A Case Study on Bipolar I disorder

In Partial Fulfillment of the Course Requirement In Medical Surgical Nursing

Presented to the Faculty of Cebu octor!s "ni#ersity College of Nursing

Rosales Stephen Seclon $ose %eodoro P& BSN III ' (

September )*+ ),,-

Table of Contents I. II. III. Introduction Objectives Nursing Assessment

1. Personal History 2. Diagnostic Results 3. Present ro!ile o! "unctional Healt# Patterns $. Pat#o #ysiology and Rationale I%. Nursing Intervention 1. &are guide o! atient 'it# disease condition 2. Actual Patient &are %. %I. (valuation and Recommendation (valuation and Im lication o! t#is &ase study to) Nursing Practice Nursing (ducation Nursing Researc# %II. *ibliogra #y

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IN%R. "C%I.N

*i olar disorder is a mood disorder t#at involves e+treme mood s'ings !rom e isodes o! mania to e isodes o! de ression. It is !ormerly ,no'n as manic de ressive disorder. During t#e manic #ase- clients are eu #oric- grandiose- energetic- and slee less. .#ey #ave oor judgement and ra id t#oug#ts- actions and s eec#. During de ressed #ases- mood- be#avior and t#oug#ts are t#e same as in t#e eo le diagnosed 'it# major de ression. /#ereas a erson 'it# major de ression slo'ly slides into de ression t#at can last !or 0 mont#s to 2 years- t#e erson 'it# bi olar disorder cycles bet'een de ression and normal be#avior 1bi olar de ressed2 or mania and normal be#avior 1bi olar manic2. A erson 'it# bi olar mi+ed e isodes alternates bet'een major de ressive and manic e isodes inters ersed 'it# eriods o! normal be#avior. (ac# mood may last !or 'ee,s or mont#s be!ore t#e attern begins to descend or ascend once again. *i olar disorder ran,s second only to major de ression as a cause o! 'orld'ide disability. .#e li!etime ris, o! bi olar disorder is at least 1.23- 'it# a ris, o! com leted suicide o! 143. *i olar disorder occurs almost e5ually among men and 'omen. It is more common in #ig#ly educated eo le. *ecause some eo le deny t#eir mania- revalence rates may be #ig#er t#an re orted. &lients o!ten do not understand #o' t#eir illness a!!ects ot#ers. .#ey may sto ta,ing medications because t#ey li,e t#e eu #oria and !eel burdened by t#e side e!!ects- blood testsand #ysicians6 visits needed to maintain treatment. *i olar I disorder is treatable 'it# a li!etime regimen o! syc#otro ic drugs in combination 'it# syc#ot#era y. .#roug# t#is case study- /e- t#e student nurse 'ill be able to gain ,no'ledge on #o' to deal and understand atients 'it# *i olar I disorder. It 'ill also #el in #o' to give t#e ro er care and treatment to t#e atient. 7iss /endy &anto- 28 year old !emale- '#o #as been staying in %icente 9otto &enter !or be#avioral sciences since :anuary 2;- 2<<;- is su!!ering !rom *i olar I Disorder.

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.B$(C%I/(S &lient = &entered A!ter 2 'ee,s o! giving #olistic nursing care to t#e atient- t#e atient 'ill be able to) 4. establis# trust and satis!ying relations#i 'it# t#e student nurse 0. state and understand t#e reason !or #er admission 8. maintain good grooming and ersonal #ygiene ;. maintain ade5uate #ydration and rest >. react accordingly to'ards stress!ul situations by using ro er co ing mec#anisms 1<. e+ ress !eelings !reely and a ro riately 9tudent Nurse = &entered A!ter 2 'ee,s o! giving #olistic nursing care to t#e atient- t#e student nurse 'ill be able to) 1. introduce sel! to t#e client and establis# trust 'it# t#e client 2. state t#e ur ose o! interaction 3. encourage client to artici ate in t#era ies and ot#er activities rendered by student nurse $. render a ro riate #olistic nursing care to t#e client 4. teac# client some #ealt#y co ing s,ills t#e

Mental Status (0amination ?eneral A earance

.#e atient 'as 'earing a '#ite s#irt and jogging ants. 9#e loo,s !res# a!ter a bat# and #er #air 'as already combed nicely. 9#e #as a good osture '#en standing and or 'al,ing. 9#e #as a good gait '#en 'al,ing. 9#e maintains a good eye to eye contact '#en interacting 'it# anot#er atient or 'it# student nurses. .#e atient is estimated to be $ !eet > inc#es tall and 'as about $4 ,ilograms in 'eig#t. .#e atient 'ears no ma,eu and doesn6t #ave any evidence o! scars or lacerations on bot# u 7otor Activity .#e atient can 'al, inde endently and #as a good gait. No tremors or motor tics noted on t#e atient. 9#e artici ates in t#e morning stretc# every morning. 9#e #as com lete !reedom o! movement and doesn6t s#o' any di!!iculties '#en moving. 9#e doesn6t #ave any mannerisms or gestures. 9#e smiles '#enever somebody greets #er. 9#e only s#o's #y eractivity '#enever s#e sees a good loo,ing guy around. ?eneral Attitude .#e atient artici ates and coo erates very 'ell on #er activities. 9#e is co#erent and attentive during interactions 'it# student nurses or to ot#er atients. 9#e is interested to interact 'it# ot#ers. 9#e is very !riendly to student nurses and greets t#em '#enever t#ey assed by. 9 eec# Pattern .#e atient s ea,s in a lo' ad 'ell modulated voice. 9#e #as no di!!iculties in tal,ing and ans'ers t#e 5uestions clearly. 9#e also organi@es #er sentences correctly and doesn6t use any unusual terms '#en tal,ing. 9#e doesn6t demonstrate ec#olalia or 'ord salad during interactions. er and lo'er e+tremities. .#e atient #as no 'rin,les. 9#e loo,s congruently t#e same 'it# ot#er 21 years old !emale.

(motions 7ood 9#e verbali@es t#at s#e !eels #a y every time student nurses come inside t#e 'ard. 9#e seems to be com!ortable during t#e interaction. A!!ect 9#e smiles to every student nurses t#at asses by during t#e interaction. 9#e greeted t#e eo le s#e ,ne' 'it# a smile inside t#e 'ard.

