Question

Case Study: Max

Client Profile: “Max is a 12-year old boy whose father died about 5 years ago. His father experienced periodic episodes of depression during his lifetime. After his father’s death, Max displayed tantrums and became more aggressive toward his toys and people. He took on a serious, almost sad expression. He seemed empty and alone, even when in a room full of people. Max saw a therapist; after a period of play therapy, he stopped being more aggressive than boys his age, began to smile and played with peers.”

            “Max’s mother went to work after his father’s death; she now works two jobs. When she is home, she is authoritarian in her parenting style. Recently, Max’s mother snooped around Max’s room and found some morbid pictures that he had drawn (i.e., pictures of funerals, cemeteries, and people being shot or knifed to death). She also found cigarettes; as a consequence, he cannot have any friends visit and he may not leave the house except to go to school.”

            Max is not turning in schoolwork and is picking fights at school. In the evening, he plays video games and makes excuses for procrastinating with his homework. He lies awake at night worrying about his homework and things such as failing school, disappointing his mother, not having friends, and wondering if everyone hates him. When his mother tells him he is going to fail school, he responds, ‘I don’t care.’”

            The school nurse notices Max’s behavior and becomes concerned, especially since two other students recently attempted suicide. She shares this information with Max’s mother and suggests that a health care provider see Max. His mother takes him to a sliding-fee-scale clinic where a family practice health care provider who volunteers at the clinic sees Max. The health care provider identifies depression as a problem, considers putting Max on medication, but decides instead to have him admitted to a residential treatment center for evaluation and treatment. A clinic social worker finds funding from various sources to cover the cost of treatment at the facility for children and adolescents. The facility has child and adolescent psychiatrists and psychiatric nurses on staff.” [Richardson, B.K. (2007). Case Study Series: Psychiatric Nursing, Clifton Park, NY: Thomson Delmar Learning.]

Case Study: The nurse on the children’s unit of the residential treatment center receives word Max will be admitted for treatment of depression. When Max and his mother arrive, the nurse does an intake interview with Max alone and then with both Max and his mother. Then the nurse interviews his mother and gives her a copy of the parent handbook while someone orients Max to the unit and its rules. Both Max and his mother are asked to sign a form indicating they have read the unit rules and will abide by them. Max’s belongings are inventoried; some are locked up, while he is permitted to keep others. The child psychiatrist prescribes fluoxetine (Prozac) as well as individual and group therapy.

            One night, Max gets irritable with the nurse for not letting him stay up past unit bedtime to watch his favorite television show. Max says, “It doesn’t matter because I am just going to kill myself tonight anyway.” The psychiatrist is notified and writes orders for Max to be placed on 1 to 1 observation within eyesight of an assigned staff member at all times. The following day Max learns he cannot go to the recreation building because a unit rule states, “Anyone who threatens to kill himself or herself cannot leave the unit until he or she no longer wishes to kill himself or herself and 24 hours have passed.” Max tells the nurse, “I was just kidding. I really wasn’t going to kill myself.”

Questions

1. Max’s mother tells you (the nurse) about the 2 other students at Max’s school who attempted suicide recently. How should you respond?

2.What data would you gather on Max and his family prior to writing a nursing care plan?

Answer 1

1. Initially we want to assess the mental situation of max. A patient desire to commit suicide affects not only the person but also the patients family and friends and health care professionals.suicide is a intentional act of killing oneself. Suicide thoughts are common in people with depression, schizophrenia etc.So effective planning should be performed to prevent suicidal intentions of patient. So should assess some factors like

1.Risk for suicide.. Assess the mental condition of the client and take history regarding family history of psychiatric illness. And confirmed that is there any history of suicidal attempt.

• Alcohol and substance abuse/use
• Abuse in childhood
• Family history of suicide... In this case there is family history of suicide.
• Fits demographic
• Grief or loss of a important relationship.
• History of prior attempt of suicide
• Hoplessness/Helplessness.
• Legal or disciplinary problems
• Psychiatric illness
• Poor support systems.

After assessment planning should be done for make arrangements to stay with friends and family. Give support to relive depression and weapons and other sharp instruments should be removed. Encourage patient to express feelings.

Prolonged isolation if needed

Work with client to identify areas of strength.

Spend time with client and discuss his problems

Encourage to contact with spiritual and religious persons.

Give psychological support. .

2. For maintaining care plan we should assess or collect personal as well as health related information. So go for mental status examination. Mental status examination is the best method to assess psychiatric patients, and it is structured assessment for patients behaviour and cognitive functioning.

• Assess appearance and general behaviour.
• Listening to spontaneous speech as the patient relates answer to open ended questions.
• Affect and mood ie immediate response of emotion.
• Thought and perception, assess inability to relate information appropriately.
• Attitude and insight.. There will some changes during interview so it should be checked.
• Structured examination of cognitive abilities. Like attention, language.memory,
• Physical examination should be performed.