I.

GENERAL OBJECTIVES
We the presenters aim to share to our participants
the knowledge and understanding that we have
gained about Bipolar disorder I, its management and
the attitude that we must obtain to be an effective and
efficient nurse in the future.
 SPECIFIC OBJECTIVES
At the end of the case presentation the audience will be able to:
•Define bipolar I disorder
•Enumerate the signs and symptoms of bipolar disorder
•Recall the patients health history
•Review the anatomy and physiology of the affected part of
nervous system
•Trace the psychopathology of the disorder
•Interpret the laboratory result of the patient
•Formulate a nursing care plan for our patient
•Discuss the medication taken by the patient
•Present the nurse patient interaction we had with our patient
 II. INTRODUCTION
Bipolar disorder (manic
depression) a mental disorder
that is characterized by severe
mood swings cycling between
periods of intense “highs” (mania
or hypomania) and periods of
intense “downs” (depression).
Types of bipolar disorder
Bipolar disorder is divided into two main subtypes:
1. Bipolar I disorder: Had at least one manic episode, with or
without previous episodes of depression.
2. Bipolar II disorder: Had at least one episode of depression and at
least one hypomanic episode. In bipolar II disorder, the periods of
depression are typically much longer than the periods of hypomania.
3. Cyclothymia: Is a mild form of bipolar disorder. Cyclothymia
includes mood swings but the highs and lows are not as severe as
those of full-blown bipolar disorder.
Causes:
•Scientists don’t really know what causes bipolar
disorder (unknown causes)
•Genetic factors
•Hormones are chemicals in the body
•Other illnesses
Triggers and risk factors for bipolar disorder:
1) Severe stress or emotional trauma
•Stress can also worsen a bipolar mood episode or extend its duration.
2) Substance Abuse
•Drugs such as cocaine, ecstasy, and amphetamines can trigger mania.
•Alcohol and tranquilizers can trigger depression.
3) Medication
•Antidepressant drugs, over-the-counter cold medicine, appetite suppressants,
caffeine, and thyroid medication can trigger mania.
4) Sleep Deprivation
5) Seasonal Changes
•Manic episodes are more common during the summer.
•Depressive episodes are more common during the fall, winter, and spring.
6) Major life changes, such as the death of a loved one
7) Having other biological family members with bipolar disorder
Diagnosis:
Complete Detailed History
Treatment:
1. Mood stabilizers: These may delay or relieve episodes of mania (highs) or
depression (lows).
•Lithium (Eskalith or Lithobid): has long been used as a first line treatment for acute
mania in people with bipolar disorder
•Divalproex sodium (Depakote)
2. Antidepressants: These are often used with a mood stabilizer in people with
depressive
episodes. If used alone, antidepressants may increase the chances of a person with
bipolar disorder switching into mania.
•Olanzapine (Zyprexa), which is FDA approved for the treatment of acute mania .
3. Antipsychotics: These are medicines that are mostly used to treat mania.
They may also be
used to treat psychosis that can occur during severe episodes of mania or
depression. Antipsychotics may be used alone or with other medicines for
treating bipolar disorder:
•Clozapine (Clozaril)
•Quetiapine (Seroquel)
•Ziprasidone (Geodon)
Other medicines: Might be suggested by the healthcare provider when a
person with bipolar disorder cannot sleep or feels nervous.

4. Anticonvulsant medications: such as carbamazepine (Tegretol), also can

have mood-stabilizing effects and may be especially useful for difficult-to-
treat bipolar episodes.
STATISTICS:
Statistics as of 2010 (January-June)
Mental Disorder Total
Schizophrenia Undifferentiated Type 97
Brief Psychotic Disorder 10
Bipolar Disorder 7
Schizophrenic Disorder 5
Alcohol Induced Psychosis 7
Seizure Disorder with Psychosis 5
Mood Disorder 2
Mental Retardation 1
Total 134

According to the records of Psychiatric Department, Cagayan Valley Medical Center, as

