Assessment and Significance of Factors Contributing to a Client’s Condition with Bipolar Disorder

QUESTION

A 24-year-old male client presented to the emergency department last evening accompanied by their mother with whom they live. Client was only wearing a pair of shorts and a tee-shirt despite the outdoor temperature of 30 degrees Fahrenheit. Client presented as loud and demanding, stating they were “king of the country.” Mother reports the client was diagnosed with Bipolar Disorder, Type I, while in college. Symptoms have been controlled with Lithium Carbonate, Risperidone, and out-patient therapy.

Mother believes the client has stopped taking their medications and is not sure the last time client saw their outpatient therapist. Reports the client has not slept for the past three nights, has lost approximately 10 lbs. in the past two weeks, and has not gone to work for a week. Client is employed as a computer software engineer but is stating “Those idiots at work don’t how brilliant I am. I refuse to work for people who do not appreciate me!” Client was admitted to the inpatient mental health unit at 0200 this morning.

Hospital Day 1: 

Nurse’s Notes: 0400 Client admitted to inpatient unit. Initially refused to partake in nursing assessment process loudly stating “I am not staying in a room with any crazy guy! What do you have to eat around this place? I am starving!” Client adhered to assessment when advised they will have a private room and a sandwich was offered, which they were permitted to eat during the assessment.

Thought process is tangential and client is hyperactive. Client stood, stretched, and flexed muscles throughout the interview stating, “I need to keep my body in shape for all the ladies I date.” Client admits to only taking prescribed medications “when I remember…I really don’t need that stuff anymore.” Reports minimal need for sleep or food over the past few days. Denies suicidal or homicidal ideations. Client permitted the nurse to take vital signs and draw bloodwork. Client placed on 1:1 safety precaution until further assessment by treatment team is completed.

Sitting in dayroom with mental health technician at present. Requires frequent redirection not to yell and/or wander on unit while other patients are sleeping.

Vital Signs: 

• Pulse: 92; Blood Pressure 136/88; Respirations: 22; Temperature: 98.3 po                                               Labs:
• Lithium Level: 0.1 milliequivalents per liter (mEq/L)
• Urine Drug Screen: Negative
• Blood Alcohol Level (BAL): 0 %

Provider Orders:

• Admit to in-patient mental health unit
• 1:1 Observation
• Lithium Carbonate 300 mg po q am and 300 mg q HS
• Risperidone-M 2 mg po daily
• Risperidone 25 mg IM prn agitation (up to two doses per 24 hours)
• Lorazepam 2 mg PO/IM prn anxiety or agitation (maximum daily dose 6 mg)
• Milieu activities as tolerated
• Lithium level every 2 days                                                                                                                              Recognize Cues (Assessment) 
• a. What are the relevant factors contributing to the client’s condition?
• b. What is the significance of the Lithium level?

ANSWER

Assessment and Significance of Factors Contributing to a Client’s Condition with Bipolar Disorder

Introduction

Assessing and understanding the factors contributing to a client’s condition is pivotal in providing effective care and interventions, especially for individuals with mental health disorders. This essay delves into the assessment of the 24-year-old male client with Bipolar Disorder Type I, highlighting the relevant factors shaping his current state and the significance of his Lithium level. The client’s presentation, medication history, and laboratory results offer insights into his condition and guide subsequent interventions.

Factors Contributing to the Client’s Condition

The client’s presentation of loudness, demanding behavior, grandiosity, hyperactivity, and tangential thought process is indicative of a manic episode, a hallmark of Bipolar Disorder Type I. His statements, such as being the “king of the country” and refusing to work due to perceived lack of appreciation, align with manic symptoms characterized by inflated self-esteem and impulsiveness. The abrupt cessation of medications and lack of outpatient therapy could have precipitated the current episode, emphasizing the importance of medication adherence and continuous therapeutic engagement.

Significance of the Lithium Level

The Lithium level of 0.1 milliequivalents per liter (mEq/L) holds significance as it reflects the therapeutic serum range for managing Bipolar Disorder. The ATI book chapter on Psychiatric Nursing highlights that maintaining Lithium levels within the therapeutic range (0.6-1.2 mEq/L) is crucial to stabilize mood and prevent relapses. A level of 0.1 mEq/L suggests subtherapeutic dosing, which might explain the current manic symptoms. It underscores the need to reestablish medication adherence and closely monitor Lithium levels to achieve therapeutic effects and manage manic episodes effectively.

Conclusion

Assessing the relevant factors contributing to the client’s condition and understanding the significance of the Lithium level provide crucial insights for planning interventions and managing the Bipolar Disorder Type I. The manifestation of manic symptoms due to medication nonadherence underscores the importance of medication education, monitoring, and continuous engagement in therapy. By addressing these factors, healthcare providers can tailor interventions to stabilize the client’s mood, enhance his well-being, and prevent further exacerbation of manic episodes.