Running head: CASE STUDY

Belmont Pines Acute Care: Case Study

Lauren Hardt

Youngstown State University

William Church
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Abstract

At Belmont Pines Hospital I began my investigation on a fifteen-year-old female for my case

study in this clinical. K.H. was admitted to Belmont Pines Acute Care Center after a previous

stay this summer. She has a family history of psychiatric illness and also has a few psychiatric

diagnoses of her own. Her mother reported that the child has attempted suicide and often has

aggressive behavior towards others. One of the bigger issues with K.H. is her noncompliance of

medications. It is hard enough to find medications that work with kids. let alone make sure that

they are being taken. The treatment team must review her previous discharge goals and identify

what needs to be changed with the current admission related to new as well as old reports of

behavior changes.

Keywords: bipolar disorder, suicide, depression disorder, compliance.

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Belmont Pines - Acute Care: Case Study

K.H. is a fifteen-year-old Caucasian female that was admitted to Belmont Pines Acute

Care Center on September 20, 2019. She lives with her family consisting of her biological

mother, father, maternal grandmother, and younger sister. The patient was previously

admitted in July of this past summer and stayed for twelve days. This is one of several

treatments that K.H. has participated in with the goal to manage her Bipolar Disorder,

Depressive Disorder, Suicidal Ideations, and Anxiety. Her most recent admittance is due to

lacerations needing medical treatment and threats to jump out of the window at her family

home. There are more precipitating factors that led to her most recent admittance that will be

addressed later on. This case study discusses and expands on K.H. and her history, influences,

stressors, nursing diagnosis, and interventions.

After researching her current psychiatric diagnoses, bipolar disorder, “… is characterized

by mood swings from profound depression to extreme euphoria (mania), with intervening

periods of normalcy” (Ball, 2019). Her diagnosis of Bipolar Disorder explains the diagnosis of

Depressive Disorder and Anxiety as they are often seen as comorbidities of Bipolar Disorder.

Before I began talking to K.H. I decided to look into her chart and learn more about her

history and the path that led her to Belmont Pines. The first thing that I looked into was her

family history. Her maternal great grandmother was Schizophrenic and her grandmother was

diagnosed with Bipolar Disorder. Also, on her mother's side K.H.’s mother and uncle are

diagnosed with Bipolar Disorder. It was interesting to see a family history that stems back

multiple generations. I initially thought that it would give K.H. additional help having family

experienced with mental illness. The thing that I forgot is that each individual is different and
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that causes many different experiences with each diagnosis. There was not much on the history

of her father. The chart simply listed that the father suffered from a diagnosis of mental illness,

but has not been in the child's life since 2005. It would be interesting to see if it is also

generational on the father's side but in this case the mothers history explains enough. The

siblings of K.H. that she lives with are unaffected to present date.

After researching her family history I moved on to the whole story of why K.H. was here.

The charts revealed that there was a lot of precipitating factors that led to her admission. Her

mother's statement began from the beginning of the day. The family was having a birthday

party for her younger sibling and while the family was distracted K.H. stole her uncles cigarettes

and phone. Once the family realized that K.H. was missing they began looking for her and found

that she had locked herself in the bathroom and was smoking cigarettes. They began knocking

on the door and asking for her to come out. She slipped out the window and ran away. Her

mother reported that she was gone for approximately four hours before returning. Upon

returning home K.H. got into a verbal altercation with her mother which led to K.H. attempting

to get physical with her mother along with threatening the younger sibling. Then after failing to

physically abuse her mother K.H. turned the aggression on herself and cut her wrists. This led to

her mother calling the police, while the police were on their way K.H. attempted to again jump

out the window. When the police arrived they witnessed K.H. screaming that she wanted to

take her own life. Once they obtained control of her, K.H. was taken to Akron Children's

Hospital in Boardman, Ohio. From there she was referred to Belmont Pines.

The report evidenced that K.H. has many precipitating factors and stressors that led her

to being admitted to BPH. One of the biggest factors is her previous admittance in July. Children
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are often admitted to BPH when their signs and symptoms begin to become out of control or

the children become a danger to themselves or others. When admitted they work on

counseling, groups, and medication management. It often takes multiple tries at finding what

meds work for each individual. Then there is a risk that the child will not adhere to taking the

prescribed meds. This is a big factor that leads to readmission. Some other factor/stressors

include her boyfriend cheating, family relationships, friend completeing suicide, and poor

grades. K.H. struggles to handle these situations due to her current diagnosis of Bipolar

Disorder, Depressive Disorder, Suicidal Ideations, and Anxiety. All of these diagnoses make it

harder for K.H. to cope with the changes that she might face in her everyday life.

When being admitted to BPH part of their intake assessment is to ask the kids what

would they consider to be their triggers. K.H. verbalized to the social workers and therapists

that there are specific triggers to her bad behavior. These triggers include yelling, being teased,

having items taken away, and having no control of input. K.H. stated when she is upset, she

does not like to be touched and hates being overcrowded. However, the patient does have

activities she likes to do to cope and feel better when she is upset. These activities include

journaling, drawing, reading, counting, and listening to music. Also, they ask each individual

what are some warning signs that would show that they are getting aggravated. K.H. reported

that she can be seen cracking her knuckles, pacing, or isolating herself in her room. It is

important for staff not to continue to push the patients when they are aggravated in order to

prevent an outburst and cause the patient to become aggressive.

