| Course | NR 326 Mental Health Nursing |
|---|---|
| Week | 6 |
| Paper type | Case study analysis |
| Length | About 1,160 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 326 Week 6
Case Study Analysis: A 68-Year-Old Retired Mail Carrier With Psychotic Depression Who Will Not Eat Because He Believes He Cannot Pay
Student Name
College of Nursing, Chamberlain University
NR 326: Mental Health Nursing
Instructor Name
Month Day, Year
Case Study Analysis: A 68-Year-Old Retired Mail Carrier With Psychotic Depression Who Will Not Eat Because He Believes He Cannot Pay
The Person Before the Label
Mr. E. is 68, a retired mail carrier who walked the same route for 31 years, widowed for two years, living alone in the house he owns outright. The case describes him on his third day on an older adult inpatient unit. He has eaten almost nothing since admission. At each meal he looks at the tray, pushes it away, and says, "I can't pay for this. They'll send the bill to my daughter." He has lost 4 kilograms in three weeks according to his daughter, and he weighs 64 kilograms today. He sits in his room with the door half closed, answers questions in short sentences after a long pause, and walked out of the 1000 group after about ten minutes, saying he was "taking a seat from someone who can pay." He wakes at about 0400 each night and sits on the edge of his bed until breakfast. He takes his morning pills only after the nurse repeats twice that they are covered.
His diagnosis is major depression with psychotic features. The fixed belief that he is ruined and cannot pay, held despite his daughter showing him his bank statement, is a delusion of poverty. He has been started on sertraline and olanzapine.
The Nursing Problem, Worded as Today
The nursing problem is that Mr. E. is not eating or drinking enough to hold his weight, because each meal is refused on the basis of a belief that he cannot pay for it. That sentence is narrower than "depression" and more useful, because it names what is going wrong for him in the next 24 hours and points at the exact moment it goes wrong: when a tray is put in front of him.
Priorities, With a Reason for the Order
I rank three problems. First, intake. At 64 kilograms and falling, in a man of 68, refusing food and most fluids is the problem that could make him medically unwell within days, and it would not wait for the depression to lift. Second, falls. He gets up at 0400 in a dark room, he is taking a medication that can lower blood pressure on standing, and he has eaten little, so the risk is highest in exactly the hours when the unit is quietest. Third, withdrawal from the unit's activity: leaving group and keeping to his room. It matters, but it is the problem most likely to improve as the depression treatment takes effect, and the least likely to cause harm in the meantime. The order is not a ranking of what matters to him; it is a ranking of what could hurt him first.
Actions With a Time and a Place
At meals, 0800, 1200 and 1700, in the dining room. Seat him at the small table nearest the kitchen door with one other quiet patient, not in his room, so the meal becomes part of the unit's routine rather than a private decision. When he says he cannot pay, do not argue with the belief or show him paperwork again, which has already failed. Say one short sentence, the same each time: "Your meals are included while you're here." Then stay seated with him for at least ten minutes and eat or drink something yourself. Offer the drink before the food, because fluid is the more urgent of the two. Record the percentage of each meal eaten and the fluids taken, and weigh him daily at 0630, fasting, using one scale and a hospital gown each time.
At 1000, the morning group. Ask him to come and sit near the door, and tell him he can leave when he wants. A seat by the door lowers the cost of staying, and ten minutes becomes fifteen more easily from a chair he can leave than from the middle of the circle.
At night, 0400, in his room. Leave a low light on near the bathroom. When he wakes, ask him to stay seated with his feet on the floor and count to sixty before he stands, and check that his call light and nonslip socks are within reach before he goes to sleep. Offer a warm drink at 0400 rather than asking him to go back to sleep; it is an hour when he is awake and may accept fluid.
Every hour during the day, at his doorway. Stop for two minutes, say his name and one thing about the unit's day, and leave. The purpose is contact without demand, since a long conversation about his worries tends to end in the same sentence about money.
Medication Watched, Not Chosen
The combination of sertraline and olanzapine was the treatment tested in the STOP-PD trial, in which 41.9% of participants given both drugs were in remission at their last assessment, against 23.9% of those given olanzapine alone (Meyers et al., 2009). The same trial found that cholesterol and triglycerides rose in both age groups. The nurse does not choose these drugs; the nurse watches for what they do. For olanzapine, that means sedation during the day, dizziness on standing, and a blood pressure taken lying and standing each morning; a fall of 20 points or more in systolic pressure on standing, or any fall, goes to the provider the same day. For sertraline, it means sodium. Jacob and Spinler (2006) reviewed reports of low sodium with these antidepressants and found older age and low body weight among the risk factors, with onset usually in the first few weeks of treatment. Mr. E. has both. New confusion, headache or unsteadiness, or a sodium below 135 mmol/L on his weekly blood test, would send me to his nurse at once.
When he hesitates over the morning pills, the explanation is the same as at meals: short, the same each time, and not an argument about his finances. "These are to help you sleep and feel less weighed down. They're included." If he refuses, the refusal is recorded and reported, not negotiated.
An Evaluation Somebody Could See
Three observable changes would show the plan is working. Within five days, he eats at least half of two meals a day and drinks at least 1,500 milliliters, recorded on the intake chart, and his morning weight stops falling. Within a week, he stays in group for the full 45 minutes at least twice. Throughout, he has no falls and his sodium stays at or above 135 mmol/L. If his weight is still falling at day five, the plan has not worked, and the team needs to know that before discussing further options.
