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Turnbull Case Study

Youngstown State University

Mental Health Case Study

Michael Turnbull

Patricia Flamino
Turnbull Case Study


When conducting a case study on a patient and their diagnosis it’s necessary to

gather objective data regarding the disease process such as symptoms and

medications along with factors that contributed to relapse. Knowledge of the psychiatric

diagnosis is extremely important in terms of the plan of care and treatment. The

patient’s relapse was brought on by his non compliance with the medication regimen.

Mental illness is often genetic in nature and I was unable to gather information

regarding family history from the patient. A therapeutic milieu or safe environment is

essential on a psychiatric floor to promote healing. Religion is valuable since in some

cultures and religions mental illness is not seen as an actual disease. Where he has the

support from his family as well as his spiritual faith to keep him motivated for his best

outcome. Nursing diagnoses allow us to evaluate current problems along with those the

patient is at risk for to set outcomes we would like the patient to achieve.
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Objective Data

Patient EM also known as “Manny” has been seeing a psychiatrist for a few

years and has had a recent outbreak of his Severe Manic Bipolar 1 disorder. He was

admitted November 12th, 2017 voluntarily seeking help for his suicidal and homicidal

ideation. I cared for Manny on November 15th, 2017 where he presented himself well

with a proper dress and mannerisms. He speech was slightly pressured but was

extremely open to his story. He was relaxed yet slightly agitated. He felt that he was

seeking help because if he hadn’t the voices in his head would cause him to crack. He

made minimal eye contact and seemed to be scanning the area for different stimulation.

The patient upon admission had chest pain where they had done an EKG that came

back normal. Other various tests that came back normal were an HIV test, CBC,

urinalysis, a drug screen and his TSH levels. Manny is on a variety of different meds.

Trazodone for his depression. Aripiprazole for hallucinations and delusions. Busprione

for anxiety. Hydroxyzine for anxiety. Haloperidol Lactate to calm him down as well.

Along with all of these meds and other interventions to get to the bottom of his issues,

he is on the psych ward at St. Elizabeth’s Hospital in downtown Youngstown.


Manny has Severe Bipolar 1 Disorder which is more on the manic side of the

manic depression spectrum. Bipolar disorder, also known as manic depression, is a

mental illness that brings severe high and low moods. People who have bipolar disorder

can have periods in which they feel overly happy and energized and other periods of

feeling very sad, hopeless, and sluggish. In between those periods, they usually feel

normal (Bipolar Disorder Center: Symptoms, Types, Tests, and Treatments). The word
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"manic" describes the times when someone with bipolar disorder feels excited which

can also involve irritability and impulsive or reckless decision-making. About half of

people during mania can also have delusions or hallucinations like Manny. Hypomania

describes milder symptoms of mania, in which someone does not have delusions or

hallucinations, and their high symptoms do not interfere with their everyday life. In

bipolar disorder, the dramatic episodes of high and low moods do not follow a set

pattern. The word "depressive" describes the times when the person feels very sad or

depressed. Someone may feel the same mood state (depressed or manic) several

times before switching to the opposite mood. These episodes can happen over a period

of weeks, months, and sometimes even years (Bipolar Disorder). How severe it gets

differs from person to person and can also change over time, becoming more or less

severe. Symptoms of mania include excessive happiness, hopefulness, and excitement,

sudden changes from being joyful to being irritable, angry, and hostile, restlessness,

rapid speech and poor concentration, increased energy and less need for sleep,

unusually high sex drive, making grand and unrealistic plans, showing poor judgment,

drug and alcohol abuse, or becoming more impulsive (Bipolar Disorder Center:

Symptoms, Types, Tests, and Treatments). During depressive periods a person may

have sadness, loss of energy, feelings of hopelessness or worthlessness, not enjoying

things they once liked, trouble concentrating, uncontrollable crying, trouble making

decisions, irritability, needing more sleep, insomnia, appetite changes that make them

lose or gain weight, thoughts of death or suicide, or attempting suicide (Bipolar Disorder

Center: Symptoms, Types, Tests, and Treatments). At either a high or low moment a

patients can manifest these a number of these symptoms.

