RUNNING HEAD: CASE STUDY BIPOLAR I DISORDER

Tayona Johnson

Mental Health Case Study

Youngstown State University

CASE STUDY BIPOLAR I DISORDER

Abstract

The purpose of this case study was to interview a patient get their background information, family

history, and precipitating factors that lead to their hospital stay. The study defines the patient’s

disorder, symptoms, and characteristics the patient displayed. Nursing diagnosis and care plans

have been identified for the patient.

CASE STUDY BIPOLAR I DISORDER

Objective Data: Patient is a twenty year old female, admitted to the unit on March 12, 2018.

The day of care was March 13, 2018. The patient was diagnosed with bipolar disorder I with

suicide ideation. The patient was also diagnosed with trichomonas when she presented to the

emergency department. The patient is negative for any other medical diagnoses except for

obesity. Behaviors observed on the unit was anxiety, flight of ideas, and restlessness. The patient

was very open with her history and her past experiences. The patient stated she started to feel

very overwhelmed and that she was in a lot of drama so it pushed her to want to kill herself. Her

only source of support was her friend who lived in Pittsburgh who she planned on moving in

with once she was discharged from the unit. The patient didn’t take any responsibility for her

behavior and constantly blamed others for what was going wrong in her life. Her medications she

is currently taking is Seroquel twice daily which is an antipsychotic and Desyrl as needed for

sleeping due to her insomnia.

Safety and security measures were maintained by not allowing the patient to wear any

shoes, restricting her from her personal items, and fifteen minute checks as protocol on the unit.

Axis 1: Bipolar Disorder I

Axis 2: Suicide Ideation

Axis 3: Obesity

Axis 4: Boyfriend broke up with her

Axis 5: GAF Scale 61-70 Mild symptoms in one area OR difficulty in one of the following:

social, occupational, or school functioning. BUT, the person is generally functioning pretty well

and has some meaningful interpersonal

CASE STUDY BIPOLAR I DISORDER

Summarize: Bipolar disorder is a mental issues accompanied by many “highs” and “lows” more

extreme than the average person experiences. “Bipolar disorder, formerly called manic

depression, is a mental health condition that causes extreme mood swings that include emotional

highs (mania or hypomania) and lows (depression)” (Mayo Clinic , 2018). According to the

Mayo Clinic (2018), signs and symptoms of Bipolar Disorder when in mania include

“abnormally upbeat, jumpy or wired, increased activity, energy or agitation, exaggerated sense of

well-being and self-confidence (euphoria), decreased need for sleep, unusual talkativeness, and

racing thoughts”. When having periods of depression, these signs and symptoms include,

“feeling sad, empty, hopeless, marked loss of interest or feeling no pleasure in activities,

Significant weight loss when not dieting, weight gain, or decrease or increase in appetite,

insomnia or sleeping too much sleep, restlessness or slowed behavior, fatigue or loss of energy,

feelings of worthlessness or excessive or inappropriate guilt” (Mayo Clinic, 2018).

Identify: Before the current hospitalization, patient states her aunt and uncle died which caused

her to feel some depression. Patient states that her roommate lied to her boyfriend making her

boyfriend break up with her. She states that her roommate is always lying and causing her drama

in her life and she was tired of the constant lies and stress. When her boyfriend broke up with her

patient stated she then got the idea to kill herself so she called 911 and stated that she was going

to kill herself and had planned on cutting her wrists. The ambulance and police then came to the

patient’s house and took her to the emergency department for treatment. Patient did not actually

hurt herself at this time but she had previously cut herself on the wrists were she had open cuts

from a few days prior.

CASE STUDY BIPOLAR I DISORDER

The patient states she just had too much going on in her life and everything seemed to

happen at once so she just wanted it all to end although she did not actually harm herself at this

time of admission.

Discuss: Patient was diagnosed with Bipolar Disorder I when she was nineteen years old. Patient

stated she could always remember having periods of highs and lows but wasn’t sure what it was.

The patient’s parents just thought the patient was going through normal teenage stages and

changes and didn’t think it was anything serious. When the patients’ behavior didn’t subside or

get any better, the patient’s grandmother decided to seek help for the patient, this is when the

doctors discovered the patient had bipolar disorder.

The patient states that she feels her mother always had a form of bipolar disorder but her

mother was never officially diagnosed with the disease. The patient feels her mother is the

reason that she has the disorder because her mother was “crazy” and abusive towards her. There

is no family history of mental disorder documented in patients chart.

Describe: There are many things nurses can do to provide care to their patients that have bipolar

disorder. “Treatment helps many people—even those with the most severe forms of bipolar

disorder—gain better control of their mood swings and other bipolar symptoms. An effective

treatment plan usually includes a combination of medication and psychotherapy” (NIMH, 2016).

It is best to couple medication administration with psychological therapy to have the greatest

effect on the patient.

The goal of milieu activities is to “manipulate the environment so that all aspects of the

client’s hospital experience are considered therapeutic” (current nursing, 2013). This is an

opportunity for patient teaching from the nurse. The nurse can gain the patients trust, teach good

coping mechanisms, and promote mutual respect to one another.

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Analyze: The patient didn’t express any religious or spiritual ties that could help her with her

coping. However, the patient states that writing in her journal and talking with her support

system really helps her to make better decisions. She states she will find a job to help her with

something to look forward to which she thinks will help her as well.

Evaluate: During the day of care, the patient didn’t seem to think she had a real problem. She

stated many times how people were always putting her in drama, but never acknowledging her

involvement in anything. Patient stated everything always comes to her and all she tries to do is

to stay away from everything but it always seem to follow her. The patient doesn’t seem to think

anything is wrong with what is going on with her or her actions. I would not be able to know

how well the patients care proceeded because I was not able to see her continuity of care.

Summarize: During the day of care, no discharge planning had occurred, however it would be

wise for the patient to continue taking her medications as prescribed and to follow up with a

therapist for continuous evaluation.

Prioritize:

1. Risk for injury r/t suicidal ideation as evidence by self-harm

2. Ineffective coping r/t inadequate family support as evidence by poor relationship with

family
CASE STUDY BIPOLAR I DISORDER

List:

1. Risk For Injury

2. Risk For Violence: Self-Directed or Other Directed

3. Impaired Social Interaction

4. Ineffective Individual Coping

5. Interrupted Family Processes

Conclusion: This case study has allowed me to take a deeper look into bipolar disorder and the

many ways that it could affect one’s life. It allowed me to be unbiased and to listen to someone’s

options without prejudice. This case study has helped me obtain more knowledge because I have

never knowingly spoken to someone with bipolar disorder.

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References

Mayo Clinic, 2018. Bipolar Disorder. Retrieved April 6, 2018

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-

20355955

Natonal Institute of Mental Health. 2016. Bipolar Disorder. Retrieved April 6, 2016

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml