Running Head: PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study- Bipolar 1 Disorder

Victoria Coppola

Youngstown State University

NURS 4842L Mental Health Nursing Laboratory

Elizabeth Sanford

February 8, 2024
Psychiatric Mental Health Comprehensive Case Study

Abstract

The following case study demonstrates the disease process of a patient with bipolar 1

disorder, along with the treatments and plan of care provided for this individual while inpatient

on a behavioral health unit. MK is a 35-year-old Caucasian female admitted to the behavioral

health unit following suicidal ideations with feelings of worthlessness and depression. MK is

diagnosed with bipolar 1 disorder, severe depression, and post-traumatic stress disorder.

Medication treatments including antipsychotics and mood stabilizer are effective for the patient

and manage her symptoms. This behavioral health unit visit and suicidal ideation was due to the

patient needing a refill on her prescription and was off of her medication for five days.
Psychiatric Mental Health Comprehensive Case Study

Objective Data

Patient identifier: MK

Age: 35 yr female

Admission date: February 6, 2024

Date of care: February 8, 2024

Psychiatric diagnosis: Bipolar 1 disorder

Other diagnoses: Severe depression, post-traumatic stress disorder, chronic back pain, and

insomnia

Behaviors on admission: MK presented to the emergency department crying for help. She

presented with suicidal ideation with a viable plan to cut her wrists due to feeling hopeless and

worthless.

Behaviors on day of care: MK was very friendly, cooperative, and willingly shared and talked

to me. She was calm and relaxed as we sat and colored pictures while we talked. She participated

in the group session earlier in the day and planned on going to the session the next day as well.

When the dinner trays arrived, MK ate all of the food on her tray and drank all of her drinks.

MK’s mother came to the unit to visit her, she appeared very excited towards the visit and gave

her mother the pages she colored to take home. As I headed off of the unit to end my day of care,

MK headed to the shower to get prepared for bed.

Safety and security measures: The behavioral health unit is a double-locked door unit with

safety checks completed every 15 minutes. Patients are not permitted off of the behavioral health

unit and a staff member is in the milieu at all times. The rooms are designed in light calm colors
Psychiatric Mental Health Comprehensive Case Study

to prevent agitation, with heavy or immovable furniture, rounded corners, and paper trash bags

instead of plastic. Items including razors, scissors, belts, scarves, hoodies, shoelaces, earrings,

and necklaces are not permitted on the unit. Pencils and pens are not allowed for use by the

patients and kept away, patients are only permitted to use crayons and markers. All medications

were administered by the nurses with appropriate patient verification and ensured all medications

were swallowed and not pocketed in the patients mouth or possession.

Laboratory Results:

Lab Value Result

Glucose 143

BUN 7

Creatinine 0.9

AST/ALT 14/13

Hbg/Hct 12.5/38.6

RBC 4.18

WBC 8.3

QTC 460

Drug toxicology Positive for

benzodiazepines, cocaine,
and cannabis

Blood urea nitrogen and creatinine are used to rule out kidney failure, when levels are

increased, kidney failure can present as depression. A complete blood count is looked at to rule

out anemia as a cause for depression in bipolar disorder. Thyroid hormones are evaluated to rule

out hyperthyroidism that presents as mania, and hypothyroidism that presents as depression.

Substance and alcohol screenings are performed as substance abuse can present as either mania

or depression (Belleza, 2023). MK’s drug toxicology was positive for benzodiazepines, cocaine,
Psychiatric Mental Health Comprehensive Case Study

and cannabis. She is positive for benzodiazepines as she is prescribed and takes olanzapine. MK

uses cannabis to cope with stressors. MK reports that her partner at the time laced her cannabis

with cocaine, and that she did not use the drug by choice, and she has ended her relationship with

him.

Psychiatric Medications:

Generic/Trade Dose/Frequency Route Classification Reasoning

Levonorgestrel/ 1 tablet daily PO Progestin Birth control
Estrad
Nicotine/ 21mg patch daily Transdermal Nicotine Tobacco
Nicoderm replacement dependence
Olanzapine/ 10mg nightly PO Atypical Bipolar 1
Zyprexa antipsychotic
Oxcarbazepine/ 300mg BID PO Anticonvulsant Bipolar 1, mood
Trileptal stabilizer
Prazosin/ 2mg capsule PO Antihypertensive PTSD/
Minipress nightly Anxiety

