Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example

Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example

Patient Initials: DP.

Gender: Female

DOB: July 1, 1994

SUBJECTIVE:

CC: ” I take medication inconsistently because I don’t think I need them. I really feel like the medication affects my mood and the person I am.”(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

HPI: The patient, a 28-year-old female, arrives at the clinic complaining that she was taking medication but had stopped due to side effects. The patient claims that the drugs have caused amnesia, weight gain, bad mood, and occasionally a feeling of euphoria. The patient occasionally experiences depressive symptoms, which interfere with her capacity to work. When she is depressed, she skips work, and her grandmother is understanding of her absences. The patient claims to experience depression four to five times a year. She does not feel like getting out of bed during these times and lacks the energy or ambition to accomplish anything. She claims that she is becoming disinterested in her creative endeavors and beginning to lose self-confidence in herself. She frequently has these episodes after spending much time working on her writing, paintings, and music. Although she has been told she is depressed, she believes she is simply exhausted from her hard work. The patient experiences creative bursts, which she adores, just before she loses it. She skips taking her meds since they make her feel sick, has more energy to do a lot of things, and goes four to five days without getting adequate sleep during these episodes. According to her friends, she talks too much and seems disorganized when she experiences creative moments. She has multiple sex partners, claiming to be explorative during these episodes and exploring her thoughts and body. The episodes typically last a week. The client disputes having OCD. For the past two months, the patient has reported seeing things that others cannot. She hears voices telling her she is terrific and highly creative when sleep-deprived. The patient claims to be too busy to eat, yet when she is depressed or sleeping, she eats anything she can get her hands on. She claims to sleep for an average of 5 to 6 hours each night and denies having any nightmares. She sleeps for roughly three hours a day when she feels creative and 12 to 16 hours a day when she is depressed.  (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Social History: The patient’s mother and older brother raised her. The patient currently splits her time between her mother and her partner. The patient has never been married but is currently in a relationship. DP is childless. The patient uses writing for enjoyment and is currently composing and planning to publish her bibliography. She paints as well and hopes to sell her works in the future to important people.  (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Education and Occupation History: She works part-time at her grandmother’s store. She claims to skip work on days when she feels down. Her grandmother is understanding of her tardiness. The patient is a cosmetology student at a vocational school right now. She wants to work as a cosmetics artist for famous people.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Substance Current Use and History: The patient admits to smoking one pack every day, but she wants to stop. The patient admits to drinking when she was 19 but no longer does so due to its adverse effects. The patient claims she has never used marijuana, but when she did, she developed paranoia. She also says she has never used cocaine, stimulants, or meth. She denies using inhalants, hallucinogens, Klonopin, Xanax, or mushrooms. DP denies taking opiates, painkillers, or other over-the-counter or prescription drugs. She denies using any synthetic products. The patient disputes having seizures or blackouts due to taking alcohol or drugs.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)           

Legal History: The patient claims to have no past legal issues. However, she was arrested once when she was caught singing and dancing in the neighborhood parking area and taken to a hospital. She claims she did not get enough rest that week. She cannot recall these incidents and believes that people made up the story. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Family Psychiatric/Substance Use History: The patient claims that her mother was thought to be crazy and may have had bipolar disorder. Her father has not spoken to her in eight to ten years because he was imprisoned for narcotics offenses. Even though her brother has never visited a doctor, the patient claims he has schizophrenia. According to DP, the father was strict, but they did not experience domestic violence or abuse. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Past Psychiatric History:

General Comment: The patient has previously been diagnosed with depression, anxiety, and bipolar disorder.

Hospitalization: When she was a teenager, she spent days without sleep due to hearing things and was eventually admitted to the hospital. The most recent hospitalization for the patient took place in the previous spring. The total number of hospitalizations is 4. The patient claims to be hospitalized for attempted suicide after taking too much Benadryl.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example) 

Medication: The patient admits to taking a drug after missing a dose for four days, but she cannot recall what it was for. The patient claims that after taking Zoloft, she felt elevated, slept less, and had a racing mind. She also took Seroquel and Risperdal, which contributed to her weight gain. The patient also took Klonopin, which made her sluggish. The other drugs are not something she can recall.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Psychotherapy or Previous Psychiatric Diagnosis: The patient states being assessed for and diagnosed with depression, anxiety, and bipolar disorder previously.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Medical History: The patient reports hypothyroidism, which she takes medication for.

Current Medications: The patient could not name her hypothyroidism medication.

• Allergies: Fur allergies that make her sneeze.
• Reproductive Hx: The most recent menstrual period was last month. The patient admits to using protection while engaging in sexual activity. The patient has multiple sex partners. 

ROS:  

General: DP denies fever, weight loss, or feelings of weakness and fatigue.

HEENT: Eyes: Patient denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: The patient reports diet changes, overeating when depressed or resting, and little in her creativity episodes. Denies feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Denies constipation. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, and odd color.

