Bipolar Depression/Mania UNFOLDING Reasoning
Brenden Manahan, 35 years
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Primary Concept Mood and Affect Interrelated Concepts (In order of emphasis) 1. Psychosis 2. Clinical Judgment 3. Patient Education 4. Communication
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lOMoARcPSD|24448587
© 2016 Keith Rischer/www.KeithRN.com
Bipolar Depression/Mania History of Present Problem: Brenden Manahan is a 35-year-old male, who has been admitted to the crisis intervention unit for exacerbation of his bipolar disorder. He was admitted on a 501 (involuntary inpatient admission, patient has been deemed either dangerous to self or others) and brought to the hospital by police because his mother feared for his safety. In the past few weeks he stopped taking his medication because he feared that his mother was poisoning him. Brenden has not slept in the past four days due to racing thoughts. He believes that he is the head of the CIA and told his mother that he needed her car to go to CIA headquarters in McLean, Virginia, and fire everyone. When the police arrived they noted that Brenden was speaking at a very rapid rate and pace and was becoming increasingly agitated. He began yelling that the police where there to poison him and prevent him from returning to his job. He has been admitted to the locked mental health unit for evaluation of his mental capacity and stabilization. Brenden will participate in the following education groups: medication education, and bipolar illness education. The goal is to resume lithium carbonate and divalproex sodium.
Personal/Social History: Brenden was diagnosed at 19 with bipolar I, and subsequently has been admitted six times due to non-adherence to the medication regimen. Brenden is divorced and has a 3-year-old son who lives with his mother. He was recently in court to have his visitations reduced to one supervised visit a week. He lives with his mother, who is supportive.
What data from the histories is important and RELEVANT and has clinical significance for the nurse? RELEVANT Data from Present Problem: Clinical Significance:
RELEVANT Data from Social History: Clinical Significance:
Patient Care Begins: What VS data are RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance:
Current VS: WILDA Pain Assessment (5th VS): T: 99.1 F/37.3 C (oral) Words: Patient denies P: 110 (regular) Intensity: R: 28 (regular) Location: BP: 142/84 Duration: O2 sat: 99% room air Aggravate: Alleviate:
-admitted to the crisis intervention unit for exacerbation of his bipolar disorder -admitted on a 501 by police because of mom -feared that his mother poisoned him -not slept in the past four days due to racing thoughts believes he is the head of the CIA -agitated and at a very rapid rate and pace -locked for mental health unit for evaluation of his mental capacity and stabilization
-This indicates that he is going through mania phase of the bipolar disorder. The patient is experiencing paranoia and experiencing grandoise delusions such as believing his mother is trying to poison him and he is the head of the CIA. - Another sign of the patient experiencing a mania phase is
-Diagnosed at 19 with Bipolar I and admitted six times due to not sticking to medication schedule. -Divorced with a 3 year old son who lives with his mother -Recently in court to have his vistations reduced to one supervised visit a week. -Lives with mtoher
-Given that he has had been diagnosed with Bipolar I at 19 and is not sticking to his medication can indicate that he experiences mania more than his medicated counterparts. Give that the patient was in court and got his vistation rights and lives with mother could influence the patient to not wanting to take medications.
P:110 R: 28 BP: 142/82
- The vital signs indicate the patient to be agitated as it seen by the increased heart rate and respirations with a slightly higher blood pressure.
Downloaded by Martin muthii ([email protected])
lOMoARcPSD|24448587
© 2016 Keith Rischer/www.KeithRN.com
What assessment data is RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT Assessment Data: Clinical Significance:
What MSE assessment data is RELEVANT that must be recognized as clinically significant to the nurse? RELEVANT Assessment Data: Clinical Significance:
Current Assessment: GENERAL APPEARANCE: Is disheveled, and according to his mother, he has not showered in several days. NEURO: Oriented to person and place but not to time, impaired ability to concentrate, labile emotions, has not slept for four days RESP: Breath sounds clear however, patient is breathing rapidly and deeply CARDIAC: Pink, warm and dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants, has adequate appetite. GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact CHEMICAL USE: Denies both use/abuse of ETOH or other street drugs
Mental Status Examination: APPEARANCE: Is disheveled, and according to his mother he has not showered in several days. He is unshaven, and has a significant odor coming from his body and or clothes. His clothes are not consistent with the weather, it is 95 degrees and is wearing multiple layers of clothing and has winter boots on. MOTOR BEHAVIOR: Psychomotor agitation present, appears restless; he is unable to sit still SPEECH: Talking fast with pressured speech. MOOD/AFFECT: Appears ecstatic, bright affect THOUGHT PROCESS: Delusional, flight of ideas/ jumping from one idea to another THOUGHT CONTENT: Believes that the CIA is controlling the nurses’ actions and following him and that he must get to the CIA headquarters immediately. PERCEPTION: Denies hallucinations INSIGHT/JUDGMENT: Has lack of insight into current condition and reason for inpatient hospitalization COGNITION: Oriented to person and place but not to time, his immediate and recall were intact but remote memory is not. INTERACTION: Approaches others, but does not engage in lasting conversation SUICIDAL/HOMICIDAL: Denies homicidal/suicidal ideation
-disheveled and haven't showered for days -oriented to person and place, not time and haven't slept -rapid and deep breathing
-This indicates that the patient during their mania episode cannot sleep thus have not been aware of time. -With the paranoia the patient experienced, that could also explain the disheveled appearance and with the breathing is possibly affected by the paranoia.
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