of January-June 2010, there were 7 cases of Bipolar Disorder. The table shows that
Bipolar Disorder is the 3rd common mental disorder.
 REASON FOR CHOOSING THE CASE:
We choose this case because we want to
broaden our knowledge on the disorder,
present an effective management for patients
with this disorder in which we can use in the
future and understand our roles as health care
providers in dealing this kind of patients.
III. HEALTH HISTORY
A. Patients Profile
Name: M.N.
Age: 45 Years Old
Gender: Female
Marital Status: Single
Address: Andaraya, Solana, Cagayan
Citizenship: Filipino
Religion: Roman Catholic
Educational Attainment: Elementary Level (Grade 5)
Occupation: None
Language/Dialect: Ilocano, Ybanag, Itawes, English and Tagalog
Date of Admission: February 25, 2010
Time of Admission: 8:26 AM
Chief Complaint/s: “sau nga sau”
“pagna nga pagna”
Final Diagnosis: Bipolar I Disorder
Attending Physician: Dra. Leonor Juliana
Source of Information: Client and Chart Data
B.HEALTH
1. Past Medical History
According to patient M.N., when she was a child
she experienced mild illnesses like cough, colds and
fever. She takes over the counter (OTC) drugs such
as tuseran forte, neozep and paracetamol. When
asked about vaccines, patient was not able to to
remember it. She first underwent surgery due to
vehicular accident.
Past Psychiatric History
M.N. stated that she experienced episodes of
depression when she got raped by her neighbor.
According to the patient, she just sings her favorite song
entitled “Katarungan” to cope up with her depression. The
patient never had any suicidal tendencies but has mood
swings. She made mentioned that she experienced
physical abuse by her mother when she was accused of
stealing money though she claimed that it wasn’t true.
History of Present Illness
On 1980, she was invited by their neighbor’s house and then after several
hours of conversation, her neighbour suddenly forced her and rape M.N. The
patient doesn’t have enough force what was happening. “Dinugo ako at parang
nasilihan ang pakiramdam ko. Masakit ngam” as verbalized by the patient. She
could not sleep for consecutive days and this behaviour lasts for almost a week.
After the incident, parents of M.N. decided to let them marry but she refused to
do so because she was in love with someone else. This experienced made her
think that her life was ruined, has no meaning and direction. She was always
pre-occupied with the incident and came to a point that she was not able to
continue her daily activities. Due to her inability to cope, her mother and aunt
decided to consult in Cagayan Provincial Hospital. The patient verbalized “One
month ako dun sa hospital malapit sa Cathedral yung Cagayan Provincial
Hospital tapos nilipat nila ako dito.”
Personal and Social Economic History
M.N. stated that she studied at Andarayan Elementary
School in Solana but did not finish schooling. According to the
patient, she is the only member of the family who suffered
mental illness. M.N. started smoking at the age of 14 because
she was greatly influenced by her grandmother. She consumes 2
tobacco sticks in a day. She made mentioned that she doesn’t
drinks liquor. Now, she still engaged in smoking and consumes
2 sticks of cigarette (Marlboro) per day. She verbalized
“Naninigarilyo ako kasi mabaho yung ihi sa loob”.
3. Family History
They were seven siblings and she was third from
the eldest. There were 5 girls and 2 boys. She said she
was particularly fortunate for having no other disease.
A history of hypertension was present on his paternal
side and no particular disease or illness on his maternal
side. She made mentioned that her brother died
because of asthma.
 2. Developmental History

