Depression/Overdose with Psychosis
SKINNY Reasoning
Jenna Taylor, 18 years old
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
Safety
Psychosis
Clinical Judgment
Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
© 2018 Keith Rischer/www.KeithRN.com
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Jenna Taylor is an 18-year-old woman who is brought to the emergency department by ambulance after she admitted to
her mother that she had taken a “handful” of dextroamphetamine/amphetamine (Adderall) this morning. Mom noted that
there are 20 tablets missing. Jenna admits that she has been hearing voices telling her that she is worthless and would be
better off dead. She denies visual hallucinations.
As the primary nurse explores these comments further, Jenna states, “The devil is in the place! I can feel it! The
voices are telling me that I am going to hell forever.” Jenna appears fearful, anxious and does not maintain eye contact.
When she briefly glances and looks your way, she appears to be looking through you.
Personal/Social History:
She was hospitalized three weeks ago for depression and suicidal ideation and was discharged ten days ago. Jenna lives
with her mother. Her parents were divorced 12 years ago. She graduated from high school, has few close friends, and has
no current plans for her future.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
- 18-year-old woman - Adolescent women with a history of depression and anxiety have a higher
risk for suicide, especially when suicide attempts have been made in the
past (Austin, Kunyk, Peternelj-Taylor, and Boyd, 2019).
- Admitted to her mother that she had taken a
- Patient had intended to harm/kill herself as she was hearing voices telling
“handful” of dextroamphetamine/amphetamine
her she would be better off dead. Hearing voices are triggering her suicidal
(Adderall) this morning. Mom noted that there
ideation (Austin et al., 2019).
are 20 tablets missing.
-
Auditory hallucinations can affect people’s lives tremendously. This is just
- Jenna admits that she has been hearing
one of the criteria for diagnosing someone with schizophrenia (Austin et
voices telling her that she is worthless and
al., 2019). Patient exhibiting auditory command hallucinations is serious
would be better off dead.
and needs to be dealt with promptly, as this can cause suicide attempts
and suicide (as seen in this case) (Austin et al., 2019).
- “The devil is in the place! I can feel it! The - Knowing what the patient is hearing can further help the nurse to
voices are telling me that I am going to hell establish a therapeutic relationship and reassure the patient they are safe
forever.” (Austin et al., 2019).
- Jenna appears fearful, anxious and does not - People in acute psychosis are usually anxious and very fearful.
maintain eye contact. Approaching the client calmly and quietly is important for the nurse to
ensure they are therapeutic (Austin et al., 2019).
RELEVANT Data from Social History: Clinical Significance:
- She was hospitalized three weeks ago for - People with a history of depression or suicidal ideation/attempts are high-
depression and suicidal ideation and was risk patients (Austin et al., 2019). Also, because she was just recently
discharged ten days ago. discharged, the patient might need to stay in PICU longer this time around.
- Lives with her mother. - Patient lives with her mother and she is her main support.
- Divorce may have been a significant trauma in her life, which has led to
SKINNY Reasoning
Jenna Taylor, 18 years old
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
Safety
Psychosis
Clinical Judgment
Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
© 2018 Keith Rischer/www.KeithRN.com
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Jenna Taylor is an 18-year-old woman who is brought to the emergency department by ambulance after she admitted to
her mother that she had taken a “handful” of dextroamphetamine/amphetamine (Adderall) this morning. Mom noted that
there are 20 tablets missing. Jenna admits that she has been hearing voices telling her that she is worthless and would be
better off dead. She denies visual hallucinations.
As the primary nurse explores these comments further, Jenna states, “The devil is in the place! I can feel it! The
voices are telling me that I am going to hell forever.” Jenna appears fearful, anxious and does not maintain eye contact.
When she briefly glances and looks your way, she appears to be looking through you.
Personal/Social History:
She was hospitalized three weeks ago for depression and suicidal ideation and was discharged ten days ago. Jenna lives
with her mother. Her parents were divorced 12 years ago. She graduated from high school, has few close friends, and has
no current plans for her future.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
- 18-year-old woman - Adolescent women with a history of depression and anxiety have a higher
risk for suicide, especially when suicide attempts have been made in the
past (Austin, Kunyk, Peternelj-Taylor, and Boyd, 2019).
- Admitted to her mother that she had taken a
- Patient had intended to harm/kill herself as she was hearing voices telling
“handful” of dextroamphetamine/amphetamine
her she would be better off dead. Hearing voices are triggering her suicidal
(Adderall) this morning. Mom noted that there
ideation (Austin et al., 2019).
are 20 tablets missing.
-
Auditory hallucinations can affect people’s lives tremendously. This is just
- Jenna admits that she has been hearing
one of the criteria for diagnosing someone with schizophrenia (Austin et
voices telling her that she is worthless and
al., 2019). Patient exhibiting auditory command hallucinations is serious
would be better off dead.
and needs to be dealt with promptly, as this can cause suicide attempts
and suicide (as seen in this case) (Austin et al., 2019).
- “The devil is in the place! I can feel it! The - Knowing what the patient is hearing can further help the nurse to
voices are telling me that I am going to hell establish a therapeutic relationship and reassure the patient they are safe
forever.” (Austin et al., 2019).
- Jenna appears fearful, anxious and does not - People in acute psychosis are usually anxious and very fearful.
maintain eye contact. Approaching the client calmly and quietly is important for the nurse to
ensure they are therapeutic (Austin et al., 2019).
RELEVANT Data from Social History: Clinical Significance:
- She was hospitalized three weeks ago for - People with a history of depression or suicidal ideation/attempts are high-
depression and suicidal ideation and was risk patients (Austin et al., 2019). Also, because she was just recently
discharged ten days ago. discharged, the patient might need to stay in PICU longer this time around.
- Lives with her mother. - Patient lives with her mother and she is her main support.
- Divorce may have been a significant trauma in her life, which has led to
