Case Study Ronald Sherbino is a 73 year old male. Recently widowed...

Case Study

Ronald Sherbino is a 73 year old male. Recently widowed from his wife of 52 years. He has one son who lives close by and a daughter who lives in Vancouver. He was diagnosed 3 years ago with diabetes which prior to his wife's passing was well controlled. He also suffers from chronic pain after a knee replacement in 2017. He lives alone in the family home and does not have visitors often due to the social distancing advisement and his son's work schedule. He visits the Emergency Department on the urging of his son who is worried about his welfare after stopping in to check on him and finding him confused and disheveled. The son reports that his dad had not been acting like himself on the phone and has discovered he has not filled his prescriptions in over a month. Ronald is admitted to the general medicine department to get his blood sugars under control.

Ronald's initial presentation to the ED revealed a blood glucose level of 26 mmol/L and he was positive for ketones. Confused to date and place. After a 5 day admission Ronald's blood sugars have stabilized and discharge planning has begun. During a health teaching session about a new insulin that has been added to his regime Ronald discloses "I don't see the point in learning this. I'm going to stop checking my blood sugars when I get home. I just want to die." Later on in the day Ronald asks the RPN administering his evening insulin "how much insulin would it take to put me in a coma?" The nurse asks if he has thoughts of harming himself. Ronald replies that he doesn't want to manage his life alone and states next time he won't answer the phone when his son calls. He also expresses anger towards his son for taking him to the hospital. Chris, Mr. Sherbino's son, is extremely upset when talking with the nurses expressing guilt that he didn't realize his dad wasn't doing well sooner and that he should have made him move into his home when his mother passed.

Patient Data: 73 years old, height 179 cm, weight 75 kg

Signs and Symptoms: Concerning statements about potential self-harm, suicidal ideation

Allergies: NKDA

Medication: Humalog 10 u subcutaneous AC TID, Lantus 12 u subcutaneous QHS, ASA 81 mg PO OD, Ramipril 5 mg PO OD, Tylenol ES 500 mg PO BID PRN for pain

Past medical history: HTN, DM, Left knee replacement

Diet restrictions: Diabetic diet with reduced sodium

Events Preceding: Recent death of spouse, Diagnosis of diabetes

Mental Health Nursing Case Study Questions:

1. Discuss 4 factors that place Ronald at risk for developing a mental illness.
2. List 3 priority nursing assessments. Why are each of these important?
3. List 3 priority nursing interventions. Why are each of these important?
4. Discuss how therapeutic communication will help the nurse care for Ronald and his family?
5. Provide 3 examples of how the nurse will employ therapeutic communication skills when caring for Ronald and his family.
6. Does Ronald's behavior warrant involuntary admission to the hospital? Why or why not?
7. Discuss three legal/ethical considerations related to this case.