Clinical Case Study: Emotion (Mood, Anxiety, & Grief)
Case: Bipolar Disorder with Depression
Related Concepts: Adaptation, Coping, Wellness, Self-Management,
Medication management & Suicide attempt
Luis Chaves is a 22-year-old who migrated to Miami at the age of 2 years
with his parents. He is unemployed and lives with his sister. He is actively
involved with an intercity gang and depressed. Today he intentionally
overdosed with paroxetine, zolpidem, oxycodone and alcohol. He goes to
his sister’s apartment to say goodbye after taking the drugs and alcohol and
confesses to overdosing. His sister immediately calls 911 as he became
unconscious. On the way to the emergency department Luis was treated
with naloxone, which produces a rapid improvement in his level of
consciousness. He becomes agitated and starts yelling that he “doesn’t
want to live anymore.”
Pre-Hospital Note
October 26 Paramedics responded to the residence at 2204.
2300 Upon arrival to the scene found a 22-year-old male
unconscious. Sister reports that the client stated
overdosing with paroxetine, zolpidem, oxycodone,
ibuprofen, and alcohol. Patent airway and
breathing spontaneously at 8 respirations per
minute, pulse 60 beats per minute, blood pressure
90/58 (69) mmHg. Naloxone administered during
transport and client’s consciousness level
increased. Began yelling, “I don’t want to live
anymore.” Respirations 20 breaths per minute,
pulse 90, blood pressure 148/98 (115) mmHg.
Handoff report to the emergency department
nurse.
1. The nurse receives the above handoff from emergency medical
personnel that brought Luis into the emergency department. What
are the 3 priority concerns or cues?
1. _________________
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2. As the triage nurse in the E.D., what is the priority focused
assessment?
A. Cultural preferences
B. Respiratory status
C. Suicide risk
D. Substance use history
3. The client responded to the naloxone on the way to the E.D. Which
substance(s) would not react to naloxone? Select all that apply.
A. Paroxetine
B. Zolpidem
C. Oxycodone
D. Ibuprofen
E. Alcohol
Luis is stabilized in the emergency department. He reports feeling
“desperate” over being estranged from his 4-year-old son and the
negative consequences of his current life decisions. He goes on to
discuss conflicts that he has with his mother, his inability to find
employment, the recent death of several close friends murdered in gang
violence, and feelings of self-loathing, helplessness, hopelessness and
depression. Luis shares that his biological father is an alcoholic and has
a drug abuse problem. However, the client denies that he has any
problems with alcohol because he “doesn’t like the taste,” and only
drinks one to two times per month. He also doesn’t take drugs because
he doesn’t “like the way they make him feel.” Luis states that his family
history is positive for depression, schizophrenia, and bipolar disorder. At
age 14 he tried to commit suicide for the first time and has made three
attempts since then with a previous psychiatric admission. He says “I
wish I hadn’t gone to my sister and told her what I did; then this would
be over.” Client denies current suicidal ideation.
4. What is the best predictor of a suicide attempt?
A. A family history of suicide attempts.
B. Previous suicide attempts.
This study source was downloaded by 100000856416705 from CourseHero.com on 11-04-2023 04:08:18 GMT -05:00
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