Runninghead: CASE STUDY

Madison Hefner

Case Study

November 6th, 2017

Youngstown State University

Saint Elizabeth’s Main Hospital

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OBJECTIVE DATA:

My patient Mark arrived at the emergency department due to an auto accident on

September 26, 2017 He attempted suicide. He believes his wife was cheating on him with his

own family members. After being treated in the emergency room he was brought on to the psych

floor where he was diagnosed with bipolar one disorder. I cared for Mark on September 28, 2017

which was two days after the accident. On this day the patient had a nose brace on for his broken

nose due to the auto accident. He was very friendly although in pain, he had bruises on his

forearm and his knee and was in a wheelchair. While talking to Mark about what brought him in,

he was very open and levelheaded about the situation. The most noticeable thing while speaking

with Mark was that he had drainage coming off of his nose dressing from his broken nose, that

would constantly drip. Safety precautions taken for Mark were for him to be in a wheelchair to

heal from his injuries. The medications that Mark was on in the hospital were : lithium 300 mg

and Risperidone 2 mg which both are anti-manics for bipolar. Mark was also on Ativan 0.5mg

which is a benzo for anxiety. The Bipolar Medication guide from HELPGUIDE.ORG shows that

these medications are proven to treat bipolar disorder. I was lucky enough to be able to take

Mark a second time the next week I came in so I was able to see improvements with his

condition if any were made. The only thing that has changed with his medications within the one

week of seeing him was his lithium level needed increased upon doctors approval for discharge,

so the doctor increased his dosage from 300 mg to 600 mg bid to get him in therapeutic range of

(.5 to 1.5) before he was allowed to be discharged.

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SUMMARIZE:

Mark’s psychiatric diagnosis was bipolar one disorder, mixed severe. With this disorder

the patient goes through intense emotional changes that are very different from their usual mood

and behavior. Mark’s manic and depressed episodes are not due to a medical condition or

substance abuse. To be diagnosed with bipolar 1 disorder the patient must have at least one

manic episode in his or her life and also suffer from episodes of depression. Many people with

bipolar one disorder can live a normal life as cited by (Web MD, 2015).

IDENTIFY:

Mark said there were many stressors that precipitated his current hospitalization. The

overall theme was his wife cheating on him. Mark believe that his wife was cheating on him in

his own house with his step daughter and son-in-law. Before all of this happened Mark was a

registered sex offender for 10 years for having sex with his step daughter, recently Mark believed

the step daughter, wife, and son-in-law were having an affair. Mark said because he did all this

before (cheating on his wife to sleep with his stepdaughter ) he knew what the signs of cheating

were. Mark said he found unexplainable stains all over the couch, secret stories between the

husband and wife were now known by the step daughter and son in law, and while drunk his

wife one night even flashed the his son in law, showing the comfortability between them. Mark

believed he caught onto the signs for weeks but when he found his son-in-law and wife in the

bedroom with his hands on the wife’s hips and with both of them getting very red in the face.

Mark does have a history of admitting to his sexual activity with his step daughter, and his wife

has forgiven him. Mark states he would of done the same for her if she would of just admitted
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the affair she was having with the step son. However, the wife did not own up to her actions.

This made Mark feel unwanted in the house so Mark decided to get into one of his old cars

(without airbags)go to the gas station, grab 2 gallons of gas and pour it all over the car, himself,

and inside the interior and drive 90 miles per hour into a pole. His car did not catch on fire nor

did he injure anyone from the accident that he caused. From there the ambulance rushed him to

the hospital and he was lucky enough to walk away with just a broken nose and some

cuts/bruises.

DISCUSS:

In Mark’s chart he never had a hospitalized incident that occurred from his bipolar one

disorder other than this most current one. Mark also states not taking any meds for this

psychiatric disorder before admission day. Mark did not finish high school or have the best

insurance to access care for himself so signs and symptoms of his mental illness( bipolar one

disorder) may not have been recognized in past occurrences.

DESCRIBE:

The nursing care that Mark received on the psych unit in downtown Youngstown

consisted of the three meds given (lithium, Ativan, risperidone). Mark was encouraged daily by

the nurses to list three goals each day, and by the end of each day to see if the goals were met or

not. Three of Mark’s goals on the day of care (September 28, 2017) were: to attend three groups

during the day, to stay positive, and to spend time with his family that come in to see him. On the

psych floor the nurses offer what is called “Group”. It is usually a set activities that any member
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on the psych unit can attend. Each group session has a different agenda, but most teach about

coping strategies and provide the patients with a good environment to open up and talk about

their current problems and stressors occurring in their life. The nurses are there to help the

patients get better and this is one way in which they can do that.

