Reference no: EM133508833

Question: M.Q. is a 31-year-old female who was brought to the hospital by ambulance in an unconscious state. She was found slumped over in her car with two empty bottles of sleeping pills on the seat beside her and a note stating that "I am too tired to keep going on, so I am helping myself to reach eternal sleep." Many of the pills were found on the car floor. The client has oily hair, is unkempt, and body odor suggesting that she has not bathed in some time. She was in a dirty tee-shirt, jeans, and tennis shoes even though the temperatures were near freezing.

M.Q.'s sister came to the hospital when her information was found in the client's purse. M.Q.'s has a long psychiatric history with several suicide attempts, starting at age 15 years of age. Her sister notes that the children in the family were in and out of foster care due to both parent's alcoholism. The sister also noted that M. Q. was diagnosed two years ago with bipolar disorder type 1 after struggling with significant mood swings from significant depression treated with antidepressants to mania episodes. Once she was diagnosed with bipolar 1, she was prescribed lithium, which "seemed to settle her down a little." M.Q.'s husband has recently separated from her as he "couldn't take her constant mood swings." M.Q. works as a nurse's aide, is religious and attends her church services regularly. She has smoked 1 ppd of cigarettes for the past 15 years. She has a history of alcohol abuse and has several Driving While Intoxicated violations. She has a history of IVDA but has not used for more than 10 years. There is a strong family history on her mother's side for depression. On assessment, vital signs were BP 110/72, HR 81 and regular, Resp 16 and unlabored, Temp 98.6 deg F, HT/WT 5'6" 135 lbs. Sat O2 97% on RA. No adventitious sounds auscultated in the lungs, and S1/S2 with no S3/S4 on cardiac auscultation. Other physical assessment was within normal limits. Skin was soft, intact, dry, and very pale and mucous membranes were dry. When client became conscious, she was slightly lethargic, but oriented to person, place, and time. Deep tendon reflexes were full and symmetric. CNs II=XII intact. Speech: no dysarthria, rate normal. Short and long-term memories intact.

Identify the most significant factors for bipolar disorder. Identify the client's three most significant abnormal blood laboratory test results and propose a reasonable explanation for these results. What is suggested by the client's serum TSH, cortisol, and vitamin B12 concentrations. Examining the lithium level, is this within normal range?

What other findings (assessment and laboratory) would concern you for adverse reactions due to serum lithium levels? Does the client require inpatient treatment or is outpatient therapy appropriate at this time? When planning for discharge, what education and resources would you provide to this client?