Crisis Management Case Study Video Transcript
Marly is a 30-year-old woman who was brought to the emergency department because of confused, agitated, and restless behavior. She was found on the street disheveled, wandering, and asking people for money. The area shopkeepers called the police. The triage nurse tells you that she delivered a healthy baby boy 10 days ago at your institution.
Her previous labs: antibody screen negative, VDRL negative, PPD negative, HIV negative, hepatitis B no surface antigen negative, rubella immune, maternal serum triple screen WNL, glucose challenge test WNL, hemoglobin electrophoresis 97% hemoglobin A. Current BP 160/90. She has small skin excoriations covering her forearms.
She is not willing to stay in bed, and she is pushing staff and swearing at other patients in the ER. She is fearful and looks behind herself constantly as if she is afraid someone is following her. She will not let the lab tech draw blood and is screaming that she is going to “kill someone.”
Her mother was contacted and tells the nurse that Marly is a single mother with a history of “mood swings and anger problems.”
She has been on psychiatric medications in the past and has been hospitalized psychiatrically twice, presenting with similar symptoms. She has had trouble with insomnia since adolescence. She smokes cigarettes one PPD, drinks alcohol, has a history of cocaine and methamphetamine use, and smokes marijuana.
She lives with her boyfriend and three children, ages 1.5 weeks, five years, and seven years, in public housing. Mother suspects the boyfriend is abusive. He also has a history of drug dependence. Marly has two older sisters with histories of alcohol and drug use. Her maternal grandparents have a history of depression and her 1st cousin died by suicide two years ago.
When you enter her room, she is talking loudly to herself and tells you “Not to get too close!”
