Bipolar Case Study
You are the RN case manager in an outpatient mental health clinic. ST is here today for her outpatient mental health appointment. She has a diagnosis of bipolar disorder and has been stable for the past 3 years, her last episode was one of mania that required hospitalization. She is 29 years old, married, with two children 2 and 4. She reports that her mood is better than it has been in a long time and she has lots of energy. When asked whether she thinks this is a recurrence of mania shes says no, she thinks that things just finally getting better.
1.It is common for a patient with bipolar illness to deny the onest of mania because it feels good. What other information would be important to ask?
2.What other information would help determine whether she is experiencing the onset of mania or hypomanic episodes?
3.Bipolar disorder is a mood disorder, characterized by episodes of depression, mania, or hypomania. What symptoms might you see if she is experiencing mania or hypomania?
4.How is hypomania different from mania?
5.When a patient first starts taking lithium what should they be cautioned as reportable side effects? What are the common side effects?
6.What are the symptoms of lithium toxicity?
7.ST’s maintenance lithium levels are 1.0 mEq/L, interpret these results.
8.What other laboratory examinations should be routinely drawn while ST is taking lithium?
9.What instructions should be given to ST when she began lithium?
10.Aside from lithium what other medications are used to treat bipolar disorder?
For this assignment, you will watch the following video in class and complete a mental status exam as part of the in-class activity. Following the class, you will finalize your mental status exam and upload it to Canvas to receive credit for this assignment. Please see the rubric for additional details on completion.
Alice, age 29, had been working in the typing pool of a large corporation for 6 years. Her immediate supervisor recently retired, and Alice was promoted to supervisor, in charge of 20 people in the department. Alice was flattered by the promotion but anxious about the additional responsibility of the position. Shortly after the promotion, she overheard two of her former coworkers saying, “Why in the world did they choose her? She’s not the best one for the job. I know I certainly won’t be able to respect her as a boss!” Hearing these comments added to Alice’s anxiety and self-doubt. Shortly after Alice began her new duties, her friends and coworkers noticed a change. She had a great deal of energy and worked long hours on her job. She began to speak very loudly and rapidly. Her roommate noticed that Alice slept very little yet seldom appeared tired. Every night she would go out to bars and dances. Sometimes she brought men she had just met home to the apartment, something she had never done before. She bought lots of clothes and makeup and had her hair restyled in a more youthful look. She failed to pay her share of the rent and bills but came home with a brand new convertible. She lost her temper and screamed at her roommate, “Mind your own business!” when asked to pay her share. She became irritable at work, and several of her subordinates reported her behavior to the corporate manager. When the manager confronted Alice about her behavior, she lost control, shouting, cursing, and striking out at anyone and anything that happened to be within her reach. The security officers restrained her and took her to the emergency department of the hospital, where she was admitted to the psychiatric unit. She had no previous history of psychiatric illness. The psychiatrist assigned a diagnosis of Bipolar I Disorder and wrote orders for olanzapine (Zyprexa) 10 mg IM STAT, olanzapine 15 mg PO daily, and lithium carbonate 600 mg tid.
Answer the following questions related to Alice:
What are the most important considerations for the nurse who is taking care of Alice?
Why was Alice given the diagnosis of Bipolar I Disorder?
The doctor should order a lithium level drawn after 4 to 6 days. For what symptoms should the nurse be on alert?
Why did the physician order olanzapine in addition to the lithium carbonate?