Question

Alice, age 29, had been working in the typing pool of a large corporation for 6 years. Her immediate supervisor recently retired and Alice was promoted to supervisor, in charge of 20 people in the department. Alice was flattered by the promotion but anxious about the additional responsibility of the position. Shortly after the promotion, she overheard two of her former coworkers saying, “Why in the world did they choose her? She’s not the best one for the job. I know I certainly won’t be able to respect her as a boss!” Hearing these comments added to Alice’s anxiety and self-doubt.

Shortly after Alice began her new duties, her friends and coworkers noticed a change. She had a great deal of energy and worked long hours on her job. She began to speak very loudly and rapidly. Her roommate noticed that Alice slept very little, yet seldom appeared tired. Every night she would go out to bars and dances. Sometimes she brought men she had just met home to the apartment, something she had never done before. She bought lots of clothes and makeup and had her hair restyled in a more youthful look. She failed to pay her share of the rent and bills but came home with a brand new convertible. She lost her temper and screamed at her roommate to “Mind your own business!” when asked to pay her share.

She became irritable at work, and several of her subordinates reported her behavior to the corporate manager. When the manager confronted Alice about her behavior, she lost control, shouting, cursing, and striking out at anyone and anything that happened to be within her reach. The security officers restrained her and took her to the emergency department of the hospital, where she was admitted to the psychiatric unit. She had no previous history of psychiatric illness.

The psychiatrist assigned a diagnosis of Bipolar I Disorder, and wrote orders for olanzapine (Zyprexa) 10 mg IM STAT, olanzapine 15 mg PO daily, and lithium carbonate 600 mg qid.

Answer the following question related to Alice:

Remember to include in-text citations and your references at the end

What are the most important considerationswith which the nurse who is taking care of Alice should be concerned?

Why was Alice given a diagnosis of bipolar disorder? Did she meet the DSM 5 criteria for the diagnosis of bipolar disorder?  

The doctor should order a lithium level drawn after 4 – 6 days. For what symptoms you should be on the alert?

What is the rationale behind the physician ordering olanzapine in addition to lithium carbonate?

Answer 1

The nurse who is taking care of Alice should be very concerned about self harming and others. Because these type of patient may experience two types of behavior ie.,mania and depression .Now she is in manic stage exhibiting her anger,irritability, behavior change

Alice experienced most if the signs and symptoms of bipolar mood disorder Luke

• Insomnia( due to work)
• Increased energy level( working more than need)
• Behavior change ( with the roommate,bringing men home)
• Anxious
• Self doubt
• Being happy in the night time spending time on dancing and in bars

By exhibiting these symptoms she falls in the DSM5 criteria for diagnosing bipolar mood disorder

The lithium test is done to check the mood level ,thinking and behavior because it acts on the central nervous system if brain in doing these functions. The doctor can diagnose the suicidal thought of patient with these level.It also helps to identify whether the patient is in manic or depressive mood.

Olanzipine is an antipsychotic drug used as adjunctive or in mono therapy to treat manic or depressive or mixed disorder in bipolar disorder