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Michael Turnbull
Patricia Flamino
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Turnbull Case Study
Abstract:
When conducting a case study on a patient and their diagnosis it’s necessary to
gather objective data regarding the disease process such as symptoms and
medications along with factors that contributed to relapse. Knowledge of the psychiatric
diagnosis is extremely important in terms of the plan of care and treatment. The
patient’s relapse was brought on by his non compliance with the medication regimen.
Mental illness is often genetic in nature and I was unable to gather information
regarding family history from the patient. A therapeutic milieu or safe environment is
cultures and religions mental illness is not seen as an actual disease. Where he has the
support from his family as well as his spiritual faith to keep him motivated for his best
outcome. Nursing diagnoses allow us to evaluate current problems along with those the
patient is at risk for to set outcomes we would like the patient to achieve.
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Turnbull Case Study
Objective Data
Patient EM also known as “Manny” has been seeing a psychiatrist for a few
years and has had a recent outbreak of his Severe Manic Bipolar 1 disorder. He was
admitted November 12th, 2017 voluntarily seeking help for his suicidal and homicidal
ideation. I cared for Manny on November 15th, 2017 where he presented himself well
with a proper dress and mannerisms. He speech was slightly pressured but was
extremely open to his story. He was relaxed yet slightly agitated. He felt that he was
seeking help because if he hadn’t the voices in his head would cause him to crack. He
made minimal eye contact and seemed to be scanning the area for different stimulation.
The patient upon admission had chest pain where they had done an EKG that came
back normal. Other various tests that came back normal were an HIV test, CBC,
urinalysis, a drug screen and his TSH levels. Manny is on a variety of different meds.
Trazodone for his depression. Aripiprazole for hallucinations and delusions. Busprione
for anxiety. Hydroxyzine for anxiety. Haloperidol Lactate to calm him down as well.
Along with all of these meds and other interventions to get to the bottom of his issues,
Summarize
Manny has Severe Bipolar 1 Disorder which is more on the manic side of the
mental illness that brings severe high and low moods. People who have bipolar disorder
can have periods in which they feel overly happy and energized and other periods of
feeling very sad, hopeless, and sluggish. In between those periods, they usually feel
normal (Bipolar Disorder Center: Symptoms, Types, Tests, and Treatments). The word
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Turnbull Case Study
"manic" describes the times when someone with bipolar disorder feels excited which
can also involve irritability and impulsive or reckless decision-making. About half of
people during mania can also have delusions or hallucinations like Manny. Hypomania
describes milder symptoms of mania, in which someone does not have delusions or
hallucinations, and their high symptoms do not interfere with their everyday life. In
bipolar disorder, the dramatic episodes of high and low moods do not follow a set
pattern. The word "depressive" describes the times when the person feels very sad or
depressed. Someone may feel the same mood state (depressed or manic) several
times before switching to the opposite mood. These episodes can happen over a period
of weeks, months, and sometimes even years (Bipolar Disorder). How severe it gets
differs from person to person and can also change over time, becoming more or less
sudden changes from being joyful to being irritable, angry, and hostile, restlessness,
rapid speech and poor concentration, increased energy and less need for sleep,
unusually high sex drive, making grand and unrealistic plans, showing poor judgment,
drug and alcohol abuse, or becoming more impulsive (Bipolar Disorder Center:
Symptoms, Types, Tests, and Treatments). During depressive periods a person may
things they once liked, trouble concentrating, uncontrollable crying, trouble making
decisions, irritability, needing more sleep, insomnia, appetite changes that make them
lose or gain weight, thoughts of death or suicide, or attempting suicide (Bipolar Disorder
Center: Symptoms, Types, Tests, and Treatments). At either a high or low moment a
Identify
Prior to his admission Manny had a number of psychological stressors that were
severely impacting his life yielding his HI and SI. Manny had found work while battling
his bipolar disease creating lanyards and selling them to various groups of people. This
is one activity that pushed Manny and he really enjoyed doing. He didn’t make a large
bang for his buck so money and finding work was always an issue. He was receiving
had thoughts in his head telling him to burn down the CEO, Joe Caruso’s, home. The
primary motive was to kill Joe. Compass then denied him access to their services and
he had to switch his psychiatric health care provider. Another stressor he has is that his
daughter who is 5 years old isn’t actually his. He had been taking care of her in his life
while split with the biological mother where then the mother had told him that the child
was in fact not his. This was extremely tragic to him after he had found out that this was
true through DNA results. He plans to be a part of her life, Faith, regardless of the
situations because he feel like she is family no matter what and still his baby girl. This
ended up throwing more voices into Manny’s head telling him to kill her and not to stop
until she is dead. This is where he then told his mother and they took the initiative to get
him further help at the hospital. Along with all of these stressors a main trigger to this
episode has been that he has been feeling better so he has stopped his medications.
