Mental Health Case Study: Bipolar Disorder 1

Brittaney Zupko

Youngstown State University

March 6, 2018

Patricia Flamino

NURS 4842L CRN 22273

Mental Health Case Study: Bipolar Disorder 2

Abstract

The following case study focuses on care provided to a twenty-six year old female

patient diagnosed with bipolar disorder during one shift. Objective data was collected from

assessment, documented history and physical, as well as other pertinent information from the

patient’s chart. Subjective information was also gathered through discussion including

stressors, behaviors, coping skills, family and patient history, and spirituality. Outcomes were

evaluated and discharge instructions and teaching were summarized. Suitable and

individualized NANDA nursing diagnoses are prioritized and listed as well.

Mental Health Case Study: Bipolar Disorder 3

Objective Data

On January 30, 2018 a 26-year-old female was voluntarily admitted to St. Elizabeth’s

hospital due to feelings of depression and suicidal ideation. Patient stated these depressive and

suicidal thoughts were brought on due to the recent marriage of an ex-boyfriend and lack of

support from family members. Patient admitted planning on overdosing on medications while

home alone the following day. The patient feels that medications need readjusted, and

voluntarily admitted self in hopes to alter current regimen to decrease current feelings and

thoughts. She has been hospitalized in the past for previous suicide attempts as well. Her DSM

IV-TR Axes were not yet listed on her history and physical, but Axis I is Bipolar Disorder. The

patient does not have any chronic medical diagnoses. This patient was put on standard safety

precautions after being transferred to the inpatient psych unit. I provided care for this patient

on the day of admission, January 30, 2018, during the evening shift. No medications were listed

on the MAR while I navigated the chart, but the patient said she takes Lithium (lithium

carbonate) for bipolar disorder, Prozac (fluoxetine) for depression, and Ativan (lorazepam) for

anxiety at home.

Summarize

The exact etiology of bipolar disorder is unknown. Theories hypothesize chemical

imbalances in the brain caused by a combination of hereditary factors and environmental

triggers may be the most credible explanation (Townsend, 2015, pp. 540). Bipolar disorder is a

chronic illness associated with severely debilitating symptoms that profoundly impact both

patients and their loved ones (Miller, 2006). The disorder typically appears in adolescence or

early adulthood and can have life-long adverse effects on the patient’s mental and physical
Mental Health Case Study: Bipolar Disorder 4

health, educational and occupational functioning, and interpersonal relationships (Valente &

Kennedy, 2010). Patients experience episodes of pathologic mood states, characterized by

mania or depressive symptoms, which are interrupted by periods of relatively normal mood

(Vieta & Goikolea, 2005). Manic periods cause an alteration in mood that are expressed by

feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated

thinking and speaking (Townsend, 2015, pp. 520).

Identify

The patient described multiple factors during our interaction that precipitated her

hospitalization. The patient has been hospitalized in the past for suicidal behavior and

depression as well. The current hospitalization was caused by feelings of worthlessness and

loneliness. The patient was in a serious relationship that ended approximately one year ago,

and found out that her ex-boyfriend recently got married. She also described feelings of

isolation from her family, and that they “do not understand her.” She claims that her family

does not understand the fluctuations in her mood and her battle with depression. Her therapist

encourages the family to participate in sessions, but her mother is not interested because she

feels that this stranger claims to know more about her daughter than she does. The patient

planned on overdosing on her medications while home alone due to these feelings, but decided

to seek help prior to harming herself. She is also frustrated because she visits her therapist

regularly, uses positive coping skills, and is compliant with her medication regimen but still feels

depressed. She is hoping that during this hospitalization her medications can be adjusted

because she feels that they are no longer working for her. Results from a recent study revealed

that previous suicidal behavior and recent affect episodes may be the strongest predictors of
Mental Health Case Study: Bipolar Disorder 5

suicidal behavior in bipolar patients (Tidemalm, 2014). Comorbidity with drug and alcohol

abuse, anxiety disorders, and familial history of suicide increase the risk of attempted suicide in

bipolar disorder as well.

Discuss

The patient has a strong family history of bipolar disorder. She stated that seven people

in her family have been diagnosed. She explained that she is very frustrated with her parents

and their lack of understanding, especially because there is such a strong presence of bipolar

disorder in their family. The patient lives at home with her mother, father, and younger

brother. She also has an older sister that is married with children whom has distanced herself

from the patient due to her “negative energy” and depressive tendencies. The patient

described the challenges she faces and how her diagnosis has impacted her life. She was going

to school to become a teacher, but had to withdraw herself due to lack of motivation and

feeling depressed. She also had to quit her job at a local daycare because her parents said she

was “too stressed and not stable.” She described feeling like a financial burden to her parents

and is looking into collecting disability.

Describe

There was a great deal of psychiatric nursing care provided to this patient by myself and

the cover nurse during my clinical experience. Examples of care included medication

administration and education, therapeutic communication, and participation in group therapy.

