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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 dishevelled. 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 unit to get his blood sugars under control.
Case Study
Ronald’s initial presentation to the ED revealed a blood glucose level of 24 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.
Additional Information
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 EC 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 diabetesMental Health Nursing Case Study Questions
**When answering please refer to overall course objectives. (ie. mental health focus)
• Discuss 4 factors that place Ronald at risk for developing a mental illness.
• Identify 3 priority nursing assessments. Discuss why each would be important?
• Formulate 3 formal nursing diagnosis with supporting evidence from the case study and
research supports in the rationale.
• Identify 3 priority nursing interventions. Discuss why each of these are important?
• How would therapeutic communication help the nurse care for Ronald and his family? Provide 3
examples of how the nurse will employ therapeutic communications skills for this case.
*Please note “example” requires the discussion of a concrete application rather than simply
listing a technique.
• Does Ronald’s behaviour warrant involuntary admission to the hospital? Why or why not?
• Discuss three legal/ethical considerations related to this case.
SCIENCE
HEALTH SCIENCE
NURSING
NURS NURS21323
