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Bipolar Disorder and Depression

Mental Health Clinical Case Study: Bipolar/Depression

Jenna Matheny

Mental Health Nursing

Youngstown State University


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Bipolar Disorder and Depression

Abstract

This case study explores the case of a 22 year old male with depression and bipolar disorder.

The purpose is to address care for this client in the best way possible. This study will focus on

the mental health history, current presentation, spiritual concerns, nursing care, stressors,

nursing diagnoses, and potential nursing diagnoses.


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Bipolar Disorder and Depression

Clinical Case Study: Mental Health Nursing

Objective Date

The patient who is going to be discussed in this case study is a 22 year old male. He was

diagnosed with bipolar disorder and depression. His past medical history is hypertension and

asthma. This patient does not have any known allergies. JG was admitted on January 23, 2020

to St. Elizabeth Hospital on the psychiatric unit. His admission note from the emergency room

says [22 y.o male with a previous psychiatric history of bipolar and presents for admission with

“I called an ambulance because I felt like hurting myself”. Patient states he is tired of “not doing

anything right in my life”. Patient states he is now homeless due to being kicked out of his

friends home. Patient states he used to live in Cornerstone Recovery and support in

Pennsylvania but left to be with family. Symptoms onset was years ago and is becoming severe

for the last few months. Symptoms usually worsened by stress].

I took care of this patient on January 30, 2020. His recent labs were not pertinent to his

diagnosis. During the interview with JG, he seemed animated. He was very engaging in the

conversation and shared a lot of information. Overall, he was relaxed during the interview, but

he was fidgeting in the chair slightly. He dressed in a neat manner and kept up on his personal

hygiene. I would say that this patient was friendly, but you could tell that he has had a rough

past. He is ambitious for the future and told me that he wanted to become a writer one day. He

says he’s “a sap for romance”.

JG was prescribed several medications for his health issues, including psychiatric and

blood pressure medications. I will only be focusing on the psychiatric medications for the
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Bipolar Disorder and Depression

purpose of this case study. The first medication is benztropine/Cogentin. It is an anticholinergic

used to treat Parkinson’s disease and also acute dystonic reactions. The next medication is

bupropion/Wellbutrin which is an antidepressant/smoking deterrents. The patient is on this

medication for depression and to also help with smoking cessation. JG is a smoker and admits

to smoking 0.5 packs/day. Fluoxetine/Prozac is another medication that this patient was

prescribed. This med is an antidepressant, specifically an SSRI. It is used to for the treatment of

major depressive disorder. It is also an acute treatment of depressive episodes associated with

bipolar disorder. The next medication JG is prescribed is olanzapine/Zyprexa. Zyprexa is an

antipsychotic used primarily for schizophrenia. It can also be used in the maintenance therapy

of bipolar disorder, which is why JG is on this medication. This medication can also help with

agitation as well. Hydroxyzine/Vistaril is another medication this patient was prescribed. It is an

antianxiety, antihistamine, sedative/hypnotic. It is used for the treatment of anxiety. Lastly, JG

was on trazodone/Desyrel. This medication is classified as an antidepressant but he was on this

medication to help him sleep.

The unit has several safety measures in place. For example, every patient goes through a

full body cavity search when they are admitted to maintain the safety of the patient and also

the safety of others. The unit is a lock down unit, so the doors are always locked so no one can

get in or out. I noticed a few things on the unit that are in place for patient’s safety. First, there

are 15 minute checks on every patient. The bathroom doors are also cut at an angle. This is

done so patients cannot hang themselves with a sheet or something similar with the door. No

patient is allowed to have shoe laces due to possible strangulation attempts. There are many

more safety measures, but those are the only ones I noticed at this time.
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Summarize the Psychiatric Diagnoses

JG was diagnosed with two different disorders. The first one is depression. According to

the American Psychiatric Association, “depression (major depressive disorder) is a common and

serious medical illness that negatively affects how you feel, the way you think and how you

act.” This disorder can cause the individual to feel extreme sadness and also a feeling of not

wanting to do normal activities. Depression can either be mild to severe. In the case of JG, I

would say that he was in a more severe state of depression considering he was having suicidal

ideations and also saying he was tired of not doing anything right in his life.

Depression can cause many symptoms. These include sadness, decreased

interest/enjoyment in previous activities. Patients can experience either weight gain or weight

loss due to appetite changes. Sleep disturbances and fatigue can also occur. If depression is

severe enough, it can cause suicidal thoughts, or difficulty concentrating. In order to be

diagnosed with depression, you have to have symptoms for two weeks or more.

The next diagnosis for JG was bipolar disorder. “Bipolar disorder, formerly called manic

depression, is a mental health condition that causes extreme mood swings that include

emotional highs (mania or hypomania) and lows (depression)” (bipolar disorder, 2018). If the

patient is experiencing a high, they may feel energized and even euphoric, but if the patient is

experiencing a low, they may feel depressed.

Bipolar disorder can exhibit is several different types. In the case of JG, I think he would

be classified as bipolar I disorder, which means he had at least one manic episode that either

happened before or after a major depressive episode. There are some risk factors that could
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Bipolar Disorder and Depression

increase your chances of developing bipolar disorder. This includes having a relative with

bipolar disorder, periods of extreme stress (example: traumatic event), or drug/alcohol abuse.

JG has experienced these risk factors. He claims he has a history of emotional, physical, and

sexual abuse. He did deny substance abuse, but says he has been in and out of foster care and

living in group homes. His biological mother and father both have a history of overdose as well.

