University : RMIT University UniLearnO is not sponsored or endorsed by this college or university.
Subject Code : NURS1066
Country : Australia
Assignment Task

 

Case Study:
The Client with Depression: Kate
 

Clinician Role: Admitting Nurse: Adult Inpatient Unit.

Identifying information: Kate is a 27-year-old single woman referred to the local inpatient Unit by her GP. She has worked in the retail industry in a variety of clothing and fashion shops for 9 years and has progressed up to the level of store manager though she lost her job 12 weeks ago due to the store she was working in closing down in favour of an online store. Kate lives in her own home with her sister, Veronica, and Veronica’s 10-week-old daughter, Jamie. Veronica moved in 4 months ago when she unintentionally fell pregnant and Kate had stepped in to support her through the pregnancy. When Kate lost her job Veronica and Kate agreed Veronica would keep her
part time job and Kate would look after Jamie when Veronica was at work as this would allow them to meet their financial commitments.

Presenting Complaint: Kate states, “I’m not coping at all with the baby; I’m sad and upset all the time, and I’m a bad sister for not supporting and loving Veronica and Jamie more”.

Current life stressors reported by Kate include:
• Her father’s death in a car accident 6 months ago. Kate had not seen him in 1.5 years and expresses guilt that they were not close.
• Her mother’s surgery for cancer 11 months earlier. Whilst she has made a good recovery Kate is fearful that she will relapse and die in the near future.
• The birth of her sister Veronica’s baby Jamie [now 10 weeks old]. Veronica had fallen pregnant after and one night stand and does not know who the father of her daughter is. Kate had taken on a lead role in supporting her sister and they had both been very excited about the birth and the impending change in their lives. After Jamie came home Kate started to struggle with having her in the house and started to resent her sister for putting them in this situation; Kate feels very guilty about this “I’m a terrible person” and thinks she should have been more supportive.
• Loss of her sense of role / structure she had gained from her job. Kate had been in her role for many years, was well like and respected and was very committed to the job. She has struggle to organise her time and establish a regular routine since then [though the arrival of Jamie has contributed to this situation as well].

History of Present Problem: Kate states that over the past 10-12 weeks (since losing her job and the birth of Jamie), she has experienced increasing Dysphoria, Anhedonia, along with feelings of guilt, resentment and worthlessness, intense crying, social isolation, and has struggled to bond / care for her niece. Kate sleeps 10 to 15 hours per night, experiencing no difficulty falling asleep or middle-of-the-night or early-morning awakening. Her appetite has diminished during the past 6 weeks, with a reported weight loss of 8 kilograms. She eats erratically, usually snacks, and meals are prepared by her sister and mother when she visits. She has not been able to provide effective care to her niece, cook, or do household chores and generally spends the day in bed. She has had become increasingly insular and has avoided social contact, tending to avoid friends and family who have come to call. Kate describes no interests or involvements outside the home, except for weekly attendance at
her local gymnastics club where she has been coaching for many years [having competed there when younger]. Prior to becoming unwell Kate enjoyed a very active social life. The mornings are the most difficult for Kate — she feels increased anxiety, has relaxing, and cries a lot. She describes feeling disconnected from Veronica and Jamie and describes increased guilt and a sense of being a ‘failure’ as a sister and aunt. She admits to occasional suicidal ideation in the form of a passive wish to be dead in hopes of relieving her emotional pain. She denies a history of suicide attempts or current suicidal plan. She denies alcohol or drug abuse though has used Alcohol and Marijuana socially when younger.

Past Psychiatric History: Kate has had no prior hospitalisation or community psychiatric treatment. She denies previous episodes of depression. There is no history of mania or hypomania. She did see a counsellor at the local Community Health Service after a relationship breakup when she was 22.

Pre-morbid Personality: Kate describes herself as being friendly, kind, well organised and committed to her job before becoming unwell. When asked further about work she says she was very hard-working, motivated to do well at work, able to plan and organised complex tasks and showed pride in her ability to see jobs through to a successful completion. She also reports a strong sense of loyalty to family and close friends, seeing herself as willing to go out of her way to help others.

