Case Clip
Bipolar Case Study Introduction
Useful before Locks 1 and 2.
Mood Disorders Escape Room
Escape the Unit
You are the RN team on a high-acuity mood-disorders unit. Clear the bipolar wing, stabilize the depression wing, and finish the handoff before the shift clock runs out.
Every station needs three keys: a clinical call, a digital clue, and an approval code earned after your worksheet checkpoint is reviewed.
Clinical call
Digital clue
Approval code
Unit Progress
0 of 8 locks solved
- Triage Bay
- Safety Huddle
- Ladder
- Med Cart
- Blue Room
- Risk Scan
- Hotline
- Handoff
Evidence Theater
Video Intel
Use these clips when a station tells your team to review the case, symptoms, or medication clues.
Concept Clip
What Is Depression?
Useful before Locks 5 and 7.
Concept Clip
DSM Understanding Mood Related Disorders
Useful when your team needs a symptom refresher.
Pharm Clip
Pharmacology Overview for Bipolar
Useful before Lock 4.
Quick Reference
Use These Before You Guess
The fastest teams keep one eye on the patient data and one eye on the clinical judgment process.
Clinical Judgment
Six-Step Loop
- Recognize cues: notice the relevant data.
- Analyze cues: connect what belongs together.
- Prioritize hypotheses: decide what matters first.
- Generate solutions: choose the safest plan.
- Take action: do the nursing work.
- Evaluate outcomes: decide if the patient is safer now.
Safety Lens
What Beats Speed
- Safety of self and others is always the top priority.
- Acute mania and suicide risk outrank teaching and discharge planning.
- Least restrictive first: verbal, milieu, chemical, seclusion, mechanical restraints.
- When suicide risk is possible, ask directly and escalate quickly.
Medication Radar
Classes To Watch For
- Lithium: mood stabilizer with serum monitoring.
- Anticonvulsants: valproate, carbamazepine, lamotrigine.
- Second-generation antipsychotics: risperidone, olanzapine, quetiapine.
- Third-generation antipsychotics: aripiprazole, brexpiprazole, cariprazine.
- Benzodiazepines: lorazepam, clonazepam for acute agitation or anxiety.
- SSRIs/SNRIs: common antidepressant classes used in depression care.
Lock Rules
What Counts As Cleared
- Each station has two on-screen parts and one worksheet checkpoint.
- The approval code only works after your worksheet section is checked.
- Do not move on until the station opens and the next one unlocks.
- If your team stalls, go back to the evidence and reference lab before guessing.
Case Stations
Clinical Locks
Clear all three keys at each station: the clinical call, the digital clue, and the approval code.
Lock 1: Triage Bay
3 keys required
Jordan Reed, 29, arrived after five days of very little sleep, risky spending, and escalating behavior. Build the first lock by finding the clearest manic evidence.
Chart Snapshot
- Slept 2 to 3 hours per night for five days and reports feeling "fully charged."
- Purchased expensive camera gear at 3:00 a.m. for a "global empire launch."
- Speech is rapid, loud, and difficult to interrupt.
- Frequently changes topic when hallway noises occur.
- Paces the dayroom and interrupts peers' conversations.
Mental Status Fragment
"I do not need sleep. I have a gift and the whole city is about to notice."
Use the bipolar case-study video if your team wants one more symptom example before deciding.
Part 1
Clinical Call
Select the six cues that best support mania.
Part 2
Digital Clue
Map each chart fragment to the clue bucket it fits best.
"Two hours of sleep and still fully charged."
"Global empire launch."
3:00 a.m. spending spree on expensive gear
Topic changes every time a hallway sound appears
Part 3
Worksheet Checkpoint
On your worksheet, record the six mania cues and one sentence explaining why Jordan is unsafe right now. Enter the approval code after it is checked.
Need a quick refresher?
- Strong mania cues include decreased sleep, pressured speech, distractibility, grandiosity, risky behavior, and overactivity.
- Shopping sprees and foolish investments belong in the "clear evidence" pile, not the background-data pile.
Lock 2: Safety Huddle
3 keys required
Jordan is now on the unit. Build the safest first-five-minute nursing plan before you move on.
Part 1
Clinical Call
Which hypothesis takes priority first in the acute phase?
Part 2
Digital Clue
Select the four immediate milieu moves that help lower stimulation and risk.
Part 3
Worksheet Checkpoint
Show your written priority hypothesis and two immediate safety actions. Enter the approval code after it is checked.
Need a quick refresher?
- Acute phase care focuses on safety first, not teaching first.
- A low-stimulation environment, short directions, and predictable limits are part of supportive bipolar care.
Lock 3: De-Escalation Ladder
3 keys required
Build the least-to-most restrictive ladder exactly the way it should happen on the unit.
Part 1
Clinical Call
Order the interventions from least restrictive to most restrictive.
Use calm, concise verbal redirection and consistent limit setting.
Reduce stimulation, move to a quieter space, and shape the milieu.
Give ordered medication for escalating agitation or loss of control.
Use seclusion only if less restrictive strategies fail and safety is threatened.
Apply mechanical restraints only as a last resort according to policy.
Part 2
Digital Clue
Match each scenario to the response level that fits it best.
Client is pacing but responds to one-step redirection.
Client settles after moving to a low-stimulation room.
Ordered PRN medication is needed for escalating agitation.
Client cannot be safe in the open unit after less restrictive efforts fail.
Immediate physical danger continues during a violent assault.
