Question

Ms. Glessner is a 35-year-old executive secretary. She has been divorced for 3 years and has two sons, 11 and 13 years of age. She is brought into the emergency department (ED) by her neighbor. She has some slashes on her wrists and is bleeding. The neighbor states that both of Ms. Glessner’s sons are visiting their father for the summer. Ms. Glessner has become more despondent since terminating a 2-year relationship with a married man 4 weeks previously. According to the neighbor, for 3 years after her divorce, Ms. Glessner talked constantly about not being pretty or good enough and doubted that anyone could really love her. The neighbor states that Ms. Glessner has been withdrawn for at least 3 years. After the relationship with her boyfriend ended, she became even more withdrawn and sullen. Ms. Glessner is about 20 pounds overweight, and her neighbor states that Ms. Glessner often stays awake late into the night, drinking by herself and watching television. She sleeps through most of the day on the weekends.

After receiving treatment in the ED, Ms. Glessner is seen by a psychiatrist. The initial diagnosis is dysthymic disorder with suicidal ideation. A decision is made to hospitalize her briefly for suicide observation and evaluation for appropriate treatment.

The nurse, Ms. Ward, admits Ms. Glessner to the unit from the ED.

Nurse: Hello, Ms. Glessner, I’m Marcia Ward. I will be your primary nurse.

Ms. Glessner: Yeah… I don’t need a nurse, a doctor, or anyone else. I just want to get away from this pain.

Nurse: You want to get away from your pain?

Ms. Glessner: I just said that, didn’t I? Oh, what’s the use? No one understands.

Nurse: I would like to understand, Ms. Glessner.

Ms. Glessner: Look at me. I’m fat, ugly, and no good to anyone. No one wants me.

Nurse: Who doesn’t want you?

Ms. Glessner: My husband didn’t want me, and now Jerry left me to go back to his wife.

Nurse: You think because Jerry went back to his wife that no one else could care for you?

Ms. Glessner: Well… he doesn’t anyway.

Nurse: Because he doesn’t care, you believe that no one else cares about you?

Ms. Glessner: Yes.

Nurse: Who do you care about?

Ms. Glessner: No one… except my sons… I do love my sons, even though I don’t often show it.

Nurse: Tell me more about your sons.

Ms. Ward continues to speak with Ms. Glessner. Ms. Glessner talks about her sons with apparent affection; however, she continues to state that she does not think of herself as worthwhile.

1. Assessment: What does the case study reveal about the client?
2. What is the Objective Data?
3. What is the Subjective Data?
4. Concentrate on two initial nursing diagnoses that seem to have the highest priority.

Answer 1

What does the case study reveal about the client

Here the case study is explaining about a 35 year old lady who is suffering from severe depression associated with suicidal thoughts. The patient is suffreing from dystymia. Dysthymia is a severe mood disorder, if untreated, may cause loss of life of the individual. Here the patient is having disturbed thought process with guilty feeling of self.She is socially withdrawn and feeling social isolation. She spend most her time by sleeping. Also addicted to alcohol and never interact with the public. She dont have confidence in her and she dont trust anyone, even the physician or the nurse. She is only concerned about her childrens. All these symptoms indicate major depressive episode with suicidal attempts.

Objective Data

Objective data means, the data collected by the nurse or the health care providers regarding the patient, during the time of assessment.Objective data includes, information regarding the patients mental status, his/her clinical signs, level of consciousness, informations regarding laboratory data, health history, vital signs, elicited clinical signs, information and details regarding image studies conducted etc. From the objective data, the physician or the health care workers will gain extra informations regarding the patient. Here sometimes informations are also collected from the immediate care givers like family member, spouse or childrens to gain maximum informations about the patient.Objective data is usually collected by direct observation, face to face interaction, assessing the body systems etc.

Here, in this scenario also, the nurse is communicating with the patient to collect more informations regarding her mental status and mind setting. The nurse is asking informations such as who did the patient care somuch or concerned about? Making her to understand that losing her boy friend is not an important matter etc.

Subjective Data

Subjective data is usually provided by the patient by his/her on words. Its a subjective feeling of self and associated problems, symptoms, complaints etc.Only the patient can provide subjective data. This includes, his/her complaints, difficulties, problems, symptoms etc.Like pain, giddiness, weakness etc.The subjective data is usually reported in patients own words itself. The subjective data is usually collected during a face to face interview.

Here, the patient is providing informations such as "I don’t need a nurse, a doctor, or anyone else. I just want to get away from this pain." "Look at me. I’m fat, ugly, and no good to anyone. No one wants me." All these are the examples of subjective data.

Two initial nursing diagnoses that seem to have the highest priority.

1. Risk for self directed violence related to hopelessness as evidenced by suicidal attempt.

(Here in the patients history itself reported that, she came with some slashes on her wrists and is bleeding. That was a suicidal attempt done by the patient.She also had history of more withdrawn and sullen after her relation with boy friend broken.Which indicate that she is experiencing isolation hopelesness and helplesness. If all these may go untreated, the individual may cause injury to themself and try to end their life. )

2. Disturbed thought process related to extreme guilt feeling as evidenced by negative mind thoughts and suicidal tendancies

(Here, the patient have disturbed thought process and guilty feeling about herself. She is reporting to the nurse, that nobody likes her, because of her fatty ugly body nobody interested in her etc. And she also tried to end her life by suicidal attempt. These problems to be resolved immediately, otherwise may cause serious complications of self harm.)