Professional Documents
Culture Documents
Ethan Thomas
Abstract
This case study explores the case of a 34-year-old male with depression and bipolar disorder.
The purpose is to address care for this client in the best way possible. This study will focus on
the mental health history, current presentation, spiritual concerns, nursing care, stressors,
Objective Date
The patient who is going to be discussed in this case study is a 34-year-old male. He was
diagnosed with bipolar disorder and depression. His past medical history is hypertension and
asthma. This patient does not have any known allergies. JG was admitted on January 24, 2021
to Trumbull Hospital on the psychiatric unit. His admission note from the emergency room says
[34 y.o male with a previous psychiatric history of bipolar and presents for admission with “I
called an ambulance because I felt like hurting myself”. Patient states he is tired of “not doing
anything right in my life”. Patient states he is now homeless due to being kicked out of his
friend’s home. Patient states he used to live in Cornerstone Recovery and support in
Pennsylvania but left to be with family. Symptoms onset was years ago and is becoming severe
I took care of this patient on January 26, 2021. His recent labs were not pertinent to his
diagnosis. During the interview with JG, he seemed animated. He was very engaging in the
conversation and shared a lot of information. Overall, he was relaxed during the interview, but
he was fidgeting in the chair slightly. He dressed in a neat manner and kept up on his personal
hygiene. I would say that this patient was friendly, but you could tell that he has had a rough
past. He is ambitious for the future and told me that he wanted to become a writer one day. He
JG was prescribed several medications for his health issues, including psychiatric and
blood pressure medications. I will only be focusing on the psychiatric medications for the
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Bipolar Disorder and Depression
used to treat Parkinson’s disease and also acute dystonic reactions. The next medication is
medication for depression and to also help with smoking cessation. JG is a smoker and admits
to smoking 0.5 packs/day. Fluoxetine/Prozac is another medication that this patient was
prescribed. This med is an antidepressant, specifically an SSRI. It is used to for the treatment of
major depressive disorder. It is also an acute treatment of depressive episodes associated with
antipsychotic used primarily for schizophrenia. It can also be used in the maintenance therapy
of bipolar disorder, which is why JG is on this medication. This medication can also help with
The unit has several safety measures in place. For example, every patient goes through a
full body cavity search when they are admitted to maintain the safety of the patient and also
the safety of others. The unit is a lock down unit, so the doors are always locked so no one can
get in or out. I noticed a few things on the unit that are in place for patient’s safety. First, there
are 15-minute checks on every patient. The bathroom doors are also cut at an angle. This is
done so patients cannot hang themselves with a sheet or something similar with the door. No
patient is allowed to have shoelaces due to possible strangulation attempts. There are many
more safety measures, but those are the only ones I noticed at this time.
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Bipolar Disorder and Depression
JG was diagnosed with two different disorders. The first one is depression. According to
the American Psychiatric Association, “depression (major depressive disorder) is a common and
serious medical illness that negatively affects how you feel, the way you think and how you
act.” This disorder can cause the individual to feel extreme sadness and also a feeling of not
wanting to do normal activities. Depression can either be mild to severe. In the case of JG, I
would say that he was in a more severe state of depression considering he was having suicidal
ideations and also saying he was tired of not doing anything right in his life.
interest/enjoyment in previous activities. Patients can experience either weight gain or weight
loss due to appetite changes. Sleep disturbances and fatigue can also occur. If depression is
diagnosed with depression, you have to have symptoms for two weeks or more.
The next diagnosis for JG was bipolar disorder. “Bipolar disorder, formerly called manic
depression, is a mental health condition that causes extreme mood swings that include
emotional highs (mania or hypomania) and lows (depression)” (bipolar disorder, 2018). If the
patient is experiencing a high, they may feel energized and even euphoric, but if the patient is
Bipolar disorder can exhibit is several different types. In the case of JG, I think he would
be classified as bipolar I disorder, which means he had at least one manic episode that either
happened before or after a major depressive episode. There are some risk factors that could
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Bipolar Disorder and Depression
increase your chances of developing bipolar disorder. This includes having a relative with
bipolar disorder, periods of extreme stress (example: traumatic event), or drug/alcohol abuse.
JG has experienced these risk factors. He claims he has a history of emotional, physical, and
sexual abuse. He did deny substance abuse but says he has been in and out of foster care and
living in group homes. His biological mother and father both have a history of overdose as well.
