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Case Bipolar Depression Mania UNFOLDING Reasoning, Brenden Manahan, 35 years old

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Bipolar Depression/Mania 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: Patient is being admitted for an exacerbation of his bipolar disorder. Patient had stopped taking his medication because he feared his mother was poisoning the medication. He’s not slept in four days due to racing thoughts. He believes he is the head of the CIA and needed his mother’s car to drive to McLean, VA. When the police arrived, they noted that he was speaking rapidly and becoming increasingly agitated, yelling at the police that they were there to poison him and prevent him from returning to his job. Relapses and exacerbation episodes can be a progressive pattern of this disorder leading to remission and relapse. This is a delusion not uncommon in the manic phase of bipolar and raises the question of whether or not he was on a high enough dose of medication. Lack of sleep is a clinical red flag for the manic phase of bipolar disorder. This is a delusion also not uncommon with a manic phase of bipolar disorder. Clients who present with pressured speech may be difficult to work with because they're hard to understand because their brain is moving very rapidly. They can behave very impulsively it may be difficult to manage this phase of their illness and it will take time to build trust. His yelling at the police is also indication of his poor judgment. RELEVANT Data from Social History: Clinical Significance: He has been admitted six times in the past due to medication non-adherence. Patient was recently in court to have his parental visitations reduced to one visit per week. The clinical significance is that there can be a rolling door syndrome when working with clients who have this mental illness with frequent admissions due to non-adherence to medication and inadequate outpatient services. This psychosocial stressor in the relationship with the child’s mother and also the reduction in visitation and the legal issues associated with that can be a precipitating factor in bringing on a manic phase as stress can trigger symptoms. 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 significan [Show More]

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