"orm o! .#oug#t .#e atient ans'ers t#e 5uestions as,ed correctly- s#e doesn6t s#o' any signs o! !lig#t o! ideas'ord salad- or ec#olalia. .#e atient as,s t#e student nurse to re eat 5uestions !or clari!ications. 9#e #as t#e ability to concentrate during t#e interaction but gets bot#ered '#enever a good loo,ing guy is around. 9#e is co#erent during t#e interaction. &ontent o! .#oug#t During t#e interaction- t#e atient is co#erent and coo eratively ans'ered t#e 5uestions correctly. 9#e is not mani ulative. 9#e doesn6t #ave any signs o! delusions- #allucinations or illusions during t#e interaction. 9#e also doesn6t #ave any ideas o! suicide or #omicide. 9#e didn6t mention any !ear or #obias. Perce tual Disturbances .#e atient doesn6t demonstrate any signs o! auditory- visual or ol!actory #allucinations or illusions during t#e interaction. 9#e #as no alteration in erce tion o! #ersel! or to t#e environment. 9ensorium and &ognitive Ability .#e atient can still recall stress!ul or #a y memories be!ore admission. 9#e is still a'are o! t#e date and time. 9#e is conscious and alert during t#e interaction. 9#e ,no's '#ere s#e is. 9#e also

,no's '#y s#e is con!ined in t#e syc#e 'ard. 9#e can verbali@e t#e !eeling o! #a iness or sadness. 9#e also #as a good abstract t#in,ing. Im ulse &ontrol .#e atient #as t#e ability to control #er anger to'ards someone- es ecially to t#e attendant '#ic# s#e t#in,s #as jealousy on #er. 9#e t#in,s t#at t#e attendant doesn6t 'ant #er to #ave a student nurse. *ut still- s#e is able to control #er anger and !ear to'ards t#at situation. 9#e doesn6t #ave t#e !eeling o! guilt. 9#e #as a se+ual !eeling disturbances- s#e gets easily attracted to good loo,ing guys and ma,es #er move to ,no' t#at guy rig#t a'ay '#enever s#e sees one. :udgment and Insig#t .#e atient is ca able in ma,ing #er o'n decisions es ecially on stress!ul situations. 9#e #as t#e ability to solve #er o'n roblems. 9#e t#in,s s#e needed #el or treatment t#at6s '#y s#e6s inside t#e 'ard- no'- s#e t#in,s s#e is already in good condition. 9#e 'ants to go #ome already. 9#e is also conscious and a'are o! #er actions being done. 9#e doesn6t 'ant o be isolated t#at6s '#y s#e is be#aving really very good inside t#e syc#e 'ard.

III& N"RSIN1 ASS(SSM(N% 1.1 Patient6s Pro!ile Name) &anto- /endy Age) 21 years old 9e+) !emale &ivil status) single Religion) Roman &at#olic &om laints) Amagsige ug la,a' la,a'B Im ressionCDiagnosis) *i olar 1 disorder- most recent e isode manic 'it# mood congruent to syc#otic !eatures P#ysician) Dr. Adol!o

1.2 "amily and Individual In!ormation- 9ocial and Healt# #istory) .#e atient /endy &anto- 21 years old is !rom *ato- Deyte. .#ey are ; in t#e !amilys#e only #as one brot#er. 9#e #as a sister living in 7andaue &ity- &ebu. Her arents are staying in *ato- Deyte. Her mot#er 'as diagnosed 'it# *i olar 1 disorder. 9#e drin,s occasionally and s#e doesn6t smo,e. 9#e doesn6t #ave allergies e+ce t !or dust. 9#e 'as admitted in t#e %977& center !or be#avioral sciences !or t#e t#ird time. 9#e 'as broug#t to t#e 7abolo olice station because o! t#e com laint o! a ta+i driverAnagsa,ay ug ta+i- dili mobayad unya nag#ubo naB according to t#e ta+i driver. 9#e 'as t#en broug#t to %977& admitted- diagnosed 'it# bi olar 1 disorder. A!ter 2 'ee,s- t#e atient 'as disc#arged and im roved. 9#e 'as accom anied by a social 'or,er to bring #er bac, to *atoDeyte. 1 'ee, later- atient 'as again seen at t#e ier area. 9#e 'as able to esca e !rom t#e social 'or,er because s#e doesn6t 'ant to go #ome. 9#e 'as broug#t by t#e ier o!!icials bac, to t#e 'ard t#en subse5uently admitted 'it# t#e same diagnosis. 9#e 'as disc#arged a!ter 3 'ee,s. "or t#e t#ird time- t#e atient 'as broug#t bac, to %977& center !or be#avioral sciences by a concerned citi@en '#o s#e claims to be #er boy!riend. According to t#e com anion- Amagsige siya la,a' la,a'- ma,uya'an ,o basin ma#ilabtan- gi a inom na sad siya ug beerB. 9#e 'as broug#t in !or consult and 'as disc#arged. A!ter a !e' #ours- s#e 'as broug#t bac, to t#e syc#iatric 'ard) Amagsige ug la,a'2+- dili na a ugongB according to t#e com anion. 9#e 'as admitted and diagnosed 'it# t#e same disorder.

1.3. Devel o! ?ro't# and Develo ment 1.3.1. Normal Develo ment at articular stage) Physical e#elopment Peo le in t#eir early 2<s are in t#eir rime #ysical years. .#e musculos,eletal system is 'ell develo ed and coordinated. .#is is t#e eriod '#en at#letic endeavors reac# t#eir ea,. All ot#er systems o! t#e body are also at ea, e!!iciency.

Alt#oug# #ysical c#anges are minimal during t#is stage- 'eig#t and muscle mass may c#ange as a result o! diet and e+ercise. In addition- e+tensive #ysical and syc#ological c#anges occur in regnant and lactating 'omen. Psychosocial e#elopment In contrast to t#e minimal #ysical c#anges- syc#osocial develo ment o! t#e young adult is great. Eoung adults !ace a number o! ne' e+ eriences and c#anges in li!estyle as t#ey rogress to'ard maturity. &#oices must be made about education and em loyment- about '#et#er to marry or remain single- about starting a #ome- and about rearing c#ildren. 9ocial res onsibilities include !orming !riends#i s and assuming some community activities. Occu ational c#oice and education are largely inse arable. (ducation in!luences occu ational o ortunities) conversely- an occu ation- once c#osen- can determine t#e education ortunities and usually ensures economic needed and soug#t. (ducation en#ances em loyment o

survival. As t#e role o! 'omen #as c#anged- many 'omen no' c#oose to assume active careers and civic roles in society in addition to t#eir roles as mot#er and C or 'i!e. Remaining single is becoming t#e li!estyle o! more and more young adults. 7any eo le c#oose to remain single- er#a s to ursue and education and t#en to #ave t#e !reedom to ursue t#eir c#osen vocation. 9ome unmarried individuals c#oose to live 'it# anot#er erson o! t#e o osite or same se+ and s#are living arrangements and certain e+ enses. 9ome eo le '#o are gay or lesbian commit t#emselves legally to a artner as in marriage. Alt#oug# nontraditional li!estyles are becoming more acce table in society- attitudes to'ards t#ese various li!estyles can contribute social ressures t#at lead to stress res onses. .#e multi le roles o! adult#ood may also create stress as a result o! role con!lict. Cogniti#e e#elopment Piaget believes t#at cognitive structures are com lete during t#e !ormal o erations eriod!rom roug#ly 11 to 14 years. "rom t#at time- !ormal o erations c#aracteri@e t#in,ing t#roug#out adult#ood and are a lied to more areas. (gocentrism continues to declineF #o'ever according to

