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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 $14.49
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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
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Course
2024 ATI RN PHARMACOLOGY
Institution
2024 ATI RN PHARMACOLOGY
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
Bipolar Depression/Mania UNFOLDING Reasoning Brenden Manahan, 35 years old Primary Conc...
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:
Readmitted for bipolar disorder Progressive pattern of this disorder. Mania, depression, hypomanic, or
mixture of these features. Relapses can occur with bipolar.
Stopped taking his meds because he thinks Decompensating. Element of paranoia (thought disorder) - is this bipolar
his mom is poisoning him or schizoaffective disorder
Not sleeping THESE ARE KEY BIPOLAR DISORDER SYMPTOMS
Racing thoughts Not sleeping is a red flag
Speaking at a rapid rate (NOTE: need to use therapeutic use of self and build trust with him-
Pressured speech need to “maintain your cool” and be strategic)
Believes people are poisoning him and He is experiencing fixed delusions and grandiosity. This is not
thinks he is the head of the CIA uncommon with the manic phase of bipolar disorder.
RELEVANT Data from Social History: Clinical Significance:
Been admitted 6 times Needs to be strongly managed, otherwise there will be an exacerbation.
Readmission is usually linked to a hospital stay that might have not been
long enough. Could be due to inadequate follow up.
Psychosocial stressors in his marriage and with his child- causes
Divorced; Taken back to court exacerbations with bipolar patients
, 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 Tachycardic, Tachypnic, Hypertensive, Low grade fever
RR 28
BP 142/84 Tachycardia and tachypnea are due to metabolic and physiological demands due to the
Temp 99.1 F mania. It is important to distinguish between tachypnea and hyperventilation. With
hyperventilation, you want to keep an eye out for respiratory alkalosis (acidosis if a
compensatory mechanism, which can also be a concern).
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?
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