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Discuss how you would address a crisis with each of the following patients.

 

Patient 1: 45-year-old male married for 15 years with 2 children. He has a history of MDD and pornography addiction which has been dealt with through therapy. This addiction had caused some trouble in the marriage but for the past 5 years, things have been going well in the marriage and patient denied looking at porn. MDD symptoms started in his 20s and have been well managed with citalopram (Celexa) 20mg daily. He comes in today visibly upset. He reports his wife has been cheating on him for two years, and he found out when he came home from work to find his wife and kids gone, a note that detailed her infidelity, and she took the children to live with the man she has been cheating with. Divorce proceedings are in effect. He states, “I had no idea. I know I had my problems but two years? I feel so stupid. I don’t know why I bothered improving myself. I don’t know how I can even go on. My work made me take some time off, but I have continued to call in. I’m at risk of losing my job, but I just can’t bring myself to go. The kids are my world, and I haven’t even talked to them for a month”. You question him about suicidal or homicidal ideations, and he replies that he has been suicidal since she left and has been drinking “at least a six-pack” a night. He has had plans to shoot himself. When asked what keeps him from acting on plans, he said, “My kids, but I’m losing hope I’ll ever see or talk to them again.” What are your next steps?

 

Patient 2: A 19-year-old married mother of a 2-month-old baby presents for her 4th visit. Her husband is present today. She presents today dressed more provocatively than you have seen her before. Her makeup is heavier than usual as well. The baby is in a carrier and is sleeping. She immediately starts discussing a video series on aliens she has been watching, and her speech is rapid, loud, and tangential. She makes several loosenesses of associations between the video series and her baby. From her rambling, it sounds as if she believes the baby is an alien, and she needs to take it to the desert and leave it on the mountain for the aliens to come and retrieve it. She reports plans to go camping with the baby and her husband this weekend. You question her about suicidal and homicidal ideations, and she denies both. Her husband states, “she has been acting “different” the last couple of weeks and fears leaving her alone with the baby.” She interjects that she knows the secret to world peace, and giving their baby back to the aliens will accomplish it. What are your next steps? 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 6660

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