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Piaget t#ese c#anges do not involve a c#ange in t#e structure o! t#oug#t- only a c#ange in its content and stability. Recently- researc#ers in t#e !ield o! syc#ology #ave suggested t#at Piaget6s !ormal o erational stage is not t#e last stage o! #uman develo ment. 9ome #ave ro osed a conce t o! ost !ormal t#oug#t. Post!ormal t#oug#t- sometimes called t#e roblem !inding stage- is c#aracteri@ed by Acreative t#oug#t in t#e !orm o! discovered roblems- relativistic t#in,ing- t#e !ormation o! generic roblems- t#e raising o! general 5uestions !rom illGde!ined roblems- t#e use o! intuition- insig#t and #unc#es- and t#e develo ment o! signi!icant scienti!ic t#oug#tB. In addition to t#e adolescent ability to t#in, in abstract terms- ost !ormal t#in,ers ossess an understanding o! t#e tem orary or relative nature o! ,no'ledge. .#ey are able to com re#end and balance arguments created by bot# logic and emotion

Diagnostic Results
None

Present Pro!ile o! "unctional Healt# Patterns

3.1 Healt# Perce tionC Healt# 7anagement Pattern .#e client usually described #ersel! as good. Rig#t no' during #er stay in t#e syc# 'ard- s#e describes #er #ealt# as !air. In order !or #er to be #ealt#y- s#e eats #e meals- drin,s #er medications and joins t#e morning stretc# !or t#e e+ercise. 9#e ta,es a bat# in t#e morning and grooms #ersel! suc# as brus#ing #er teet#. .#e robable cause o! #er bi olar disorder 'as t#at it 'as #ereditary #er mot#er 'as diagnosed be!ore. 3.2 NutritionalH7etabolic Pattern 9#e usually eats t#e 3 meals served to #er 1brea,!ast- lunc#- dinner2 9#e usually drin,s a !e' amount o! !luids- about 2G3 glasses a day. 9#e #as no restrictions or re!erences in !ood. 9#e usually ears bee!- em anada- !is#- and vegetables. Her a etite is good and does not encounter any roblems in eating. 9#e can !eed #ersel!.

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3.3 (limination Pattern 3.1.1 *ladder .#e atient does not #ave any com laints 'it# #er usual attern o! urinating. 9#e does not use any assistive devices eit#er. 3.1.2 *o'el 9#e usually de!ecates once every t#ree to !our days. .#e color is usually bro'n. 9ometimes s#e encounters consti ation or di!!iculty in de!ecation. 9#e does not use any assistive devices '#ile de!ecating.

3.$ ActivityG(+ercise Pattern (veryday in t#e morning s#e joins t#e morning stretc#. In t#e morning s#e eats brea,!ast. .#en s#e ta,es a bat# and brus#es #er teet# and goes bac, to #er room. 9ometimes s#e goes out and sits on t#e benc#es. 9#e usually 'as#es #er clot#es on 7ondays. .#e client is ca able o! ambulating but moves very slo'ly sometimes. *ut s#e is ca able o! bat#ing- dressing and grooming. 9#e doesn6t #ave any com laints on dys nea or !atigue. 3.4 &ognitive Perce tual Pattern .#e client does not #ave any sensory de!icits. 9#e does not use any glasses or #earing aids. 9#e is able to erceive ain- #eat and cold. 9#e is ca able o! reading and 'riting. 3.0 RestG9lee Pattern 9#e usually slee s at 8 m and 'a,es u around 8 or ; in t#e morning. 9#e #as ade5uate slee ing #ours 1about 1<G12 #ours o! slee 2. 9#e does not need any slee ing aids. 9#e does not #ave any di!!iculty in remaining or !alling aslee . 3.8 9el! Perce tion .#e client is concerned o! #er condition. 9#e 'ants to go #ome already. And sometimes tal,s about #er mot#er. 9#e #o es to get better. 3.; Role Relations#i Pattern

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&ommunication) .#e language t#e client s ea,s is &ebuano. Her s eec# is not really clear and sometimes it is #ard to understand '#at s#e is saying. .#e client6s verbali@ation is unclear. 9#e is ca able o! 'riting. 9#e does not usually use any gestures '#ile communicating. (ye to eye contact is oor. Relations#i .#e client lives 'it# #er !amily- also toget#er 'it# #er mot#er. 9#e usually does t#e decision ma,ing in t#e !amily. .#ey do not #ave any con!licts 'it# t#eir !amily members. 3.> 9e+uality .#ere #asn6t been any c#ange in #er se+ual relations. 3.1< &o ingG9tress 7anagement Pattern 9#e can ma,e decisions alone. /#enever s#e is tense or under stress- s#e usually rays and as,s #el !rom ?od !or guidance. .#e client said t#at in order !or t#e nurse to rovide #er 'it# more com!ort and security- s#e 'ants t#e nurse to be t#ere 'it# #er i! ever s#e needs any assistance. 3.11 %aluesG*elie! 9ystem .#e client !inds a source o! strengt# !rom ?od. 9#e believes t#at religion or ?od is im ortant to #er. 9ome o! t#e usual religious ractices s#e does are raying everyday and going to mass every 'ee,.

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$. Pat#o #ysiology and Rationale

2&3 Normal Anatomy and Physiology of the Ner#ous System

C(N%RA4 N(R/."S S5S%(M I. *RAIN)

Cerebrum6 Gdivided by a dee groove into 2 sections called cerebral #emis #eres. &erebral &orte+ 1outermost art2 o De!t &orte+) systematic analysis- language- s eec#- mat#ematics- abstract- reasoning o Rig#t &orte+G assimilation o! sensory e+ eriences- dancing- music- art a reciationgymnastics &or us &allosum 4 Dobes o! &erebral &orte+) "rontal) o voluntary motor activityo *roca6s areaGcom le+ muscular activity o! tongue- mout#- laryn+ 1res onsible !or e+ ressive s eec#2 o Pre!rontal areas) concentration- motivation- !ormulateCselect goals- lanninginitiateCmaintainCterminate actions- sel! monitor- ability to use !eedbac,- emotional stability- roblem solving activities Parietal) o tactile sensations 1tem erature- touc#- ressure2 o &once t !ormation- abstraction o Rig#tGorientation- a'areness o! si@e and s#a es1stereognosis2- ro rioce tion o De!tG assists 'it# rig#tGle!t orientation and mat#ematics Occi ital) o &ontains visual rece tive and visual association areas. o 9tores visual memories

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.em oral) o &ontains rimary auditory rece tive area I secondary auditory association areas o D(".G s o,en language memories o RI?H.G ot#er sound memories t#at are not language 1 music- noise- animal sounds2 o /ernic,e6s areaGcontains cells t#at !acilitate understanding language &entral o /#ere nerve !ibers !or taste and ot#er association !ibers asses be!ore reac#ing cerebral corte+ and arietal lobe

