This simulation focused on caring for Mattie Justice, a client who was in the acutely manic phase of bipolar

disorder. Initially, Mattie required intensive, continuous supervision. Her poor judgment, impulsiveness, and lack of insight resulted in behaviors that were unsafe for her and for those around her, and were challenging for the nurse to manage in an inpatient milieu. Many times, clients such as Mattie need some form of isolation and frequent boundary setting. Because Mattie had discontinued her lithium regimen prior to hospitalization, her inpatient hospitalization goals included re-instituting her medication regimen, along with teaching her about medication and its importance. Discharge needs also included continued psychiatric follow-up and education and support for Mattie's family. Bipolar I disorder is characterized by one or more manic episodes, usually alternating with major depressive episodes. Manic episodes are periods of abnormally and persistently elevated, expansive, or irritable mood. Hypomania is a subcategory of mania and is slightly less severe. It does not have the psychotic features or severely impaired functioning that would require hospitalization, such as in manic states. Often, clients with bipolar disorders will discontinue medications when they are stabilized. They are often maintained on lithium as a first-line choice for treatment. If they experience frequent breakthrough symptoms, they may respond well to augmenting agents, such as an atypical antipsychotic (such as olanzapine), or carbamazepine (Tegretol). Benzodiazepines, such as clonazepam (Klonopin), may be useful to assist in reducing agitated symptoms when clients are acutely manic. The focus for care initially in acute mania is re-instituting medication, safety, and physiological stability. When the client's acute mania has resolved, foci for care include medication teaching, symptom management, and discharge planning. Intrusive behaviors can be challenging to control in the inpatient setting. Maintaining close observation, with frequent structuring and direction, are often necessary to assist the client in behavioral control. Assisting the client to understand and identify trigger symptoms of acute mania is an important focus for inpatient care. This helps the client after discharge to monitor symptoms, and to seek care earlier in order to avoid hospitalization. It is important to work with families of clients who suffer from bipolar disorders, in order to provide support and education about coping with this difficult illness. If patient has manic episodes, give lithium as long as the therapeutic level is 0.5-1.5 or 0.6-1.2 mEq/L then leave the patient be as long as the patient wont disturb the others. For depression attack, give MAOI, TCAs and SSRI. Dont combine the three or two treatment because it can cause convulsion to the patient and its lethal. SSRI should be given in the morning because it can cause insomnia if given at night. MAOI is given at night because it can cause CNS sedation so it can cause the patient to sleep. Just watch out for the sodium of the patient when given the lithium because they can cause hyponatremia if too much lithium. If given the TCAs be sure to have the antidote which is the physostigmine (antilirium) because it can be life threatening.