According to the patient, she was born through normal spontaneous delivery and her birth
was planned and wanted by her parents. The patient was breastfed adequately. The patient was not
able to recall her early motor and language development. She said that her parents support and try
to meet their needs. The patient said that she loves to play but not with her older siblings. She
prefers toys such as dolls. She also said that she has a good sleeping pattern when she’s still a child.
The patient was an active pupil who was once a leader. She loves to sing and dance in their
classroom and join athletic activities. She said she was very obedient that made her as one of the
favorites of her teacher. She was a leader and peace maker in the group. She was not rebellious.
She verbalized “Hindi ako pasaway”. Filipino was her favorite subject. She said that she was usually
scolded and hit with a belt by her mother everytime she does wrong. The patient has a good
relationship with other people. The patient describes herself as kind and friendly to her
sibling/playmates. She cannot remember the number of her friends. According to the patient, she
was confused with her identity but she claimed that she was a “tomboy” before but she did not
have any attractions with girls. She had her menarche when she was 12 years old. She experienced
her coitarche when she got rape at the age of 14.
4. Functional Assessment
a. Self-esteem, self concept
M.N. did not finish schooling. She attended at school until
grade 5. According to the patient their family have a huge farm.
Their source of income was from farming. They used to plant corn,
rice and other vegetables. When ask about herself, she describes her
illness by stating “Magaling na ako” but when the patient was asked
to pray, she prayed for her healing “Panginoong Diyos, tulungan
niyo po ako na tuluyang gumaling”. The patient is a Roman
Catholic. She seldom attends mass but she prays always. She
strongly believes in miracles and power of God. The Lord is her
source of strength.
b. Activity/ Exercise
According to the patient, she performs any household
chores or any typical leisure work such as gardening and
cleaning house premises. She also said that she used to walk
and considers walking around as his form of exercise. Now
that she in the psychiatric ward, her usual activities are
cleaning the surroundings and doing laundry. She used to
wash her clothes and the clothes of other psyche patients.
She doesn’t need any assistance in doing her daily activities
and she is not using any mobility aids such as wheelchair.
c. Sleep/ Rest
According to the patient, she usually sleeps 8:00 in the
evening and wakes up at 5:00 but most of the time her sleep
pattern was disrupted because of other patients that are
not behaved and also when giving medications. “Hindi ako
makatulog kasi ang ingay ng mga kasama ko,sinusumpong
kasi sila” as verbalized by the patient. She made mention
that she also experiences nightmares. She seldom takes a
nap in the afternoon but takes time to compensate for the
lack of sleep.
d. Nutrition/ Elimination
The patient eats 3x a day. She eats the food that is being
served to them in the ward. According to the patient, she loves
to eat cooked liver and adobong baboy. She also likes fish such
as tilapia and galunggong and also vegetables like ampalaya.
According to the patient, she drinks 6-8 glasses of water with 2
cups of coffee per day. With regards to the urination, she
urinates 3-5 times a day (about 250 ml per urination) in a light
yellow color and has a clear appearance. She defecates once a day
usually in the morning. Her stool is foul, dark, and semi-formed.
According to the patient she doesn’t have any difficulty in
urinating and defecating.
e. Interpersonal Relationships/ Resources
The patient claims that she has a good relationship with
her family, friends and neighbors. She loves to mingle with
different kinds of people. Patient M.N. is the third among
the 7 siblings. She values the existence of a great social
support especially in times of need. According to the patient,
her family is also visiting her in the ward once in awhile.
Patient M.N. is married and she had six children. She said
that she is very happy everytime her family visits her.
f. Coping and Stress Management
Whenever she felt stressed, she used to smoke 2 – 3 sticks
of cigarette a day. She started this when she was about 14
years old because she was greatly influence of her
grandmother. She doesn’t used to drink any liquor. “Ayaw ko
uminom ng alak” as verbalized by the patient. She also said
that if she has problems she used to sing her favorite song
“KATARUNGAN” to feel relieve.
g. Personal Habits
Patient M.N. used to smoke 2 cigarette sticks a day. She started
smoking at the age of 14 years old because she was greatly
influenced by her grandmother. “Mabaho kasi yung ihi kaya ako
nagsisigarilyo” as verbalized by the patient. The patient is aware of
the risks of smoking, thus she had an operation “Nicotine
Lyphoma Chest” when she was 38 year old. The patient did not
take any drugs such as marijuana nor alcohol.
IV. MENTAL STATUS EXAMINATION
A. GENERAL APPEARANCE
Patient M.N. is always alert and awake. When it comes to the
manner of dressing, she is neat and appropriate. She is always
clean. M.N. practice proper hygiene, thus, she always takes a
bath. She is in an upright posture and has no problem with gait.
The patient is always smiling. According to her, she is always
happy. She also has a direct eye contact whenever we
communicate.
B. SPEECH
The patient talks in a moderate, rapid voice. Her
words are very clear but she skips one topic to another.
She talks non-stop and her responses are in detailed. M.N.
elaborates her answers and expresses her thoughts and
feelings freely.
C. MOTOR ACTIVITY
The patient talks fast without pauses, thinks and moves
rapidly. Most of the time the patient ignores the person
who wish to speak and continue talking even no one is
paying attention on her. Whenever she was interrupted she
often starts all over again.
D. EMOTIONAL STATE
The patient has general feeling of happiness. The patient has
an appropriate affect. Both words and actions are congruent to the
situation.
E. EXPERIENCES
The patient did not have plans or a history of harming others.
She made mentioned that she doesn’t have any hallucinations. She
verbalized “Wala akong naririnig Ma’am”.
F. THINKING
The patient has delusions specifically grandiose delusion. She
claims that she is famous.
G. ORIENTATION AND COGNITIVE FUNCTIONING

The patient is oriented to time, place and people around her. M.N. can
count from 1-20 rapidly, can do simple calculations. When asked what
actions she will take when she sees wallet on the ground, she verbalized “
Ibabalik ko yung wallet tapos di ko kukunin yung pera kasi hindi naman
akin. Masama kumuha ng pera ng iba”. The patient was not able to explain
properly proverbs such as “ Aanhin pa ang damo kung patay na ang
kabayo”. M.N. was able to identify the similarities and differences of some
objects (pencil and paper) and foods/dinks (milk and coffee). She verbalized
“Ang lapis yung ginagamit pansulat tapos yung papel yung susulatan. Ang
milk yung kulay white,yung kape kulay black”.
V. ANATOMY AND PHYSIOLOGY
VI. PSYCHOPATHOLOGY
 VII. LABORATORY AND DIAGNOSTIC EXAMS
HEMATOLOGY RESULT
February 28, 2010
09:17:50am
PARAMETERS NORMAL VALUES RESULT ANALYSIS

Hemoglobin mass concentration 120-160 130 NORMAL

Erythrocyte Volume Fraction 0.37-0.47 0.40 NORMAL

Erythrocyte Number 4-5.5 5 NORMAL

Concentration
Thrombocyte Number 150-400 262 NORMAL
Concentration

Mean Corpuscular Volume 86-100 89 NORMAL

Mean Corpuscular Hgb 26-31 26 NORMAL

Mean Corpuscular Hgb Content 310-370 329 NORMAL

Leukocyte Number Concentration 5-10 5.84 NORMAL

Neutrophils 35-65 54.6 NORMAL

Lymphocytes 20-40 33.7 NORMAL
Monocytes 2-8 7.2 NORMAL
Eosinophils 0-5 4.3 NORMAL
Basophils 0-1 0.2 NORMAL
VIII. COMMUNICATION PROCESS RECORDING
IX. NURSING CARE PLAN
THANK YOU!!!