Case Study: Bipolar Disorders: Nursing Care of Persons With Mood Lability

The parents of a 16-year-old African American male adolescent describe him as “addicted to online gaming with bouts of severe agitation and anger often directed at the family, including swearing, throwing furniture, and physical abuse directed toward his two younger brothers.” His mom states that he threw his laptop and broke it when she tries to set limits with him about the time he spends on the computer. When you are interviewing the 16-year-old young man, he identifies a shift in his sleep pattern with recently only sleeping 3 to 4 hours a night; racing thoughts centered around the fictional world of the online game; and some grandiose thinking that he can change the world, become a millionaire, and does not need to do well in his school studies because that doesn’t matter as much as achieving the highest level in the game. His speech is noted to be fast paced and pressured. He demonstrates almost complete social isolation other than his game connections, poor judgment regarding school, and inattention to his hygiene. The teen’s mother states that she must prepare, plate, and serve his food to him while he is on the computer or he will not eat during the day. The parents and the patient both agree that 2 months ago, the patient was “depressed.” They both describe low mood and irritability, inattention to hygiene and other activities of daily living, increased sleep and withdrawal from friends and family, and hopeless or helpless ideation centered on the patient’s self-worth. The patient admits to experiencing suicidal thoughts at that time. Patient also stated that he had constant intrusive thoughts and had been looking up ways to kill himself including overdosing on meds , jumping off roof, jumping in front of a train and cutting and drowning.Patient was noted to have superficial cuts on his left arm. Patient states that he does this to make him feel better. The patient has been having problems with his sexuality as he states he has interest in boys and not girls.

Patient denies pain, skin is intact, medical problem asthma. No known allergies.

a. The nurse practitioner prescribes divalproex sodium 250-mg delayed-release capsules for the patient. List the major side effects to assess for with the use of divalproex sodium.

b. What are the major nursing concerns for this teenager who has recently been diagnosed with a bipolar disorder?

1. Read the case study and answer the learning objectives.

2. Using the textbook is recommended.

Case study

Stacy Smith is a 28 year-old, single, black female who comes to the Employee Health Clinic complaining of a migraine headache and fatigue. She has been an employee in the Information Technology Department for the past 6 years, having started immediately after graduating with honors from college. She is currently working as an interim department manager while her supervisor is out on medical leave. She lives alone in her own apartment, she often spends time by herself and stopped going to the gym saying “ I used to go to the gym 4 times a week but I don’t have any interest or motivation to go anymore”. She used to eat healthy foods but is eating a lot of fast food and has gained 10 pounds in the last month. Although she has experienced migraines on occasion in the past, they are now having more frequently (1-2 per week) and are becoming more severe (7/10 on a self-report of pain accompanied by nausea and light sensitivity). She has been feeling extremely stressed and fears being unable to cope with the responsibilities of her job. She has had several recent conflicts with the employees under her supervision. She is having increasing trouble sleeping and has recently begun to have 2 or 3 glasses of wine before going to bed every night. She feels edgy and destressed and wants to be given “something like Ativan” to help calm her nerves and get her through the day. She has no other medical problems and no known allergies.

Objectives

1. How would you communicate with a distraught client like Stacey? What communication techniques would be effective and why?

2. Stacey is diagnosed with a Major Depressive Disorder. Enumerate the signs and symptoms to support this diagnosis.

3. Complete a substance abuse assessment of your choice on this patient (for example: CAGE Questionnaire).

4. Complete a depression rating scale of your choice for this patient (for example: Zung Self-Rating Depression).

5. What are the non-pharmacological interventions would you use to reduce the clients level of stress and why?

6. What are the psycho-pharmacological interventions for Stacey’s diagnosis (major depression), write the indication, side effects, adverse effects and nursing consideration.