Professional Documents
Culture Documents
SCHOOL OF NURSING
Baguio City
CASE ANALYSIS
Case 3:
Bipolar Disorder
Submitted to:
Sir Jay Ablog
Submitted by:
BABAY, Leanlexoz Valiant
MERCADO, Ismael
CASTRO, Alyssa Jean
CABRITO, Carla Cassandra
DEL ROSARIO, Katrina
GOMEZ, Charlene Dec
MATEO, Lynn Dinah
MIRALLES, Sharmayne
OTEYZA, Darianne
PINLAC, Paula Jane
BSN 3D1
PROFILE:
Marina
Believes that she had switched souls with that senior senator from her
state states that it would make her particularly well suited for a high
position in government; perhaps even the presidency.
Worries that she will forget some of her thoughts begun writing notes
everywhere (notebook, computer, even on the walls of her dormitory.
Family & friends known her for being extremely tidy and organized
room is disarray with frantic and incoherent messages written all over
the walls and furniture. (messages reflect her disorganized, grandiose
thinking about spiritual and sexual themes)
Family History
5 siblings the only one who always obeyed her parents and played
the role of the GOOD GIRL in the family she describes as Little Miss
Perfect
Describes her siblings as rebellious her older sister told her parents
that she was sexually active in high school
Parents are strict with sexual matters never discussed issues r/t to
sex except to make it clear that their children were to remain virgins
until they were married
Mother forbade her to wear makeup.
Never dated high in high school and has never had a steady boyfriend
BIPOLAR DISODER
ACCORDING TO DSM 5
Bipolar disorder is a mental health condition that is characterized by periods
of both MANIA and DEPRESSION; the criteria for bipolar requires at least one
depressive episode and one mania episode.
Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased goal-directed activity or energy,
lasting at least 1 week and present most of the day, nearly every day (or any
duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or
more) of the following symptoms (four if the mood is only irritable) are present to a
significant degree and represent a noticeable change from usual behavior:
1
2
3
4
5
6
7
Hypomanic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased activity or energy, lasting at least
4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three
(or more) of the following symptoms have persisted (four if the mood is only
irritable), represent a noticeable change from usual behavior, and have been
present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli), as reported or obsen/ed.
6. Increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is
uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or
occupational functioning or to necessitate hospitalization. If there are psychotic
features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication or other treatment).
BIPOLAR 1
BIPOLAR 2
Mania
Hypomania
Mild Mania
Hypomania does not have psychotic
symptoms.
Sustained mood :
elevated (heightened),
expansive (grand, superior) or
irritabl
e.
OTHER TYPES
Rapid Cycling
"Mixed features
GENDER RELATED Female are more likely to experience rapid cycling and
mixed states
MEDICATIONS/TREATMENTS
LITHIUM (first drug of choice)
Mood stabilizing drugs are used to treat bipolar disorder by stabilizing the
clients mood, preventing or minimizing the highs and lows that characterize
bipolar illness, and treating acute episodes of mania.
Daily dosages generally range from 900 to 3,600 mg - serum lithium level
should be about 1.0 mEq/L.
Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels
of more than 1.5 mEq/L are usually considered toxic.
********!!!!!!!WARNING: Lithium
Toxicity is closely related to serum lithium levels and can occur at therapeutic
doses. Facilities for serum lithium determinations are required to monitor
therapy
Toxic effects of lithium are:
Severe diarrhea
Vomiting,
Drowsiness
Lack of coordination.
Muscle weakness
*if untreated, these symptoms worsen and can lead to
Renal failure
Coma, and death.
*When toxic signs occur, the drug should be discontinued immediately.
