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Patient Case Study Mental Health Nursing Clinical

Sarah Ihnat

Nursing Department, Youngstown State University

NURS 4842L: Mental Health Clinical

Mrs. Phyllis Jean Defiore-Golden

March 17, 2021

Abstract

This case study will look into a patient who was diagnosed with bipolar 2 disorder. This patient

was experiencing a hypomanic episode during the time of care. The patient indicator being

used is D.Y. The case study will include, objective data on the patient, a summary of the

patient’s psychiatric diagnosis, stressors will be identified, the patient and the patient’s family

history of psychiatric diseases will be explored, the evidenced based nursing care will be

discussed, spiritual, ethnic, and cultural findings will be analyzed, patients outcomes will be

evaluated, discharge plans will be summarized, all diagnoses will be prioritized, a list of

potential nursing diagnoses will be discussed and a conclusion.

Objective data:

The patient D.Y was admitted to Mercy Health Youngstown campus on February 18, 2021. I

provided care for this patient eight days after his admission to the psyachtric floor on February

26, 2021. The patient admitted himself voluntarily, during our time together he even stated he

was happy to be there and getting the help he needed. This was D.L’s first psychiatric

hospitalization. D.L was admitted with a psychiatric diagnosis of Bipolar 2 disorder, during the

time of care he was experiencing a hypomanic phase. The patient’s lab results were all normal,

but his toxicology screen was positive for cannabis use. During the patient’s admission process

he was angry and hostile. He denied having any suicidal or homicidal ideations. The patient

stated he was very worked up when he presented to the Emergency Department due to his

coworkers making racist remarks. On the day of care, the patient was very calm and open to

talking with me. He was happy to have someone listen and “not judge” in his words. On the day

of care the patient was excited to participate in group therapy and talk about his different

coping skills. The coping skills the patient stated that worked best for him included exercise and

his weighted blanket. The patient was diagnosed with Levin Syndrome, a rare syndrome that is

characterized by the need for excessive amounts of sleep (hypersomnolence). The

safety/security measures in place for this patient include hourly checks and removing any

personal belongings that can be used to hurt themselves, another patient, or staff member. The

patient’s medications included divalproex, lithium, and olanzapine. These medications are a

combination of antimanic drugs (divalproex, and lithium), as well as antipsychotic drugs

(olanzapine), together these drugs help to control the patient’s bipolar disorder and his current
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hypomanic state. On the day of care the patient was dressed neatly and appropriately. While

talking the patient was relaxed and very open. The patient’s speech was clear and easy to

understand.

Summary of psychiatric diagnoses:

1. Bipolar 2 disorder is mental illness that affects the patient’s mood. Someone diagnosed

with bipolar disorder has periods of mania and depression. Bipolar 2 is a bit different

than bipolar 1. Patients diagnosed with bipolar 2 disorder have more periods of

depression or hypomania, compared to someone with bipolar 1 having more periods of

mania, “The diagnosis of bipolar I requires the presence of at least one manic episode,

with or without a history of major depressive episodes, while bipolar II disorder requires

at least one hypomanic and one major depressive episode” (Datto, Pottorf, Feeley,

LaPorte, & Liss, 2016). Due to the depressive episodes, especially associated with bipolar

2 disorder, the chance of suicide is elevated, “Over their lifetime, the vast majority

(80%) of psychiatric patients with bipolar disorders have either suicidal ideation or

ideation plus suicide attempts. (Suominen, Mantere, Lepp, Arvilommi, & Isometsa

2021)”.The signs and symptoms of bipolar disorder include; mood swings, risk taking

behaviors, euphoria, hopelessness, depression, changes in sleeping patterns, changes in

weight, loss of interest, and anxiety.

2. Hypomania is a mood elevation above normal, the elevation is typically not so severe

that it causes impairments to the individual. The presence of hypomania is important in

distuinging the between the diagnosis of bipolar 1 and bipolar 2 disorder, “Identifying a

past history of hypomania can be difficult and, as a result, BSDs are frequently

misdiagnosed as unipolar major depressive disorder, borderline personality disorder, or

other disorders. (Camacho, Almeida, Moura, Fernandes, Ribeiro, Da Silva, & Oliveira-

Maia 2018)”. The symptoms of hypomania include; abnormally upbeat, increase in

activity, increase in agitation, unusual talkativeness, racing thoughts, and distractibility.

Stressors and behaviors:

The patient stated stressors that lead to him becoming agitated/aggressive are

things such as, his coworkers making racist remarks, his girlfriend not working, and his

father being hard on him. The patient said three days prior to his admission to the

hospital he had recently broken up with his girlfriend of three years. He said he was fed

up supporting her and not receiving support back from her. The patient then said when

he went to work that day, his coworkers were making racist remarks which caused him

to start a fight. The patient opened up about the fact his father has always been hard on

him and the fact his father is in a wheelchair, which leaves the patient to help support

his family. The patient admits to not being compliant with medications while at home.

While in the psychiatric unit the patients medication doses have been changed and he

seems to be tolerating the changes well.

