Question

Richard is a 25 y.o. male patient who is being admitted to the inpatient mental health unit. He has a diagnosis of Bipolar 1 disorder. He has no history of physical or medical illnesses. During the admission assessment, Richard indicates that when he was 21 y.o., he was treated for bipolar 1 as an outpatient in the hospital clinic. He indicates was prescribed Carbamazepine but stopped taking it about 1 year ago. He told the nurse he has recently moved to the city as a mechanic, lives with a close relative temporarily. He does not have any friends in the city. About 3 weeks ago he had a surge of energy, was working 14-hour days and was up at night for days. During the interaction Richard often talked about his past depression and suicidality. Over the past month he has lost 15 lbs., has difficulty eating and has no appetite. He does not have the”…energy to get out of bed..” and has missed 4 days of work in the past week. He acknowledges having thoughts of ending his life by “driving off the road”. However, he says he is uncertain and afraid that if he takes his own life he will go to hell. You are the nurse assigned to provide care to Richard.

1. How would you describe what Richard is experiencing? (from a nursing perspective)

Answer 1

ANSWERS:-

Richard is experiencing episode of depression,which is followed by a manic episode.

* Bipolar disorder is a characterized by unusual shifts in a person's mood,energy and ability to function.There will be episodes of depression and elevated mood called mania.

* Bipolar 1 is characterized by episodes of mania and depression.

* During Depressive episodes person feels depressed mood, decreased energy and activity,feeling of guilt or worthlessness and suicidal thoughts.

* During manic episode person feels increased energy with hyperactivity and decreased need for sleep.

* Here Richard had a surge of energy and he was working for 14 hours per day and had reduced need for sleep that he was awake at night for days 3 weeks ago- which indicate a manic episode. He also had depression and suicidal thoughts in the past ,and at present he has loss of appetite, difficulty in eating, lost 15lbs over the past months, feeling no energy to get out of bed and missed 4 days of work , he has suicidal thoughts also - this indicate he is in depression.

* Richard needs treatment like medications and psychotherapies like group therapy,supportive psychotherapy and behavioral therapy etc .