If lithium levels exceed 3.0 mEq/L, dialysis maybe indicated.
prescribed for people who have rapid cycling- four or more episodes of
mania and depression in a year
2. ANTIPSYCHOTIC DRUGS
Side Effects:
Dizziness
Drowsiness
Fatigue
Nausea
FOR BIPOLAR
Tremor
Rash,
control psychotic
symptoms
Weight
gain
short-term treatment to
such as
hallucinations, delusions or mania symptoms (occur during acute
mania or severe depression; some also treat bipolar depression and
several have demonstrated long-term value in preventing future
episodes of mania or depression)
Abilify (aripiprazole)
Side Effects:
Clozaril (clozapine)
Geodon (ziprasidone)
Weight gain
Latuda (lurasidone)
High cholesterol levels
Saphris (asenapine)
Increase risk of diabetes
Seroquel (quetiapine)
Blurred vision
Zyprexa (olanzapine)
Dry mouth
Drowsiness
3. BENZODIAZEPINES
-help control certain manic symptoms (restlesness, agitation or
insomnia) ; slow the activity of brain--help treat mania, anxiety, panic
disorder and seizures
Side Effects:
Ativan (lorazepam)
Klonopin (clonazepam)
Valium (diazepam)
Xanax (alrazolam)
WARNING:
Drowsiness
Lightheadedness
Fatigue
Blurred vision
Slurred speech
Memory loss
Muscle weakness
Side Effects:
Nardil (phenelzine)
Parnate
Difficulty getting to sleep
ELECTROCONVULSIVE
THERAPY
FOR BIPOLAR (ECT)
(tranylcypromine)
Dizziness
Marplan
(isocarboxazid)
short-term
treatment
for severe manic or depressive episodes, (particularly
when symptoms involve serious suicidal or psychotic symptoms or when
Dry mouth
medicines seem to be ineffective. It can be effective in nearly 75% of
patients)
Hypertension
an electric current is passed through the scalp to cause a brief seizure in the
Weight gain
brain.
PROCEDURES
Prior to ECT , a person is given a muscle relaxant and put under general
anesthesia.
-
Electrodes are placed on the patient's scalp, and an electric current is applied
that causes a brief seizure. Because the muscles are relaxed, the seizure will
usually be limited to slight movement of the hands and feet.
The patient awakens minutes later, does not remember the treatment or
events surrounding the treatment, and may be briefly confused
short term memory loss is a common side effect, although this usually goes
away 1-2 weeks after treatment, and can be minimized based on how the
electrodes are placed on the scalp and other technical aspects
Side Effects:
Mild nausea
Diarrhea
Anorexia
Polydipsia
Therapies
applied
that could be
1. PSYCHOTHERAPY
"talk" therapy:
- behavioral therapy
- cognitive therapy
- interpersonal therapy
or
Polyuria
Fatigue or lethargy
Weight gain
Acne
2. SUPPORT GROUPS
3. EDUCATION
4.
MANAGEMENT
LIFESTYLE
Can help those with bipolar disorder fill time and give
back to those in need, which can help them feel more
balanced. Involve yourself in charitable activities based on
personal interests or hobbies.
8. Risk for self-directed or other directed behavior r/t wild and bizarre
behavior
Be
communicating with the client. Avoid at first, then activities in small groups,
vague or evasive remarks.
Recognize
accomplishments (projects
responsibilities
keep.
initiated).
successes.
and
support
fulfilled,
the
clients
completed,
inter-actions
Directly
real
things;
do
not
dwell
on
the
interject
doubt
regarding
delusional material.
INTERVENTIONS
Provide a quiet environment, with a low
level of stimulation.
Monitor
sleep
patterns.
Provide
structured schedule of activities that
includes established times for naps or
rest.
Before
bedtime,
provide
nursing
measures that promote sleep, such as
back rub; warm bath; warm, non
stimulating drinks; soft music; and
relaxation exercises
JOURNALS
Managements for Patients with Bipolar Disorder
4. Psychological interventions should form the foundation of therapy for
adolescents and children, as medicines used in bipolar disorder can have a
damaging effect on childrens growth and development.
5. Nurses are in a position to build rapport and counsel that bipolar patient on
effective techniques for managing the disorder and maintaining a good state
of physical health. Interventions for the patient experiencing mania include
encouraging patients to eat high-calorie finger foods to help
maintain nutrition during states where the patient may not want to
sit down to consume a meal(Follin, et al., 2006). It is also important to
encourage and provide a quiet non-stimulating environment and
quiet activities for the patient to do. During periods of depression,
patients should be encouraged to participate in group therapy. It is also
helpful to encourage patients to use a journal to write down their feelings
when they are having difficulties talking about them.
REFERENCES:
Schultz D.P. & Schultz S.E. (2005). Theories of Personality. Belmont, CA:
Thomson Wadsworth
Company