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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 is a 29 y/o female who is married with two children ages 2 and 4.

She has a diagnosis of Bipolar Disorder. Today she presents hyperverbal, & pacing constantly.

Her last episode was one of mania that required hospitalization. She is wearing alot of makeup.

She reports that her mood is better than it has been in a long time and she has lots of energy.

She has been shopping at the mall and spending alot of money. She is sleeping 2 hrs per night.

She states that things are finally getting better with her illness.

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?

How is hypomania different from mania?

Case Study Progress

Lithium (Eskalith) is commonly used to treat bipolar disorder. S.T. has been taking lithium for several years.

5. S.T.’s maintenance lithium level results are reported as 0.2mEq/L. Interpret these results

6. What other laboratory examinations should be routinely performed while S.T. is taking


7. What instructions should have been given to S.T. when she began lithium therapy?

8. Aside from lithium, what other medications are used to treat bipolar disorder?

9. Even though she has been taking lithium for a year, you review some teaching about drug

therapy with S.T. Which statement by S.T. reveals a need for further education?

a. “I will call my doctor if I have severe vomiting or diarrhea.”

b. “I need to be careful because lithium is addictive.”

c. “I take the lithium tablets with meals.”

d. I will keep my appointments to have my drug levels checked.”

10. Given her history of bipolar disorder, what should you teach S.T. to minimize mood swings?

Case Study Outcome

S.T. is told that her lithium level is NOT within normal limits, and states, “I need to take my medication daily and not skip doses.”

She reports she will be compliant with her medications and followup with therapist.

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