References
Jacob, S., & Spinler, S. A. (2006). Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults. Annals of Pharmacotherapy, 40(9), 1618-1622. https://doi.org/10.1345/aph.1G293
Meyers, B. S., Flint, A. J., Rothschild, A. J., Mulsant, B. H., Whyte, E. M., Peasley-Miklus, C., Papademetriou, E., Leon, A. C., & Heo, M. (2009). A double-blind randomized controlled trial of olanzapine plus sertraline vs olanzapine plus placebo for psychotic depression: The Study of Pharmacotherapy of Psychotic Depression (STOP-PD). Archives of General Psychiatry, 66(8), 838-847. https://doi.org/10.1001/archgenpsychiatry.2009.79
NR 326 Week 6 instructions, in plain terms
The Week 6 case study gives you a patient with a mental health condition and asks for a nursing analysis. You will likely need a summary of the case, prioritized nursing problems, nursing interventions with rationales, medication considerations, evaluation criteria and scholarly support in APA. Describe the patient by behavior before the diagnosis does any work. Word the nursing problem around what is happening today and why. Rank your priorities and argue for the order based on what could harm this person first. Give each action a time and place so another nurse could carry it out. Discuss medications as things to watch, not choose. Write evaluation criteria that someone else could see.
Inside the NR 326 Week 6 example
The paper opens with Mr. E.'s 31 years on one mail route, his widowhood and his refusal of meals on his third day on an older adult unit. The diagnosis follows, with his belief that he is ruined named as a delusion of poverty. The nursing problem is written narrowly as inadequate intake caused by that belief. Priorities run intake first, then falls, then withdrawal, each with a reason. Actions are fixed to 0800, 1200 and 1700 meals in the dining room, the 1000 group, 0400 at his bedside and hourly visits to his doorway. The medication section reports STOP-PD remission figures and explains what to watch. Evaluation lists intake, weight, group attendance, falls and sodium, each with a day to check it.
Where the points sit in the NR 326 Week 6 rubric
Case study rubrics generally score the case summary, problem identification, prioritization with rationale, interventions, evaluation, evidence and APA. Problem identification earns points when the problem is specific to this patient, which the wording about refused meals and the poverty delusion achieves. Prioritization is credited for an argued order, and the paper explains why intake comes before falls. Interventions earn the most when they are specific and evidence-based, so each one names a time, a place and a reason. Medication content counts when it stays within nursing monitoring, such as watching sodium levels. Evaluation scores when outcomes are measurable and dated. Meyers and colleagues and Jacob and Spinler support the medication section, and the APA reference list completes the rubric.
NR 326 Week 6 help from the desk
The biggest point loss is an analysis anyone could write from a textbook chapter, with actions that would fit every patient carrying the same diagnosis. A second common problem is drifting into medication selection, where the paper argues for one drug and stops doing nursing. Students also list priorities without explaining the order, or write goals such as "patient will feel better" that no one could check. Leaving out the delusion and treating the refusal as a simple appetite problem misses the center of this case. Make each action specific enough to hand to another nurse. If your case is a different patient, send the case study, and we can show how an NR 326 analysis would prioritize it.
Get a NR 326 Week 6 example written to your instructions
Send the Week 6 case and whatever element list your section published, and a custom example is written to that case and returned inside 24 to 48 hours. The first one is free. Where your case came off the floor rather than out of the classroom, send the presentation type only and the analysis gets built around that.
More NR 326 papers and pre-licensure samples
- NR 326 Week 1: Psychiatric Unit Expectations Post
- NR 326 Week 2: Therapeutic Communication Exercise
- NR 326 Week 3: Process Recording Example
- NR 326 Week 4: Mental Status Exam Write-Up
- NR 326 Week 5: Suicide Risk Assessment Write-Up
- NR 326 Week 7: Therapeutic Milieu Brief
- NR 326 Week 8: Reflection
- NR 327 Week 6: Newborn Transition Write-up
- NR 325 Week 6: Insulin Infusion Safety Analysis
- NR 328 Week 6: Chronic Illness Care Plan
- NR 324 Week 6: Spinal Fusion Perioperative Write-Up
NR 326 Week 6 questions, answered
How much of the paper should discuss medication?
Enough to show you know what you are watching for and no further. Selection sits with prescribers, and answers built around it lose ground in a pre-licensure course. What earns marks is what you would monitor across a shift, what would send you to find the nurse, and how you would answer a person who is not certain they want to keep taking anything.
Can I use a case from my own clinical week?
Where your section allows it, yes, with everything identifying removed and the location kept general. Many classrooms issue the case themselves so that no actual patient enters the assignment at all. Tell us which one you are working from, because a teaching scenario and somebody you met on a unit support very different claims about how they responded.
What makes a nursing action specific enough?
It has to name a moment. Encourage participation is not an action; sitting with somebody through the first ten minutes of a group they have walked out of twice is one. The test is whether a classmate reading your paper could go and do that thing tomorrow without asking you a single question about what you meant by it.
Where can I find a free NR 326 Week 6 sample paper?
The complete Week 6 case study analysis of Mr. E., with ranked nursing problems, timed actions, medication monitoring, dated evaluation criteria and its references, appears on this page.
Why does the NR 326 Week 6 paper rank intake above falls?
Because refusing most food and fluid at 64 kilograms could make a 68-year-old medically unwell within days, and that risk would not wait for his depression to lift.