Person providing report: Home Care Coordinator
Situation:
17-year-old male recently discharged from an inpatient psychiatric facility for
suicidal ideation, depression, and obesity.
Now for home care evaluation of weight loss and depression.
Background:
Thomas Sykes is a 17-year-old male who lives in an inner-city apartment with
his sister Keisha and Keisha’s 3-year-old son, Torrey. Thomas’ father is not
involved in his life. His mother passed away about 10 years ago from
complications associated with uncontrolled diabetes and obesity. Following his
mother’s death, Thomas moved in with Keisha and she became his legal
guardian. About a year ago, Keisha, Thomas, and Torrey moved for Keisha’s
new job in the local battery plant. Her shifts rotate between days and
evenings, requiring Thomas to care for Torrey when Keisha has to work the
evening shift.
Thomas has been overweight for most of his life, but over the past year, he has
gained 60 pounds and weighed 240 pounds on admission for inpatient
treatment. With a height of 5 feet, 11 inches, Thomas is obese, with a BMI of
33.5. Last year, Thomas was in his junior year of high school and had been
planning to graduate with his classmates, so the move was hard for Thomas.
He did not make friends at his new school and spent most of his time alone
playing video games or watching television with Torrey. He began skipping
school up to three times a week and did not want to leave the apartment.
Following an appointment with a pediatric nurse practitioner, Thomas was
admitted to the inpatient psychiatric unit for evaluation for his suicidal
ideation. He has undergone group therapy, individual therapy, and is on
escitalopram. Upon discharge, he stated that counseling was helping and he
was feeling less depressed. Before discharge, Thomas met with the nutritionist
to establish an eating plan to help him get to a healthier weight. He is working
on this healthy eating weight-loss plan and keeping a food log.
Assessment: Obesity and depression

Recommendation:
During your visit, repeat the Columbia-Suicide Severity Rating Scale and
compare it to the last one that was administered. Have a plan for on-going
support in the community.
Conversation between Thomas, Keisha, and the student nurse (ECSN):
The first step is performing hand hygiene, introducing yourself and confirming the patient ID.
Thomas: “Hello. I am feeling better and glad to be out of the hospital.”
ECSN: “I see you have lost 14 pounds since I last saw you!”
Keisha: “Isn’t that wonderful, Thomas! Look how many pounds you lost!”
Thomas: “I’m feeling better every day. The counseling is helping and I think the meds are starting to
work. I made a friend in the hospital, Wesley, and I’ve texted with him a few times. We’re trying to
figure out when we can go see a movie together.”
ECSN administers the Columbia Depression scale
Q1: Have you wished you were dead or wished you could go to sleep and not wake up?
Thomas: (answers no)
Q2: Have you had any actual thoughts of killing yourself? (If NO, go directly to question 6.)
Thomas: (answers no)
Q6: Have you ever done anything, started to do anything, or prepared to do anything to end your life?
Thomas: (answers no)
ECSN: “How do you feel about returning back to school?”
Thomas: “I wish I didn’t have to go back there, but I know I have to.”
Keisha: “I know it will be hard, Thomas. Some of those kids are really mean, but when you were in the
hospital, a girl from your math class called to see if you were OK.”
Thomas: “Really! What was her name?” (excited, smiling)
Keisha: “Angela. She told me that she knew some kids were mean to you and she felt bad that she had
not spoken up to them and commented on social media but didn’t want them going after her. She
knows now that was wrong. I have an appointment at your school tomorrow to talk to the principal and
guidance counselor.”

Thomas: “I’m not sure that’s a good idea. It could make it worse; I need to stand up to those idiots
myself.”
Keisha: “Since you missed school, they know you were in the hospital. Now they need to know how you
were treated so they can do something about it. Angela told me that it is probably happening to others
too. We can’t let this happen to anyone else.

• Discuss the clinical manifestations evidenced during your assessment. How would you explain these manifestations?
• Explain the nursing management considerations for this patient. Discuss the knowledge guiding your thinking.
• What specific issues would you want to take into consideration to provide for this patient’s unique care needs?

ANSWER

Clinical Manifestations and Nursing Management for a Patient with Obesity and Depression

Clinical Manifestations

The patient, Thomas Sykes, presents with the following clinical manifestations:

Obesity: Thomas has a BMI of 33.5, indicating obesity. His weight gain of 60 pounds in the past year, combined with a sedentary lifestyle and unhealthy eating habits, contributes to his obesity. Obesity is a multifactorial condition with adverse effects on physical and psychological well-being.

Depression: Thomas was admitted to an inpatient psychiatric unit for suicidal ideation, depression, and isolation. He has lost interest in activities, experienced changes in sleep and appetite, felt low self-esteem, and struggled with school attendance. The Columbia Depression scale confirms his current mood state, suggesting improvement with counseling and medication.

Nursing Management Considerations

The nursing management for Thomas involves a comprehensive approach that addresses his physical and psychological well-being:

Collaborative Care: Collaboration with the healthcare team, including psychiatric nurses, therapists, nutritionists, and school personnel, is essential. Coordinated efforts ensure a holistic approach to address both obesity and depression.

Medication Adherence: Monitor Thomas’ adherence to escitalopram, an antidepressant. Educate him about its benefits and potential side effects. Monitor for any changes in mood, behavior, or side effects.

Psychotherapy: Ensure continuity of counseling to address Thomas’ depression. Monitor his progress and engage in therapeutic conversations to enhance his coping skills and self-esteem.

Weight Management: Collaborate with the nutritionist to monitor Thomas’ adherence to the healthy eating weight-loss plan. Provide education about healthy dietary choices and portion control.

Physical Activity: Encourage Thomas to engage in regular physical activity, considering his preferences and interests. Physical activity has both physical and psychological benefits.

School Support: Collaborate with school personnel to address Thomas’ concerns about returning to school. Advocate for a safe and supportive environment to prevent bullying and isolation.

Unique Care Needs

Thomas’ unique care needs encompass his psychosocial and physical well-being:

Support System: Acknowledge the support provided by Keisha and Torrey. Foster open communication between family members to create a supportive home environment.

Social Isolation: Address Thomas’ social isolation by encouraging interactions with peers. Recognize Angela’s positive influence and consider facilitating connections with peers who share his interests.

Individualized Approach: Recognize Thomas’ desire to stand up to challenges himself. Balance empowerment with the need for appropriate support and advocacy to ensure his emotional well-being.

In summary, Thomas’ case underscores the importance of addressing both obesity and depression through collaborative and patient-centered care. The nursing management considers his unique needs, promotes medication adherence, counseling, healthy lifestyle changes, and a supportive school environment. By addressing both physical and psychological aspects, nurses play a pivotal role in Thomas’ journey toward improved well-being.