Question

Ms. Horowitz is brought to the emergency department (ED) after being found on the highway shortly after her car broke down. When the police came to her aid, she told them that she is “driving to fame and fortune.” She appears overly cheerful, constantly talking, laughing, and making jokes. At the same time, she walks back and forth beside the car, sometimes tweaking the cheek of one of the policemen. She is coy and flirtatious with the police officers, saying at one point, “Boys in blue are fun to do.”

She is dressed in a long red dress, a blue and orange scarf, many long chains, and a yellow and green turban. When she reaches into the car and starts drinking from an open bottle of bourbon, the police decide that her behavior and general condition might result in harm to herself or others. When they explain to Ms. Horowitz that they want to take her to the hospital for a general checkup, her jovial mood turns to anger and rage, yet 2 minutes after getting into the police car, she is singing “Carry Me Back to Old Virginny.”

On admission to the ED, Ms. Horowitz is seen by a psychiatrist, and her sister is called. The sister states that Ms. Horowitz stopped taking her lithium about 5 weeks ago and is becoming more agitated and out of control. She reports that Ms. Horowitz has not eaten in 2 days, has stayed up all night calling friends and strangers all over the country, and finally fled the house when the sister called an ambulance to take her to the hospital. The psychiatrist contacts Ms. Horowitz’s physician, and her previous history and medical management are discussed. It is decided that she should be hospitalized during the acute manic phase and restarted on lithium therapy. It is hoped that medications and a controlled environment will prevent further escalation of the manic state and prevent possible exhaustion and cardiac collapse.

Provide objective data

Provide subjective data

Nursing diagnosis

Potential treatment for this client

Answer 1

Objective data:

• High level of energy and activity.
• Irritable mood.
• Decreased need for sleep.
• Rapid or "pressured" speech.
• Rapid thoughts.
• Tendency to be easily distracted.
• Increased recklessness.
• Increased sexual desire.

Subjective data:

• Chest pain
• nausea
• pounding or racing heart
• sweating
• chills,
• trembling
• breathing problems
• weakness or dizziness
• tingly or numb hands
• chest pain
• stomach pain
• and nausea.

Nursing diagnosis:Disturbed sleep pattern related to the symptoms of mania, as evidenced by sleeping only a few hours in a week without feeling tired.

Treatment :Medications may include: Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid)