Discussion | NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent | Walden University

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Gify is a 15-year-old Hispanic female who was admitted to acute care in the psychiatric hospital for suicidal ideations with a plan to cut her wrist on March 20th, 2021.  Gifty has been in the custody of the Department of Health and Human Services for the last three years.  She was removed from her mother’s custody due to neglect and her mother’s drug use.  Gifty was in a foster home for more than a year.  She reported having a nightmare that she killed her foster family and began to constantly feel worried that she might do something to harm the family.  She told her foster-mother she needed to go live somewhere else because she was worried she would kill the family and was taken to a residential group care facility by case worker.  After three weeks at the residential group care facility, Gifty reported SI and was transported to our facility. Gifty’s diagnoses are major depressive disorder recurrent severe and generalized anxiety disorder. 

Gifty has had two previous acute psychiatric inpatient stays in the last two years with diagnoses of major depressive disorder and generalized anxiety disorder

Upon admission Gifty stated she had a depressed mood everyday for the last three weeks.  She reported a decreased appetite, hypersomnia, decreased energy, feeling worthless, and feeling hopeless. Gifty initially improved but has regressed during her stay.  She was stable for discharge eight days after admission, but DHS did not have placement arranged for her.  As she has waited for DHS to find placement, Gifty’s depression and particularly her anxiety have worsened.  She attempts to call her caseworker on a daily basis.  The caseworker does not answer, nor does she respond to the voicemails left for her.  In her words, she “worries about stuff all day everyday” and specifically mentions worrying about where she will go when she leaves, her siblings, her clothing at the residential group care facility, and that she will have to repeat the 9th grade.   She had a panic attack yesterday and today.  During the panic attacks, Gifty reported she could not breathe, chest pain, nausea, she was visibly shaking, and she stated she felt like her heart was about to beat out of her chest.  Buspar 5 mg by mouth twice daily was ordered today.  Other current medications include Prozac 20 mg by mouth daily and Vistaril 25 mg by mouth as needed every six hours.  Gifty has denied suicidal ideations since March 27th.  She continues to be safe for discharge, but if her symptoms continue to worsen, she may not be safe for discharge when DHS finds placement for her.

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