Question

Bipolar Disorder cc. "Our mother died three weeks ago and we lost our father several months ago. I think that my sister was depressed and just wanted to be with them." HPI. B.J. is a 31 y/o F who was brought to the hospital by ambulance. She was found slumped over in her car in front of the funeral home where memorial services for both her father and mother had been recently held. There were two empty bottles of sleeping pills on the seat beside her and a note that read, “I am going to be with my mom and dad. It is just too sad being here without them. I love you all and you will be in my prayers." When she was found by the director of the funeral home, her hair was oily and unkempt and she smelled as if she had not bathed in a long time. She was dressed in a dirty, orange tee shirt, jeans, and tennis shoes. Recently, per patient's sister, B.J. would call her at odd times of the day, such as 3am just to talk. She would ramble on the phone, become sarcastic and hostile and hang up. She preached about religion and her bad parents and sex. She would also go on 2-3 day shopping sprees and max out credit cards. She was recently started on Lithium which was starting to work. B.J. has not been coping well with the death of her parents. PMH. Episodes of depression first occurred when the patient was a junior in high school and led to psychiatric admissions at 15 and 19 years of age. She met her first husband in the psychiatric ward of the hospital at age 19 following a suicide attempt. The patient was treated with antidepressants and psychotherapy and discharged on both occasions after approximately 5 weeks. She was a foster child with abusive caregivers, biological parents were alcoholics. Patient was diagnosed with bipolar disorder 6 years ago. After her 3d baby, she went into depression. Per sister, patient got weird" after being started on Paxil. SH. 3 daughters, currently in second marriage, has worked as a nurses aid and health insurance adjuster. Smoked 1 ppd for nearly 15 years, history of alcohol abuse with DUIs, history of IVDA but has not used for more than 10 years. Strong history of mental illness-paternal grandmother suffered from depression, two maternal aunts diagnosed with bipolar disorder Both parents had a long history of alcohol abuse Father was previously diagnosed with pancreatitis and then diabetes mellitus Mother has been relatively well and died from a broken heart" Patient has 3 living brothers, 3 sisters and 3 daughters One brother died from AMI at age 34, another brother died at age 6 months FH. Meds. Lithium 600mg PO QAM and 600mg PO QHS Sumatriptan 50-200mg PO PRN Allergies: Aspirin (swelling of the face) ROS. Migraine headaches, 2-3x/month. (-) aura but (+) for nausea, vomiting and photophobia PE and Lab Tests. General Tired looking natient white female in NAD Pl is very nale

Question 1. Why has this patient been taking sumatriptan as needed? (1 pts)

Question 2. Does this patient have lithium toxicity? (1 pts)

Question 3. Identify two significant risk factors for bipolar disorder (2 pts)

Question 4. Describe the two primary types of bipolar disorder. (2 pts)

Question 5. Does this patient have any signs of abnormal hepatic function? (1 pts)

Question 6. Identify two abnormal blood laboratory test results and propose a reasonable explanation for these results. (2 pts)

Question 7. Brain damage may have occurred from this patient’s most recent suicide attempt. List 2 symptoms of brain damage. (1 pts)

Question 8. Does this patient require inpatient treatment or is outpatient therapy totally appropriate? (1 pt)

Question 9. Does this patient have any signs of abnormal kidney function? Why is it important to monitor kidney function in patients taking Lithium? (2 pt)

Question 10. Identify 2 teaching points that you will include in the patient’s discharge plan regarding Lithium? (2 pt)