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