Nursing Case Study for Bipolar Disorder
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Outline
Kelli is a 20-year-old patient brought to the ER after being reported by neighbors in her apartment complex for disruptive behavior. Law enforcement and emergency medical services were called, and, as a team, decided she needed a higher level of medical care.
The patient says she is” on a break from art college” but works at a local restaurant as a server and occasionally cleans houses as well. She has also sold her paintings and drawings in the past as well. She denies taking any medication. She also says, “I don’t understand why I am here. I was working on my art projects, and I guess I played my music too loud or something. I said I’d come here so I would not be arrested.”
What are some questions that should be included in the initial assessment?
What interventions do you anticipate being ordered by the provider?
Kelli’s drug and alcohol tests are negative. Her roommate is now at the bedside and asks to speak to staff privately. She expresses concern that Kelli can be emotional at times as well as going days without sleep then not being able to get out of bed. The nurse returns to further evaluate the patient.
With this new information, what might the nurse ask Kelli?
Kelli admits to being able to stay awake for what seems like entire weekends without being tired, but that is when she says her creativity is best. When she was attending college and living in the dorms, she says she had lots of friends but worried about what she calls “all the partying.” This is because she liked to “hook up” with strangers because it was fun, but she worries about possible sexually transmitted infections now that she is older. She says she was extremely popular, and her talent was at its peak. But there are times she could not pay attention in class or even get out of bed, so she dropped out of school. Sometimes, she cannot even touch her art supplies, but says she is probably the “most talented artist around.”
What signs and symptoms indicate Kelli may have bipolar disorder?
Are there risk factors for this condition?
Kelli’s medical records have arrived, and the provider advises nursing staff she has a history of being brought to the ER for similar episodes. The provider says, “This patient is a schizophrenic. We don’t have time for this.”
What is the best response to the provider’s statement?
Kelli rests quietly in the exam room with her roommate at the bedside. She asks, “Can someone help me get better? I am tired of this. I am such a burden on everyone.”
What should the nurse screen Kelli for at this point?
How can the nurse address Kelli’s question about help?
Kelli is amenable to being held for the state’s required psychological hold. She says she wants to be able to live her life as “normally” as possible. She asks about medications that may be available to help.
What patient education about medications should the nurse provide at this time?
The nurse knows which medications may be prescribed for long-term management of this condition?
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Transcript
Hey everyone. My name is Abby. We’re going to go through a case study for bipolar disorder together. Let’s get started in this scenario. We have a patient named Kelli. She’s 20 years old and brought to the ER after being reported by her neighbors in her apartment complex for a disruption. Law enforcement and emergency medical services were called, and, as a team, decided that she needed a higher level of care. The patient says that she is on a break from art college and works at a local restaurant as a server and occasionally cleans houses as well. She has also sold her paintings and drawings in the past. She denies taking any medication. She states, “I don’t understand why I’m here. I was working on my art projects and I guess I played my music too loudly or something. I said, I’d come here. So I would not be arrested. Now that we have the scenario, let’s take a look at our critical thinking checks number one and number two below.
Great job. Kelli’s drug and alcohol tests were negative. Her roommate is now at the bedside and asked to speak to staff privately. She expresses concern that Kelli has been very emotional at times and going for days without sleep and then not being able to get out of bed. These are some pretty major fluctuations. The nurse returns to further evaluate the patient. Now that we have some more information, let’s take a look at our critical thinking check number three below.
Well done. Kelli admits to being able to stay awake for what seems like entire weekends without being tired. And that is when she says her creativity was best when she was attending college and living in the dorms. She said she had lots of friends, but worried about what she calls, “all the partying.” This is because she liked to hook up with strangers because it was fun. But she worries about possibly contracting some sexually transmitted infections. Now that she is older, she says she was extremely popular and her talent was at its peak at this time. But there are times she could not pay attention in class or even get out of bed, so she dropped out of school. Sometimes she could not even touch her art supplies, but says she is probably the “most talented artist around.” In light of this new info, let’s take a look at our critical thinking checks. Number four and number five below.
Great job. Kelli’s medical records have arrived, and the provider advises nursing staff that she has a history of being brought to the ER for similar episodes. The provider says, “This patient is a schizophrenic. We don’t have time for this.” Knowing that information, let’s take a look at our critical thinking check number six below.
Well done. Kelli is now resting quietly in the exam room with her roommate at her bedside. She asks, “Can someone help me get better? I am tired of this. I am such a burden on everyone.” Now, what does this tell you that we might be concerned about? Take a look at our critical thinking checks number seven and number eight below. And you decide.
Great job. Kelli is amenable to being held for the state’s required psychological hold. She says she wants to be able to live her life as normally as possible. She asks about medications that may be available to help. Now that we have some more information, let’s take a look at our critical thinking checks. Number nine and number 10 below.
Fantastic work. This wraps up our case study on bipolar disorder. Please take a look at the attached study tools and test your knowledge with a practice quiz. We love you guys now go out and be your best self today. And as always happy nursing.
References:
Bipolar disorder in adults: Clinical features
Author:Trisha Suppes, MD, PhD updated Jan 2020; Bipolar disorder in adults: Assessment and diagnosis
Author:Trisha Suppes, MD, PhD updated Feb 2021; Bipolar disorder in adults: Choosing maintenance treatment
Author:Robert M Post, MD updated Dec 2021
U.S. Department of Health and Human Services. (n.d.). Bipolar disorder. National Institute of Mental Health. Retrieved January 3, 2022, from https://www.nimh.nih.gov/health/topics/bipolar-disorder
Source is National Institute of Health (NIH)
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Mental Health Nursing Study Plan
Concepts Covered:
- Studying
- Substance Abuse Disorders
- Anxiety Disorders
- Cognitive Disorders
- Eating Disorders
- Medication Administration
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Bipolar Disorders
- Developmental Considerations
- Concepts of Mental Health
- Health & Stress
- Trauma-Stress Disorders
- Psychological Emergencies
- Somatoform Disorders
- Communication