Question

David Camp, age 33 years, is admitted to the psychiatric mental health unit after an attempted suicide. He tried to hang himself, but the rope could not hold his weight. After that, he planned to borrow a friend’s gun and shoot himself, but his friend became aware of this plan and brought him to the emergency department.

Mr. Camp states that this is his third episode of depression. His first episode was in college. He feels hopeless about his farm and is worried his children think he is a disappointment. No matter how much he sleeps, he feels exhausted and tired. “I’m not even interested in my son’s 4-H club and in attending church. It’s purposeless; I’m purposeless, worthless, really.” When questioned by the nurse, Martha Amos, he says that he has lost 16 pounds over the past 2 months. “I’m just not interested in eating. I’m not taking any medications, either; I’m only taking organic herbs.” He says that his previous antidepressant medications were effective.

Mr. Camp has poor eye contact and speaks in a slow, soft tone. He sits bent over in the chair. His mood is depressed and his affect is flat. His clothes hang on him.

This episode of depression was preceded by a week of hypomanic behavior. During this period, he felt extremely good, he spent more than he should have on a car, and he finished his current task on the farm (harvesting wheat) in record time. He was happy that he was able to complete so many activities with such little sleep. He slept 5 hours a night (normal for him is 9 hours), yet he felt rested and energetic. This period of happiness made him feel worse when he began to feel depressed. “I know what it’s like to feel happy. I’ll never feel that way again.” He admits to experiencing the “happy times” at least four times. “The doctor said I had hypomania,” he tells Ms. Amos.

Assessment

Objective Data

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Subjective Data

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Nurse’s Personal Perspective

Diagnosis

Risk for injury

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Ineffective coping

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Outcome Identification

Planning

Implementation

Short-Term Goals	Intervention	Rationale	Evaluation
Client will remain safe from self-injury.	Assess client’s level of violence.	Determines the level of suicide precautions required.	Mr. Camp remains free of self-injury throughout his stay in the hospital unit. He has one-to-one supervision for the first 2 days and then is placed on a lower level of risk precautions for the remainder of his stay.
	Observe, record, and report any changes in client’s behavior or mood.	The risk of suicide changes with mood and behavioral changes.
	Provide one-to-one supervision.	A client at high risk needs constant supervision.
	Observe every 15 minutes while suicidal.	Ensures the client’s safety.
	Remove all objects capable of causing harm.	A suicidal client may use objects to harm himself in the hospital.
	Ask the client whether he has a plan for suicide and if so, what the details are.	Determines the risk of violence—the more detailed the plan, the greater the lethality.
Client will state one reason to live by day 2 of hospitalization.	Convey a nonjudgmental manner	Demonstrates that the client is worthwhile.	Mr. Camp identifies his family as his greatest source of support.
	Help client list negative and positive self-attributes.	Depressed clients cannot view themselves realistically.
	Help client list positive aspects of life (e.g., family, farm, and friends).	Depressed clients may not view their surroundings or social life realistically.
	Support client’s expression of anger.	Self-destructive behavior can be viewed as anger turned inward.
Client will appropriately express feelings of depression and rage in day 2 of hospitalization.	Encourage verbalization of feelings and convey acceptance of them.	The nurse’s nonjudgmental behavior conveys that the client’s feelings are neither good nor bad.	Mr. Camp expresses anger toward his illness, how it has affected his life, and how he must learn to live with bipolar II the rest of his life.
	Provide a safe environment for expressing feelings.	Encourages release of feelings
	Role-play common emotional conversations.	Practice helps the client improve his skills
	Spend time with client even though he may want to remain silent.	The nurse’s presence is a positive support for the client.
	Encourage client to identify supportive relationships in the community.	The client’s negative perception limits his awareness of support persons in his life.

Evaluation

Answer 1

Hypomania is defined as a mild form a of mania marked by elation and hyperactivity

objective data

-poor eye contact,speaks slow in soft tone,he sits bent over in the chair,his clothes hang on him,lost his weight

subjective data

-hopeless,feels exhausted and tired, not interested in eating ,not taking medications,

diagnosis

1.risk for injury

evaluation -Mr.Camp will be free from injury

2.ineffective coping

evaluation-Mr Camp coping pattern will be improved