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?
• 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.
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Fill in the blank(s) with the appropriate word(s).
The ________ increases the heart rate and strengthens myocardial contractions through the release of epinephrine and nonepinephrine.
A. Sympathetic nervous system B. Parasympathetic nervous system
The paramedic should suspect altered medication metabolism in a patient with:
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