7ippocampus Part o! t#e medial section o! t#e tem oral lobe (ssential role in t#e rocess o! memory

Basal 1anglia 9tructures includes caudate nucleus- utamen- globus allidus- substancia nigrasubt#alamic nucleus Processing station t#at lin, t#e cerebral corte+ to t#alamic nuclei &ontrol o! com le+ motor activity

iencephalon o .#alamus) c#annels all ascending 1sensory2 in!ormation e+ce t smell- to t#e a ro riate cortical cells o Hy ot#alamus) regulates AN9 !unctions 1#eart rate- *P- 'aterGelectrolyte balance- body tem erature- #unger- slee G'a,e!ulness2- regulator o! ituitary gland 4imbic System &enter !or !eelings and control o! emotional e+ ression

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(ssential role in t#e inter retation o! smells 1it receives nerve !ibers !rom ol!actory bulbs2

Brain Stem o 7idbrain) visual and auditory re!le+es o Pons) Auditory rocessing- secretes nore ine #rine and serotonin o 7edulla Oblongata)%oluntary motor- auditory and ain at#'ays- tactile- tem erature

Reticular Formation &om osed o! a com le+ net'or, o! gray matter- ascending reticular at#'ays and descending reticular at#'ays. Assists in regulation o! s,eletal motor movement and s inal re!le+es "ilters incoming sensory in!ormation to t#e cerebral corte+ ReticularGActivating 9ystem controls slee G'a,e cycle and consciousness

Cerebellum Integrates sensory in!ormation related to t#e osition o! body arts &oordinates s,eletal muscle movement and regulates muscle tension '#ic# is necessary !or balance and osture &erebellar eduncles o In!erior Gsensory at#'ays !rom s inal cord and medulla Gcarry in!ormation related to t#e osition o! body arts o 7iddle Gcarry in!ormation about voluntary motor activities o 9u erior Gsends im ulses !rom cerebellum to t#e brain stem- t#alamus and corte+

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II. 9 inal &ord

Ascending and escending Path8ays Ascending1sensory2) carry sensory in!ormation t#roug# t#e s inal cord to t#e brain Descending 1motor2) carry mostly e!!erent signals to t#e s inal cord

III. Protective and Nutritional 9tructures

Cranium and /ertebral Column Meninges 3 membranes t#at envelo e t#e brain and s inal cord !or rotection o Pia mater o Arac#noid o Dura 7ater Cerebrospinal Fluid Blood Brain Barrier Prevents some drugs !rom crossing into t#e brain

P(RIP7(RA4 N(R/."S S5S%(M

Spinal Ner#es &onsists o! a dorsal and ventral root '#ic# unite to !orm a s inal nerve 31 airs o! s inal nerves) ; cervical- 12 t#oracic- 4 lumbar- 4 sacral- 1 coccygeal Cranial Ner#es Ol!actory O tic Occulomotor .roc#lear .rigeminal Abducens 10

"acial %estibulococ#lear ?losso #aryngeal %agus Accessory Hy oglossal

A"%.N.MIC N(R/."S S5S%(M

G coordinates involuntary activities suc# as visceral !unctions- smoot# and cardiac muscle c#anges and glandular res onses. Sympathetic Ner#ous System G&oordinates activities used to #andle stress o *P and HR increases o Pu ils dilate o Rela+ation o! *ronc#ial muscles o Increased s'eating o Piloerection

Parasympathetic Ner#ous System GAssociated 'it# conservation and restoration o! energy stores and is geared to act locally and discretely !or a longer duration. o Increased motility and secretion o! ?I. o Decreased Heart Rate o &onstriction o! *ronc#i o Rela+ation o! urinary bladder s #incters o Pu ils constrict

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$.2 9c#ematic Dra'ing o! t#e Develo ment o! *i olar 1

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Preci itating !actors) J9ubstance abuse 1alco#olism- drug abuse2 J&#anges in biological r#yt#ms 1including slee - seasonal and #ormonal c#anges2 JPsyc#ological stressors JP#ysical and syc#ological trauma 1stro,e- #y erintense lesions2

Predis osing !actors) JHereditary !actors 1#istory o! syc#ologic illness) de ression and bi olar disorder2 J*iologic !actors 1neuroc#emical imbalances2 JNeuroendocrine !actors

Imbalance in t#e catec#olamines in t#e brain 1Nore ine r#ine- serotonin- do amine2

9igns and sym toms 17anic #ase2 1. In!lated sel! esteem or grandiosity 2. Decreased need !or slee 3. 7ore tal,ative t#an usual or ressure to ,ee tal,ing $. "lig#t o! ideas 4. Distractibility 0. Psyc#omotor agitation 8. (+cessive involvement in leasurable activities t#at Have #ig# otential !or ain!ul conse5uences 1De ressive #ase2 1. De ressed mood 2. Diminis#ed interest or leasure in all or most activities nearly everyday 3. 9igni!icant 'eig#t loss $. Insomnia 4. Psyc#omotor agitation 0. "atigue 8. "eeling o! 'ort#lessness ;. Diminis#ed ability to t#in, >. Recurring t#oug#ts o! deat# 21

isease process6 *i olar Disorder I .#e e+act syc#o at#ology o! t#is condition is yet to be determined but several t#eories suggest t#at it arises !rom a com le+ interaction o! genetic dis osition- neuroc#emical in!luencesanatomical variations- substance abuse- and stress!ul erinatal and c#ild#ood e+ eriences. I. *iologic .#eories) ?enetic t#eories ?enetic studies im licate t#e transmission o! major de ressive !irstGdegree relatives- '#o #ave t'ice t#e ris, o! develo ing de ression com ared 'it# t#e general o ulation. "irstGdegree relatives o! eo le 'it# bi olar disorder #ave a 33 to ;3 ris, o! develo ing bi olar disorder com ared 'it# a 13 ris, in t#e general o ulation. "or all mood disorders- mono@ygotic 1identical t'ins #ave a concordance rate 1bot# t'ins #aving t#e disorder2 t'o to !our times #ig#er t#an t#at o! di@ygotic 1!raternal2 t'ins. Alt#oug# #eredity is a signi!icant !actor- t#e concordance rate !or mono@ygotic t'ins is not 1<<3- so genetics alone does not account !or all mood disorders 1,elsoe-2<<42 7ar,o'it@ and 7ilrod 12<<42 discussed indications o! a genetic overla bet'een earlyG onset bi olar disorder and early onsetGalco#olism. .#ey noted t#at eo le 'it# cycling- oorer res onse to lit#ium- slo'er rate o! recovery- and more #os ital admissions. 7ania dis layed by t#ese clients involves more agitation t#an elationF clients may res ond better to anticonvulsants t#an to lit#ium. II. Neuroc#emical .#eories Neuroc#emical in!luences o! neurotransmitters 1c#emical messengers2 !ocus on serotonin and nore ine #rine as t#e t'o major biogenic amines im licated in mood disorders. 9erotonin #as many roles in be#aviour) mood- activity- aggressiveness and irritability- cognition- ainbior#yt#ms- and neuroendocrine rocess. De!icits o! serotonin- its recursor try to #an- or a metabolite o! serotonin !ound in t#e blood or cerebros inal !luid occurs in eo le 'it#

