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Group 12 - Topic 5

Delilah Van Campen

Arianna Salinas

Tiffany Nguyen

Karina Pasasin

Prisila Mendoza

Lynette Rodriguez

Autumn Sweet

Alli West

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The patient presented to the emergency department several days into a manic episode. The patient's neighbor reports that the patient has been acting "hyper" over the past few weeks, and has expressed delusions of grandiosity stating "I am God Jesus mother," and "I am a powerful person." The patient has not slept for the past 4 days and stated that she is going to cleanse herself of her sins by bleaching herself inside and out.

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The patient is a 45-year-old woman who has a history of bipolar disorder with manic episodes. The patient has a history of non-adherence to Lithium and has not taken her medication for the past 3 months.

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The patients vital signs have been assessed as follows: BP: 138/72 mmHg, HR: 95, RR: 20, T: 37.5 C. The patient has no allergies documented. Mental Status was assessed.

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Continue the patient on 1:1 for safety. Continue educating the patient about the importance of medication adherence. Hospitalization will be important to continue with treatment and mood stabilization. Implement slow delusion correction over time.

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1) Patient safety due to her physical risk of ingesting toxic substances that could result in injury or death:

-Performing an environment check for safety and removing anything that can be used to harm the patient or others. Decreasing environmental stimuli could also help calm the patient down. The patient will be put on 1:1 for further monitoring and observations.

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2) The patient is experiencing delusions.

-Typically for inpatient scenarios this approach could be different, but in the ER we need to counter her delusions for safety reasons, and possibly administer mood stabilizers. However prior to administration of these medications we need to double check for allergies.

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3) Sleep deprivation and malnutrition.

-Perform a physical assessment, asking for any potential allergies and obtain baseline labs including lithium levels.

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Risk for injury related to delusional thinking.

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Despite our best efforts the patient is still physically and mentally decompensating...

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Despite our best efforts the patient is still physically and mentally decompensating...

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3 nursing actions to facilitate transition to a higher level of care:

1) Notify the emergency doctor of the possible emergency medications (Hence why we check for allergies).

2) Make sure the patient is on 1:1 and that they no not have access to supplies that could be used to harm the patient or others.

3) Educate the patient about the importance of medication adherence, and treatments.

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What is the most effective medication used for the treatment of Bipolar 1 with recurrent manic and depressive episodes?

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Lithium

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Name 2 symptoms that need to be present for a mania diagnosis.

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-euphoria

-grandiosity

-inflated self-esteem

-increased energy and mood

-pressured speech

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What is something that we can adjust in the patient’s room to reduce environmental stimuli?

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-turn off the TV

-lower the lights

-limit the number of people in the room/ area