NRP 556 Sarah O’Neil Reflection

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Sarah O’Neil is a 25-year-old female that introduced to the center for additional stir-up with respect to her explosions of crying at work, feeling overpowered, and exhausted, resting for extended periods of time, not having energy, and having irregular contemplations of self-destruction. She had hypomania, a lack of sleep, and a lot of energy prior to this hypomania and lack of energy. 

A diagnosis of bipolar disorder, as opposed to other mood disorders, could be made, according to Dunphy, in patients who experience psychotic symptoms, have episodes of hypomania or hypomania, have a family history of bipolar disorders, are younger than 25 years old or are not responsive to treatment (2019).

NRP 556 Sarah O’Neil Reflection

As per the iHuman contextual investigation for a person to be determined to have bipolar turmoil, they should meet the measures for a hyper episode that was gone before by a hypomanic episode or a significant burdensome episode (iHuman). Increased self-esteem, decreased need for sleep, increased talkativeness, racing thoughts, distraction, increased risk-taking behavior, increased goal-directed behavior, and psychomotor agitation is typical signs of the episode (Dunphy, 2019). Prior to her depressed hypomanic state, Sarah acknowledged having experienced an episode of hypomania. 

A few weeks earlier, Sarah had a hypomanic episode in which she had less sleep, more energy, a better mood, and more goal-directed activities like writing and getting things done. She was also grandiose, her thoughts were racing, and her speech was pressured. Hypomania and manic episodes are the defining characteristics of bipolar disorder (Hosang et al., 2022). Her fluctuating energy levels—when she had high levels of energy and then dropped to an all-time low—ruled out borderline personality disorder. Sarah does exhibit signs and symptoms of anxiety and depression; however, the hypomanic and manic phases of her illness rule out anxiety and depression, leaving us with bipolar disorder 2 as a possible diagnosis.

Since we cannot diagnose patients with bipolar disorders as family nurse practitioners, we must know which ICD 10 codes to use for each visit with a patient who is experiencing symptoms related to bipolar disorder. One analysis that can be utilized for this visit is sadness with the ICD 10 code of F32 because of her inclination discouraged and the absence of self-worth. One more conclusion that can be utilized for Sarah is uneasiness with an ICD 10 code of F41.96 since she has been feeling restless and unwell. 

NRP 556 Sarah O’Neil Reflection

Sarah has been suspicious of her coworkers and has the impression that they are conspiring against her and writing everything down. To describe her behavior and code the visit, one could use the ICD-10 diagnosis of paranoid delusional disorder (F22). Sarah conceded that she would have discontinuous considerations of needing to take her life yet expressed she wouldn’t do so in light of her loved ones. The ICD-10 diagnosis of suicidal ideation or thoughts would be R45.851. Sarah has been experiencing low self-esteem, sleeping more than usual, and experiencing excessive exhaustion. 

The codes for low self-esteem are R45.81, low energy is R53.83, and hypersomnia is G47.19. Sarah has a variety of symptoms that can be diagnosed and categorized on their own; however, her final diagnosis is bipolar disorder type 2, which is a condition that only FNPs can truly diagnose. The correct picture will be created for the office visit by making use of the codes that we are permitted to document.

A qualified healthcare professional should be referred to a patient who has been diagnosed with bipolar disorder type 2 in order to prescribe the appropriate treatment plan. We should refer patients who are suspected of having bipolar disorder type 2 to a psychiatrist for definitive treatment because family nurse practitioners cannot accurately diagnose bipolar disorder type 2. Because this disease will require continuous monitoring throughout one’s life, having the right treatment plan is crucial. As per the AHCCCS site, all patients ought to approach the self-destruction or emergency hotline number in the event that somebody encounters a social well-being emergency (AHCCCS, 2022).

NRP 556 Sarah O’Neil Reflection

Patients who are diagnosed with bipolar disorder type 2 should, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), have a consistent routine that they are supposed to stick to, eat well while trying to get regular exercise in, take their medications as prescribed, even if they feel well, keep a journal that tracks their mood, update their primary care provider on their care plan after seeing a counselor or psychiatrist, be reminded not to drink or use drugs, and have a support network (SAMHSA).

In the essential consideration setting I would need to get a reference ready so that Sarah O’Neil for her might see a specialist and I would set her up with a gathering with a nearby emergency guide so she could get more assets and have a care group or a help individual, she could go to. I would explain to Mrs. O’Neil what bipolar disorder type 2 is and what to look for if her diagnosis keeps getting worse so that she knows when to get help. It will be crucial to ensure that Sarah has a social worker who can follow up on her to ensure that she is complying with her new diagnosis. I would like the social worker to talk to Sarah to make sure she is aware of her diagnosis, the possible treatment plan, when to get help, and whether or not she actually poses a threat to herself. 

Sarah needs a comprehensive plan that begins with the primary care provider referring her to a psychiatrist, counselor, support group, and social worker for assistance in finding resources. Continual follow-ups are then required to monitor her behavior and ensure that her treatment plan is working as intended. According to Kerslake (2022), Healthline provides eight distinct support groups that can assist a patient in making the diagnosis of bipolar disorder type 2. Counselors or support groups can help a person who has just been diagnosed with bipolar disorder type 2 keep an eye on them to make sure they don’t go into full-blown mania or psychosis.

NRP 556 Sarah O’Neil Reflection

As indicated by SAMHSA, patients ought to constantly have support gatherings, and the best gathering to have is your loved ones. If you inform your close friends and family about your diagnosis, they will be better able to assist you in the event that therapy fails or the patient becomes a danger to themselves. Sarah will have a follow-up appointment with her primary care provider after meeting with the psychiatrist and counselor to learn more about the treatment plan. 

Sarah ought to be prompted that she might feel improved in 2-3 weeks with drugs, yet the full impact isn’t seen for a couple of months. I would closely monitor Sarah and have her go to the primary clinic for a follow-up visit every three months to make sure her treatment plan is effective for her and that she is feeling well. When Sarah is feeling quite a bit improved, she will be encouraged to continue to accept her prescriptions as endorsed and will be prescribed to have a subsequent once-a-year in the essential consideration office, however, she is to follow up as frequently as the specialist needs her to. Persistent observation is vital to a remedial treatment plan for Sarah.


Arizona AHCCCS. 2022.

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. Primary care: The art and science of advanced practice nursing—an interprofessional approach (5th ed.). F. A. Davis.

Hosang GM, Martin J, Karlsson R, et al. Association of Etiological Factors for Hypomanic Symptoms, Bipolar Disorder, and Other Severe Mental Illnesses. JAMA Psychiatry. 2022;79(2):143–150. 


IHuman Sarah O’Neil case.

Kerslake, Risa. 2022. The 8 Best Bipolar Support Groups of 2022.

Substance Abuse and Mental Health Services Administration. 2022. Living Well with Bipolar Disorder.