Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Bipolar I Disorder: Case Study

Gianna Myers

Nursing Department, Youngstown State University

NURS 4842: Mental Health Nursing

Professor Teresa Peck

October 26, 2023

Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Abstract

This case study covers the psychiatric diagnosis of bipolar disorder and the symptoms

experienced in this disease. It will overview a G.S., a 48-year-old male admitted to the behavioral health

floor during a manic episode and withdrawal from alcohol. Multiple journals were researched for

information using the Maag Library A-Z Research Database. This paper highlights the manifestations and

effects on one’s life with Bipolar I disorder, including the intense highs and low episodes. With the use of

group therapy and a medication regimen of mood stabilizers and antipsychotics, the patient's symptoms

become manageable so, G.S. can function at a high level that was admitted to the floor.
Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Objective Data

Patient Identifier G.S.

Age 48

Sex Male

Date of Admission October 21, 2023

Date of care October 24, 2023

Psychiatric Diagnosis Bipolar Disorder

Other Diagnoses Alcohol abuse

Behavior on admission G.S. presented to the ER agitated, stating he is having active hallucinations and

demonstrates delusional thinking. The patient denies wanting to harm himself but has been binge drinking

and non-compliant with medications (stated by the aunt in which G.S resides). G.S. remains agitated

because he cannot smoke during admission.

Behaviors on the day of care/ interview G.S. was cooperative and willing to speak openly during the

interview. The patient stated he feels wonderful and has felt this way forever. He participated in 2 group

activities today, sharing his thoughts loudly in each question pertaining to his symphonies, which could

not be redirected by staff. G.S. states that he has recently taken up the violin and has mastered it within

the 2 months he’s started. He states at once that these symphonies are just playing and running around in

his head, his understanding of how he cannot control his thoughts due to the manic episode he was

experiencing. When asked about his concentration levels he states he does not have time to read and

concentrate due to all the other projects going on in his life including inventing, garage painting projects,

symphonies he puts on, and more).

Safety and Security Measures Throughout the admission safety checks were implemented around the

clock every 15 minutes, suicide precautions were implemented and staff was present in the milieu at all

times on the unit. Lithium levels were drawn, and medication EKG was taken on patients. Medications

were administered to the patient by the nurse, and the nurse verified all medications were taken at the time

of administration.
Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Laboratory results

Lab Value Result

Lithium 0.2 mEq/L

Hgb 16.4 g/dl
HCT 44%
WBC 6.2
Na 132 mEq/L
K+ 3.4 mEq/L
Cl 100 mEq/L
BUN 20 mg/dL
Creatinine 1.0 mg/dL
Glucose 110 mg/dL
Alcohol 0.25
Toxicology (+)Marijuana
ALT 59 units/L
AST 46 units/l
Platelets 175,000/mL

Psychiatric Medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Lithium Lithium Antimanic Agent 600 mg Q12 hrs Mood stabilizer

Risperidone Risperdal Antipsychotic 2 mg daily Mood stabilizer

Haloperidol Haldol Antipsychotic 5 mg Q4 hrs Agitation

Lorazepam Ativan Benzodiazepine CIWA Q1 hrs Sleep/ Anxiety

chlordiazepoxide Librium Benzodiazepine 10 mg Q6 hrs Sleep/Anxiety

Nicotine Patch NicoDerm CQ Nicotine Replacement 14mg patch daily Tobacco

Dependance

Summarize the psychiatric diagnoses

Bipolar Disorder formerly called manic-depressive illness is a mental illness that causes unusual

shifts in a person’s mood, energy, activity levels, and concentration levels. These symptoms make it very

difficult to carry out most daily activities. There are three main types of bipolar disorders, all of which

affect mood, energy, and activity levels (Geerling, 2022). Bipolar 1 Disorder is specifically classified by

manic episodes that last for at least 7 days or manic symptoms that are so severe that the person needs
Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

immediate medical care. Usually, depressive episodes will also occur, lasting around 2 weeks. Signs and

Symptoms of this disorder include periods of intense highs and lows in emotion, sleep patterns, energy

levels, and character behaviors. When experiencing intense lows, one may become depressed, sad, and

hopeless. This will cause them to lose pleasure or interest in most activities. On the other hand, when one

experiences intense highs, they may feel euphoric, full of energy, or very irritable.

Mood episodes are one undesirable effect of Bipolar 1 Disorder, these are defined as distinct

periods of unusually intense moods and/or behaviors. These episodes can be broken down into two

categories: manic episodes and depressive episodes (Videbeck, 9th edition). Symptoms of manic episodes

include; feeling very high, elated, or touchy. The patient will have a decreased need for sleep, feel jumpy

and wired, talk fast about a lot of different ideas and subjects (flight of ideas), feel able to do many things

at once without being tired, feel very important and powerful, having the excessive need for drinking, sex,

food, and other pleasurable activities. While symptoms of depressive episodes include, feeling very sad,

slowed down, and restless. The patient will have trouble sleeping too little or too much, talking very

slowly, forgetting a lot and trouble concentrating, lack of interest, feeling hopeless or worthless, and

thinking about death or suicide (Mayo Clinic, 2022). If someone experiences four or more episodes of

mania or depression this would be considered rapid cycling.

Identify the stressors and behaviors that precipitated current hospitalization

Before admission, G.S. was admitted for noncompliance with medications of Lithium and

Risperidone. The patient's guardian stated that G.S. had become very agitated and pacing around the

house constantly, while not getting any sleep; stating he only needs 3 hours of sleep per night. The patient

was binge drinking, counteracting the effectiveness of his medication regimen. The patient also states the

use of pot as a coping mechanism for his stressors in life. G.S. stated that he was having active

hallucinations and delusional thinking. The patient stated he traveled all across America to put on

symphonies, also stating that ‘money’ talks to him. G.S. finds his hallucinations to be the way he

‘connects with the world and comforts him because this is the gifted ability he was given’.
Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Discuss patient and family history of mental illness

G.S. was married once and divorced, with a son in his 30’s who he has no contact with. The

family history of G.S. includes an alcohol-dependent father who left the client when he was at the age of

10. G.S. states that his childhood relationship with his father was abusive; stating that the father would

“hit him around, and mom just sat there.” G.S.’s half-brother also suffers from alcohol dependence, whom

he does not have much contact with. The Patient's mother was ‘moody’ and often depressed, but would

experience moods randomly being fun and loving; similar to the symptoms of bipolar disorder. G.S. lost

his mother at the age of 15 so lives with his aunt who helps to care for certain needs of the patient,

including all of his finances.

G.S. has a history of alcohol dependence and states that he drinks at least every weekend

(champagne, margaritas, and beer) to get intoxicated enough to feel euphoric and expose himself to all of

the mind thoughts and visions he loves to see. The patient states he does not date but is involved with

random sexual encounters. When asked about sex, the patient gets agitated and defensive about sharing

details of his private life; G.S. then goes on to share that he experienced a lot of sex in New York, trailers

in Indiana, and Los Angeles California. G.S. recently lost his job at Walmart, lost his best friend due to a

fight, and has been fighting with his aunt more than normal. The patient states his ‘mind’ affects his work

and relationships only because people don't like him because he is too smart and gets nervous around him,

causing him not to connect well with other people.

Describe the psychiatric evidence based nursing care provided and milieu activities attended

During G.S. staying in the inpatient unit, he received care from the behavioral health nursing staff. The

patient received a combination therapy of medication and therapy. G.S. was placed on Benzodiazepines to

help reduce stressors and antipsychotics to help stabilize mood on a day-to-day basis. During these mad

passes the registered nurse would ensure no pocketing of medication during administration. Each

medication was explained to G.S. being that it eased his anxiety knowing each medication he was taking.
Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Group therapy was implemented to help him connect better with people around him. He was encouraged

to participate in each session to learn new coping skills.

Throughout his stay therapeutic relationships were built between the nursing staff and the patient,

this helped to comfort G.S. and provide honest answers and actions. The nursing process was

implemented during the care of G.S., the staff used each phase including assessing, diagnosing, planning,

implementing, and evaluating to better care for the patient and work toward his patient goals. The patient

stated he was still experiencing hallucinations so the nurse reoriented the patient once after and then

distracted him from the situation. The behavioral health unit also used Milieu Therapy by making the

environment as stress-free as possible for the patient. The unit provided a set, detailed schedule for each

day, all three meals were cooked and served to the patient, and phone calls were scheduled for the same

hour each day. G.S. also worked with the floor psychiatrist on the unit, his social worker, and the unit

manager to ensure all needs were met during his time on the inpatient floor. Many community resources

and support group information were provided for patients by social workers to ensure a smoother

transition from inpatient units.

