1. The nurse in charge of the ward should never have allowed
the patient to have free unmonitored access to a telephone while he was in a manic state. She is responsible for overseeing the care of the patients on the ward and making sure they do not engage in harmful, destructive or inappropriate behavior. The patient should have been receiving medication to control his manic episodes. If his manic episodes are not controlled, then the nurse should notify his doctor so that his medication regimen can be changed. The telephone should be located outside the locked ward so that its use can be monitored by the nurse in charge of the ward. No patient should be allowed to use it unmonitored. Patients in manic states of bipolar disorder exhibit delusions of grandeur which seems to have been the case here, with the patient ordering pizza for every patient on the ward (Soreff and McInnes, 2004). The nurse in charge should have been aware of his behavior becoming exaggerated and that he was getting out of control, and called the doctor for a medication adjustment then, and this incident would have been avoided. Since the problem arose because the patient had not been monitored correctly, the nurse in charge should be held responsible for the cost of the pizzas.
2. This patient suffering from major depression is manifesting signs of committing suicide by wanting to give away personal possessions, saying she won't need them anymore after Saturday (Depression, 2005). The nurse should ask the patient why she won't need the sweater anymore to make sure that the suspicion is correct. If the patient has a plan for committing suicide, the nurse should immediately place the patient on suicide watch and document the findings. At the same time, she should provide the patient with supportive care, and try to engage her in conversation to find out what she is feeling and why she no longer wants to live. She should find out the significance...