L. F. Gonzales College of Science and Technology Institute Maharlika Highway, San Leonardo, ue!a "ci#a
TABLE OF CONTENTS I. Intr Intro oducti uctio on II. Obje Object ctiv ives es III.Nursing Process A. Assess Assessme ment nt
1. Gener eneral al Dat Data a a%e&
'ge&
'ddress&
Ci!il Status&
(ate 'd%itted&
Chief Co%)laint&
(iagnosis&
Infor%ant&
2. Reason Reason for hospit hospitali alizat zation ion . !a"il# !a"il# histor# histor# of of "ental "ental illness illness $. %istor# %istor# of present present illness illness
$* +sycho)atho)hysiology and +sychodyna%ics
B. Planning C. Nursing management Process recoding
D. Evaluation and learning derived E. Conclusion / recommendation
I.Drug stud# A. Generic name B. Brand name C. Classification D. Mechanism of action E. Patient dosage F. Contraindications G. Adverse effect
Bipolar disorder "he illness tends to #e highly genetic, #ut there are clearly environmental factors that influences hether the illness is occur in a particular child$ Bipolar disorder can s%ip generations and ta%e different in different individuals$ "he small group of studies that have #een done vary in the estimate of the ris% to a given individual$ &or the general population a conservative estimate individual's ris% of having full#loom #ipolar disorder one percent$ Disorder in the #ipolar spectrum may affect *+, ho one parent has #ipolar disorder, the ris% to each child is 13-+, hen #oth parents have #ipolar disorder, the ris% increases to -.+$ "he ris% in si#lings and fraternal tins is 12+, and the ris% of identical tins is appro!imately .-+$ Bipolar disorder is classified into to, the #ipolar / and the #ipolar //$ "he #ipolar / disorder in hich individual may e!perience one or more manic episodes or mi!ed episodes$ During a manic episode must #e present to a significant degree$ /mpairment in various of functioning, psychotic symptoms, and the possi#ility of selfharm e!ist$ Bipolar // disorder is characteri0ed #y recurrent maor depressive episodes ith hypomanic (a mood #eteen euphoria and e!cessive elation)
"his case study aims to
4no the definition and the history of the development of #ipolar manic disorder$
/dentify the facts that may contri#ute in acuiring #ipolar manic disorder$
&ormulate appropriate diagnosis on hich to #ase the necessary psychiatric nursing interventions$
/mplement interventions and psychodynamic approach$
5valuate the actions done to clients and its effectivity$
A. Assessment
1. General Data Name Age Address Civil 6tatus Date Admitted Chief complaint
/nformant
Nestor 2 Nueva 5cia 7arried August , 2--. 1$ 8anana%it 2$ 8oor sleep 3$ Nam#a#ato ng #ahay $ Nag#a#asag ng gamit 9ife
2. Reason for %ospitalization :er ife #rings him here at 7ariveles 7ental :ospital, August , 2--. 11- in the morning$ 6he said that his hus#and Nestor is not in normal mental state again$ :e refused to ta%e his medicine, he had sleep distur#ance and the last time he forced his daughter to get money to her and #ought him cigarettes$ And #efore that day, his hus#and thre a stone at his neigh#ors' house$
. !a"il# %istor# of /ental Illness According to his ife, he is the only one in the family having this mental illness$
&. Related vents'3ituations to Present %ealth +ondition According to the medical doctor, 7r$ Nestor has mental illness #ecause of trauma he e!perienced$ ;ne day, he said that he sa his father sta##ed #y his father's friend and after that incident, he never forget that$ :e also said that they have financial pro#lem and he thin%s that their younger 11yearold son as not his son$ :e thin% that his ife having an affair ith another man$ :oever, he never confronted his ife a#out it in afraid that his ife got angry$
(. Pre)/orbid Personalit# 4ssess"ent During our interaction ith the patient, he seems to #e %ind to us and eager to anser our uestion$ :e does not hesitate to anser although e as% a#out his personal life$ 9e also noticed his %indness during the session$ 9e almost thin% that e are tal%ing to a normal person$ /n addition, he possesses silence uite some time as he is thin%ing something that e do not as%$
*. +ourse in the 5ard &rom August 2--. until no, according to 7r$ Nestor, he only got one trou#le inside the hospital$ "he reason of that commotion is a stic% of cigarette$ &rom then on, he
. /ental 3tatus 0a"ination
a* General (escri)tion
(1) Appearance 6een this adult male in #lue 77: uniform ith short hair and nails, poorly %ept ith #ody odor$ 9ith no slippers, li%e any #ody inside the hospital$ Not so nourished, and slim in #uilt$
(2) Behavior and 8sychomotor Activity :e is not harmful as e first thought a#out him$ :e responds in every uestion that e gave$ :e also participates in e!ercise, games, draings, or any program or activities that e planned for them$ :e on in the