Neurological: The patient denies headaches, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Musculoskeletal: The patient denies muscle pain and weakness. Denies back pain and muscle or joint stiffness.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating. No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE:

Vital signs: Stable

Temp: 98.8F

            BP: 120/65

            P: 84

             RR: 18

             O2: Room air

             Pain: 0/10

             Ht: 5’8 feet

             Wt: 135 lbs

             BMI: 20.5

             BMI Range: Healthy weight

LABS:

Lab findings WNL

Tox screen: Negative

Alcohol: Negative

Physical Exam:

General appearance: The patient seems well-nourished and fed. The patient looks her age and is well-groomed. Most of the time, the patient made pleasant and frequent eye contact with the interviewer. The question regarding the history of mental illness in her family seemed to annoy the patient. The patient was also annoyed by probes that seemed to be repeated, particularly those about whether or not the patient had ever attempted suicide or self-harm.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Cardiovascular: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is normal, and capillaries refill within two seconds.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Musculoskeletal: Normal range of motion. Regular muscle mass for age. No signs of swelling or joint deformities. Muscle and back pain rated 3/10.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear.

Psychiatric: The patient has a depressed mood, irritability, insomnia, and experiences creativity and depression episodes, lasting about one week each, 4 to 5 times a year. Creativity episodes come before depression episodes. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Neuropsychological testing: Emotional functioning is impaired.

Behavior/motor activity: The patient’s behavior was appropriate and constant most of the time. However, she demonstrated irritability towards particular questions that seemed too personal, like about her family’s psychiatric history.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Gait/station: Stable.

Mood: Depressed mood.

Affect: The patient’s mood was depressed.

Thought process/associations: comparatively linear and goal-directed.

Thought content: Thought content was appropriate.

Attitude: the patient was uncooperative at times

Orientation: Oriented to self, place, situation, and general timeframe.

Attention/concentration: Good

Insight: Good

Judgment: Good.

Remote memory: Fair

Short-term memory: Good

Intellectual /cognitive function: Good

Language: clear speech, with a tone assessed to be normal

Fund of knowledge: Good.

Suicidal ideation: The patient reports attempted suicide after overdosing on Benadryl in 2017. The patient denies current suicidal ideation.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

The 28-year-old female patient stated that she had a history of taking drugs but stopped them because they made her uncomfortable. She is oriented to self, place, situation, and general timeframe. She has sound judgment, good short-term and long-term memory, good insight and knowledge base, and clear speech. The patient displayed sporadic resistance and seemed agitated when asked about the mental health background of her family. The patient was also annoyed by inquiries that seemed to be repeated, mainly inquiries about whether or not the patient had ever attempted suicide or self-harm. The patient appeared to be depressed. Though now nonexistent, she acknowledges having had suicidal thoughts and attempts. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Differential Diagnosis:

1. F31 Bipolar I Disorder:

The patient exhibits bipolar disorder symptoms. She experiences both manic and depressed episodes. She enjoys her periods of creativity before she experiences depressive spells. She skips taking her meds since they make her feel sick, has more energy to do a lot of things, and goes four to five days without getting adequate sleep during these episodes. According to her friends, she talks too much and seems disorganized when she experiences creative moments. She enjoys having sex with various people during these episodes and exploring her thoughts and body. The episodes typically last a week. She does not feel like getting out of bed and lacks the energy or ambition to accomplish anything when she is down. She claims that she is becoming disinterested in her creative endeavors and beginning to lose self-confidence in herself. She frequently has these episodes after spending much time working on her writing, paintings, and music. Although she has been told she is depressed, she is unsure and believes she is simply exhausted from her hard work.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Patients with bipolar I disorder report both manic and depressed episodes per the DMS-5. Patients with manic episodes report increased energy, feeling high, elated, or extremely irritable or touchy, feeling more active or wired than usual, having reduced need for sleep, talking quickly about various topics or having a flight of ideas, having racing thoughts, feeling like they can do many things at once without getting tired, experiencing increased appetite for food, drinking, sex, and other pleasurable activities, and feeling unusually important. Patients who experience depressive episodes describe feeling down, sad, worried, sluggish, restless, having trouble falling asleep or sleeping excessively, talking very slowly, and unable to come up with anything to say (NIMH, 2022). Additionally, the patient experiences frequent forgetfulness, struggles with concentration and decision-making, cannot complete simple tasks, loses interest in practically all activities, and experiences suicidal thoughts. These symptoms match those that DP reported. The diagnosis of bipolar I condition was confirmed since she meets the DMS-5 criteria.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)  

• F32.9 Major Depressive Disorder:

Depression is characterized by apathy and constant sadness. All depressive disorders substantially restrict the patient’s ability to perform daily tasks because of the sorrow, emptiness, irritation, and physical and psychological changes they are characterized by. Depressed people show significantly less excitement or interest in nearly all activities for the day, pretty much every day. According to the DMS-5 criteria, a person must exhibit five of the following symptoms to be diagnosed with depression: difficulty sleeping, loss of interest or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, difficulties concentrating or paying attention, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood (Chand et al., 2021). When DP is depressed, she stays in bed and lacks the energy or ambition to get up and accomplish anything. She claims that she is becoming disinterested in her creative endeavors and beginning to lose self-confidence in herself. She frequently has these episodes after spending much time working on her writing, paintings, and music. Although she has been told she is depressed, she is unsure and believes she is simply exhausted from her hard work. The DMS-5 criteria for MDD are not met by these episodes, which happen 4-5 times per year for a little over a week; as a result, the diagnosis was rejected.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

