Nursing Case Study for Mania (Manic Syndrome)
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Outline
Approximately 24 hours after being admitted to a psychiatric facility, Kelli, a 20-year-old suspected bipolar disorder patient, is brought back to the ER. The staff was worried about her behavior and vital signs. The charge nurse from the facility gives a report to the ER nurse saying, “She has not slept at all, talks constantly, and has a flight of ideas. She seems really grumpy and refuses to participate in group activities.”
V/S as follows:
BP 170/90 SpO2 96% on Room Air
HR 122 bpm and regular
RR 20 bpm Temp 37.5°C
What does the nurse understand about the term “flight of ideas?
The nurse should be concerned about what complication Kelli may be experiencing? Why does the nurse think this?
Upon entering the exam room, the nurse finds Kelli standing on the stretcher trying to reach the tops of the privacy curtains. Her speech is rapid but clear as she says, “The goddess of creativity talks to me, and I have to change the curtains and I will need paint for the walls. If you can also get me some different clothes so I can dress up for the party.” She proceeds to talk about redecorating her home and school with interspersed comments about clothes and shoes, grades, her friends, and many other topics. She also says that she does not like the facility she was at because the staff is using mind control.
The nurse should be concerned about what complication Kelli may be experiencing? Why does the nurse think this?
After sharing her thoughts about possible psychosis with the provider, he concurs and asks the nurse to interview the patient to get more information. He also says he will come in and conduct a mental status exam.
What are some things the nurse should ask during the interview?
What does the nurse know about a mental status exam?
Kelli answers questions during both the nurse and provider exams. Her heart rate continues to be elevated and she is sweating profusely.
What type of medication (s) does the nurse anticipate the provider to order?
The provider verbally prescribes ziprasidone (Geodon) 10 mg IV once now.
Should the nurse clarify this order? Why?
The nurse administers the medication after clarification.
What side effects might the nurse expect? Which are the highest priorities for monitoring/intervention?
Kelli is in on the stretcher with both side rails up. New vitals:
BP 120/60 SpO2 98% on Room Air
HR 82 bpm and regular
RR 12 bpm Temp 37.1°C
She is released back to the psychiatric facility with a new prescription for risperidone 20 mg PO daily.
What interactions and/or long-term effects should be monitored with this medication if it is prescribed (orally) long-term?
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Transcript
Hi guys, my name’s Abby, and we’re going to go through a case study for manic syndrome or mania. Let’s do it together. Alright. Here’s our patient scenario. Kelly is a 20 year old who is suspected of having bipolar disorder. She is brought back to the ER after only 24 hours of being admitted to a psychiatric facility. The staff was worried about her behavior and vital signs. The charge nurse from the facility gives a report to the ER nurse saying she has not slept at all, talks constantly and has a flight of ideas. She seems really grumpy and refuses to participate in group back activities. Let’s take a look at those vital signs.
Her vital signs are as follows: her blood pressure coming in high at 170/90 mmHg with a heart rate of 122 beats per minute and a regular rhythm. She’s saturating well on room air at 96%. Her respiratory rate of 20 breaths per minute, and a temp of 37.5 degree Celsius. Now that we have some information about her vital signs, let’s take a look at our critical thinking checks. Go to number one, two, just below.
Great job upon entering the exam room, the nurse finds Kelly standing on the stretcher, trying to reach the tops of the privacy curtains. Kelly’s speech is rapid but clear, and she states, “the goddess of creativity talks to me and I have to change the curtains and I will need to paint the walls. If you can also get me some different clothes so I can dress up for the party.” She proceeds to talk about redecorating her home and school with comments interspersed regarding clothes and shoes, grades, her friends, and many other topics. She also says that she does not like the psychiatric facility because the staff is using mind control. Now that we have some more information, let’s take a look at our critical thinking check number three.
Excellent work! After sharing her thoughts about possible psychosis with the provider, the provider concurs and asks the nurse to interview the patient to get more information. He also says he will come in and conduct a mental status exam of his own. Once we get that information, let’s go ahead and take a look at our critical thinking checks. We’ll go to number four and five.
Wonderful work. Kelly answers questions during both the nurse and the provider’s exams. Her heart rate continues to be elevated and she is sweating profusely. With this in mind, let’s take a look at our critical thinking check number six below.
Wonderful job. The provider verbally prescribes ziprasidone 10 milligrams IV once to be given. Now that we have medication and we’re treating her, let’s think critically with number seven below.
Wonderful work. The nurse administers medication after a bit of clarification. With this in mind, now we can take a look at our critical thinking check number eight, just below.
Well done. Kelly is on the stretcher with both side rails up. We have a new set of vitals for her. They are as follows: her blood pressure 120/60 mmHg, far more regulated. Her heart rate has come down to 82 beats per minute. She’s still in sinus rhythm, her respiratory rate is 12 breaths per minute. Sounds a lot more restful and she’s saturating great on room air at 98%, her temperature has also come down with the excitement at 37 degrees Celsius. Kelly is released back to the psychiatric facility with a new prescription for risperidone 20 milligram by mouth every day. With this in mind, we can take a look at our critical thinking check number nine below.
Wonderful work. This wraps up the case study on mania and manic syndrome. 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; Psychosis in adults: Epidemiology, clinical manifestations, and diagnostic evaluation
Author:Stephen Marder, MD updated Aug, 2021; The mental status examination in adults
Author:Mario F Mendez, MD, PhD updated Mar 2019; https://www.rxlist.com/geodon-drug
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Nursing Case Studies
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.
We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.
