You are the registered nurse case manager in an outpatient mental ...

[wrbasek0]

You are the registered nurse case manager in an outpatient mental health clinic. s.t. is here today for her outpatient mental health appointment
 
  she has a diagnosis of bipolar disorder and has been stable for
  the past year. Her last episode was one of mania that required hospitalization. she is 29 years old, married,
  with two children aged 2 and 4. she reports that her mood is better than it has been in a long time and
  she has lots of energy. When asked whether she thinks this is a recurrence of mania, she says no,she thinks
  that things are just finally getting better.
 
  It is common for patients with bipolar illness to deny the onset of mania because it feels
  good. What other information would be important to ask S.T.?
 
  What other information would help determine whether S.T. is experiencing the onset of a
  manic or hypomanic episode?
 
  Bipolar disorder is a disorder of mood, characterized by episodes of depression, mania, or
  hypomania. What symptoms might you see if S.T. is experiencing mania or hypomania?
 
  How is hypomania different from mania?

Question 2

J.B.'s daughter visits him in the hospital, and they have a long talk. she is shocked when she realizes that her father is lonely to the point of considering suicide and
 
  tells you that she will do all she can to help him
  when he goes home.
 
  What important information needs to be conveyed to J.B.'s daughter about the first few
  weeks of therapy with the SSRI?

[EAN94]

Answer to Question 1

 How many hours is she sleeping at night?
 Are her thoughts racing?
 What kinds of activities is she involved in?
 Have other people made any comments about her behavior?

 Obtain collaborating information from S.T.'s husband. Be cautious about violating the Health
Insurance Portability and Accountability Act (HIPAA); you can obtain information from the
husband only if he is present during the interview or if you receive the patient's permission to talk
to her husband regarding her care. Check your facility policy, state laws, health advocacy laws,
power of attorney laws, and durable power of attorney laws.
 Assess body language, eye movements, and nonverbal communication.
 Have her keep a 24-hour food diary.

 Inflated self-esteem or delusions of grandeur (belief that the individual has special powers or
abilities)
 Decreased need for sleep
 More talkative than usual
 Pressure to keep talking
 Flight of ideas or reported racing thoughts
 Distractibility
 Increase in goal-directed activity
 Agitation, excessive moodiness, or irritability
 Excessive involvement in pleasurable activities that have a high potential for painful consequences
(impulsive or reckless behavior)

 Mania symptoms cause significant impairment in social or occupational functioning. Symptoms
last at least 1 week. Patients experiencing mania might require hospitalization to protect the
patients from harm to themselves or others.
 Hypomanic symptoms do not cause significant impairment in social or occupational functioning
or include psychosis, but are associated with a change in behavior that is uncharacteristic
of that person and is observable to others. Symptoms last at least 4 days but do not require
hospitalization.

Answer to Question 2

As the medication starts to work and the depression lessens, the patient's energy level improves and
the suicide potential increases. It is important to monitor him closely during this time. She needs
to check on him (watch his mood, level of interest, appearance, behavior, and speech pattern) and
ensure that he keeps his therapy appointments. He needs to continue to take the medication on a
regular schedule and not stop taking it abruptly. If he has problems with the medication's adverse
effects, the medication dose will need to be tapered down before being discontinued. This needs to
be done under the supervision of a health care provider; it must not be performed without notifying
the provider.

[wrbasek0]

Excellent

[ktidd]

TYSM