Summary of the Psychiatric Diagnosis

Bipolar 1 disorder is a mental illness characterized by extreme mood swings, from

emotional highs (mania) to lows (depression). Mania is a state of great excitement or euphoria

that presents with increased talkativeness, rapid speech, racing thoughts, and increased energy

level. Depression causes you to feel hopeless and lose interest or pleasure in activities. These

mood swings can affect sleep, energy, activity, judgment, behavior, and the ability to think

clearly. The criteria for a bipolar 1 disorder diagnosis includes having at least one manic episode

that may be preceded or followed by hypomanic or major depressive episodes (Mayo Clinic,

2022). People living with bipolar disorder may not be aware they are in the manic phase, and

will be shocked by their behavior. During episodes of mania one can experience hallucinations,
Psychiatric Mental Health Comprehensive Case Study

including sensations of seeing, hearing or smelling things that are not there. Bipolar disorder is

often misdiagnosed as depression, this misdiagnosis leads to treatment only including

antidepressants and not mood stabilizers. Due to the common misdiagnosis, patients should be

screened to determine if they’re at risk for bipolar disorder, most psychiatric nurse practitioners

use the Mood Disorder Questionnaire before prescribing antidepressants (Handrup, 2020).

Identify the Stressors and Behaviors that Precipitated Current Hospitalization

Prior to admission, MK was living at home with her mother and father, during my day of

care she shared that her father abused her when she was younger and it still affects her to this

day. MK has post-traumatic stress disorder from the situation, and although she lives with her

father, she has no relationship with him. Post-traumatic stress disorder often causes those to

relive the traumatic event and often isolates themselves affecting their ability to work, perform

daily activities, or relate to friends and family. Those with PTSD are at risk for developing

depression, anxiety, and alcohol or other substance abuse (Dr Williamson, 2017). This stressor is

something MK has been dealing with her whole life, a recent stressor that occurred prior to her

admission was the loss of her job. Three months prior to MK’s admission she shared that she has

lost her job and has been unemployed since. MK was working as a manager at a dispensary and

shared that she loved her job and couldn’t imagine doing anything else. She shared that not

having a job has been her main stressor and is causing her to feel worthless and that she has

failed. MK does live at home and is supported by her parents, but due to her limited income she

did not get her medication refilled. After being off of her medication for a couple of days, MK

began to not feel like herself and she was concerned about how she was feeling. She had her

mother take her to the hospital because she knew she needed to help and did not want to harm

herself even though she felt like she should.

Psychiatric Mental Health Comprehensive Case Study

Patient and Family History of Mental Illness

MK stated that she was diagnosed with bipolar 1 disorder when she was 18-years-old.

She shared that she has struggled with depression since she was a young adult due to the abuse

from her father. MK and her mother have a very close relationship, her mother also has a

diagnosis of depression, but is not bipolar. When asked about her father she did not want to

discuss him and avoided the topic. MK is an only child, and has no children of her own.

Psychiatric Evidence Based Nursing Care Provided

While on the behavioral health unit, MK was treated and cared for by various nurses. The

nurses preform safety checks every 15 minutes and a nurse is present in the milieu at all times to

ensure patient safety, but also enables support and rapport. The nurses administer all

medications, and ensures each patient swallows the medication to ensure proper treatment and

prevent hoarding of pills and overdosing. Nursing actions provided for a patient with bipolar 1

include setting and maintaining limits on destructive behavior, decreasing environmental stimuli,

providing a structured environment, and reorienting the patient to person, place, and time as

indicated (Videbeck, 2019).MK is prescribed a mood stabilizer and anticonvulsant; she is aware

of what the medications are used for and the common side effects. The unit offers group therapy

sessions that MK enjoys attending. During the sessions, patients are able to express themselves

to the group and share their stories, feelings, and future plans. The group session activity that

MK attended on my day of care allowed each patient to pick one song to share to the group and

express how the song makes them feel. MK was excited to listen to music and shared that music

is an escape for her and a coping mechanism she uses daily. She shared that she feels the group

sessions are effective for her and they make her feel seen and not alone.
Psychiatric Mental Health Comprehensive Case Study

Ethnic, Spiritual and Cultural Influences

MK is a Caucasian, single woman from a middle-class family. She is currently

unemployed, living with her parents and depending on them for financial assistance. She plans to

apply for unemployment upon discharge, until she feels she is stable and ready to go back to

work. MK shared that her parents are Christians; though she does not practice a certain religion,

she does believe there is a higher power. MK does not pray or attend any church services.

