and her friend when they ask about potential discharge?

Answer 1

Mood disorders

Mood disorders are one of the commonly seen mental health problem, that affect the person's emotional state. It is characterised by the extremes of the emotional state, either depression or severly elevated mood , called Mania. The major mood disorders are Depression, mania , Bipolar disorders, Dysthymia etc.

Suicide: It is an intentional act of killing oneself.

  

Potential Nursing Diagnosis:

* Risk for suicide related to mood disorders, hopelessness and previous suicidal attempt.

* Risk for self directed -violence related to depression.

* Self care deficit , neglect of personal hygiene related to depression.

2.Medical dangers: possibility of medical dangers for Ally:

A. Suicide, or self harm: She is a suicidal patient, with ideas of hopelessness, and have a recent history of suicidal attempt.

B. Medication overdose, lithium toxicity : Over consumption of lithium can cause lithium toxicity, a fatal condition , characterised by blood Lithium level : 1.5mEq / L , nausea, diarrhoea, shaking hands, confusion, dizziness , seizures and increased urination etc.

C. Hypotension or hypertension : Her past medical history reveals that she is having hypertension, abnormally high blood pressure . She may have the tablets for hypertension in her apartment. If she is taking potential discharge and going back to apartment, there are chances of over eating it ( Hypotension) or neglectng then increase in Bp may occur.

C. Hypoglycemia or Hyperglycemia. : Ally was diagnosed with type 2 diabetes. She may be taking the treatment. If she takes inappropriately the overdose of medication, then she may get hypoglycemia, otherwise she may get Hyperglycemia, if she is not managing the diabetes.

Priority nursing interventions:

* Close supervision of the patient by nurse or friend

* Provide a safe environment, remove all sharp things, pills and weapons from the environment by nurse and friend.

* Create a safety contract between patient and the care providers, that she wiil not conduct any self harm / suicide. If any thought of suicide , then contact the nurse/ counsellor/ care giver.

* Encourage the patient to ventilate her feelings of suicide or self harm and hopelessness.

* Arrange for a Counselling session and contact family members if she permits.

* Educate the client regarding the appropriate use of medications

Appropriate response for Ally and to her friend whe they ask for a potential discharge:

Nurse can appropriately respond to them : " I can understand your situation, but Ally's safety is the primary concern for us. If you ( Ally's friend) are undertaking a complete responsibility, then the physician can decide over discharge matter. But before that we have to ensure that Ally's condition got stabilized or not". Nurse has to educate the friend regarding the risk of taking Ally to home and her suicidal tendency. Strictly warn her to remove all medications and weapons from her vicinity and close supervision is mandatory.