Before her stay at BPH K.H. was prescribed Geodon and Wellbutrin XL. She reported

that she has been noncompliant with the Geodon because she does not feel as though she
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needs to be taking it. Geodon is a newer antipsychotic medication that changes the effects of

chemicals in the brain and treat the manic symptoms of Bipolar Disorder. Since K.H. has not

been taking the medication it is not able to help stabilize her and prevent episodes of mania

that then lead to hospitalizations. Her mother reported that she has been compliant with her

Wellbutrin XL. K.H. was prescribed Wellbutrin to treat her depression. She has been taking this

med for a lot longer than the Geodon and reports little to no side effects. The doctors at BPH

prescribed her Zoloft. She has refused to start taking it because she states “my friend took that

and she lost her sex-drive.'' They are currently looking to add additional medications but

nothing else had been added to the chart at the time.

I had the chance to talk to K.H. for a very short amount of time. At the beginning she

was very eager to participate in talking with me and then when the time came she seemed to

shy away. When I sat down with K.H. it was obvious that she was uncomfortable. I began with

talking about things that had nothing to do with why she was admitted to Belmont Pines. We

talked about what music she liked, her favorite animals, and whether or not she was addicted

to coffee like me. After talking for a bit I began to ask more serious questions that pertained to

my overall goal. I asked her if she could tell me what happened that day that led to her mother

calling the police. K.H. reported that she felt very uncomfortable with all of her family being

over and she felt that her house was overcrowded and it was extremely loud. Both of these

things triggered her and caused her to spiral. She explained that when she feels like losing

control she always feels the need to hurt herself because it seems to bring her back down. I

aksed her if she had been taking her medications on a regulated schedule and she said “I don’t

see the point in taking those stupid meds because they never ever have worked for me!”. My
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next question was how long did she give the medications to work and she told me less than 2

weeks. This sparked up the opportunity for me to explain that the meds take anywhere from 4-

6 weeks to work. It was obvious that K.H. had a large amount of knowledge deficit when it

came to her medications. The whole time we were talking she kept pulling at her left sleeve.

She was doing it to cover her stitches that she had received from cutting herself. I asked her

how she felt about the stitches and she said ashamed. K.H. explained how her friend had

committed suicide a few weeks ago and that although she realizes the pain it causes it does not

always make her feel like she shouldn’t do it. That was the end of my conversation with K.H.

because she wanted to head back outside. I left the conversation feeling very solemn for a

young girl that felt so lost.

While receiving care at Belmont Pines Hospital the purpose is to set and achieve goals

that are created by the treatment team that most directly increase the future functionality of

the child. When it comes to K.H. the team focused on goals for self-harm prevention, improving

mood, and compliance to medications.

The treatment team also constructed a few short-term goals for the patient to meet

before discharge. These short-term goals included:

1. Patient will take prescribed dosage of medications at scheduled times for

3 days in a row.

2. Patient will verbalize the importance of adhering to prescribed

medications before leaving Belmont Pines Hospital.

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3. Express anger/thoughts of any self-harm or harm to others to doctors in

order to allow staff to implement the use of previously taught coping

mechanisms.

4. Patient will learn coping skills, including problem solving and emotional

regulation. This will be measured by her demonstrating these skills

during therapy sessions and bringing journal to every therapy session to

show that she practiced between sessions.

The first priority for K.H. is risk of suicide related to history of self-harm. K.H. has verbalized

thoughts of hurting herself along with attempting to do so by cutting her wrists. Her mother

explained how she cut her left wrist with a pocket knife when she called the police. The hospital

report included that the cut was fixed with eleven stitches. It is important that the treatment

team investigate these thoughts and actions of hurting herself and others by preventing access

to objects that can aid in such behaviors. These objects may include self-care items, sharp

objects, mirrors, belts, shoelaces, underwire from bras, writing utensils, metal silverware for

meals and shower curtains. The patient must report suicidal thoughts, report thoughts of

hurting others and verbalize thoughts during times of stress and frustration to staff members

during hospitalization.

Some possible nursing diagnoses for K.H. include:

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1. Impaired social interaction related to feelings of worthlessness as

evidenced by isolation and lack of eye contact when conversing with

others (Ball, 2019).

2. Ineffective individual coping related to biochemical changes in the brain

as evidenced by inability to ask for help and destructive behavior towards

self or others (Townsend, 2017).

3. Risk for self-directed violence related to severe Depression, Mood

Disorder, and Suicidal Ideations as evidenced by previous violence

attempts and suicidal plan (Ball, 2019).

4. Noncompliance related to deficient knowledge on the benefits of

compliance as evidenced by therapeutic effect not being achieved or

maintained and failure to comply to a therapeutic recommendation

(Townsend, 2017).

In conclusion, K.H. has behaviors that will continue to be an on-going investigation for

the treatment team and her family. Even though K.H. met all of her short-term goals during her

previous hospitalization, she was readmitted a few months later. It is important to investigate

the causes for K.H. continuous aggression toward mother and the consistant risk for suicide.

Also, it is essential for the doctor to identify medications that can help with K.H.’s treatment in

order to create a stability with her mood. Those involved in her care need to stay aware that
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they are dealing with a fragile teen, that is struggling the most with noncompliance. I believe

that with the proper balance of meds and the use of coping mechanisms, K.H. will have a very

hopeful future.
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References

Ball, J., Bindler, R. M. G., Cowen, K. J., & Shaw, M. R. (2019). Child health nursing: partnering with

children & families (3rd ed.). New York, NY: Pearson.

Parekh, R. (Ed.). (2017, July). What is ADHD? Retrieved from https://www.psychiatry.org/patients-

families/adhd/what-is-adhd.

Townsend, M. C., & Morgan, K. I. (2017). Essentials of psychiatric mental health nursing: concepts

of care in evidence-based practice (7th ed.). Philadelphia, PA: F.A. Davis Company.