Analyze ethnic, spiritual and cultural influences that impact the patient

G.S. is a caucasian, divorced male in his late 40’s. He is currently unemployed and lives with his

aunt who provides care in areas he cannot for himself, including finances. The patient does not state a

specific religion he follows at the moment, but he claims to follow Mother Earth. G.S. states the

vibrations he hears in the rock and universe help to better connect him with Mother Nature.

G.S. lacked cultural influence from child development, losing both parents by the age of 15 affected his

ability as a child to build values, belief systems, and understanding of themselves as members of society.

The abusive relationship between himself and his father influenced how confident and comfortable

interacting with others would be. Without both parents in his life, his aunt had to step in and take

guardianship of G.S. Children's development can be influenced by how to act by interacting with their

parents, for this reason, the parents' cultural background often influences a child’s behavior. Without
Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

parental influence, there is a lack of social skills, discipline, and exposure to social norms. This was

shown in a research article published by The Journal of Affective Disorders indicating that with high

levels of parental involvement there is a significantly decreased likelihood of psychological distress;

“Notably, parental involvement in children’s lives can help children learn how to manage stressors and

maintain a healthy physical and mental state. Indeed, several studies have found that parental involvement

plays a crucial role in improving depression, loneliness, insomnia due to anxiety and suicidal ideation

among adolescents” (Tian,Zhang,Miao,Pan, 2021). This goes on to prove that parental-adolescent

involvement is crucial in the development of children growing up.

Evaluate the patient outcomes related to care

During [Link]. staying in the inpatient unit he displayed multiple positive outcomes desired in his care.

Some outcomes that we look for with Bipolar Disorder are remaining free from harming others or

themselves, being able to tell the difference between reality and hallucinative thoughts, and increasing the

ability to care for oneself in activities of daily living. From when G.S. arrived on the floor to today there

have been no instances of violent or threatening violent behaviors to himself or others. His medication

regimen has been promptly followed by both patient and staff without any problems; this also allowed for

a strict schedule to be followed each day on the unit. The patient stated how the scheduling increased his

daily productivity and plans to use this technique upon discharge.

G.S. also had improvements in their sleep schedule, getting onto the unit he was getting around three

hours of sleep every night, and today he sleeps through the night for 7-8 hours. Nutrition has improved for

him, usually eating 70% of each meal served, no significant weight loss or gain was seen at this time.

Some other outcomes met is the ability for G.S. to recognize distortions in reality and perception of self;

by the end of the patient's stay, he was experiencing little to no auditory or visual hallucinations. The

patient has also remained clean of alcohol and marijuana during his stay in the behavioral health unit and

plans to continue to refrain from these upon discharge.

Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Both depressive and manic episodes have been managed since admission on the floor. G.S. shows

great strides in his mental health; each day he adds something new to his chores or self-care. This includes

staying up on his oral and body hygiene, keeping his personal space free of clutter, and learning the

importance of finances and money. G.S. attributed his medications and group therapy sessions along with

the nursing staff to helping to get his disorder at a more manageable level.

Summarize the plans for discharge

When G.S. is discharged, he will return home with his aunt. The patient is to continue the medication

regimen of Lithium (600 mg Q12 hours) and Risperidone (2 mg daily) while continuing lab appointments

to have his lithium levels drawn on a set basis. He was given information about all Alcoholics

Anonymous groups and times in the surrounding area of his house and was advised to attend at least 4

meetings per week. With that G.S. will continue his sobriety from alcohol and marijuana being that he

understands the negative effects it has on his body, mind, and counteracting effects on his medications.

G.S. states that it is important to him to make amends with his best friend to gain back a stronger support

system. He will also be actively looking for a new job, while using his learned social skills from group

therapy to ensure better connections with other people. Both aunt and patient were educated on the signs

and symptoms of lithium toxicity, the main symptoms being nausea/vomiting, severe hand tremors,

confusion, and visual changes; if any of these were to be seen the patient would seek immediate medical

attention. G.S. was involved in all aspects of discharge planning and has agreed that these are all done for

him and that it would be of great benefit to go through with this plan.

