Case Study #3: Bipolar Disorder
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 is 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, "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 not previous history of psychiatric
illness.
The psychiatrist assigned a diagnosis of bipolar I disorder and wrote orders for
chlorpromazine (Thorazine) 50mg IM STAT and PRN chlorpromazine 25mg PO qid, and
lithium carbonate 600mg qid.
Case Study #3- Critical Thinking Questions
The doctor should order a lithium level drawn after 4 to 6 days. What will be an expected
therapeutic level?
The nurse is concerned about lithium toxicity. For what symptoms should the nurse be on
alert for? How are these symptoms different that the expected side effects that many people
experience when they first start lithium?
Why did the physician order chlorpromazine in addition to the lithium carbonate?
Case Study #3:Bipolar Disorder
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 is 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, 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 not previous history of psychiatric illness.
The psychiatrist assigned a diagnosis of bipolar I disorder and wrote orders for
chlorpromazine (Thorazine) 50 mg IM STAT and PRN chlorpromazine 25 mg PO qid, and lithium carbonate 600 mg qid.
Case Study #3-Critical Thinking Questions 3. The doctor should order a lithium level drawn after 4 to 6 days. What will be an expected therapeutic level?
4. The nurse is concerned about lithium toxicity. For what symptoms should the nurse be on alert for? How are these symptoms different that the expected side effects that many people experience when they first start lithium?
5. Why did the physician order chlorpromazine in addition to the lithium carbonate?