ANALYZE:

In Mark’s charts it says he did not have a certain religion he sided with.Maybe the nurses

never asked them or just forgot to fill in this box. However through communicating with Mark

he told me before his accident he did not believe so much in a “higher power”. Now after his

accident he sees how lucky he is to be alive, to have a son and a sister who are there for him, he

now believes God has a purpose for keeping him alive. He told me he plans to join a church

when he gets out of the hospital and that he wants to find out what God's purpose is to keep him

alive. Mark said that this accident was definitely a life changing experience for him.

EVALUATE:

Mark’s outcomes related to the care the hospital provided were of course to make him

better and to stabilize him enough to be discharged. All of the medications given to him were

checked for therapeutic rang to make sure they were helping Mark’s mental health and work

towards the goal of discharge. Group was held daily for Mark to attend to teach certain coping

strategies(as mentioned above). Family hours were also offered to assure Mark that he has

support at home after he was discharged. Mark’s sister and son came in every night during

Mark’s stay at Saint Elizabeth’s.

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SUMMARIZE:

Discharge plans will be finalized for Mark as soon as his labs for the medication lithium

come up within therapeutic range. Once discharged Mark has stated that he is going to live with

his son and avoid all communication with his wife (soon to be ex). He plans to get his stuff out

of his old house with the help of the police. Mark said his wife is going to stay in their old house

with the step son and daughter. Mark’s long term goals would be to stay clear of alcohol and

drugs. As of now there is nothing set up for after care but Mark said he is going to look into a

place that will help him decrease his drinking and correct bad habits.

NURSING DIAGNOSES:

Priority nursing diagnoses for Mark would be: (in order)

#1.)Risk for self harm r/t suicide attempt

Goal: Keep patient free from harm on day of care

Interventions: Make sure the pt is not left alone at any time while in the hospital, teach

the pt coping skills which they start to feel overwhelmed, ask they pt if they feel suicidal

now...if yes then ask them if they have a plan...then ask them if they have the means to

act on the plan.

#2.)Self care deficit r/t anergia AEB diagnosis of bipolar disorder with depression
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Goal: Pt will groom and dress appropriately with help of the nursing staff and family

members on day of care

Interventions: Encourage the use of a toothbrush, soap, shaving equipment and wash

clothes, Give step by step reminders on how to brush teeth or how to get dressed.

#3.)Risk for ineffective individual coping r/t inadequate level of resources AEB

verbalization of not being able to cope.

Goal: Provide the pt with coping strategies and assure the pt knows how to use

them.

Interventions: Assess the cultural beliefs of the patient, ​Observe for causes of

ineffective coping such as poor self-concept​, grief, lack of

problem-solving

skills, lack of support, or recent change in life situ​ation. Assess for

intergenerational family problems that can overwhelm coping abilities.

These priority nursing diagnosis for Mark were chosen and constructed from a website

called Nurseslabs. These diagnosis are the top three most important ones for Mark at this time in

care. However mark can have many other NANDA nursing diagnoses some of which would be

would be: risk for injury r/t driving car into a pol at 90 miles per hour in a car filled with

gasolinet. Risk for violence: self-directed or others directed r/t current car crash and attempt at
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self harm(suicide). Impaired social interaction r/t family drama AEB verbalization from Mark

from his wife's affair with the step son and daughter. (Martin,P- Nurseslabs)
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-ABSTRACT-

This case study is done on a 46 year old male named Mark. He has a history of drug

(marijuana) and alcohol abuse but this is his first time in the hospital for treatment of a mental

illness. Mark was diagnosed with bipolar 1 disorder, mixed severe. In this case study I will

explain what events brought Mark to the hospital, the definition of his illness, goals and

outcomes for Mark, and nursing diagnoses that pertain to Mark’s diagnosis and his needs of care.
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Reference sheet:

Bipolar I Disorder. (n.d.). Retrieved November 06, 2017, from

https://www.webmd.com/bipolar-disorder/guide/bipolar-1-disorder#1

Bipolar Medication Guide. (n.d.). Retrieved November 06, 2017, from

https://www.helpguide.org/articles/bipolar-disorder/bipolar-medication-guide.htm

Martin, P. (n.d.). For All Your Nursing Needs. Retrieved November 06, 2017, from
https://nurseslabs.com/