22

de ression. Positron emission tomogra #ies demonstrate reduced metabolism in t#e re!rontal corte+- '#ic# may romote de ression. Nore ine #rine levels may be de!icient in de ression and increased in mania. .#is catec#olamine energi@es t#e body to mobili@e during stress and in#ibits ,indling. Kindling is t#e rocess by '#ic# sei@ure activity in a s eci!ic area o! t#e brain is initially stimulated by reac#ing a t#res#old o! t#e cumulative e!!ects o! stress- lo' amounts o! electric im ulses- or c#emicals suc# as cocaine t#at sensiti@e nerve cells and at#'ays. .#ese #ig#ly sensiti@ed at#'ays res ond by no longer needing a stimulus to induce sei@ure activity- '#ic# no' occurs s ontaneously. It is t#eori@ed t#at ,indling may underlie t#e cycling o! mood disorders as 'ell as addiction. Anticonvulsants in#ibit ,indlingF .#is may e+ lain t#eir e!!icacy in t#e treatment o! bi olar disorder. Dysregulation o! acetylc#oline and do amine also are being studied in relation to mood disorders. &#olinergic drugs alter moodslee neuroendocrine !unctionand t#e electroence #alogrG #ic atternF t#ere!ore- acetylc#oline seems to be im licated in de ression and mania. .#e neurotransmitter roblem may not be as sim le as under roduction or de letion t#roug# overuse during stress. &#anges in t#e sensitivity as 'ell as t#e number o! rece tors are being evaluated !or t#eir roles in mood disorders. Neuroendocrine in!luences Hormonal !luctuations are being studied in relation to de ression. 7ood disturbances #ave been documented in eo le 'it# endocrine disorders suc# as t#ose o! t#yroid- adrenalarat#yroid- and ituitary. (levated glucocorticoid activity is associated 'it# t#e stress res onseand evidence o! increase cortisol secretion is a arent in about $<3 i! clients 'it# de ression'it# t#e #ig#est rates !ound among older clients. Post artum #ormone alterations reci itate mood disorders suc# as ost artum de ression and syc#osis. About 43 to 1<3 o! eo le 'it# de ression #ave t#yroid dys!unction- notably an elevated t#yroidGstimulating #ormone. .#is roblem must be corrected 'it# t#yroid treatment- or treatment !or t#e mood disorders is a!!ected adversely.

23

Psyc#odynamic .#eories 7any syc#odynamic t#eories about t#e cause o! mood disorders seemed to Ablame t#e victimB and #is or #er !amily. "reud loo,ed at t#e sel!Gde reciation o! eo le 'it# de ression attributed t#at sel!Gre roac# to anger turned in'ard elated to eit#er a real or erceived loss. "eeling abandoned by t#is loss- eo le becomes angry '#ile bot# loving and #ating t#e lost object. *iring believed t#at one6s ego 1or sel!2 as ired to be ideal 1t#at is- good and loving- su erior or strong2 and t#at to be loved and 'ort#y- one must ac#ieve t#ese #ig# standards. De ression results '#en in reality- t#e erson 'as not able to ac#ieve t#ese ideals all t#e time. :acobson com ared t#e state o! de ression to a situation in '#ic# t#e ego is a o'erless- #el less c#ild victimi@ed by t#e su erego- muc# li,e a o'er!ul and sadistic mot#er '#o ta,es delig#t n torturing t#e c#ild. 7ost syc#oanalytical t#eories o! mania vie' manic e isodes as a Ade!enseB against underlying de ression- 'it# t#e id ta,ing over t#e ego and acting as an undisci lined #edonistic being 1c#ild2. 7eyer vie'ed de ression as a reaction to a distressing li!e e+ erience suc# as event 'it# syc#ic causality. Horney believed t#at c#ildren raised by rejecting or unloving arents 'ere rone to !eeling o! insecurity and loneliness- ma,ing t#em susce tible to de ression and #el lessness. *ec, sa' de ression as a resulting !rom s eci!ic cognitive distortions in susce tible eo le. (arly e+ eriences s#a ed distorted 'ays o! t#in,ing about one6s sel!- t#e 'orld- and t#e !utureF t#ese distortions involve magni!ication o! negative events- traits- and e+ ectations and simultaneous minimi@ation o! any ositive.

2$

.reatment) Psyc#o #armacology 1. Dit#ium = is a salt contained in t#e #uman body- it is similar to gold- co er- magnesiummanganese- and ot#er trace elements. Res onse rate in acute mania to lit#ium t#era y is 8<3 to ;<3. In addition to treating t#e range o! bi olar be#aviours- Dit#ium also can stabili@e bi olar disorder by reducing t#e degree and !re5uency o! cycling or eliminating manic e isodes 1?ris'old I Pessar- 2<<2 2. &arbama@e ine = used in grand mal and tem oral lobe e ile sy as 'ell as !or trigeminal neuralgia- 'as t#e !irt anticonvulsant !ound to #ave moodGstabili@ing ro erties- but t#e t#reat to agranulocytosis 'as great. 3. %al roic acid = ,no' as dival roe+ sodium or sodium val roate- is an anticonvulsant used !or sim le absence and mi+ed sei@ures- migraine ro #yla+is- and mania. .#e mec#anism is unclear. $. ?aba entin- Damotrigine- and .o iramate = anticonvulsants sometimes used as moodstabili@er- but are used less !re5uently t#an val roic acid. 4. &lona@e am = anticonvulsant and a ben@odia@e ine used in sim le absence and minor motor sei@ures- anic disorder- and bi olar disorder. .#is drug may be used in conjunction 'it# lit#ium or ot#er mood stabili@ers but is not used alone to manage bi olar disorder. Psyc#ot#era y 9omatic t#era ies) 1. (&. 1(lectroconvulsive t#era y2 #as been used '#en clients resent 'it# treatmentGresistant or severe de ression. 2. .79 1.ranscranial magnetic stimulation2 'as recently introduced as an alternative somatic t#era y. In t#is t#era y- stimulation is a lied over t#e le!t dorsolateral re!rontal corte+ to minimi@e occurrence o! sei@ures. 3. P#otot#era y- or e+ osure to brig#t arti!icial lig#t can mar,edly reverse de ression

