8.6 Learning Activities

Case Study

Jennifer Rogers is a 31-year-old female with bipolar I disorder who was admitted to the hospital last night for surgical repair of a left tibial fracture sustained in a fall during a manic episode. She was diagnosed with bipolar disorder in her mid-twenties, shortly after she was married and graduated from law school. Her most recent manic episode occurred 6 months after her wedding and required hospitalization at that time. She recently stopped taking her medication.

Staff initially had difficulty communicating with Jennifer due to her profound hearing loss and deafness. Jennifer is able to read lips and communicates using American Sign Language. She went to surgery early this morning, shortly after arriving at the ED via ambulance. Post-surgery, she has been admitted to the orthopedic unit and has been there for a couple of hours. She is currently manic, expressing grandiose ideas that she is urgently needed in Washington, D.C., to solve current political issues.

Jennifer is married and has no children. Her sister lives in the area and is supportive. Jennifer works as an attorney who specializes in tax law.

Her husband, Joe Rogers, is in the room with her and is serving as her interpreter at this time.
Jennifer’s injuries were sustained from a fall and altercation at a bar. Paramedics who responded to the 911 call at the bar stated that she was ranting about the government and talking about how her destiny is to be ”an angel,” who can help solve all of our government’s problems. She climbed onto a table in the bar, and in the struggle that ensued with security, she fell off of the table and sustained a tibial fracture.

Jennifer’s husband had contacted the emergency room when he discovered that she was missing from their home last evening, and he was here prior to her surgery. Her sister and he had been searching for her for hours before the accident when they were informed that she had left work early that day. Joe reported that she had not been sleeping or eating much for the past 2 weeks. The last time she stopped taking her medications was 2 years ago, resulting in a manic episode. At that time,  she accumulated over $12,000 in credit card debt on excessive shopping.

Reflective Questions
1. What CUES do you recognize as relevant in providing nursing care for Jennifer?
2. What is your hypothesis for Jennifer’s priority nursing problem(s)?
3. What initial steps should be taken to provide client-centered care to Jennifer?