Case Summary
Mania is a mental state characterized by elevated mood, racing thoughts, excessive energy, and a decreased need for sleep. It sometimes includes psychotic symptoms such as delusions or hallucinations. Isabella suffered from bipolar mania, which has greatly affected her social life and decisions. Her husband (Hector) was shocked by some of her behaviors of wearing heavy makeup, leaving the house at night, buying a laptop for a neighbor’s child, and abnormal hyperactivity.
In bipolar disorder, mania may occur as part of a manic episode or a mixed episode. A manic episode is diagnosed if an individual has an abnormal high mood plus three or more other symptoms of mania. Isabella had signs and symptoms such as grandiose beliefs, engaging in risky behaviors, decreased need for sleep, and pressured speech. According to the case presented, Isabella did not sleep properly; she could not sleep for more than 2-3 hours each night for the past week. She also had pressured speech; the nurse noticed that Isabella was irritable and spoke rapidly in half Spanish and English while switching from one topic to another. Similarly, Isabella had hyperactivity since she was actively helping in community cleaning, and church and was also too focused on assisting other patients. Some of her grandiose actions included wearing provocatively and heavy makeup, which could be intended to dress impressively. Equally, Isabella involved herself in risky behaviors, such as trying to leave the house at night, which would have led to her attack by robbers.
Additionally, as a bipolar patient, Isabella needed some safety concerns that required immediate attention following her risky behaviors. One of the behaviors was leaving the house late; it can be risky for a lady to walk alone at night because there is an increased risk of being assaulted, robbed, or raped. Similarly, Isabella was overworking herself as a result of hyperactivity which could harm her because too much work exhausts the body and leads to a state of chronic stress (Sanders et al., 2017). Another safety concern is the throwing of furniture in the house; the lady is living with her husband (Hector) and her two children, aged 7 and 11 years, respectively. These young children could get knocked by the chairs thrown by their mother carelessly into the room.
Moreover, as a bipolar mania patient, I would recommend a few foods for Isabella. I would advise her to take foods that are high in protein and healthy fats, such as omega-3s, which are essential because they aid in stabilizing blood sugar levels and provide energy. In addition, I would recommend plenty of fruits and vegetables because they are high in antioxidants and other nutrients that help to protect the brain from damage. She should also avoid processed foods and sugary drinks, both of which can increase inflammation in the brain and make it harder for cells to communicate with each other. Regarding culture and communication, I would consider a few elements. Concerning culture, I will learn some of the offensive practices so as not to offend Isabella, who is already irritable. Undertaking some of Isabella’s hated activities could trigger her anger (hitting someone with an object). On the other hand, I would practice direct communication since, as a mania patient, she suffers from poor judgment. Direct communication will ensure that Isabella is only executing instructions and not thinking for herself.
There are two key reasons why Isabella would have stopped taking the lithium medication. She might have stopped taking her lithium medication because she might have felt that she is no longer experiencing any symptoms. It is important to evaluate why Isabella stopped taking their prescribed medications and to ensure that the patient understands the importance of adhering to their treatment plan. Medications such as lithium are essential in helping to control the symptoms of bipolar disorder. When medication is not taken as prescribed, it can lead to a relapse in symptoms and can be dangerous for the patient (Jawad et al., 2018). In some cases, discontinuing medication without first consulting with a healthcare professional can even lead to death.
Furthermore, I will consider it important to monitor Isabella’s lithium levels if the medication is restarted. I would anticipate doing a blood test to measure lithium levels in her bloodstream. This measurement will be necessary to ensure that the medication level is therapeutic and not toxic. Additionally, I will also order other lab tests, such as a complete blood count (CBC) or thyroid function tests, to screen for any potential side effects of lithium therapy. When communicating with Isabella, I will be aware of her intense and rapid mood swings and avoid topics that could potentially upset or anger her. Likewise, it is important to monitor fluid intake for patients taking lithium medication to treat bipolar mania because dehydration can increase the risk of lithium toxicity (Barroilhet & Ghaemi, 2020). Lithium toxicity can cause serious side effects, including vomiting, diarrhea, nausea, and seizures. Therefore, it is important for patients taking lithium medication to drink plenty of fluids and stay hydrated.
In addition, lithium observation medication administration is essential because it helps to regulate mood and behavior. It can help prevent or manage episodes of mania, hypomania, depression, and aggression. It is a very effective medication when used in combination with other medications and therapy. Conversely, there are essential elements for medication monitoring if Isabella resumes lithium. Firstly, the blood level of lithium should be monitored to ensure therapeutic levels are reached and maintained. Too much lithium can lead to toxicity, while too little lithium may not be effective in treating mania (Sani et al., 2017). Secondly, liver function should be observed, as lithium can cause liver damage in some people. Thirdly, renal function (kidney function) should also be monitored, as lithium can cause renal impairment in some individuals. Lastly, the signs and symptoms of overmedication, such as nausea, vomiting, drowsiness, muscle weakness, ataxia/incoordination, or under medication which includes anxiety and irritability, should be as well be checked.
