Mental Health

A 44-year-old female named Sandra Combs was brought to the ER after a suicide attempt. She has a laceration on her left wrist and is experiencing suicidal thoughts. She has no known allergies and signed consents for medical information to be shared with her boyfriend. She does not have insurance and has been under a lot of stress since breaking up with her ex-boyfriend. She has been placed on safety precautions and her vital signs are stable. Tests were done and showed positive for cannabis use. She is experiencing chest pain and has a history of hypothyroidism. Pain medication was administered and a treatment plan was discussed with her and her boyfriend. She has a history of depressive disorder and previous suicide attempts. She has no relationship with her children and relies on her boyfriend for support. She is willing to seek mental health treatment and her boyfriend is supportive. A psychosocial assessment was done and she is currently being evaluated by a psychiatrist. We have a 44-year-old Caucasian female named Sandra Combs. She was transported to the ER via private car, which she was accompanied by her boyfriend. Her chief complaint is suicidal ideation and pain to her left wrist that is from a laceration due to a suicide attempt 24 hours ago. Patient has no known allergies. Patient also states it's okay to disclose medical information to her boyfriend and it's okay to talk in front of her boyfriend. Patient also signed all consents and disclosed that she does not have any insurance. Patient says she's been under a lot of stress here recently. She broke up with her ex-boyfriend two weeks ago, which is not the one that is currently present at the visit. Patient was placed on a one-on-one for safety issues, safety precautions initiated. Patient was placed into the psych room in which patient was asked to remove all clothing and was provided a hospital gown. Her current vital signs are 97.5 temp, 156 over 87 blood pressure, 18 respiration, 88 pulse, 97% O2 on room air. Tests that were ordered were a urine drug screen, which showed positive for cannabis. Patient did disclose that she does smoke marijuana daily. A toxicology result for ethanol, which was negative. A urine was collected for UA, which was normal. Her RPR was collected and it was non-reactive due to her increased sexual behaviors that were disclosed. A patient did say that she had some chest pain at triage, so an EKG 12 lead was initiated, which showed normal sinus rhythm without ischemia. Patient has a history of hypothyroidism, so a TSH and a P4 were ordered and they were both normal. Patient has current pain rated 1 out of 10 to her left wrist for a laceration and measurement of 106 point centimeters times four centimeters. This laceration was caused by a suicide attempt 24 hours ago, in which patient used a box cutter to cut her wrist. She said that she has not had any form of medicational pain relief. She states that applying pressure to the area is the only thing that alleviates the pain. Tylenol 500 milligrams, Q8 hours, PO, was ordered for this patient and administered for her pain. She currently also states she has chest pain rated 2 out of 10. She states that the stressful events that could be causing the chest pain was her boyfriend broke up with her about two weeks ago and she relied on that boyfriend for financial and housing needs, basically. Room care was initiated to the laceration. Orders state clean with normal saline, apply TAO, and apply dry dressing. Patients state that she is having some sleep issues, say that she has insomnia where she's been sleeping less than four hours nightly. She states that she has not tried any type of medication or intervention, such as melatonin or anything of that sort. She states that her anxiety has been a 6 out of 10 for the past week. She states that the anxiety is relieved when she smokes marijuana or cigarettes. There's no fever currently present, her skin is warm and dry, normal in color, no other open areas other than the laceration. WBCs were within normal limits. UA was fine, all blood work was fine, her glucose, MCV, and chloride level were slightly elevated and her CO2 was slightly decreased. Nothing alarming, nothing that needs significant intervention. Patient denies any respiratory issues. She does have a history of tobacco use, one pack a day, marijuana use daily. Her abdomen was non-tender upon auscultation. Her lungs were clear in all four quadrants, normal breath sounds. She has no respiratory distress noted, no nasal flaring, and no stridor. Her rate is 18, she is on room air, she does not have any coughs or any type of sputum. Patient does not have any type of cardiovascular issues, any history of any cardiovascular issues. She does state she has a chest pain, 2 of 10, which could be initiated by her anxiety. She has no edema, she denies any type of numbness or tingling in any extremities. Her extremities are warm to touch, her blood pressure currently is 156 over 87, a 12 lead EKG with no myoclonus rhythm, and there were no heart murmurs noted. Upon her neuroassessment, she has normal speech, hearing normal, parla was present, no gross focal defects noted, she's learned to orient at times four. She's able to follow commands, able to move all extremities, her hand grips were equal in strength, her leg movements were equal in strength as well. Patient has no history of any type of GI or liver issues, her bowel sounds are active in all quadrants, non-distended, abdomen moves soft and non-distended, non-tender. Patient currently weighs 201 pounds, 71.20 inches, she's on a regular diet. Patient does state that she has had a decrease in appetite in the past