Running Head: CASE PRESENTATION

Case Presentation
February 12, 2017
Barb Gibbs
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CASE PRESENTATION

CASE PRESENTATION 60-YEAR-OLD CAUCASION MALE

On 2/3/17 a 60-year-old caucasian male was admitted to our facility from Central

Regional Hospital under involuntary baker act for suicidal ideations with a plan of starvation and

for major depressive disorder. He was admitted to the hospital initially on 1/2/17 for a bladder

infection requiring IV antibiotics. Upon admission, the patient refused to eat, based on his

discharge instructions, several attempts were made to encourage the patient to eat. The attempts

were unsuccessful, once the patient was stabilized, he was transferred to our facility in the older

adult unit for evaluation and treatment for his suicidal ideations, depression and refusal to eat.
Patient is currently on disability as a result of an unsuccessful shoulder surgery, resulting

from a fall at work 6 months ago. The patients spouse states he became severely depressed after

the failed surgery and his inability to return to work and normal everyday living activities.

Patient is not currently ambulatory, which is thought to be temporary, due to weakness from his

attempt at starvation. During his stay in the hospital, the patient developed a bedsore on his

coccyx as well as a loss of 34 pounds over the course of his stay.

The patient has been sent to the emergency room on 2/4/17 and 2/8/17 when he presented

in our facility in a catatonic like state and was unresponsive to the sternal rub performed by the

nurse on duty. The hospital determined the catatonic state of the patient was voluntary as all tests

were normal. In both instances, the patient was discharged from the emergency room and

returned to our facility to continue his treatment.

The patients initial diagnoses of major depressive disorder was confirmed by our

psychiatrist, Dr Williams. He placed the patient on Haloperidol, 10mg BID, as well as

Citalopram 40mg OID. To date, the patient has been compliant with taking his medications.

Since his arrival, the patient has continued to carry out his plan of starvation. His typical daily

consumption consists of 8-10 oz of water, 1-2 pieces of pineapple chunks and 4-8 oz of med

pass.
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CASE PRESENTATION

The case managers, as well as the therapists have been in regular contact with the

patients spouse. She has requested, despite the patients unwillingness to live, every means

possible is used to treat the patient for his depression and starvation attempt. The spouse has also

informed our staff she is currently undergoing chemotherapy and therefore, in the patients

current physical and mental state, unable to care for the patient at home. However, if he improves

and became ambulatory, he will then be welcome home. The patient mentioned during his

therapy session my wife cant, take care of me, she can barely take care of herself because of

her chemo treatment. Im a man and I cant even take care of myself. I just want to die. The

therapist has noted the patients chart expressing he is struggling with the belief he can no longer

be the man society expects him to be. She will continue to address this concern with the patient

during her daily one on one sessions.

The team consisting of the therapist, the treating physician, the charge nurse and case

manager have discussed the case in depth to formulate a treatment plan This was presented to the

spouse, to which she agreed. The therapist on the case will continue with daily one on one

therapy sessions with the patient. The physician will continue with med adjustments for the

depression as he deems necessary. The nursing staff will continue to treat the patients bedsore

by turning him every two hours. The case manager will attempt to secure placement that will

serve both the psychological and physical needs of the patient after discharge. The entire team

will continue to encourage the patient to eat.

The case manager and therapist met to determine the best approach regarding the

patients unwillingness to eat. It was decided the case manager, who has formed a professional

relationship with the patient, would have a conversation with him, in an attempt to obtain why he

was not eating.

On 2/9/17 the case manager spoke with the patient and asked why he was refusing to eat.

The patient stated I have a hole in my jaw bone. The doctor looked at it and didnt see anything,
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CASE PRESENTATION

but I know its there. The case manager asked if the patient would be able to eat soft foods on

one side of his mouth. The patient stated yes. When asked what types of food, he stated banana

and fruit cocktail. Thereafter, the case manager was able to get the patient to eat 1/3 of a banana

and 4-5 chunks of pineapple. When asked if he liked the med pass, the patient stated its ok. Its

just so thick. The case manager asked if it would be better to drink it with a straw, to bypass the

jaw pain, if it was thinned with milk. The patient agreed. Once thinned with milk, he drank 8 oz

of med pass. Upon further discussion, the patient stated to the case manager my eyes dont

work, my body wont work and I can hardly speak. Ive only got days left. Im too far gone to

come back from this, its just not possible. After making the patient aware that this was likely

due to lack of nutrition, the patient subsequently agreed to eat half of his meals, three times a day

until the case manager returned on Monday, where it would be reevaluated if eating improved his

physical wellbeing.
The case manager met with the charge nurse to discuss the newly identified information

pertaining to foods the patient agreed to eat. The case manager consulted with the nurse as to

protocol for special meal requests. The nurse requested from the case manager the information

obtained from the patient regarding his food preferences and notated the patients chart, specific

for the weekend staff.

As of 2/10/17 it is reported the patient has been more alert and responsive. The patient is

no longer catatonic or in his bed all day. On several occasions he has been observed sitting in the

day room in his jerry chair. The patient has also been observed pushing himself around with his

feet in his wheel chair. The current plan is to continue treating him for depression and encourage

the patient to eat regularly. Elder affairs will be contacted regarding the bedsore the patient

obtained during his stay at the hospital.