Part 3
Worksheet Checkpoint
Show the completed intervention ladder on your worksheet and explain why mechanical restraints come last.
Need a quick refresher?
- Use the least restrictive option that still keeps the patient and staff safe.
- The ladder on this page follows the exact class order: verbal, milieu, chemical, seclusion, mechanical.
Lock 4: Medication Cart
3 keys required
Stabilize the med cart by sorting classes first, then cracking the lithium range console.
Part 1
Clinical Call
Match each medication to the best class or role.
Lithium
Mood stabilization and suicide-risk reduction.
Mood stabilization and suicide-risk reduction.
Valproate
Example from the anticonvulsant group.
Example from the anticonvulsant group.
Risperidone
Common atypical antipsychotic option.
Common atypical antipsychotic option.
Aripiprazole
Use it to spot a third-generation agent.
Use it to spot a third-generation agent.
Lorazepam
Helpful during acute anxiety or agitation.
Helpful during acute anxiety or agitation.
Part 2
Digital Clue
Crack the lithium range console. Enter the four values exactly.
Part 3
Worksheet Checkpoint
Turn in your med matrix with one example each of a mood stabilizer, anticonvulsant, antipsychotic, and benzodiazepine.
Need a quick refresher?
- Lithium therapeutic range in your source materials: acute mania 0.8 to 1.4 mEq/L, maintenance 0.4 to 1.0 mEq/L.
- Use the pharmacology video if your team wants one more medication overview before submitting.
Lock 5: Blue Room
3 keys required
Maria Lopez, 44, has had a steep decline for more than two weeks. Separate depression cues from mania distractors.
Shift Report
- Stopped painting and no longer attends church activities she used to enjoy.
- Sleeps 12 to 14 hours a day and still reports exhaustion.
- Has eaten very little and lost 8 pounds in two weeks.
- Says, "My family would be better off without me."
- Takes a long time to answer and struggles to focus on questions.
Nursing Note
Maria cries during the interview, calls herself "a burden," and quietly hands her sister online banking passwords "just in case."
Use the depression video if your team wants a quick symptom refresher before sorting the evidence.
Part 1
Clinical Call
Select the seven cues that best support major depression with suicide concern.
Part 2
Digital Clue
Sort each patient statement into the best bucket.
"Nothing feels worth doing, including painting."
"Here are my passwords in case you need them later."
"I can start three businesses this week and never sleep."
"My family would be better off without me."
Long pauses, psychomotor slowing, and difficulty deciding
Part 3
Worksheet Checkpoint
Show your list of five depression criteria and two suicide warning clues before entering the approval code.
Need a quick refresher?
- Key depression clues in your source materials include anhedonia, fatigue, sleep disturbance, appetite change, guilt, poor concentration, and thoughts of death.
- Giving away valuables or preparing accounts for others can push concern toward suicide preparation.
Lock 6: Suicide Screen
3 keys required
Separate background risk, protective factors, and immediate warning signs before the situation worsens.
Part 1
Clinical Call
Sort each clue into the category that fits best.
Previous suicide attempt last year
Heavy alcohol use on weekends
Supportive partner willing to remove firearms and stay present
Can clearly name reasons to live and agrees to collaborate with treatment
Begins giving away jewelry and sentimental items
Says, "I already know which pills I would use."
Increasing social isolation after a recent death in the family
Future-oriented goal of attending a daughter's graduation
Part 2
Digital Clue
Decode part of the SAD PERSONS screen by matching letters to factors.
S
D
P
O
N
Part 3
Worksheet Checkpoint
Show your suicide-risk worksheet with at least three risks, two protective factors, and two warning signs identified.
Need a quick refresher?
- Warning signs are more urgent than background risk factors because they suggest the patient may be closer to acting.
- Protective factors matter, but they do not erase risk.
Lock 7: Hotline Window
3 keys required
When safety is uncertain, the next question matters. Get the question right, then build the next four moves.
Part 1
Clinical Call
Which assessment question is the priority right now?
Part 2
Digital Clue
Select the four immediate follow-up moves that belong right after a "yes" answer.
Part 3
Worksheet Checkpoint
Show your suicide assessment script with at least four follow-up questions or actions.
Need a quick refresher?
- Asking directly does not create suicidality. It clarifies risk.
- Once risk is present, move fast toward plan, means, intent, and safety support.
Lock 8: End-of-Shift Handoff
3 keys required
Finish the shift by connecting the clinical judgment loop to the outcomes you actually want to see.
Part 1
Clinical Call
Match each clinical judgment step to the best nursing move.
Recognize cues
Analyze cues
Prioritize hypotheses
Generate solutions
Take action
Evaluate outcomes
Part 2
Digital Clue
Select the four findings that show the unit is actually becoming safer.
Part 3
Worksheet Checkpoint
Submit your final handoff worksheet with one priority, one intervention, and one evaluation point for each patient.
Need a quick refresher?
- Clinical judgment is a loop: notice, connect, prioritize, plan, act, reassess.
- An outcome only counts if the patient is safer or functioning better than before.
Exit Bay
Shift Locked Down
You cleared every station by using clinical judgment, not just spotting vocabulary words. Hold onto your worksheet packet for the final class debrief.
What Your Team Proved
- You can separate mania from depression using cue clusters.
- You can prioritize safety before teaching or discharge planning.
- You can think in least-restrictive steps and reassess outcomes.
Bring To Debrief
- Your completed worksheet packet
- The hardest lock your team solved
- One medication class and one safety intervention you want to remember