Evaluate the Patient Outcomes Related to Care

Outcomes that are desired for a patient with bipolar 1 disorder include a treatment plan to

minimize symptoms, remaining free from harming themselves or others, displaying a calm and

subdued energy level, performing self-care activities, and exhibiting decreased restlessness and

exhaustion due to adequate sleep. On the day of care, MK was very calm and talkative, she

enjoyed coloring as a mechanism to sooth herself. MK shared that prior to her admission she was

experiencing insomnia and had a period where she was awake for 4 days. Since admission, MK

has been experiencing adequate sleep levels, eating all of her meals, and performing self-care

activities such as showering, brushing her hair, and wearing clean clothes. MK is back to taking

her medications regularly and shared she feels like herself again. She has remained safe from

harm from herself and to others, denies any continued suicidal ideations, and shared that she

knew admitting herself on a behavioral health unit was the safest option for her.

Plans for Discharge

When MK is discharged, she will return home to her mother and father’s house. She

shared that she wants to move out of her parents’ house and be away from her father, but she

financially is unable to. MK and her mother have discussed getting an apartment together as her
Psychiatric Mental Health Comprehensive Case Study

mother does not have a good relationship with her father either. She shared that her parents do

not believe in divorce, but her mother thinks it is time for them to separate. Upon discharge MK

also plans to apply for unemployment and eventually get a job at another dispensary. MK will

continue to be compliant with her treatment plan of olanzapine and oxcarbazepine, as she was

educated that abruptly stopping the medication can cause a relapse and return to a manic or

depressive episode.

Prioritized Nursing Diagnoses

1. Risk for suicide related to previous suicidal ideations as evidenced by viable plan.

2. Disturbed thought process related to sleep deprivation as evidenced by staying awake for

4 days.

3. Ineffective coping related to ineffective problem solving as evidenced by self-destructive

behavior.

4. Low self-esteem related to domestic abuse and evidenced by shame and guilt.

5. Interrupted family process related to domestic abuse as evidenced by family separation.

6. Readiness for enhanced coping related to behavioral health unit admission as evidenced

by expressed desire to improve coping skills.

Potential Nursing Diagnoses

- Ineffective coping -Inadequate sleep -Social isolation

- Ineffective health maintenance -Anxiety -Hopelessness

Conclusion

Bipolar 1 disorder is a complex mental illness that experiences extreme mood swings,

from emotional highs (mania) and lows (depression). During manic episodes of bipolar disorder,
Psychiatric Mental Health Comprehensive Case Study

patients often become a harm to not only themselves but also to others, as they often are unaware

of their behavior during the episode and believe they are in the right and everyone around them

is negative. MK was admitted following suicidal ideations with a viable plan. It was very eye-

opening talking to MK, as she was very aware of her actions and mental illness. She shared

multiple examples of coping mechanisms she uses including when anxious and starting to panic

she will orient herself to the room and focus on 5 objects. I found MK’s story interesting as she

did not want to commit to her plan, but her illness was making her feel hopeless and that she

should, seeking her to get help on her own. MK has a great support system from her mother and

shares that she has a great group of friends in her life. I believe the collaboration between MK’s

treatment plan and support system will allow her thrive and function at an optimal level upon

discharge.
Psychiatric Mental Health Comprehensive Case Study

References

Belleza, M. (2023, August 9). Bipolar disorder: Nursing care management study guide.
Nurseslabs. https://nurseslabs.com/bipolar-disorder/

Handrup, C. T. (2020, November 3). Understanding bipolar disorder. American Nurse.

https://www.myamericannurse.com/understanding-bipolar-disorder/

Mayo Foundation for Medical Education and Research. (2022, December 13). Bipolar disorder.
Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-
causes/syc-20355955

Videbeck, S. L. (2019). Mood disorders and suicide. Psychiatric-mental health nursing (8th ed).
Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

Williamson, V. (2017, September 2). The impact of post-traumatic stress disorder. Nursing in
Practice. https://www.nursinginpractice.com/clinical/the-impact-of-post-traumatic-stress-
disorder/
Psychiatric Mental Health Comprehensive Case Study

Case Study Comment Sheet 4842 (Turn in with Case Study)

Student Name_____________________________________
Pt Identifier______________
Date(s) of Care_____________

__________ Objective Data presentation the patient, treatments, medications

_ _________ Discuss patient / family history of mental illness

___________ Identify stressors and behaviors that precipitated current hospitalization

___________ Summarize the psychiatric nursing interventions with rationales

___________ Evaluate patient outcomes for nursing care provided

___________ Analyze ethnic, spiritual and cultural influences that impact care of the patient

___________ Patient education required (based on symptoms, diagnosis, medications, labs,

safety, etc.)

___________ Priority patient needs (day of care and discharge)

__________ Summarize discharge plans and community care

__________ Actual nursing diagnoses, prioritized, using R/T and a.e.b.

___________ List of potential nursing diagnoses

___________ Conclusion paragraph

____________ Style, spelling, grammar, clarity, organization, APA format