24

$. %N9 1%agus nerve stimulation2 = a acema,er li,e device is surgically im lanted in t#e le!t side o! t#e c#est sends tiny electric s#oc,s into t#e vagus nerve in t#e nec,- and t#e nerve t#en relays messages dee into t#e brain. It is believed t#at %N9 #el s regulate t#e release o! neurotransmitters in t#e brain Interactive .#era ies 1. Inter ersonal t#era y 2. "amily t#era y 3. ?rou t#era y $. &ognitive t#era y 4. *e#avioral syc#ot#era y

20

Psychodynamics6 Actual !actors t#at led to t#e develo ment o! disorder) Preci itating !actors) Abusive !amily members Previous se+ual #arassment Peer ressure Predis osing !actors) JHereditary !actors 1mot#er is diagnosed 'it# bi olar 12 J*iologic !actors 1neuroc#emical imbalances2

Imbalance in t#e catec#olamines in t#e brain 1Nore ine r#ine- serotonin- do amine2

9igns and sym toms 1mani!ested2 17anic #ase2 1. In!lated sel! esteem or grandiosity 2. Decreased need !or slee 3. 7ore tal,ative t#an usual or ressure to ,ee tal,ing $. Distractibility 1De ressive #ase2 1. De ressed mood 2. Diminis#ed interest or leasure in all or most activities nearly everyday 3. Insomnia $. "eeling o! 'ort#lessness 4. Diminis#ed ability to t#in,

28

$.$&lassical &linical

2;

C4ASSICA4 S5MP%.M 7anic #ase) 1.In!lated sel! esteem or grandiosity

C4INICA4 S5MP%.M 7ani!ested

RA%I.NA4( &lients 'it# mania #ave e+aggerated sel! esteem. .#ey believe t#ey can accom lis# anyt#ing. .#ey rarely discuss t#eir sel! conce t realistically. &lients 'it# mania can go days 'it#out slee or !ood and not even reali@e t#ey are #ungry or tired. &lients e+ eriencing manic e isode t#in, move and tal, !ast. &ognitive ability is con!used and jumbled 'it# t#oug#ts racing one a!ter t#e ot#er. &lients cannot connect conce ts and jum !rom one subject to anot#er .#e ability to concentrate or ay attention is grossly im aired because t#e ersons attention s an is brie! &lients 'it# mania e+ erience syc#omotor agitation and seem to be in er etual motion. 9itting still is di!!icult. &lients in t#e manic #ase do not consider t#e ris,s involved in t#ese activities. &lients 'it# de ression describe t#emselves as #o eless- #el lessdo'n- or an+ious .#ey e+ erience an#edonialosing any sense o! leasure !rom activities t#ey !ormerly enjoyed. &lients in t#e de ressive #ase mani!est 'eig#t loss !rom lac, o! a etite or disinterest in eating. 9lee disturbances are common) eit#er clients cannot slee or t#e 2> !eel e+#austed and unre!res#ed no matter #o' muc# time t#ey

2.Decreased need !or slee

7ani!ested

3. 7ore tal,ative t#an usual or ressure to ,ee tal,ing $. "lig#t o! ideas

7ani!ested

Not mani!ested

4. Distractibility

7ani!ested

0. Psyc#omotor agitation

Not mani!ested

8. (+cessive involvement in leasurable activities t#at Have #ig# otential !or ain!ul conse5uences 1De ressive #ase2 1. De ressed mood

Not mani!ested

7ani!ested

2. Diminis#ed interest or leasure in all or most activities nearly everyday 3. 9igni!icant 'eig#t loss

7ani!ested

Not mani!ested

$. Insomnia

7ani!ested

I/& Nursing Inter#ention

1. &are ?uide o! Patient 'it# disease condition
Care for Patients with Bipolar 1 PHAR7A&ODO?I& .R(A.7(N. 1. Dit#ium 2. &arbama@e ine 3. %al roic acid $. Anticonvulsants P9E&HO9O&IAD .R(A7(N. AND R(HA*IDI.A.ION 1. Patient and !amily education 2. 9u ortive .#era y 3. Individual t#era y $. "amily t#era y 4. Re#abilitation 0. (&. 1(lectroconvulsive t#era y2 8. .79 1.ranscranial magnetic stimulation2 ;. P#otot#era y Actual atient care)

3<

Name o! atientF &anto- /endy /ardF &#ie! com laint) magsige ug la,a' la,a'

age)21

Nursing care lan NeedsC roblemsC cues I Psyc#ologic overload Objective cues) Restlessness Irritable Overe+cited Distractability Agitation 9ubjective cues) Agana#an na,o moga'as diri ste #- ,ay nay sige amantay na,o samo, ayu- dag#an a jud ,uting sa #igdaanB as verbali@ed by t#e atient Nursing diagnosis 7ild an+iety related to uncom!ortable environment 9cienti!ic basis An+iety is a vague !eeling o! discom!orta !eeling o! a re#ension caused by antici ation o! danger or ast e+ eriences. 9ource) syc#iatric mental #ealt# nursing Objectives o! care ?eneral objectives) a!ter 2 'ee,s o! nurse client interaction t#e client 'ill be able to demonstrate e!!ective co ing strategies in dealing 'it# an+iety Nursing actions Rationale

7easures to develo co ing strategies) 1. rovide Gcalm sa!e and calm environment environment #el s client to control over '#at mig#t #a en 2. encourage G!eeling o! atient to tal, isolation about decreases !eelings and concerns G#el s client 3. teac# im rove rela+ation roblem tec#ni5ues solving s,ills and learns to lo'er level o! an+iety G#el s in $. encourage reducing atient to an+iety artici ate in daily activities G rovides a 4. be !eeling t#at available to t#ere is a client !or su ort tal,ing and erson listening Gto determine 0. revie' t#ose t#at are

31

co ing s,ills used in t#e ast 8. rovide com!ort measures II Psyc#ologic overload Objective cues) Restlessness Increased irritability Dar, circles around t#e eye "re5uent ya'ning 9ubjective cues) Asa,it man a,ong #idgaan diri raman ,o matog sa ling,oranan ,ay dag#an ,uting didtounya 'a na od laing lugar didtoB as verbali@ed by t#e atient 9lee attern disturbance) !re5uent a'a,ening related to un com!ortable slee ing area Psyc#iatric commorbidities t#at are common in clients 'it# *i olar 1 disorder include antisocial be#avioran+iety be#avior and conduct disorder. &linical sym tom o! manic e isode includes !lig#t o! ideas and decrease need !or slee . &lients 'it# mania can go in days 'it#out slee or !ood. 9ource) syc#iatric mental #ealt# nursing ?eneral objectives) a!ter 2 'ee,s o! nurse client interaction t#e client 'ill be able to re ort im rovement on rest and slee 7easures to im rove rest and slee ) 1. encourage artici ation in regular e+ercise rogram o! daytime 2. assist client to develo individual rogram o! rela+ation 3. recommend midmorning na

#el !ul in current roblems Gto limit degree o! stress source) saunders 3rd edition