Medical History: Kate’s only physical history is a fractured ankle when she was 21. The injury was the catalyst for her retiring from competing and moving into gymnastics coaching.

Family History: Kate’s father died 6 months ago in a MCA, was 56 years old. Her sister is 32 years old and is single with one daughter, aged 10 weeks. Her mother was diagnosed with cervical cancer 11 months ago though is in remission at present. Kate believes her maternal grandmother was depressedbut knows no details about this. Kate had several significant relationships in her mid-twenties however these all ended ‘badly’ and so she has chosen to remain single for the last 3 years. Kate has a large group of friends from many areas of her life though she reduced her contact with many of her friend when Veronica fell pregnant so she could concentrate on supporting
her sister through her pregnancy.

Social and Developmental History: Kate is the youngest child of two siblings. Her mother’s labour and delivery with her were normal, and developmental milestones (talking, walking, etc.) were reached at an early age. She denies any maladaptive behaviours or experiencing unusual stressors or trauma as a child. Academically, Kate was a B grade student throughout her educational experience. She had friends at school and in the community and did not date until after high school. She completed a 3 year business Diploma at TAFE. Kate was raised in the eastern suburbs of Melbourne and lived in the family home until she was 25, at which time she moved into her own home. She had been focused on establishing their career and making extra payments on her mortgage prior to losing her job. Kate describes her relationship with her
mother and sister as good. Her father had a history of infidelity and had left her mother on three earlier occasions before leaving again 18 months ago. Kate strongly supported her mother through this time and chose to sever contact with her father. She feels that there are many unresolved issues in her relationship with her father that she can no longer resolve due to his death.

 

Mental Status Examination

General Appearance: Kate is an underweight young woman who is appropriately dressed, although with an mildly unkempt appearance. She presents with a downcast, averted gaze.

Speech: Kate speaks slowly and quietly with a flat tone. Her responses to questions are delayed but appropriate and her thinking is generally goal- directed.

 

Thought Content: Themes of worthlessness, helplessness, guilt, hopelessness, are evident, as well as a pervasive sense of being a failure as a sister and aunt.

Affect and Mood: Kate’s affect is blunted with restricted range. Her mood is described as sad and depressed. Kate frequently experiences episodes of crying but is unable to explain what she is crying about.

Motor Behaviour: Posture is rigid, slumped slightly forward, with few spontaneous movements.

Perceptions: There is no evidence of delusions, hallucinations or other psychotic phenomena.

Suicide Potential: Kate describes a passive wish for death that comes and goes, but there is no active suicidal intent or plan. She feels that she has let her family down already but at the same time states suicide would hurt them even more “I could never do that to Mum or Ronnie and Jamie”.

Orientation: Kate is oriented to person, place, and time.

Concentration: Kate’s concentration is impaired, as evidenced by an inability to do Serial 7’s accurately and a digit span of 4 forward, none backward.

Recent and Remote Memory: Kate’s recent memory is intact, with three of three objects recalled after 5 minutes. She is able to describe accurately events from the past.

Insight and Judgement: Kate has insight into her illness though she is feels both angry that it has happened to her as well as being very self-critical. Her judgment is intact and she accepts that she needs mental health treatment.

 

Formulation of Impression
Kate presents with a 10-week history of depressed mood; anhedonia; feelings of worthlessness, guilt, hopelessness, and helplessness, suicidal ideation; withdrawn behaviour and impaired functioning; decreased concentration; and decreased appetite and weight loss in the context of multiple significant.

 

Traditional Nursing Diagnostic Focus

The following nursing diagnoses for Kate are derived from the assessment data gathered:
• Mood Disturbance
• Dysfunctional Grieving
• Risk for Self-directed Violence

 

 

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  • Posted on : March 24th, 2019
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