Primary Concept Mood and Affect Interrelated Concepts (In order of emphasis) Psychosis 2. Clinical Judgment 3. Patient Education 4. Communication

Bipolar Depression/Mania
History of Present Problem:

Brenden Manahan is a 35-year-old male, who has been admitted to the crisis intervention unit for exacerbation of his bipolar disorder. He was admitted on a 501 (involuntary inpatient admission, patient has been deemed either dangerous to self or others) and brought to the hospital by police because his mother feared for his safety. In the past few weeks he stopped taking his medication because he feared that his mother was poisoning him.

Brenden has not slept in the past four days due to racing thoughts. He believes that he is the head of the CIA and told his mother that he needed her car to go to CIA headquarters in McLean, Virginia, and fire everyone. When the police arrived they noted that Brenden was speaking at a very rapid rate and pace and was becoming increasingly agitated.

He began yelling that the police where there to poison him and prevent him from returning to his job. He has been admitted to the locked mental health unit for evaluation of his mental capacity and stabilization. Brenden will participate in the following education groups: medication education, and bipolar illness education. The goal is to resume lithium carbonate and divalproex sodium.

Personal/Social History:
Brenden was diagnosed at 19 with bipolar I, and subsequently has been admitted six times due to non-adherence to the medication regimen. Brenden is divorced and has a 3-year-old son who lives with his mother. He was recently in court to have his visitations reduced to one supervised visit a week. He lives with his mother, who is supportive.

Question:
1. What data from the histories is important and RELEVANT and has clinical significance for the nurse?
2. What VS data are RELEVANT and must be recognized as clinically significant by the nurse? Explain why.

3. What CURRENT assessment data is RELEVANT and must be recognized as clinically significant by the nurse? Explain why.

4. What MENTAL STATUS EXAMINATION assessment data is RELEVANT that must be recognized as clinically significant to the nurse? Explain why.

5. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? Fill out the Drug study below:

6. What lab results are RELEVANT and must be recognized as clinically significant by the nurse?  Explain why.

7. What is the primary problem that your patient is most likely presenting with?

8. What is the underlying cause/pathophysiology of this concern?

9. Fill out the missing Expected outcome:

Collaborative Care: Medical Management

10. What interventions will you initiate based on this priority?  Fill out the Expected outcome.
11. What body system(s) will you most thoroughly assess based on the primary/priority concern?

12. What is the most likely complication/problem that the nurse should anticipate?

13. What nursing assessments will identify this complication EARLY if it develops?

14. What nursing interventions will you initiate if this complication develops?

Evaluation:  Evaluate the response of your patient to nursing and medical interventions during your shift. All physician orders have been implemented that are listed under medical management.
Two hours later…  The nurse observes the patient yelling and banging on the door of the unit. They need to let him out because he has to get to CIA headquarters to stop a terrorist attack. The staff tries to reorient him and the more they talk with him, the more agitated he becomes.
15. Has the status improved or not as expected to this point?
16. Does your nursing priority or plan of care need to be modified in any way after this evaluation assessment?
17. Based on your current evaluation, what are your nursing priorities and plan of care?

18. Fill out Nurse to Physician SBAR for Change in Status:
Situation:

Background:

Assessment:

Recommendation:

19. Education Priorities/Discharge Planning:
• What will be the most important discharge/education priorities you will discuss with Brenden about his medical condition to prevent future readmission with the same problem?
• What are some practical ways you as the nurse can assess the effectiveness of your teaching with this patient?
20. Caring and the “Art” of Nursing
• What is the patient likely experiencing/feeling right now in this situation?
• What can you do to engage yourself with this patient’s experience, and show that he/she matters to you as a person?

21. Use Reflection to THINK Like a Nurse  Reflection-IN-action (Tanner, 2006) is the nurse’s ability to accurately interpret the patient’s response to an intervention in the moment as the events are unfolding to make a correct clinical judgment.
• What did I learn from this scenario?
• How can I use what has been learned from this scenario to improve patient care in the future?