(3) Attitude toard 5!aminer :e is sitting straight in front of us$ :e ust staring to us at first, #ut in fe moments, he ansers our uestions$ :e respects our presence in e!cusing himself every time he ill go to the comfort room or hen he ants to al% for a hile$
$* +sycho)atho)hysiology Modifia$le Factors 6u#stance a#use 6leep deprivation 6tress
onModifia$le Factors enetic factors
/m#alance 6erotonin and Norephinephrine level
/ncrease in 6erotonin and Norephinephrine
Chemical changes in the #rain
4indling
+sychodyna%ics
Balance #eteen physiological safety needs (lo 6ocioeconomic) A#raham 7aslo :ierarchy of Needs
;rally fi!ated (smo%ing and drin%ing) (;ral stage ? @ean 8iaget)
Distur#ed 8sychological Aspects (Chained #y his ife) (7aslo :ierarchy of Needs)
&ear (auditory hallucination) (Collective unconscious ? Carl @ung's "heory)
&amily constellation ? Alfred Adler
B. Planning NURSING CARE PLAN
C/"S
6u#ective
/0SIG (I'G1SIS
Distur#ed thought process related to ina#ility to trust as evidenced #y suspiciousness of others, resulting in alteration in societal participation$
G1'L213"CTI4"S
Short-Term Goal
9ithin 1 ee%, client ill start to recogni0e and ver#ali0e hen thin%ing is nonreality #ased$
IT"04"TI1S 8rioriti0e safety of the client$
0'TI1'L" •
Client may harm self or others in disoriented, confused state$
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Disorientation may endanger client safety if he or she un%noingly anders aay from safe environment$
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&reuently orient client to reality and surroundings$ •
Long-Term Goal
Client ill e!perience no delusional thin%ing #y discharge from treatment$
"ry to redirect violent #ehavior ith physical outlets for the clients an!iety$ •
5ncourage the client to ver#ali0e true feelings$ "he nurse should avoid #ecoming defensive hen angry feelings are direct at him$
8hysical e!ercise is a safe and effective ay of relieving pentup tension$
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er#ali0ing feelings ith a trusted individual may help client or% through unresolved issues$
"4'L/'TI1
oal met$ After a ee% of intervention, the client a#le to recogni0e and ver#ali0e hen thin%ing is non reality #ased$
C.
Nursing management +rocess recording
Client initials 6e! Age Date of #irth Address Nationality 8hysical appearance Description of the environment "entative diagnosis oals of interventionE;#ective
Nestor 7ale 2 years old 7arch 2*, 1*. @aen, Nueva 5cia &ilipino /n #lue 77: uniform, short hair, short nails, poorly %ept and no slippers$ 6unny day, clear environment and good atmosphere under the #ig mango tree$ Bipolar manic ith psychotic features "o help the client to e!press thought and feeling$
6tudent uestion •
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A%o po ay si 8atria$ 4ayo po #a, pede %o po #a malaman ang inyong pangalanG
7aari po #a %ayong ma%inig at sumagot sa mga #agay #agay na itatanong %o sa inyoG
8atient response •
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A%o si Nestor$
6ige$
"herapeutic communication •
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iving information
Accepting
FationaleEDefense mechanism •
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/nforming the client of facts increases his %noledge a#out a topic or let the client %no hat to e!pect$ "he nurse is functioning as a resource person$ iving information also #uilds trust ith the client$ Accepting response indicates that the client has heard and folloed the train of thoughts$
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Ano po #a ang tra#aho ninyo #ago %ayo mapunta ditoG
4uya, mayroon po #a %ayong gustong i%uento o sa#ihin sa a%inG
Ano ang ginagaa mo %apag nalulung%ot %aG
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Dati a%ong tricycle driver tapos nagtitinda din a%o ng mais %asama ang asaa %o$
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5!ploring
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9ala$ 7agtanung %a na lang$
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Broad openings
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Na%i%ipag%entuhan a%o sa %ai#igan %o na si /nggo$
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5ncouraging description of perception
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9hen client deals ith topic superficially, e!ploring can help them e!amine the issue more fully$
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7a%e e!plicit that the client has the lead in the interaction$ &or the client ho is hesitate a#out tal%ing, #road opening may stimulates him or her to ta%e the initiative$
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"o understand the client$ "he nurse must see things from his perspective$ 5ncouraging the client to descri#e the ideas fully may relieve the tension the client is feeling, and he might not #e less li%ely to ta%e action or ideas that are harmful or frightening$