Identify the Stressors and Behaviors that precipitated current hospitalization

From talking with JG, his story was hard to follow. He explained how he has lived in

foster care. JG stated that he used to live in Cornerstone Recovery and support in Pennsylvania

but left to be with family. He said his father was diagnosed with cancer so he moved in to help

out with his health. His friend was also living at this house as well. He talked about how the

friend was using him for money and verbally and physically abusing him. He eventually got

kicked out of the house where he was living by the friend and is homeless. JG claims that his

symptoms started showing up years ago before this recent hospitalization. He was had multiple

hospitalizations for the same problem. Over the last few months, JG says that the symptoms

have become more severe.

The interview taught me that JG has an extensive past of emotional and physical

trauma. His mental health has definitely taken a toll due to these issues. His parents have a

history of drug abuse/overdose, so that could be factoring in to his stress. He says he doesn’t

deal with stress well, and doesn’t have proper coping mechanisms. He is trying to learn new

ones but wants to get healthy first.

Discuss patient and family history of mental illness


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Bipolar Disorder and Depression

This patient does have a history of bipolar disorder. He talked about having his first

noticeable symptoms many years ago. He has been struggling ever since. He claimed he was

doing okay until he got kicked out and was homeless. That put JG under a lot of stress and

made the symptoms even worse. He has had many recent hospitalizations over the past 2 years

for bipolar symptoms and depression symptoms. He says that his highs and lows are out of

control. JG didn’t talk about if his family had a history of mental illness, but they do struggle

with addiction.

Describe the psychiatric evidence based nursing care provided and milieu activities attended

Patient safety is the highest priority. The first thing the nurse should do is make sure the

environment is safe for the patient and others around them. They should remove all harmful

objects from the client. The nurse should also maintain close observation of the client to

promote patient safety. On the psychiatric floor at St. Elizabeth hospital, they have 15 minute

checkups. Encouraging communication between the client and the nurse is also key. As the

nurse, you want your patient to trust you and feel that they can confide in you if they need to

talk. Powerlessness is a problem that individuals with depression go through, especially in this

case of JG. The nurse should empower the patient and allow them to gain control of what is

happening. They should also promote positive self-esteem. The nurse does this by focusing on

the patient’s strengths. “The nurse in the hospital, office, school, or community setting can

provide the essential elements of effective care for depression, including early detection by

screening, medication teaching, depression education, teaching coping skills, and appropriate

use of specialists and resources.” (Bernstein, 2006)

Analyze ethnic, spiritual and cultural influences that impact the patient
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Bipolar Disorder and Depression

JG did not talk about any cultural influences. He did say that he was a spiritual person

now, but hasn’t always been. During the interview, he talked about how he says that having a

lack of religion in his life is what led to his struggle. JG did say that he has been focusing on his

religion and putting his faith into a “higher being” to help him through this difficult time.

Evaluate the patient outcomes related to care

There are several outcomes that this patient should be focused on. He should be

focusing on his mood and trying to prevent further suicide attempts. It is a good thing that he

noticed that he was not in the right mind set and called the ambulance. Hopefully JG will learn

proper communication skills and be able to express how he is feeling with a trusted support

system in the future. Some outcomes may include: Client will seek out staff when feelings of

harming himself begin, and most importantly the client will not harm himself. Another outcome

will be that the client will verbalize symptoms of bipolar/depression in order to know when the

mood is starting to change.

Summarize the plans for discharge

While talking with JG, I did ask the question about his plans after he gets discharged. He

talked about how he is going to a group home in Pittsburgh, Pennsylvania. He was not sure as

to how he was going to get there, but he said he was going to get there anyway he could. JG

says he is going to focus on himself and also with his writing. He wanted to eventually publish a

book of his own and become a famous writer. I would say that JG has a flight of ideas when it

comes to his future, and unrealistic thinking as well.


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Bipolar Disorder and Depression

Before the patient is discharged, he will have to be able to verbalize that he has an

understanding of his situation. He also needs to be able to acknowledge the symptoms of

depression and bipolar disorder. JG will need to learn adequate coping mechanisms, and how

to deal with stress properly. We talked to the patient about finding a good support system. The

patient has been compliant with his medications, but education was also provided to him to

make sure he stays compliant.

Prioritized list of all actual diagnoses

 Risk for Suicide related to Bipolar Disorder as evidenced by previous attempts


 Ineffective coping related to depression as evidenced by not taking care of personal
needs
List of Potential Nursing Diagnoses

 Risk for suicide


 Low self-esteem
 Powerlessness
 Disturbed thought process
 Imbalanced nutrition: less than body requirements
 Self-care deficit
 Fear
 Anxiety
 Risk for injury
 Knowledge deficit

Conclusion

In conclusion, JG does have two serious mental problems. He will have to learn new

coping mechanisms and stay compliant with his medication. After collecting all the information

about this patient, it seems that he is going in the right direction. The psychiatric floor in the
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Bipolar Disorder and Depression

hospital is helping him through this process by using milieu therapy and encouragement.

Overall, this case study was interesting. There was a lot of information that was learned during

this process. Hopefully, JG’s health will improve after he moves to Pennsylvania and removes

himself from the negative environment that he was been dealing with.
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Bipolar Disorder and Depression

References

Bernstein KS. (2006). Clinical assessment and management of depression. MEDSURG


Nursing, 15(6), 333–342.

“Bipolar Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 31 Jan.
2018, www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-
20355955.

Townsend, Mary C., and Karyn I. Morgan. Essentials of Psychiatric Mental Health Nursing:
Concepts of Care in Evidence-Based Practice. F.A. Davis Company, 2020.

What Is Depression?, www.psychiatry.org/patients-families/depression/what-is-depression.