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 Glessner has been withdrawn for at least 3 years. After the relationship with her boyfriend ended, she became even more withdrawn and sullen.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 cyclothymic 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

subjective data

patient often expressed somatic compliants ,feeling themselves are not useful anymore,feel insignificant and likely to commit suicide

objective data

depressed facial expression and patient has some slashes on her wrists with suicidal ideation

NURSING DIAGNOSIS

Disturbances in the regulation of mood ,behavior and affect that go beyond normal due to cyclothymic disorder   as evidenced by suicidal behavior

subjective data

patient expressed that she is faty,ugly and not good to anyone

objective data

reduced quality of life ,poor self image  

NURSING DIAGNOSIS

chronic low self- esteem ; long standing negative self evaluation related to repeated past failure in marrital life as evidenced by negative view of self and abilities