What Should the Nurse Do?

Elena is a thirty-two-year-old female who presents to the psychiatric outpatient clinic for a follow-up appointment. Elena has a complex medical and psychiatric history, contributing to her ongoing mental health challenges. She was diagnosed with bipolar disorder at the age of twenty-one and has experienced multiple episodes of both mania and depression since then. Her medical history also includes hypothyroidism, for which she takes levothyroxine. Elena reports a recent exacerbation of depressive symptoms, including persistent low mood, fatigue, and feelings of hopelessness. She mentions difficulty concentrating, changes in appetite with unintended weight loss, and disrupted sleep patterns. During the assessment, she reveals a history of trauma, which she acknowledges has played a role in her mental health struggles. Additionally, Elena has a past history of substance use disorder, particularly alcohol misuse, but reports being in recovery for the past three years. She attends regular Alcoholics Anonymous meetings as part of her ongoing support network.

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Sarah is a forty-two-year-old female who arrives at the psychiatric clinic seeking assistance for a complex set of mental health challenges. Sarah’s history reveals a long-standing struggle with bipolar disorder, which was initially diagnosed during her early twenties. Over the years, she has encountered recurrent episodes of both manic and depressive states, impacting her overall quality of life. Recently, Sarah has been grappling with intensified symptoms of depression, including persistent feelings of hopelessness, a diminished interest in activities she once enjoyed, disrupted sleep patterns, and noticeable changes in her appetite leading to unintentional weight loss. In addition to her psychiatric history, Sarah reports a significant life event that triggered this latest episode—a recent divorce after a fifteen-year marriage. The stressors associated with this major life change have exacerbated her bipolar symptoms, leading her to seek professional help. Sarah’s vital signs upon arrival indicate a heightened level of physiological distress, with an increased heart rate of 105 bpm and elevated blood pressure reading at 140/90 mmHg. During the initial assessment, she expresses difficulties in concentrating at work, which has led to a decline in her professional performance and an increasing sense of inadequacy. Sarah also admits to struggling with social isolation, finding it challenging to connect with friends and family members, exacerbating her feelings of loneliness.

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Rodney is a forty-five-year-old male who presents at the psychiatric inpatient unit following a referral from the emergency department due to an acute exacerbation of schizophrenia. Rodney appears disheveled, with poor eye contact and a guarded demeanor. He is oriented to person, place, and time, but is preoccupied with auditory hallucinations, reporting command hallucinations instructing him to harm himself. He exhibits paranoid delusions, expressing a belief that he is being followed and persecuted. Rodney has a complex psychiatric history, dating back to his early twenties when he was initially diagnosed with schizophrenia. He has a history of multiple psychiatric hospitalizations, often precipitated by medication noncompliance. His medical history includes hypertension, for which he takes amlodipine, a medication that has been well-tolerated. In the current episode, Rodney’s family reports a recent decline in his overall functioning. They noticed increased social withdrawal, decreased self-care, and disrupted sleep patterns. He denies any recent substance use or changes in medications. His vital signs on admission are within normal limits, and initial laboratory workup, including a complete blood count and comprehensive metabolic panel, is unremarkable.

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Emily is a thirty-two-year-old female who arrives at the psychiatric outpatient clinic for follow-up care after a recent hospitalization for a major depressive episode with suicidal ideation. Emily reports a two-month history of persistent low mood, anhedonia, feelings of hopelessness, and changes in sleep and appetite. During her hospitalization, she was started on a therapeutic dose of sertraline and engaged in individual and group therapy sessions. Emily has a history of recurrent depressive episodes since her early twenties, with intermittent periods of stability. She has a family history of mood disorders, and her past psychiatric treatments have included various antidepressant medications and psychotherapy. Emily’s medical history is notable for hypothyroidism, managed with levothyroxine, and there is no reported history of substance use. During her initial assessment, Emily’s vital signs are within normal limits, and she expresses a commitment to continue with her medication regimen and follow-up appointments.

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Aarav, a twenty-eight-year-old nonbinary individual, seeks care at the psychiatric outpatient clinic due to escalating symptoms of anxiety and panic attacks. Aarav provides a comprehensive account of the distress, linking it to heightened stress levels arising from work-related pressures and challenges in personal relationships. Aarav describes the anxiety as pervasive, affecting both day-to-day functioning and overall well-being. The reported symptoms encompass various dimensions. Aarav mentions experiencing disrupted sleep patterns, characterized by frequent awakenings and difficulty falling asleep due to intrusive thoughts. Racing thoughts dominate waking hours, contributing to a heightened sense of unease. Physical manifestations during panic attacks include palpitations, a racing heartbeat, and shortness of breath, further intensifying the emotional distress. A thorough exploration of Aarav’s medical history reveals no significant health issues or prior engagements with mental health services. This marks Aarav’s first encounter with seeking professional support for mental health concerns. The absence of a mental health treatment history prompts the nurse to gather additional information about Aarav’s coping mechanisms, support systems, and any past strategies employed to manage stress. Aarav’s social history unveils a dynamic and supportive network of friends and family. However, recent challenges in personal relationships have strained these support systems, contributing to Aarav’s sense of isolation and exacerbating the anxiety symptoms.

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Riya is a thirty-five-year-old female, who presents at the mental health clinic reporting persistent symptoms of depression and anxiety. Riya expresses a sense of overwhelming sadness, loss of interest in previously enjoyable activities, and pervasive worry about the future. The nurse notes vital signs, revealing an increased heart rate and slightly elevated blood pressure. Riya’s medical history indicates a previous diagnosis of hypothyroidism, managed with medication. Her psychiatric history unveils that Riya has a history of recurrent depressive episodes, with the current episode marked by increased severity. Riya has engaged in therapy intermittently but has struggled to maintain consistent follow-ups due to various barriers, including financial constraints and limited accessibility to mental health services. Communication challenges emerge as Riya highlights difficulties in expressing her emotions verbally, contributing to a sense of isolation.

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