Subjective and Objective Data
Objective and subjective data cues that should guide my nursing care for Isabella include:
- A family history of bipolar disorder.
- A personal history of bipolar disorder.
- Presence of psychotic symptoms, such as delusions or hallucinations (Chaudhary et al., 2021).
- History of suicide attempts.
- Use of alcohol or drugs.
- Unstable or rapidly changing moods (irritability, hostility, argumentative)
- Sleeping too little or too much.
- Provocative, aggressive, deluded, or out-of-control behavior.
- Speech patterns (pressured speech, rapid switching between topics).
Maslow’s Hierarchy of Needs
The physiologic, safety, belonging, and self-esteem needs of Isabella can be arranged in order of priority as follows:
- Physiologic needs; are the most important and need to be met first; for example, food, water, shelter, and sleep. Isabella should sleep more than 2-3 hours, as she does in most cases.
- Safety needs; these entail safety and protection from danger, such as trying to move out at night.
- Belonging needs; these are the feelings connected to others and a sense of being part of something larger than oneself.
- Self-esteem needs; these include feeling good about oneself, having a positive view of oneself, and being respected by others. Disrespect may increase her irritability, thus leading to her committing suicide due to her poor judgment condition.
Bipolar Mania Description Process
Mania can be characterized by hyperactivity, euphoria, racing thoughts, distractibility, and poor judgment. Some symptoms of mania include: talking too fast, jumping from one idea to another, being easily distracted, fatigue, unusual talkativeness, and decreased sleep (Mayo Foundation for Medical Education and Research, 2021). They may also engage in risky behavior due to poor decisions, such as spending sprees, sexual promiscuity, and substance abuse, and becoming extremely angry or irritable. The main neurotransmitters involved in bipolar disorder are dopamine, serotonin, and norepinephrine (Siddique et al., 2018). During manic episodes, there is an excess of dopamine and norepinephrine (Coryell, 2022). This causes symptoms such as increased energy, feelings of euphoria, impulsiveness, and decreased need for sleep. During depressive episodes, there is a decrease in serotonin levels leading to feelings of sadness or hopelessness, decreased energy, changes in appetite or weight, and difficulty sleeping.
There are several tests needed for patients on lithium medication. The first test is a CBC to check for anemia, infection, and other abnormalities. The second one is the thyroid test to make sure the patient’s thyroid gland is working normally. The third test will be the kidney function test to ensure proper kidney functionality, as well as blood tests to measure levels of sodium, potassium, calcium, and magnesium in the blood (Devanand et al., 2018). These tests are necessary because lithium can cause serious side effects if it builds up to high levels in the body. Moreover, mania can lead to risky behavior and put the patient’s safety at risk. Patients in a manic state may be more likely to take unnecessary risks, such as violent outbursts, sexual indiscretions, driving dangerously, or spending money irresponsibly.
Mania Nursing Interventions
- Mood stabilizers like lithium are typically prescribed to help control manic episodes (Barroilhet & Ghaemi, 2020).
- Monitor electrolytes – an imbalance can trigger mania symptoms or make them worse.
- Provide nutritional support, including adequate protein and essential vitamins and minerals, since malnutrition can worsen mania symptoms (Lobo et al., 2020).
- Encourage regular sleep and a healthy lifestyle – lack of sleep and poor lifestyle habits can worsen mania symptoms.
- Administer medication as prescribed by the prescribing physician; many medications are effective in treating bipolar mania, but it is important to work with a doctor to find the best medication regimen for each individual.
- It is vital to monitor a person with bipolar disorder for suicidal thoughts or behaviors, especially during a manic episode.
The therapeutic range for lithium is 0.6 to 1.0 mmol/L; a lithium drug card should include information on what the therapeutic range is and how to monitor levels. Lithium toxicity can occur at levels above 2 mmol/L, so it is vital to stay within the therapeutic range (Barroilhet & Ghaemi, 2020). Above all, mild lithium toxicity includes nausea and vomiting, drowsiness and confusion, muscle weakness, as well as increased thirst and urination. On the other hand, moderate toxicity is ataxia, dystonia, tremor (trembling or shaking), and seizures; then severe toxicity is coma and death.
References
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Mayo Foundation for Medical Education and Research. (2021). Bipolar disorder. Mayo Clinic. Web.
Sanders, A. F., Hobbs, D. A., Stephenson, D. D., Laird, R. D., & Beaton, E. A. (2017). Working memory impairments in chromosome 22q11. 2 deletion syndrome: The roles of anxiety and stress physiology. Journal of Autism and Developmental Disorders, 47(4), 992-1005. Web.
Sani, G., Perugi, G., & Tondo, L. (2017). Treatment of bipolar disorder in a lifetime perspective: Is lithium still the best choice?Clinical Drug Investigation, 37(8), 713-727. Web.
Siddique, S. A., Tamilselvan, T., Vishnupriya, M., & Balamurugan, E. (2018). Evaluation of neurotransmitter alterations in four distinct brain regions after rapid eye movement sleep deprivation (REMSD) induced mania-like behaviour in Swiss albino mice.Neurochemical Research, 43(6), 1171-1181. Web.