Discuss
Family history plays a major role in the inheritance of bipolar disorder. Manny
was adopted and had no ties or communication with his biological family. He currently
lives with his fraternal parents where he is attempting to get on his feet while struggling
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Turnbull Case Study
with his psychiatric issues. He has a girlfriend, Lorain, where he sleeps over her place
multiple times a week and she is also active in his daughter’s life. None of his family
members have and history of psychiatric issues and they are all supportive in getting
him back to getting better. The first time I approached Manny, his mother was sitting at
the table talking to him and I sat down next to them. She stated that she comes every
day and is worried about her son. This is a clear indication that she is supportive.
Describe
There is a lot of clinical evidence that makes his bipolar clear and concise. As I
spent time with Manny, I felt that he had a lot of stressors on his mind and that they
impact his life. The stressors previously stated are extremely relevant. He presented
himself with pressured speech, limited agitation where you can tell he had a lot to say.
He was relaxed about most topics, but when we were talking about his daughter he
tensed up where I felt that she was his main trigger of his mania/aggression. He was
also very paranoid with minimal facial grimacing, but still relevant, and he was always
looking around needing the urge to be stimulated. Overall, Manny was extremely
friendly and persistently repeated that he was there so that he can get the help he
needs. The staff has stated he is progressing and I was able to tell due to his state of
mind.
Analyze
and his family go to church together every Sunday. They are very family oriented and
do a lot of activities together especially around the holidays. They live in Youngstown
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Turnbull Case Study
and get by. During our conversation you can tell how much he is influenced by his faith
in god and that a major stressor in his life is also financial. He repeatedly said that he
needs to keep faith so that the voices in his head will go away and he can get back to
Evaluate
There are many patient outcomes that we want to see and have created with
Manny. He no longer has any suicidal ideations or any homicidal ideations towards Joe
Caruso. St E’s team is still monitoring his suicidal ideation towards his X girlfriend. The
ultimate goal is to get him on an agenda where he is compliant with his meds, and is not
Summarize
essential with the plan of care so that progress and proper interventions are
implemented. The goal is to get the patient back to their day to day live with minimal
Prioritize
Bipolar Disorder has various nursing diagnosis. These nursing diagnoses from
most severe to the lease sever are risk for injury, risk for violence (self-harm or upon
family processes, and total self-care defect (Nursing Care Plan for Bipolar Disorder).
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Turnbull Case Study
These are all major issues that are personalized to each person experiencing severe
bipolar disorder.
List
harm to himself or others due to his suicidal and homocidal ideations with a plan.
evidence by manic behaviors, loud threatening verbal behaviors, and poor attention
span. Manny also has ineffective individual coping related to changes in communicating
patterns, verbally attacking others, with the inability to efficiently problem solve or ask
Reference
https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Bipolar Disorder Center: Symptoms, Types, Tests, and Treatments. (n.d.). Retrieved November
Nursing Care Plan for Bipolar Disorder. (n.d.). Retrieved November 29, 2017, from http://
medicachemistry.blogspot.com/2013/03/nursing-care-plan-for-bipolar-disorder.html