Prioritized list of all actual diagnoses using individualized NANDA format.

a. Risk for Self Directed Violence related to mania evidenced by hostility, hallucinations and suicide

precationary.

b. Risk for injury related to destructive behaviors evidenced by marijuana use, alcohol use, and

multiple sexual partners.

Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

c. Acute confusion related to alcohol abuse evidenced by delirium, visual and auditory

hallucinations.

d. Imbalanced Nutrition: Less than body requirements related to lack of concentration and

motivation to eat evidenced by dry mucous membrane, imbalance electrolyte values, and weight

loss.

e. Ineffective Health self - management related to unpredictability of clients evidenced by low social

support system, depressive episodes, guardian controlling finances, manic episodes, inability to

focus or concentrate on tasks.

f. Ineffective Coping is related to inability to acknowledge responsibility for actions and results of

actions evidenced by feeling superior from mind ability, active hallucinations causing mind

blocks, belief in conspiracies or unusual beliefs, disturbed connection with other people.

g. Ineffective Role performance related to impaired social interactions evidenced by job loss, losing

close friends, and hostility towards family members.

h. Ineffective Activity Planning related to unrealistic perception of events as evidenced by delusions

of grandeur, auditory and visual hallucination and hypervigilance leading to decreased ability for

thought process and concentration level.

List of potential nursing diagnoses

Risk for care given role strain

Risk for Suicide Ideation

Ineffective Denial r/t depressive state

Disturbed personal Identity

Risk for Paranoid Ideation r/t suspension of others

Social Isolation

Compromised family coping

Risk for Self Neglect

Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Conclusion paragraph

In conclusion, bipolar disorder affects about 2% of adults in America and is the most costly

mental health condition for insurance nationwide. Similarly to G.S., the rates of this disorder are elevated

amongst people who are depressed, have anxiety disorder, and have substance abuse disorders (Laidi,

Godin, 2022). I found G.S. to be an interesting patient to do a case study of bipolar disorder on; he

exhibits prominent signs and symptoms that represent people struggling with this disorder. This disease

requires day-to-day treatment for the long term, there is no cure for bipolar disorder, but through behavior

therapy and the right combination of mood stabilizers and other bipolar medicines, most people with

bipolar disorder can live normal, productive lives and control the illness. In addition, one can join support

groups if you are one with bipolar disorder or a family member supporting an individual with bipolar

disorder. One good organization is the National Association on Mental Illness(NAMI). The increase in the

social support system helps to increase the chances of better outcomes for those suffering from bipolar

disorder.
Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

References

Geerling, B., Kelders, S. M., Stevens, A. W. M. M., Kupka, R. W., & Bohlmeijer, E. T. (2023). Why

patients diagnosed with bipolar disorder start, continue or discontinue health‐related apps supporting their

self‐management. Journal of Psychiatric & Mental Health Nursing (John Wiley & Sons, Inc.), 30(3),

537–546. [Link]

Laidi, C., Godin, O., Etain, B., Bellivier, F., Elandaloussi, Y., Olié, E., Aouizerate, B., Gard, S., Loftus, J.,

Belzeaux, R., Dubertret, C., Laouamri, H., Passerieux, C., Pelletier, A., Polosan, M., Schwan, R.,

Samalin, L., Llorca, P. M., Courtet, P., FondaMental Advanced Center of Expertise for Bipolar Disorders

(FACE-BD) collaborators, … Leboyer, M. (2022). Direct medical cost of bipolar disorder: Insights from

the FACE-BD longitudinal cohort. Journal of affective disorders, 306, 223–231.

[Link]

Lippincott CoursePoint for Videbeck: Psychiatric-Mental Health Nursing, Ninth Edition (Sheila L.
Videbeck)

Mayo Foundation for Medical Education and Research. (2022, December 13). Bipolar disorder. Mayo

Clinic. [Link]

Tian, S., Zhang, T.-Y., Miao, Y.-M., & Pan, C.-W. (2021). Psychological distress and parental

involvement among adolescents in 67 low-income and middle-income countries: A population-based

study. Journal of Affective Disorders, 282, 1101–1109.

[Link]