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Prior to his admission Manny had a number of psychological stressors that were

severely impacting his life yielding his HI and SI. Manny had found work while battling

his bipolar disease creating lanyards and selling them to various groups of people. This

is one activity that pushed Manny and he really enjoyed doing. He didn’t make a large

bang for his buck so money and finding work was always an issue. He was receiving

counseling services at Compass where he felt he wasn’t being treated properly so he

had thoughts in his head telling him to burn down the CEO, Joe Caruso’s, home. The

primary motive was to kill Joe. Compass then denied him access to their services and

he had to switch his psychiatric health care provider. Another stressor he has is that his

daughter who is 5 years old isn’t actually his. He had been taking care of her in his life

while split with the biological mother where then the mother had told him that the child

was in fact not his. This was extremely tragic to him after he had found out that this was

true through DNA results. He plans to be a part of her life, Faith, regardless of the

situations because he feel like she is family no matter what and still his baby girl. This

ended up throwing more voices into Manny’s head telling him to kill her and not to stop

until she is dead. This is where he then told his mother and they took the initiative to get

him further help at the hospital. Along with all of these stressors a main trigger to this

episode has been that he has been feeling better so he has stopped his medications.


Family history plays a major role in the inheritance of bipolar disorder. Manny

was adopted and had no ties or communication with his biological family. He currently

lives with his fraternal parents where he is attempting to get on his feet while struggling
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with his psychiatric issues. He has a girlfriend, Lorain, where he sleeps over her place

multiple times a week and she is also active in his daughter’s life. None of his family

members have and history of psychiatric issues and they are all supportive in getting

him back to getting better. The first time I approached Manny, his mother was sitting at

the table talking to him and I sat down next to them. She stated that she comes every

day and is worried about her son. This is a clear indication that she is supportive.


There is a lot of clinical evidence that makes his bipolar clear and concise. As I

spent time with Manny, I felt that he had a lot of stressors on his mind and that they

impact his life. The stressors previously stated are extremely relevant. He presented

himself with pressured speech, limited agitation where you can tell he had a lot to say.

He was relaxed about most topics, but when we were talking about his daughter he

tensed up where I felt that she was his main trigger of his mania/aggression. He was

also very paranoid with minimal facial grimacing, but still relevant, and he was always

looking around needing the urge to be stimulated. Overall, Manny was extremely

friendly and persistently repeated that he was there so that he can get the help he

needs. The staff has stated he is progressing and I was able to tell due to his state of



Manny is an African American male who is extremely religious. He stated that he

and his family go to church together every Sunday. They are very family oriented and

do a lot of activities together especially around the holidays. They live in Youngstown
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and get by. During our conversation you can tell how much he is influenced by his faith

in god and that a major stressor in his life is also financial. He repeatedly said that he

needs to keep faith so that the voices in his head will go away and he can get back to

his normal day to day life.


There are many patient outcomes that we want to see and have created with

Manny. He no longer has any suicidal ideations or any homicidal ideations towards Joe

Caruso. St E’s team is still monitoring his suicidal ideation towards his X girlfriend. The

ultimate goal is to get him on an agenda where he is compliant with his meds, and is not

a harm to himself or others. So he can get back to an adequate level of functioning.


Discharge planning will include compliance of medication along with the

utilization of new coping mechanisms. The continuation of seeing a psychiatrist is

essential with the plan of care so that progress and proper interventions are

implemented. The goal is to get the patient back to their day to day live with minimal

issues relating to the bipolar disorder interfering with productivity.


Bipolar Disorder has various nursing diagnosis. These nursing diagnoses from

most severe to the lease sever are risk for injury, risk for violence (self-harm or upon

someone else), impaired social interaction, ineffective individual coping, interrupted

family processes, and total self-care defect (Nursing Care Plan for Bipolar Disorder).
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These are all major issues that are personalized to each person experiencing severe

bipolar disorder.


Manny is susceptible to risk for injury as evidence by impaired judgement. Risk of

harm to himself or others due to his suicidal and homocidal ideations with a plan.

Impaired social interaction related to disturbed thought process and agitation as

evidence by manic behaviors, loud threatening verbal behaviors, and poor attention

span. Manny also has ineffective individual coping related to changes in communicating

patterns, verbally attacking others, with the inability to efficiently problem solve or ask

for help with the presence of hallucinations.

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Bipolar Disorder. (n.d.). Retrieved November 29, 2017, from

Bipolar Disorder Center: Symptoms, Types, Tests, and Treatments. (n.d.). Retrieved November

29, 2017, from

Nursing Care Plan for Bipolar Disorder. (n.d.). Retrieved November 29, 2017, from http://