Bipolar Depression/Mania
UNFOLDING Reasoning
Brenden Manahan, 35 years old
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
1. Psychosis
2. Clinical Judgment
3. Patient Education
4. Communication
Bipolar Depression/Mania
History of Present Problem:
Brenden Manahan is a 35-year-old male, who has been admitted to the crisis intervention unit for exacerbation of his
bipolar disorder. He was admitted on a 501 (involuntary inpatient admission, patient has been deemed either dangerous to
self or others) and brought to the hospital by police because his mother feared for his safety. In the past few weeks he
stopped taking his medication because he feared that his mother was poisoning him.
Brenden has not slept in the past four days due to racing thoughts. He believes that he is the head of the CIA and told
his mother that he needed her car to go to CIA headquarters in McLean, Virginia, and fire everyone. When the police
© 2016 Keith Rischer/www.KeithRN.com
, arrived, they noted that Brenden was speaking at a very rapid rate and pace and was becoming increasingly agitated. He
began yelling that the police where there to poison him and prevent him from returning to his job.
He has been admitted to the locked mental health unit for evaluation of his mental capacity and stabilization. Brenden
will participate in the following education groups: medication education, and bipolar illness education. The goal is to
resume lithium carbonate and divalproex sodium.
Personal/Social History:
Brenden was diagnosed at 19 with bipolar I, and subsequently has been admitted six times due to non-adherence to the
medication regimen. Brenden is divorced and has a 3-year-old son who lives with his mother. He was recently in court to
have his visitations reduced to one supervised visit a week. He lives with his mother, who is supportive.
What data from the histories is important and RELEVANT and has clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Pt admitted for acute exacerbation of bipolar Relapse and exacerbation can be a progressive and repeating pattern.
disorder
Admitted 6x r/t medication non- compliance Pt has a habit of going off of his meds or not taking care of himself. Does
he have access to his medications or the means to get help? Revolving
door.”
Stopped taking meds because he thought his Pt is delusional, which is expected in a manic phase.
mom was poisoning him.
Hasn’t slept (4 days). This is a hallmark for manic phase of bipolar disorder.
Thinks that he is head of CIA and needs his Pt is delusional, not uncommon for manic phase.
mom’s car to go to HQ and fire everyone.
Police state that pt was speaking rapidly and Pt with pressured speech are difficult to work with because they can be
growing increasingly agitated. Police state that hard to understand. This phase is difficult to manage until the mania can be
pt yelled that the police were there to poison controlled. May take significant time to gain their trust (Halter, 2018, p.
him to keep him from returning to work (CIA). 223).
RELEVANT Data from Social History: Clinical Significance:
Pt had visitations with his son reduced to one Pt’s divorce and legal issues may be stressors causing exacerbation of his
supervised visit per week. bipolar disorder
Current VS: WILDA Pain Assessment (5th VS):
T: 99.1 F/37.3 C (oral) Words: Patient denies
P: 110 (regular) Intensity:
R: 28 (regular) Location:
BP: 142/84 Duration:
O2 sat: 99% room air Aggravate:
Alleviate:
Patient Care Begins:
What VS data are RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
Pulse 110 BPM Tachycardia is a red flag. Manic episodes increase metabolic and physiologic demands (Halter,
2019, p. 224).
© 2016 Keith Rischer/www.KeithRN.com
UNFOLDING Reasoning
Brenden Manahan, 35 years old
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
1. Psychosis
2. Clinical Judgment
3. Patient Education
4. Communication
Bipolar Depression/Mania
History of Present Problem:
Brenden Manahan is a 35-year-old male, who has been admitted to the crisis intervention unit for exacerbation of his
bipolar disorder. He was admitted on a 501 (involuntary inpatient admission, patient has been deemed either dangerous to
self or others) and brought to the hospital by police because his mother feared for his safety. In the past few weeks he
stopped taking his medication because he feared that his mother was poisoning him.
Brenden has not slept in the past four days due to racing thoughts. He believes that he is the head of the CIA and told
his mother that he needed her car to go to CIA headquarters in McLean, Virginia, and fire everyone. When the police
© 2016 Keith Rischer/www.KeithRN.com
, arrived, they noted that Brenden was speaking at a very rapid rate and pace and was becoming increasingly agitated. He
began yelling that the police where there to poison him and prevent him from returning to his job.
He has been admitted to the locked mental health unit for evaluation of his mental capacity and stabilization. Brenden
will participate in the following education groups: medication education, and bipolar illness education. The goal is to
resume lithium carbonate and divalproex sodium.
Personal/Social History:
Brenden was diagnosed at 19 with bipolar I, and subsequently has been admitted six times due to non-adherence to the
medication regimen. Brenden is divorced and has a 3-year-old son who lives with his mother. He was recently in court to
have his visitations reduced to one supervised visit a week. He lives with his mother, who is supportive.
What data from the histories is important and RELEVANT and has clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Pt admitted for acute exacerbation of bipolar Relapse and exacerbation can be a progressive and repeating pattern.
disorder
Admitted 6x r/t medication non- compliance Pt has a habit of going off of his meds or not taking care of himself. Does
he have access to his medications or the means to get help? Revolving
door.”
Stopped taking meds because he thought his Pt is delusional, which is expected in a manic phase.
mom was poisoning him.
Hasn’t slept (4 days). This is a hallmark for manic phase of bipolar disorder.
Thinks that he is head of CIA and needs his Pt is delusional, not uncommon for manic phase.
mom’s car to go to HQ and fire everyone.
Police state that pt was speaking rapidly and Pt with pressured speech are difficult to work with because they can be
growing increasingly agitated. Police state that hard to understand. This phase is difficult to manage until the mania can be
pt yelled that the police were there to poison controlled. May take significant time to gain their trust (Halter, 2018, p.
him to keep him from returning to work (CIA). 223).
RELEVANT Data from Social History: Clinical Significance:
Pt had visitations with his son reduced to one Pt’s divorce and legal issues may be stressors causing exacerbation of his
supervised visit per week. bipolar disorder
Current VS: WILDA Pain Assessment (5th VS):
T: 99.1 F/37.3 C (oral) Words: Patient denies
P: 110 (regular) Intensity:
R: 28 (regular) Location:
BP: 142/84 Duration:
O2 sat: 99% room air Aggravate:
Alleviate:
Patient Care Begins:
What VS data are RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
Pulse 110 BPM Tachycardia is a red flag. Manic episodes increase metabolic and physiologic demands (Halter,
2019, p. 224).
© 2016 Keith Rischer/www.KeithRN.com
