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
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:
- Exacerbation of Bipolar Disease - Reason why patient was admitted on a 501 (involuntary
- Has been admitted previously inpatient admission)
- Dangerous to self, others, and police - May have some relationship between staff, relapse
- Noncompliant with medication regimen - Pt is at risk to harm himself and others
- -Agitated, rapid speech - Pt stopped taking lithium carbonate and divalproex,
- Has not slept for four days remission, and relapse
- Evidence why he is behaving this way
- Pt may not be able to follow directions or have ability to listen
- Pt cannot relax of sleep, symptom of mania, can make
delusions worse
RELEVANT Data from Social History: Clinical Significance:
-Diagnosed at 19 - Lets medical professionals how long pt has had disorder, how
-Admitted six times in the past due to long mother has been supporting son
non- adherence to med regimen - Previous admissions show relapse in illness
- Has a three-year-old son - May need to change care plan based on nonadherence
-Is divorced to medication regime
-Lives with mother, who is supportive - Pt has limited access to son, may be related to instability
and safety of son
- May be related to reasons of depression
- Mother may be Pt. support system
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:
Pts BP is - May be related to stress and agitation to how Pt is feeling
elevated 142/84 -Low grade fever
-Temp is slightly elevated - Pulse is elevate, may be related to agitation, anxiety from how Pt is feeling
99.1 F - Respirations are increased as well, can be associated with the mania the patient is
-Pulse- 110 experiencing
-Resp: 28 -Increased HR may be from exacerbation from illness
Current Assessment:
GENERAL Is disheveled, and according to his mother, he has not showered in several days.
APPEARANCE:
NEURO: Oriented to person and place but not to time, impaired ability to concentrate, labile
emotions, has not slept for four days
RESP: Breath sounds clear however, patient is breathing rapidly and deeply
CARDIAC: Pink, warm and dry, no edema, heart sounds regular with no abnormal beats, pulses strong,
equal with palpation at radial/pedal/post-tibial landmarks
GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants, has
adequate appetite.
GU: Voiding without difficulty, urine clear/yellow
SKIN: Skin integrity intact
CHEMICAL USE: Denies both use/abuse of ETOH or other street drugs
What assessment data is RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT Assessment Data: Clinical Significance:
-Pt is disheveled -These findings may be expected with Bipolar disease and
-Not showered in several days depression, clinical significance is important to provide a safe
-Has not slept in four days environment for Pt
-Impaired ability to concentrate, - May need an EKG to see what cardiac function is at
labile emotions -Sign Pt may be hydrated since urine is clear and yellow
-Pt resp. is raid and deep -Need to do a urine test to see if patient has anything in system also before
-Urine is clear and yellow administering medications in case he does have something in his system
-Denies both use/abuse of for clearance
ETOH/street drugs
Mental Status Examination:
APPEARANCE: Is disheveled, and according to his mother he has not showered in several days. He is
unshaven, and has a significant odor coming from his body and or clothes. His clothes are
not consistent with the weather, it is 95 degrees and is wearing multiple layers of clothing
and has winter boots on.
MOTOR BEHAVIOR: Psychomotor agitation present, appears restless; he is unable to sit still
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
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:
- Exacerbation of Bipolar Disease - Reason why patient was admitted on a 501 (involuntary
- Has been admitted previously inpatient admission)
- Dangerous to self, others, and police - May have some relationship between staff, relapse
- Noncompliant with medication regimen - Pt is at risk to harm himself and others
- -Agitated, rapid speech - Pt stopped taking lithium carbonate and divalproex,
- Has not slept for four days remission, and relapse
- Evidence why he is behaving this way
- Pt may not be able to follow directions or have ability to listen
- Pt cannot relax of sleep, symptom of mania, can make
delusions worse
RELEVANT Data from Social History: Clinical Significance:
-Diagnosed at 19 - Lets medical professionals how long pt has had disorder, how
-Admitted six times in the past due to long mother has been supporting son
non- adherence to med regimen - Previous admissions show relapse in illness
- Has a three-year-old son - May need to change care plan based on nonadherence
-Is divorced to medication regime
-Lives with mother, who is supportive - Pt has limited access to son, may be related to instability
and safety of son
- May be related to reasons of depression
- Mother may be Pt. support system
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:
Pts BP is - May be related to stress and agitation to how Pt is feeling
elevated 142/84 -Low grade fever
-Temp is slightly elevated - Pulse is elevate, may be related to agitation, anxiety from how Pt is feeling
99.1 F - Respirations are increased as well, can be associated with the mania the patient is
-Pulse- 110 experiencing
-Resp: 28 -Increased HR may be from exacerbation from illness
Current Assessment:
GENERAL Is disheveled, and according to his mother, he has not showered in several days.
APPEARANCE:
NEURO: Oriented to person and place but not to time, impaired ability to concentrate, labile
emotions, has not slept for four days
RESP: Breath sounds clear however, patient is breathing rapidly and deeply
CARDIAC: Pink, warm and dry, no edema, heart sounds regular with no abnormal beats, pulses strong,
equal with palpation at radial/pedal/post-tibial landmarks
GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants, has
adequate appetite.
GU: Voiding without difficulty, urine clear/yellow
SKIN: Skin integrity intact
CHEMICAL USE: Denies both use/abuse of ETOH or other street drugs
What assessment data is RELEVANT and must be recognized as clinically significant by the nurse?
RELEVANT Assessment Data: Clinical Significance:
-Pt is disheveled -These findings may be expected with Bipolar disease and
-Not showered in several days depression, clinical significance is important to provide a safe
-Has not slept in four days environment for Pt
-Impaired ability to concentrate, - May need an EKG to see what cardiac function is at
labile emotions -Sign Pt may be hydrated since urine is clear and yellow
-Pt resp. is raid and deep -Need to do a urine test to see if patient has anything in system also before
-Urine is clear and yellow administering medications in case he does have something in his system
-Denies both use/abuse of for clearance
ETOH/street drugs
Mental Status Examination:
APPEARANCE: Is disheveled, and according to his mother he has not showered in several days. He is
unshaven, and has a significant odor coming from his body and or clothes. His clothes are
not consistent with the weather, it is 95 degrees and is wearing multiple layers of clothing
and has winter boots on.
MOTOR BEHAVIOR: Psychomotor agitation present, appears restless; he is unable to sit still
