Skip to ContentGo to accessibility pageKeyboard shortcuts menu
OpenStax Logo

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
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
Poor sleep
Low appetite
Low mood
Suicidal ideation

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.



Rationale: Safety of the client is always the first priority in planning nursing care.


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.


This book may not be used in the training of large language models or otherwise be ingested into large language models or generative AI offerings without OpenStax's permission.

Want to cite, share, or modify this book? This book uses the Creative Commons Attribution License and you must attribute OpenStax.

Attribution information
  • If you are redistributing all or part of this book in a print format, then you must include on every physical page the following attribution:
    Access for free at
  • If you are redistributing all or part of this book in a digital format, then you must include on every digital page view the following attribution:
    Access for free at
Citation information

© Jun 12, 2024 OpenStax. Textbook content produced by OpenStax is licensed under a Creative Commons Attribution License . The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, and OpenStax CNX logo are not subject to the Creative Commons license and may not be reproduced without the prior and express written consent of Rice University.