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Introduction
Mr. Jones is a 50 year old unmarried male and of African descent. He was admitted to
the ward as an urgent admission with a history of talking out of context, hearing animals talking
to himself and being aggressive for no reason. He also claimed that he hears a dominant voice
telling him to do things. He verbalized that he has problems sleeping at night, but smoke, use
drugs or alcohol. Mr. Jones has a family history of psychotic illness in both his mothers and an
uncle. He is allergic to sea foods such as crab and shrimp crab and has a medical history of
asthma. His medical diagnosis is bipolar affective disorder. Upon doing a nursing assessment Mr
Jones was observed to be alert and oriented to time, place and person. It was also observed that
Bipolar Disorder
swings that range from the lows of depression to the highs of mania. When you become
depressed, you might feel sad or hopeless and lose interest or pleasure in most activities.
(mayoclinic.com). Sign and symptoms of the manic phase of bipolar disorder are euphoria, poor
judgment, delusions and hallucinations, aggressive behaviour, risky behaviour and rapid speech.
The exact cause is unknown, but several factors seem to be involved in causing and triggering
inherited traits and the environment. Risk factors are relatives with bipolar disorder; stress and
drug or alcohol abuse are also thought to cause bipolar disorder. Conditions that commonly occur
with bipolar disorder are anxiety; attention deficit/ hyperactivity disorder (ADHD), addiction or
substance abuse and physical health problems. If left untreated isolation and loneliness,
Medication
500mg po od.
This drug is an anticonvulsant and vascular headache suppressant. It is used for manic episodes
associated with bipolar disorder. This drug works by increasing the levels of y-aminobutyric acid
(GABA) in the brain, which decreases seizure activity. The contraindications of this drug are
hypersensitivity and urea cycle disorder. Some side effects of this drug are agitation, dizziness,
headaches, insomnia, visual disturbances, nausea, vomiting, abdominal pain, rash, dry skin,
tremors and irregular menses. The therapeutic effects observed, was that this drug decreased the
Haloperidol (Haldol)
Haloperidol (Haldol) is another medication that was prescribed for Mr. Jones. The dosage
of this drug is 5mg am & 10mg pm po. Haloperidol is an antipsychotic/neuroleptic drug. This
drug is used for psychotic disorders, prolonged parenteral therapy in chronic schizophrenia, acute
seizures. Haloperidol works by depressing the cerebral cortex, hypothalamus, limbic system,
which control activity and aggression. It blocks the neurotransmission produced by dopamine at
synapse; exhibits strong alpha adrenergic and anticholinergic blocking action. The
contraindications of this drug are blood dyscrasias, bone marrow depression, Parkinson disease,
angina, epilepsy/seizure disorder, urinary retention, glaucoma. Some side effects of this drug are
extrapyramidal reactions, blurred vision, dry eyes, constipation, and dry mouth. The therapeutic
effects observed from Haloperidol are that it decreased the signs and symptoms of psychosis.
Benztropine (Cogentin)
Benztropine (Cogentin) is another drug that was prescribed for Mr. Jones. This drug is a
cholinergic blocker and an antiparkinson agent. The dose for Mr. Jones is 2mg po bd. This drug
is used for Parkinsons symptoms, acute dystonia and hyper- salivation. This drug works by
blocking cholinergic activity in the central nervous system, which is partially responsible for the
symptoms of Parkinsons disease. It also restores the natural balance of neurotransmitters in the
central nervous system. The contraindications of this drug are hypersensitivity, closed angle
glaucoma, myasthenia gravis, and GI/GU obstruction dementia. Some side effects of this drug
are confusion, depression, blurred vision, dry eyes, constipation, and dry mouth. The therapeutic
effects observed from Benztropine are decreased involuntary movements, reduction of rigidity
and tremors.
When these medications are given, it is the responsibility of the nurse to monitor the
Nursing Management
Nursing Diagnosis: Social withdrawal related to clients mistrust of others as evidence by client
Expected Outcomes: Short term: The client will participate in group activities on the ward by
Long Term: (1) The client will continue to participate in group activities during
hospitalization
(2) The client will display a trusting attitude towards staff members during
hospitalization.
Nursing Interventions:
1. Establish a therapeutic relationship with the client by being present and showing a
positive attitude.
2. Establish trust one to one with the client.
3. Gradually introduce client to other clients on the ward.
4. Educate the client on the importance of socializing.
5. Encourage client to participate in ward chores.
6. Provide positive reinforcement when client interacts with other clients or staff members.
7. Monitor client for signs of withdrawal.
8. Administer prescribed medications.
9. Monitor for therapeutic effects and side effects of the medication.
10. Record and report all findings.
Evaluation: The client was observed to have minimal interaction with other clients during the
Expected Outcomes: Short term: Client will be oriented within three (3) days.
Long term: The client will show a reduced amount of hallucination during
hospitalization.
Nursing Interventions:
Evaluation: Client showed a reduced amount of hallucination during the first 8 hours shift.
Nursing Diagnosis: Risk for aggression related to clients history of aggressive outburst.
Expected Outcomes: Short term: (1) Client will be able to identify what triggers her aggression
Long term: The client will be free from aggression during hospitalization.
Nursing Interventions:
1. Maintain a therapeutic relationship with client.
2. Assess clients potential for aggression, paying attention to probable causes.
3. Encourage client to identify triggers that may cause aggression.
4. Advice client to inform staff nurse of these triggers.
5. Educate client on the consequences of displaying aggressive behaviour.
6. Engage patient in diversional therapy to deter the aggressive behaviour.
7. Give praise to client for displaying positive behaviour.
8. Record and report all findings.
Conclusion
Mr Jones condition has improved since admission. This was as a result of his getting
prescribed medication for his illness. At times it was observed that he would sit alone, quiet and
antisocial. He verbalized many times that he wants to go home soon to be with his mother. Mr
Jones still hears the dominant voice telling him to do things like stand up for your rights when
he feels like he is being taken advantage of, which sometimes gets him into trouble with the
nurses.
References
Deglin, J. H., & Vallerand, A. H. (2009). Davis's drug guide for nurses (11th ed.). Philadelphia,
Doenges, M., Moorhouse, M. F., & Murr, A. (2009). Nursing Care Plans Guidelines for
Individualizing Client Care Across the Life Span. (8th. ed.). Philadelphia: F.A. Davis
Company.
staff, M. (2012, January 18). Definition. Mayo Clinic. Retrieved November 29, 2014, from
http://www.mayoclinic.com/health/bipolar-disorder/DS00356