Bipolar Spectrum Disorder Case Study

Rick is a 30-year-old attorney that presents with emaciation, flamboyant shirt, mismatched socks, and irritability. In addition, he is sexually suggestive, easily angered, and highly impulsive. He shares his impaired judgment and its strain on his marriage, as well as his lack of sleep and appetite. He is restless and speed is loud and pressured. He also speaks about impregnating his secretary and taking out a second mortgage on his house in order to pay for three law offices. Based on these symptoms, Melanie would most likely diagnose Rick with a Bipolar Spectrum Disorder. Rick’s subjective symptoms include his claims to multitasking with great success as well as his emotionally labile state. He also expresses his impulsivity and purchase
most treatment guidelines advocate lithium and divalproex as first-line mood-stabilizing agents” (Preston et al., 2010) (Varcarolis 294). A first-line mood stabilizer for these manic episodes is lithium carbonate. This is due to its ability to rude many of the symptoms that Rick is experiencing. These include his “elation, grandiosity, flight of ideas, irritability, anxiety, insomnia, psychomotor agitation, hypersexuality, and paranoia” (Varcarolis 294). Rick is also experiencing rapid speech, some aggression, and increased psychomotor activity. These can all be initially slowed or decreased with the use of antipsychotics. According to Varcarolis, this is used to “prevent exhaustion, coronary collapse, and death until lithium reaches therapeutic levels … [and] given in conjunction with lithium to help control the mania” (294). The nursing diagnosis that would address Rick’s main problem would be Risk for Injury due to his acute mania. Individuals that are experiencing acute mania will often exhibit signs such as “excessive and constant motor activity, poor judgment, lack of rest and sleep, poor nutritional intake” which can all put the patient at risk for injury, specifically cardiac collapse (Varcarolis 288). In addition, patients may also exhibit symptoms such as “loud and crass speech” which may annoy others (Varcarolis
Education on the patient’s medication management, as well as psychotherapy management would be of utmost importance. Ensuring that the patient is aware of the importance of psychotherapy and medication management should be the first nursing intervention. This is due to the fact that should he not be compliant with medication and therapy, mania will most definitely recur and lead to more complications for the patient. Some questions that could be asked to determine the success of these nursing interventions include the following: How many hours of sleep do you get every night? How do you take your medication? What is your medication used for? When do you take your medication? Have you been attending psychotherapy sessions? Which therapies have been more beneficial than others? Have you had any recent episodes of elation, euphoria, or increased impulsivity since you were last