Positive self talk was also encouraged throughout our conversation. A major topic of

conversation with this patient was distinguishing between appropriate and inappropriate

coping mechanisms, and what strategies would be implemented moving forward. I felt that it
Mental Health Case Study: Bipolar Disorder 6

was also important to help the patient identify with the psychiatric diagnosis of bipolar

disorder, recognize maladaptive behaviors, and adherence to her medication regimen. I was

also able to provide guidance and clarification to the patient regarding medication

administration. The patient admitted to becoming frustrated and stopping her medication

regimen because she felt it “was not working properly.” I encouraged her to always comply

with prescribed medications and not to abruptly discontinue, but also commended her for

reaching out for help when she experienced suicidal ideations. Group therapy was an example

in which the milieu environment was fostered, with the patient actively engaging and

participating. “Talking in group sessions helps me express myself and makes me feel like I am

not alone,” stated the patient.

Analyze

This patient is of both Irish and Slovakian decent. She has little association with her

heritage, and there is no significant relationship between it and her mental illness. She

identifies religiously as a follower of Christian faith. She described how she recently has evolved

into a more spiritual individual than in her past. She explained frequently visiting a nearby

church that is within walking distance of her house. She stops by the church when she feels sad,

worthless, and lonely. The patient seemed much calmer and more relaxed while discussing her

faith and beliefs. She admitted to attempting suicide multiple times in her past while

experiencing severe depression, and described feeling as though she is still alive because God

has a purpose for her on earth. She also stated recently purchasing a bible and reading it every

night before going to bed to help her relax and unwind. As a Christian myself this part of our

conversation was very touching.

Mental Health Case Study: Bipolar Disorder 7

Evaluate

Due to this patient’s situation prior to hospitalization, the main focus of care was safety.

Therefore, the outcome that the patient will remain free of harm and injury during my shift was

met. The patient denied experiencing any suicidal thoughts, and agreed to a verbal contract to

alert the staff if beginning to experience early signs of mood fluctuations. During our

conversation the patient was very friendly and open to talking. A second outcome appropriate

to this patient’s situation was to have the patient identify three positive attributes of herself to

help foster positive self-esteem by the end of our discussion. Unfortunately this goal was not

met due to time constraints. However, I feel quite confident that the patient was making

positive strides in gaining more insight on her self worth. For the most part, the patient appears

to be in control of her condition and knows when she needs to seek help. She explained using

various coping strategies and distraction techniques at home, such as working on puzzles and

adult coloring books, listening to music, reading, and using the “5-4-3-2-1” technique. She

stated that for the most part these techniques work well for her. According to the study

“Staying Well with Bipolar Disorder,” participants admitted to controlling their bipolar disorder

by receiving adequate amounts of sleep, providing insight into their triggers and warning signs,

maintaining manageable levels of stress, having a compassionate support network, and

remaining mindful of their illness (Russell, 20014). Overall, the patient conversed with me in an

appropriate manner, was engaged, and actively participated in her care.

Mental Health Case Study: Bipolar Disorder 8

Summarize

On the day of my clinical experience the patient did not have written orders for

discharge, but discharge planning was starting to be implemented on admission to the unit. The

patient plans to return home to her parents’ house following hospitalization. She also will

continue to attend weekly sessions with her therapist as she was doing previously. The patient

is hoping that this hospitalization opens up her parents’ eyes, and encourages them to

participate in therapy sessions that they were not interested in before. She is hopeful that a

change in her medication regimen will be made during her stay that will help stabilize her

mood, and that she also learns new skills to help her live with bipolar disorder.

Prioritize

1) Risk for Injury related to bipolar disorder as evidenced by multiple suicide attempts and

feelings of self harm.

2) Ineffective Coping related to inadequate social support as evidenced by patient stating

her family “does not understand her.”

3) Chronic Low Self-Esteem related to life changes caused by bipolar disorder as evidenced

by feelings of worthlessness and previous suicide attempts.

Mental Health Case Study: Bipolar Disorder 9

List

Disabled Family Coping

Disturbed Sleep Pattern

Disturbed Thought Process

Disturbed Personal Identity

Fear

Hopelessness

Nutritional Deficit: More than the body requires

Nutritional Deficit: Less than the body requires

Risk for Self Directed Violence

Ineffective Role Performance

Social Isolation

Conclusion

In conclusion, my interaction with this patient helped open my eyes to mental health

issues. If I were to see this person outside of the hospital I wouldn’t be able to identify that she

is living with bipolar disorder. After our conversation I feel more informed about the struggles

patients with mental health issues face, and how greatly it can impact their life. This patient is

actively involved in her plan of care, and I am hopeful that this hospitalization positively

impacts her moving forward.

Mental Health Case Study: Bipolar Disorder 10

References

McCormick, U., Murray, B., & McNew, B. (2015). Diagnosis and treatment of patients with

bipolar disorder: A review for advanced practice nurses. Journal of the American

Association of Nurse Practitioners, 27(9), 530–542. http://doi.org/10.1002/2327-

6924.12275

Russell, S. J., & Browne, J. L. (2005). Staying Well with Bipolar Disorder. Australian & New

Zealand Journal of Psychiatry, 39(3), 187-193. doi: 10.1080/j. 1440-1614.2005.01542.x

Tidemalm D, Haglund A, Karanti A, Landén M, Runeson B (2014). Attempted Suicide in Bipolar

Disorer: Risk Factors in a Cohort of 6086 Patients. PLoS ONE 9(4): e94097.

doi:10.1371/journal.pone.0094097

Townsend, M. (2015). Psychiatric mental health nursing: Concepts of care in evidence-based

practice (8th ed., pp. 520-545). Philadelphia: F.A. Davis.