From talking with JG, his story was hard to follow. He explained how he has lived in
foster care. JG stated that he used to live in Cornerstone Recovery and support in Pennsylvania
but left to be with family. He said his father was diagnosed with cancer, so he moved in to help
out with his health. His friend was also living at this house as well. He talked about how the
friend was using him for money and verbally and physically abusing him. He eventually got
kicked out of the house where he was living by the friend and is homeless. JG claims that his
symptoms started showing up years ago before this recent hospitalization. He was had multiple
hospitalizations for the same problem. Over the last few months, JG says that the symptoms
The interview taught me that JG has an extensive past of emotional and physical
trauma. His mental health has definitely taken a toll due to these issues. His parents have a
history of drug abuse/overdose, so that could be factoring into his stress. He says he doesn’t
deal with stress well and doesn’t have proper coping mechanisms. He is trying to learn new
This patient does have a history of bipolar disorder. He talked about having his first
noticeable symptoms many years ago. He has been struggling ever since. He claimed he was
doing okay until he got kicked out and was homeless. That put JG under a lot of stress and
made the symptoms even worse. He has had many recent hospitalizations over the past 2 years
for bipolar symptoms and depression symptoms. He says that his highs and lows are out of
control. JG didn’t talk about if his family had a history of mental illness, but they do struggle
with addiction.
Describe the psychiatric evidence-based nursing care provided and milieu activities attended
Patient safety is the highest priority. The first thing the nurse should do is make sure the
environment is safe for the patient and others around them. They should remove all harmful
objects from the client. The nurse should also maintain close observation of the client to
promote patient safety. On the psychiatric floor at Trumbull Hospital, they have 15-minute
checkups. Encouraging communication between the client and the nurse is also key. As the
nurse, you want your patient to trust you and feel that they can confide in you if they need to
talk. Powerlessness is a problem that individuals with depression go through, especially in this
case of JG. The nurse should empower the patient and allow them to gain control of what is
happening. They should also promote positive self-esteem. The nurse does this by focusing on
the patient’s strengths. “The nurse in the hospital, office, school, or community setting can
provide the essential elements of effective care for depression, including early detection by
screening, medication teaching, depression education, teaching coping skills, and appropriate
Analyze ethnic, spiritual and cultural influences that impact the patient
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Bipolar Disorder and Depression
JG did not talk about any cultural influences. He did say that he was a spiritual person
now but hasn’t always been. During the interview, he talked about how he says that having a
lack of religion in his life is what led to his struggle. JG did say that he has been focusing on his
religion and putting his faith into a “higher being” to help him through this difficult time.
There are several outcomes that this patient should be focused on. He should be
focusing on his mood and trying to prevent further suicide attempts. It is a good thing that he
noticed that he was not in the right mind set and called the ambulance. Hopefully JG will learn
proper communication skills and be able to express how he is feeling with a trusted support
system in the future. Some outcomes may include: Client will seek out staff when feelings of
harming himself begin, and most importantly the client will not harm himself. Another outcome
will be that the client will verbalize symptoms of bipolar/depression in order to know when the
While talking with JG, I did ask the question about his plans after he gets discharged. He
talked about how he is going to a group home in Pittsburgh, Pennsylvania. He was not sure as
to how he was going to get there, but he said he was going to get there anyway he could. JG
says he is going to focus on himself and also with his writing. He wanted to eventually publish a
book of his own and become a famous writer. I would say that JG has a flight of ideas when it
Before the patient is discharged, he will have to be able to verbalize that he understands
his situation. He also needs to be able to acknowledge the symptoms of depression and bipolar
disorder. JG will need to learn adequate coping mechanisms, and how to deal with stress
properly. We talked to the patient about finding a good support system. The patient has been
compliant with his medications, but education was also provided to him to make sure he stays
compliant.
Conclusion
In conclusion, JG does have two serious mental problems. He will have to learn new
coping mechanisms and stay compliant with his medication. After collecting all of the
information about this patient, it seems that he is going in the right direction. The psychiatric
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Bipolar Disorder and Depression
floor in the hospital is helping him through this process by using milieu therapy and
encouragement. Overall, this case study was interesting. There was a lot of information that
was learned during this process. Hopefully, JG’s health will improve after he moves to
Pennsylvania and removes himself from the negative environment that he was been dealing
with.
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Bipolar Disorder and Depression
References
“Bipolar Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 31 Jan.
2018, www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-
20355955.
Townsend, Mary C., and Karyn I. Morgan. Essentials of Psychiatric Mental Health Nursing:
Concepts of Care in Evidence-Based Practice. F.A. Davis Company, 2020.