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Case Study/Concept Map: Bipolar Mania

Noreen, age 32, had always been described as “moody.” Depending upon what was happening in her life at the time, she could be very sad and depressed, or very lighthearted and happy. During her “down” times she would feel tired, experience loss of appetite, and sleep a lot. During her “happy” times, she would party a lot, be very outgoing, and have a remarkable amount of energy. Noreen did well in college and graduated at age 26 with an MBA. Since that time, she has been employed in the administration department of a large corporation, in which she has had several promotions. Two weeks ago, management was to make the announcement of who would be fulfilling the position of vice president of corporate affairs. Noreen and a male colleague, Ted, were vying for the position. It was a choice position that Noreen desperately wanted. She became very depressed when the announcement was made that Ted had been chosen. She stayed at home, in bed, and slept a lot for several days. On about the 4th day, she got up, feeling exhilarated, and decided to go shopping. She spent more than $1,000 on clothing. She then decided to have a party for several hundred people, ordering it catered, and planning all the details. Tonight was the party. Noreen wore a new, very expensive dress, drank a lot of champagne, was very jovial and seductive, and bragged to everyone who would listen that she would soon be getting a new job, and that the people at her old organization would be sorry they had failed to promote her. She left the party with a man she hardly knew. At 3:00 a.m., she was picked up by the police, under the grandstand at the local baseball stadium wearing only her

underclothes, high-heeled shoes, and carrying a half-filled bottle of champagne. She was alone and speaking very loudly and rapidly. The police brought her to the emergency department of the local hospital where she was admitted to the psychiatric unit with a diagnosis of manic episode. Design an initial care plan for Noreen.

Subjective/Objective Data: Patient appeared to be experiencing a flight of ideas ever since she was not chosen for the position and felt depressed after. During her initial episode which was the depressive state, she was experiencing withdrawal and spend 4 days at home sleeping a lot with no social participation. After the depression, she started to experience the mania episode where she spent a lot of money on new clothes, threw a party, got intoxicated and ended up with only her underclothes in a stadium. Noreen was experiencing poor judgement and interpersonal chaos all under the influence of alcohol.

Nursing Diagnosis: 1. Risk for injury & self-directed violence related to manic impulsivity evidenced by poor impulse control and extreme hyperactivity. 2. Ineffective individual coping related to inadequate level of perception of control evidenced by changes in usual communication patters and inability to problem-solve. 3. Impaired social interaction related to hyperactivity and impulsivity evidenced by change of patterns of interaction and increase of manic behaviors when highly stimulated.

Nursing Interventions/Actions: 1 .Fr e q u e n t l ya s s e s sp a t i e n t sb e h a vi o rf o rs i gn sofi nc r e a s e dh y p e r a c t i v i t yo r a g i t a t i o na nde a r l ys i g n so fama n i ce p i s o d e . 2 .Ob s e r v ef o rd e s t r u c t i v eb e h a v i o rt o wa r d ss e l fo rot he r s .Ma i n t a i nafir m, c a l m, a n dn e u t r a la p p r oa c ha ta l lt i me s . 3 .Wh e np o s s i b l e ,p r o vi d ea ne n v i r o n me n twi t hmi ni mu ms t i mu l i . Outcome: 1. Patient will respond to external controls (medications, interventions) when potential of actual loss of control occurs. 2 . Pa t i e n twi l lr e p o r ta na b s e n c eo fd e l u s i o n s , r a c i n gt h o u g h t s , a n di r r e s p o ns i b l e a c t i o n sa sar e s ul to fme d i c a t i o nsa d he r e n c ea n de n v i r o n me n t a ls t r u c t u r e s . 3 .Pa t i e ntwi l lp utf e e l i n g si n t owo r d si n s t e a do fa c t i on swh e ne x p e r i e n c i n g a n x i e t yo rl o s so fc o n t r o lbe f o r ed i s c h a r g e ....