Chapter 8
Case Study
- What CUES do you recognize as relevant in providing nursing care for Jennifer?
Jennifer has a diagnosis of Bipolar I disorder and is currently experiencing a manic episode, as indicated by grandiose delusions, elevated energy, poor sleep, and minimal food intake. She recently stopped taking her medications, which is consistent with her previous manic episode that led to hospitalization and significant financial consequences. She has a profound hearing loss and primarily communicates using American Sign Language, although she is currently relying on her husband to interpret. She sustained a tibial fracture during a manic event at a bar, which required surgical repair. Postoperatively, she remains in a manic state and demonstrates impaired judgment and impulsivity. She has a history of wandering behavior and leaving work early, which, along with her poor self-care, reflects declining stability. Jennifer also has a supportive sister and husband, which may be important to her care planning.
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What is your hypothesis for Jennifer’s priority nursing problem(s)?
Jennifer’s priority nursing problems likely include risk for injury due to impaired judgment and recent orthopedic surgery, impaired communication due to her deafness and lack of a certified interpreter, and disturbed thought processes related to her manic state. Other concerns include nonadherence to her medication regimen, sleep pattern disturbance, and possible imbalanced nutrition due to limited food intake during her episode. Overall, she is at high risk for both physical and psychiatric complications, and her current symptoms suggest she requires close monitoring, structured care, and psychiatric support.
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What initial steps should be taken to provide client-centered care to Jennifer?
The first step is to ensure Jennifer’s safety through fall precautions and close monitoring, especially given her recent surgery and impulsive behavior. It is essential to arrange for a certified medical interpreter proficient in American Sign Language to support accurate communication, rather than relying on her husband, to respect her autonomy and comply with HIPAA guidelines. Creating a calm and structured environment will help reduce stimuli that could worsen her manic symptoms. Medication administration should begin as prescribed, with monitoring for effectiveness and side effects. The care team should provide orientation and reassurance to help ground Jennifer when she is experiencing delusions. Pain management, support with nutrition, and sleep hygiene should be addressed. Finally, psychiatric consultation should be requested, and the family should be involved as appropriate to support her recovery and continuity of care.
Answers to interactive elements are given within the interactive element.