Patient/Family mental health illness history:

The patient has never been hospitalized for his bipolar 2 disorder before. It is

documented the patient’s mother has been diagnosed with depression. It is also

documented that the patient’s eldest sister also has a diagnosis of bipolar disorder. The
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patient seemed to be very protective of his eldest sister. The patient made a comment

about his farther not believing his eldest sister was mentally ill, and felt she “put on a

show for attention”.

Psychiatric evidence-based nursing care provided:

The patient participated in group therapy normally twice a day, this is an

example of cognitive behavioral therapy. The patient seemed to enjoy the chance to

express himself during group therapy. When speaking with the patient he mentioned

group therapy is something he may seek out once he is discharged from the hospital.

Evidence based research shows, “Constructive inpatient group therapy can be the

catalyst for patients to continue with treatment after discharge (Farkas-Cameron

2004).”

Analyze ethnic, spiritual, & cultural influences:

The patient is a twenty-four-year-old Caucasian male. D.Y is religious and stated

he was raised Roman Catholic, but now identifies as Christian only. The patient

graduated from Brookfield High School, and has his high school diploma. The patient has

completed some college classes, but is taking a break from school currently. The patient

spoke about hoping to get back to college one day. The patient is newly single, but is

hoping to rekindle his relationship with his ex, whom he dated for three years. The

patient lives at home with his mother, father, older sister, and younger brother. The

patient stated he has a “big, close, loving Italian family”, the patient appears to enjoy
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spending time with his family weekly. The patient is currently employed at a factory and

sells upcycled items on the side. The patient identifies himself as a “jack of all trades”

and feels he can do anything with a little practice.

Evaluate the patient outcomes:

During my day of caring for this patient, he was very much involved in his care.

He had a care team meeting that day and was eager to talk with the doctor/nurse

practitioner, and social worker. The patient stated “he wants to feel this good all the

time”. The patient eagerly participated in group therapy twice a day, and interacted well

with the other patients on the unit. He was compliant with his medication, and seemed

to understand the dosage was changed to help better suit him.

Summarize discharge plans

The patient’s discharge plan is for him to go back home to his mother and

father’s house. No date has been set for his discharge. After speaking with his nurse I

learned that a date for discharge was not set yet because they wanted to evaluate how

the patient did with his medication dose change. The patient seemed slightly

disappointed that a discharge date was not yet set.

Prioritized list of actual diagnoses:

1. Risk for violence as evidenced by poor impulse control.

2. Impaired social interaction R/T excessive hyperactivity and agitation as evidenced by

dysfunctional interaction with family, peers, and/or others

3. Ineffective individual coping R/T ineffective problem-solving strategies/skills as

evidenced by using extreme poor judgement in social situations (fighting).

4. Interrupted family process R/T family role shift as evidence by patient having to help

provide for the family.

5. Knowledge deficit R/T disease process as evidenced by med compliance.

List of potential nursing diagnosis:

1. Risk for injury as evidence by periods of mania.

2. Risk for anxiety as evidence by disorganized thought process.

3. Risk for self-care deficit as evidence by periods of depression.

4. Risk for disturbed sleep pattern as evidence by periods of mania.

5. Risk for situational low self-esteem as evidence by periods of depression.

Conclusion:

In conclusion, D.Y suffers from Bipolar 2. He voluntarily admitted himself to the

psychiatric floor when he was feeling violent. D.Y was very cooperative with his treatment and

seemed interested in getting better and back to his life. D.Y’s main issue is medication

compliance. The nurse who discharges him should teach and stress to him the importance of

him taking his medication as prescribed. Although a discharge date was not set on the day of

care, the discharge plans were for him to go back to his mother and father’s house. After

discharge, it would be benefical for the patient to continue to see a therapist or to find a group

therapy he can join. The patient needs to work on his coping strategies for when he gets

agigtated/frustrated, individual therapy or group therapy can help the patient achieve this.
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References:

Camacho, M., Almeida, S., Moura, A. R., Fernandes, A. B., Ribeiro, G., Da Silva, J. A., . . .

Oliveira-Maia, A. J. (2018, October 04). Hypomania Symptoms Across Psychiatric Disorders:

Screening Use of the Hypomania Check-List 32 at Admission to an Outpatient Psychiatry Clinic.

Retrieved March 17, 2021, from

https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00527/full

Datto, C., Pottorf, W. J., Feeley, L., LaPorte, S., & Liss, C. (2016, March 11). Bipolar II

compared with bipolar I disorder: Baseline characteristics and treatment response to

quetiapine in a pooled analysis of five placebo-controlled clinical trials of acute bipolar

depression. Retrieved March 17, 2021, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788818/

Farkas-Cameron, M. M. (2004, June 29). Inpatient group therapy in a managed health

care environment: Application to clinical nursing practice. Retrieved March 17, 2021, from

https://www.sciencedirect.com/science/article/abs/pii/S1078390398900465

Suominen, K., Mantere, O., Lepp, S., Arvilommi, P., & IsometsÃ, E. T. (2021, February

04). Suicidal Ideation and Attempts in Bipolar I and II Disorders. Retrieved March 17, 2021, from

https://www.psychiatrist.com/jcp/depression/suicide/suicidal-ideation-attempts-bipolar-i-ii-

disorders/
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