week, stating that she eats very small portions, maybe twice a day. She has drunk two liters of water within the past 24 hours, so that she has not had any types of issue with oral liquid intake. No history of diabetes. Patient does have a history of hypothyroidism. Patient states that she takes Synthroid, 75 micrograms daily. Patient says she does not see a primary care health physician, so she gets her refills from an online virtual consult. We did order a T4 and a TSH, both were normal. She has no history of any type of communication problems. She has normal speech, normal hearing, no glasses, English is her primary language. Patient does not have any history of any type of renal or bladder issues, there was no bladder dissension noted. She denies any type of pain or burning with urination. She denies any frequency. UA was collected, it was clear in color, there was no odor present. UA did come back and everything was normal. Her last menstrual period was 4-1 of 24. She denies any type of discharge or odor in the vaginal area. Patient states she has no history of any type of bowel issues, states her last bowel movement was today and it was normal. Her psychosocial assessment, she does have a history of borderline depressive disorder. She states that she got this diagnosis at 22 years old. She said that it was being treated. She cannot remember the medication she used to take, but she has not taken it since she was 30 years old. She has a history of suicide attempt two years ago with her last attempt in which she used a knife and cut her throat. She was hospitalized for two weeks, followed by a mental health facility for one month. She's currently divorced. She has two children, ages 18 and 22, in which she has no relationship with either. She does not have, she's unemployed with no insurance. She does not see a primary care physician. Patient states the last time she was seen by any psychiatric physician was when she was hospitalized two years ago. She does verbalize feeling alone and hopeless. Patient states that she does not have any friends. Her only current support system is her current boyfriend, which was a friend for three years with her recent breakup with her ex-boyfriend. He became her boyfriend and primary support. Her current stressor is her ex and their relationship issues. She does state that she did rely on him for housing and financial issues. She's not had a job in six years. She states that she copes with it by smoking cigarettes or marijuana, and she also initiates self-harm. Patient denies any type of religious spirituality. She states that she does not take any type of routine antidepressants or antipsychotic medication. She said that she has not taken any type of those medications since she was released from the hospital two years ago. Patient has a family history of diabetes from her father. Smoking, both her mother and her father had smoked tobacco, and she states that her mother had substance abuse issues. The patient is willing to adhere to a high level of care and willing to adhere to better mental health treatment currently, and also when released, she would like to look into possibly getting a primary care health physician to be able to maintain her mental health. The boyfriend is at bedside, and he is also willing to learn different coping mechanisms to help the patient be able to cope better with her situation, and he is also willing to learn stressors, and also willing to reach out to local facilities to see if they can't get on a type of program to help her with her mental health issues while she is uninsured. The patient's boyfriend does also state that he is aware of her condition. Education was provided to him about anxiety and the stressors and signs and symptoms of depression. After the initial assessment was completed, patient was also referred to psychiatric services in which she received a psychosocial assessment. The findings were as follows, good hygiene, dressing was age appropriate, patient was cooperative and had appropriate responses to all questions, she had normal gait, very poor posture, she seemed very calm, however depressed, this is appropriate, deemed her diagnosis very flat affect, her speech was in normal limits, she was A and O times four, her memory is intact, patient does state that she had some suicidal ideation, she does state that she had some intent as well at this time, in which the nurse was notified one on one was continued and the psychiatric visitation also proceeded after notifying the nurse. She denies any type of delusions or hallucinations at this time. Patient is reliable with her answers. Patient states she has been under a lot of personal stress, does not cope well with any type of stressors. She has no coping mechanisms other than smoking cigarettes, smoking marijuana and inducing self-harm. Her only support system is her current boyfriend. She has no spiritual beliefs, she does have an extensive sexual history, which she states is a side effect of her anxiety. She does state she has poor sleeping patterns and she's been sleeping less than four hours, which also contributes to her anxiety. She has poor attitude toward others, as she states she has no relationships with other family or her children. After the evaluation, it's believed that she's in the sixth stage of Erickson's stages of development, intimacy versus isolation, as she voices she wants to have a relationship with the opposite sex, however, she is afraid to be hurt due to her previous relationship. After the psychiatric evaluation was complete, it was deemed that she does need a higher level of care and was referred to an outside mental health facility, in which she agreed to go.