Unfolding Case Study
Recently widowed; reports a decreased and depressed mood for the past month, with low energy and periods of feeling; appetite is diminished; weight loss; low appetite; has not been participating in any of the activities; has lost enjoyment and pleasure; has suicidal thoughts; family history of depression and anxiety; brother had been diagnosed with bipolar II disorder; mother and father appeared to have had depression; sister has had two suicide attempts; feels lonely and isolated; has been unable to go to services; anxious, passive suicidal ideation, blunted affect, depressed mood; blood pressure: 145/92.
Rationale: The client has cues that could indicate depression and also has passive suicidal ideation. He is recently widowed, isolated, and lonely. The things that used to bring him purpose are not in his daily life (church, work). His blood pressure is high, which could indicate anxiety, pain, or hypertension. The client is oriented to person, place, time, and situation, which is a normal finding. Likewise, respirations, temperature, and oxygen are all within normal limits.
| Cue | Contributes | Does Not Contribute | Irrelevant |
| Oxygenation level | ✓ | ||
| Chronic health conditions | ✓ | ||
| Family history of depression | ✓ | ||
| Orientation to person, place, and time | ✓ | ||
| Use of alcohol | ✓ | ||
| Isolation | ✓ | ||
| Audio visual-hallucinations | ✓ |
Rationale: The chronic health conditions, a family history of depression, and the isolation he is experiencing in the living facility have all contributed to his depression. He is orientated; therefore, this has not contributed to his depression and he does not drink or report any hallucinations so these are not contributing to his depression as they could for other clients. His oxygenation level is normal and not a relevant factor.
| Cue | Depression | Anxiety | Insomnia |
| Anxiety | ✓ | ✓ | ✓ |
| Poor sleep | ✓ | ✓ | ✓ |
| Low appetite | ✓ | ✓ | |
| Low mood | ✓ | ✓ | |
| Suicidal ideation | ✓ | ✓ | ✓ |
| Withdrawn | ✓ |
Rationale: Depression presents with low mood, sadness, low energy, anhedonia, and can include anxiety and insomnia.
Anxiety manifests with anxiety, insomnia, and can be a warning sign for suicide.
Insomnia can manifest with anxiety, depression, and can be a warning sign for suicide.
a, b, d, f, g, i
Rationale: The client is in danger and needs to be placed under observation to ensure his safety (a). The nurse should communicate with him therapeutically (b), give him emotional support (f), and validate his experiences and feelings (g). To encourage his recovery, he should be encouraged to come out of his room (d) and participate in activities that he enjoys (i). He avoids social interaction where he lives, so it would be inappropriate for someone from the assisted living community to visit (c) and his medications would not be withheld (e). His intake needs to be monitored and encouraged so he would not be eating his meals in private in his room (h).
| Expected Outcome | Unexpected Outcome | |
| Joins in activities in the assisted living community | ✓ | |
| Does not wish to meet with his son | ✓ | |
| Takes his medication | ✓ | |
| Wants to keep living | ✓ | |
| Loses weight | ✓ | |
| Eats meals in private | ✓ |
Rationale: Following his stay in the unit, the client should no longer have suicidal ideation, should take his medication as prescribed, and join in the activities expected of him when he returns to the assisted living community. Having recovered from his depressed state, he should no longer be wishing to isolate himself in his room and continue losing weight; also his desire to socialize with others, such as his son, should improve.