D.Evaluation and learning derived
1$ "he client physical appearance improved from poor to good hygiene$
2$ "he students had learned ho to interact and understand the emotions and coping mechanism$
3$ "he client shoed interest in each therapy$
$ "he client as a#le to e!press hisEher on feelings and thoughts during nurseclient interaction$
E. Conclusion / ecommendation
As a conclusion, #ipolar is a serious mental disorder that could lead to serious of harmful situation or even complications that they could #e manic or depressed$ According to the stimuli, that they encounter this disorder needs careful handling and attentive support emotionally, #ecause they could #e lac%ing from emotional support or attention from immediate family$ Hi%e our client ith the help also of other mental personnel$ "hese mental institution patient can #e managed ell and #e free from the said disorder$
9e recommend careful management and careful attention plus support to those affected #y the disorder and for those ith symptoms of said disorder, %indly report immediately into different or nearest mental institution$
Generic na%e Hithium car#onate
rand na%e 8riadel
Classification
Antimanic drug
Mechanis% of 'ction "hought to disrupt sodium e!change and transport in nerves and muscles and control re upta%e of neurotransmitters$
+atient (osage *--mg B/D
Contraindications
(none)
'd!erse "ffect •
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CN6 Di00iness, drosiness, headache, tremor, ata!ia, slurred speech, hallucination C #radycardia, hypotension
ursing Inter!entions •
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Biperiden
A%ineton Anti par%insonian
Biperiden has an antropineli%e #loc%ing effect on all peripheral structures that are parasympathetic innervated$
2mg ;D
Caution should #e o#served in patient ith manifest glaucoma thought no prohi#itive rise in intraocular pressure has #een noted folloing either oral or parenteral administration$ 8atient ith prostatism epilepsy or cardiac arrhythmia should #e given this drug ith caution$
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Dry mouth
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Advise patient to ta%e ith food or mil% to minimi0e $/$ upset$ Advise to limit foods and #everages containing caffeine$ "ell patient to maintain adeuate fluid inta%e$ 5mphasi0e importance of having regular #lood tests to help detect and prevent serious adverse reactions$
Advise the client to avoid dry, #ul%y, and irritating foods and fluids such as to#acco and alcohol$ Advise client to tal%ing too much if not necessary$
eneric name Diphenhyramine
Chlorproma0ine hydrochloride
Brand name
Classification
Benadryl Antihistamine , antitussive, antiemetic, antivertigo agent, antidys%inetic
Antipsychotic , an!iolytic, antiemetic
7echanism of Action /nterferes ith histamine effect at histamine receptor sites> prevents #ut does not reverse histaminemediated response$ Also possesses CN6 depressant and anticholinergic properties$
8atient Dosage 2mg 8; :6
7ay #loc% 1-mg postsynaptic B/D dopamine receptors in #rain and depress areas involved in a%efulness and emesis$ Also possesses anticholinergic, antihistaminic, and adrenergic#loc%ing properties$
Contraindications •
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:ypersensitivity to drug Alcohol intolerance Acute asthma attac% 7A; inhi#itor use ithin 1 days Breastfeeding Neonates, premature infants
:ypersensitivity to drug Angleclosure glaucoma Bone marro depression 6evere hepatic or cardiovascular disease
Adverse 5ffect •
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Nursing /nterventions
CN6 drosiness, headache, parado!ical stimulation C hypotension, tachycardia, palpitations 55N" #lurred vision, tinnitus / diarrhea, constipation, dry mouth
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CN6 sedation, drosiness, e!trapyramidal reaction, tardive dys%inesia, pseudopar%insonism, sei0ure C tachycardia, hypotension 55N" #lurred vision, dry eyes, lens opacities, nasal congestion / constipation, ileus, anore!ia, dry mouth :epatic aundice, hepatitis
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Advise patient to avoid alcohol and other depressant such as sedatives$ Caution patient to avoid driving and other ha0ardous activities until he %nos ho drug affects concentration and alertness$ "ell patient to ta%e capsule or ta#lets ith a full glass of ater, ith or ithout food$ /nstruct patient not to crush sustainedrelease capsules$ "ell patient to mi! oral concentrate in uice, soda, applesauce, or pudding$ Caution patient to avoid driving and other ha0ardous activities until he %nos ho drug affects concentration and alertness$