• F60. 3 Borderline Personality Disorder:

The patient exhibits some symptoms of borderline personality disorder. Borderline personality disorder (BPD), a cluster B condition, is characterized by hypersensitivity to rejection and the resultant instability of relationships with others, the perception of oneself, one’s mood, and one’s behavior. Borderline personality disorder, which encompasses other physical and mental health co-morbidities, causes substantial impairment and despair (Chapman et al., 2022). Five or more of the following characteristics define a generalized pattern of interpersonal relationships, self-image, affective instability, and evident impulsivity that begins in early adulthood and emerges in a variety of contexts: A pattern of severe and volatile relationships marked by shifting between extremes of idealization and devaluation; a significantly and continuously unstable self-image or sense of self; impulsivity in at least two domains with a tendency to be self-destructive; frantic attempts to avert real or imagined abandonment; a marked reactivity of mood, persistent feelings of emptiness, inappropriately intense anger, or difficulty controlling anger. Individuals with bipolar disorder may experience periods of stable mood in between episodes of manic and depressive states, similar to individuals with borderline personality disorder who suffer severe mood fluctuations. This diagnosis was rejected because the patient did not meet the criteria for BPD.  (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)  

Plan:

Combining pharmacotherapy and psychotherapy would considerably help address and alleviate symptoms.

Safety Risk/Plan:

The patient claims to have had suicidal thoughts and attempted suicide once but has no such ideas or plans. She has no homicidal intentions and no current plans. Despite heightened conflicts and frustration, the patient is not a danger to others. Admission is not required. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Pharmacological Interventions:

Mood stabilizers such as lithium and atypical antipsychotics, including risperidone and olanzapine, can aid in treating manic episodes and symptoms. Depressive symptoms can be alleviated by prescribing quetiapine or lurasidone or mixing olanzapine and fluoxetine (Sekhon & Gupta, 2023). Lithium is strongly advised, with a starting dose of 300 milligrams taken two to three times daily. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Psychotherapy:

Mindfulness-based cognitive therapy (MBCT) and acceptance therapy can help patients with mood problems and prevent recurrence. Interpersonal therapy is frequently indicated to address interpersonal issues and role shifts, such as with the patient’s mother, whom she believes is against her. Cognitive-behavioral treatment will aid in the improvement of impaired and dysfunctional cognitions and attitudes, which contribute to depressive episodes (Sekhon & Gupta, 2023). Mindfulness is used in dialectical behavioral therapy, which can assist in enhancing tolerance for distress and control of emotions. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)  

Education:

1. Educate the client on medication side effects, potential complications, and the need for medication adherence.
2. Advise the client on the need to follow up with therapy sessions.
3. Regularly evaluate withdrawal symptoms to avoid relapse.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)
4. Educate the client on healthy lifestyle choices, such as balanced diets and routine physical activity.
5. Encourage the client to work with the healthcare team and seek help anytime.  

Consultation/follow-up: Follow-up is in one week for further assessment. 

Referral: See endocrinologists for thyroid assessment

Reflection:

This activity is an excellent learning opportunity for identifying mood disorders in accordance with the complete patient evaluation. The activity allows for identifying symptoms and possible diagnostic impressions based on these symptoms. It also permitted the application of DMS-5 criteria to corroborate the diagnosis, which is common in mental health practice. Assessing the patient provided hands-on practice, increasing confidence and boosting overall patient assessment skills. Most of the time, the patient was cooperative but appeared bothered by personal questions, which needed excellent interpersonal skills. This activity provides insights into tackling such circumstances while being professional and assuring the patient’s safety and respect of dignity. If I had another chance with this patient, I would need the presence of a caregiver, such as a mother or big brother, to conduct a thorough assessment and build a solid care plan.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Working with bipolar patients necessitates high ethical standards and compassion due to the patient’s difficulties in daily activities and social relationships. During the assessment, the physician must support autonomy, beneficence, and nonmaleficence to ensure that the patient feels heard and respected and that no action or questions cause emotional or psychological harm. These highly vulnerable patients should be treated with great care, love, and compassion. Promoting the health of a bipolar patient can include providing education to families and the patient about the disorder, its signs, triggers, and management strategy to empower them to participate in the treatment actively. Psychosocial support and therapy are needed to ensure the patient develops positive outcomes. (Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)  

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing). In: StatPearls [Internet]. StatPearls Publishing.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)

Sekhon, S., & Gupta, V. (2023). Mood disorder. In: StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example) https://www.ncbi.nlm.nih.gov/books/NBK558911/

Chapman, J., Jamil, R.T., & Fleisher, C. (2022). Borderline Personality Disorder. In: StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing.(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example) https://www.ncbi.nlm.nih.gov/books/NBK430883/

NIMH. (2022). Bipolar disorder. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/bipolar-disorder(Assessing a Patient with Bipolar I Disorder Comprehensive Nursing Essay Example)