Ge+ercise at bed time may stimulate and not rela+ client Gto en#ance client6s ability to !all aslee Gna ing in t#e a!ternoon can disru t normal slee ing at nig#t Gcom!ortable bed gives good rest Gto reduce need !or nig#t time elimination Gca!!eine can inter!ere 'it# slee

$. rovide com!ortable bed !or rest 4. limit !luid inta,e in evening 0. instruct atient to avoid ca!!eine at nig#t 8. increased

32

#ysical activity at daytime

G #ysical activity at daytime gets t#e atient tired. source) saunders 3rd edition

III #ysiologic overload Objective cues) Psyc#omotor agitation Irritability (levated mood (asily distractible 9ubjective cues) Aa'ayun jud na,o na siyanaa ,oy rig#t diri- di,o gana#an ubos iya tan a' na,oB as verbali@ed by t#e atient

Ris, !or injury related to e+treme #y eractivity during manic #ase o! bi olar disorder

During manic e isode- t#e individual e+#ibits an abnormal ersistently elevated or irritable mood. Im airment in various areas o! !unctioningsyc#otic sym toms and t#e ossibility o! sel! #arm e+ists. 9ource) syc#iatric mental #ealt# nursing 8t# edition

?eneral objectives) A!ter 2 'ee,s o! nurse client interaction t#e client 'ill be able to demonstrate be#aviorsli!estyle c#anges to reduce ris, !actors and rotect sel! !rom injury

7easures to reduce ris, !actors and rotects client !rom injury 1. maintain lo' level o! stimuli in t#e environment 2. rovide !re5uent rest eriods 3. rovide structured activities $. rovide !re5uent #ig# calorie !luids 4. redirect violent be#aviors 0. encourage use o! tec#ni5ues to reduceC manage vent emotions 8. encourage artici ation in sel!G#el

G#els decrease escalation o! an+iety G revents e+#austion G rovides !ocus G revents de#ydration G #ysical e+ercise can decrease tension and rovide !ocus G#el s decrease anger

Gto en#ance sel!Gesteem source)

33

rograms

saunders 3rd edition

3$

Patient6s Name) &anto- /endy

age) 21 years old *RLN9/I&K D(N9 7OD(D

se+) !emale

1. syc#ologic overload) an+iety &ues) irritable restless ness overe+cited G distractible

7easures to demonstrate e!!ectice co ing strategies 1. rovide sa!e and calm environment 2. encourage atient to tal, about !eelings 3.teac# rela+ation tec#ni5ues $. encourage atient to artici ate in daily activities 4.be available !or client in listening 0. rovide com!ort measures

A case of Miss Canto, bipolar1 d/order with chief complaints of sigeg lakaw2x

2. Psyc#ologic overload) slee attern disturbance &ues Gincreased irritability G !re5uent ya'ning

1. 7ild an+iety related to uncom!ortable environment 2. Disturbed slee attern) !re5uent a'a,ening related to uncom!ortable sleeping area

7easures to im rove slee and rest 1. encourage artici ation on regular e+ercise rogram at daytime 2.assist to develo a rogram o! rela+ation 3. recommend midmorning na $. limit !luid inta,e in t#e evening 4. instruct atient to avoid ca!!eine 0.increase #ysical activity at daytime

8<3 resolution o! #ysiologic I syc#ologic roblems.

Grestlessness 3. ris, !or injury related to 3. P#ysiologic overload) ris, !or injury Gdar, circles around t#e eye manic #ase o! &ues bi olar 1 G Irritation disorder Gelevated mood Geasily distractible Gsyc#omotor agitation

7easures to reduce ris, !or injury 1. maintain lo' level o! stimuli in t#e environment 2. rovide !re5uent rest eriods 3. rovide structured activities $. rovide #ig# calorie inta,e 4. redirect violent be#avior 0. encourage to use tec#ni5ues to manage vent emotions 8. encourage artici ation in sel! #el

Actual 9tate A!ter 2 'ee,s o! burse clinet interaction t#e clinet 'ill be able to gain ,no'l'dge- attitude and s,ills in managing bi olar 1 disorder

!b"ecti#es of care$ after %&'() mins of n*rse'clinet interaction, the client will be able to$ 1+ demonstrate effecti#e coping strategies on anxiet, 2+ report impro#ement on rest and sleep pattern %+ demonstrate beha#iors to red*ce risk factors and protects self from in"*r,

Desired Outcome

30

Drug t#era eutic record DrugC doseC !re5uencyCroute 7ec#anismC classi!ication IndicationsC contraindications Indications) G syc#otic disorder Gmanic #ase !or manicGde ressive Grestlessness and a re#ension Gadjunct in treatment o! tetanus &ontraindications) Gdrug allergy Gcomatose Gseverely de ressed GPar,inson6s disease Gliver damage 9C() Gdro'siness Ginsomnia Gvertigo Gort#ostatic #y otension Gdry mout# Gblurred vision Princi les o! .reatment care G use cautiously 'it# res iratory disorders G discontinue i! /*& is de ressed G D& i! serum creatinine level becomes abnormal G monitor &*& Gavoid e ine #rine Ggive drug as rescribed G avoid alco#ol Gavoid over t#e counter drugs Gavoid activity t#at re5uires alertness G romote sa!ety G rovide oral care Gre ort !or side e!!ects Guse 'it# caution in #ot 'eat#er (valuation

&#lor roma@ine Anti syc#otic 1<<mg tab H9 An+iolytic Anti syc#otic drug bloc, ost syna tic do amine rece tors in t#e brain de ress arts o! t#e brain involves in 'a,e!ulness.

38

DrugC doseC 7ec#anismC IndicationsC !re5uencyCroute classi!ication contraindications &arbama@e ine 2<<mg tab PO Antie ile tic Antie ile tic activity may be related to its ability .o in#ibit olysyna tic res onses and bloc, ost =tetanic otentiation. Related to .&A6s. Indications) Gre!ractory sei@ure dCo Gtrigeminal neuralgia Gbi olar 1 disorder Gneurogenic diabetes insi idus &ontraindications) Gbone marro' de ression G#y ersensitivity G regnancy lactation 9C() Gdi@@iness Gdro'siness Gnausea Gvomiting Gunsteadiness

Princi les o! care Guse cautiously 'it# #istory o! adverse #ematologic reaction Garrange !or !re5uent eye e+am G&*& monitoring Gdo not discontinue abru tly Garrange !or urinalysis

.reatment

(valuation

Ggive drug 'it# !ood Ginstruct to s'allo' tablet '#ole Ginstruct to avoid alco#ol Gavoid activities t#at re5uire alertness G romote sa!ety Ggive drug as e+actly as rescribed

3;

DrugC doseC 7ec#anismC !r5uencyCroute classi!ication Halo eridol 2<mg M tab OD Do aminergicG bloc,ing agent Anti syc#otic 7ec#anism not !ully understoodanti syc#otic bloc,s ost syna tic do amine rece tors in t#e brainde ress t#e RA9including t#ose arts o! t#e brain t#at are involved 'it# 'a,e!ulness and emesis.

IndicationsC contraindications Indications) G syc#otic disorder Gtourettes syndrome Gbe#avioral roblem in c#ildren G#y eractive c#ildren &ontraindications) G#y ersensitivity Gcoma Gsevere &N9 de ression GPar,inson6s disease Gliver damage 9C() GDry mout# Gnausea and vomiting Gseating Gdro'siness G#eadac#e Gvertigo

Princi les o! care Guse cautiously 'it# regnancy and lactation Gdo not give I7 injections to c#ildren Gdo not use !or I% injections GD& i! /*& count is de ressed GD& drug i! serum creatinine level becomes abnormal

.reatment

(valuation

Gavoid activities t#at re5uire alertness G rovide oral care G,ee atiet recumbent to deacresed #y otensive e!!ects Gavoid rolonged e+ osure to t#e sun Ggive drug as rescribed Gmonitor elderly !or de#ydration G romote sa!ety

3>

DrugC doseC 7ec#anismC !r5uencyCroute classi!ication *i eriden 2mgCtab *ID Antic#olinergic Activity in t#e &N9 t#at is believed to normali@e .#e #y ot#esi@ed imbalance o! c#olinergic and do aminergic neurotransmission in t#e basal ganglia in t#e brain.

IndicationsC contraindications Indications) G ar,insonism Grelie! o! sym toms o! e+tra yramidal disorder &ontraindications) G#y ersensitivity GcloseGangle glaucoma G e tic ulcers 9C() Gdisorientation Gcon!usion Gnervousness Glig#t #eadedness Gdi@@iness Gdry mout# Gblurred vision

Princi les o! care GGuse cautiously 'it# tac#ycardiaregnancy and lactation Greduce dosage in #ot 'eat#er G discontinue or reduce dosage i! dry mout# ma,es s ea,ing or s'allo'ing di!!icult

.reatment

(valuation

Gta,e drug 'it# !ood G rovide oral care G romote sa!ety Gavoid activities t#at re5uire alertness Gavoid alco#ol Gre ort !or side e!!ects Gta,e drug e+actly as rescribed

$<

9OAPI( N 1 9 = Agana#an na ,o moga'as diri ste # ,ay nay maldita samo, ,aayu- unya dag#an a jud ,uting sa #igdaananB as verbali@ed by t#e atient O = atient seen staying a'ay !rom t#e attendant6s 5uarter- tal,ing 'it# student nurses- co#erent and communicative- already ta,en a bat# and 'earing clean- se+y clot#es A =mild an+iety related to uncom!ortable environment P =to develo a co ing strategy I = rovided sa!e and calm environment- taug#t rela+ation tec#ni5ues- encouraged atient to join t#era ies- encouraged atient to verbali@ed !eelings- encouraged atient to sociali@ed and interact 'it# ot#er eo le- rovided com!ort measures ( =t#e atient s#o'ed ositive res onse and coo erated very 'ell to t#e interventions 9OAPI( N 2 9 =Asa,it man a,ong #idgaan diri raman ,o matog sa ling,oranan ,ay dag#an ,uting didto- unya 'a na od laing lugar didtoB as verbali@ed by t#e atient O = Patient seen sitting on t#e benc# near t#e dining area- tal,ing 'it# student nursesF s#e #as ta,en a bat# already- 'earing ne' clean clot#es A =disturbed slee attern) !re5uent a'a,ening related to uncom!ortable slee ing area

P =to im rove slee Crest attern I =identi!ied !actors contributing to slee disturbance- enumerated 'ays to lessen t#ese !actorsencouraged #ygiene be!ore slee ing at nig#t- instructed to limit ca!!einated drin,s ( =t#e atient s#o'ed ositive res onse to t#e interventions given by t#e student nurse

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/& (#aluation and recommendation

*i olar 1 disorder is very common among t#e atients in %icente 9otto 7emorial 7edical &enter Psyc#iatric /ard. 9#e 'as manageable alt#oug# sometimes #e really 'ants to do t#ings on #is o'n 'ay. A!ter all t#e encounter and interaction- /endy &anto #ad s#o'n trust and 'as able to communicate 'ell. 9#e seems not a roac#able but once you interact 'it# #er you 'ill notice t#at s#e is not '#at you t#in,. .#is case study #as #el ed us in dealing 'it# atients '#o #ave *i olar 1 disorder- #o' t#ey react to certain stimuli- t#eir signs and sym toms- t#e at#o #ysiology o! t#e disorder and its treatment as 'ell as t#e nursing interventions in dealing 'it# t#is ty e o! disorder. It #as develo ed our interest in understanding 'it# t#is ,ind o! disorder. .a,ing care o! t#is atient 'as never been easy but c#allenging. It needs more atience and understanding. /e recommend ot#er students to communicate and tal, to #im and to let #im e+ ress #is !eelings.

/I& (#aluation and Implication of this Case Study to6

Nursing (ducation .#is case study contains data and !acts about t#e clients diagnosed 'it# bi olar 1 disorder. .#is study 'ould serve as a care guide to ot#er nursing students '#o 'ill soon be e+ osed in t#e syc#iatric area o! t#eir course. .#is u dates us on t#e current ideas t#at could increase t#e sco e o! nursing in suc# a 'ay t#at 'e add more current insig#ts to our ,no'ledge. In t#is 'ay- student nurses can better signi!icant ot#ers o! t#ose atients #aving t#e same ,ind o! illness. .#is broadens #ori@ons on t#e acce tance and care o! suc# disorders. Nursing Practice Nurses are in t#e best osition to assess- address and manage clientsO syc#otic sym toms and roblem so education and training are im ortant to e5ui nurses 'it# t#e necessary ,no'ledge and s,ills to im lement t#e t#era y. a nursing care lan is used to illustrate #o' t#e t#era y could be incor orated into nursing care. Pro er t#era eutic a roac#es are also necessary !or a more trusting relations#i bet'een t#e student nurse and t#e atient so to romote e!!icient nursing care. Nursing Researc# .#e ur ose o! t#is revie' is to describe t#e mental state and totality o! ossible 'ellness o! an individual 'it# bi olar 1 disorder- and to ma,e a ro riate recommendations !or nursing ractice to im rove care- ro er #ealt# a roac# and 'ellness interventions. "or more studies and researc# about t#is case- t#e more 'e can o en our minds to a ne' and e!!ective 'ays o! caring t#ese atients. .#is 'ill also serves as a guide !or us student nurses to be able to understand more t#e condition o! t#e atient and enable us to !ormulate e!!ective nursing actions.

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*I*DIO?RAPHE) Psyc#iatric 7ental Healt# Nursing t#ird edition 9#iela D. %idebec, Psyc#iatric 7ental Healt# Nursing sevent# edition 9#ives 9aunders Anatomy and P#ysiology 7edical 9urgical Nursing 4t# edition *runer

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