CASE STUDY

BIPOLAR DISORDER

A.INTRODUCTION

Bipolar disorder, formerly called manic depression, is a mental health condition that
causes extreme mood swings that include emotional highs (mania or hypomania) and
lows (depression).When you become depressed, you may feel sad or hopeless and lose
interest or pleasure in most activities. When your mood shifts to mania or hypomania
(less extreme than mania), you may feel euphoric, full of energy or unusually irritable.
These mood swings can affect sleep, energy, activity, judgment, behavior and the ability
to think clearly. Episodes of mood swings may occur rarely or multiple times a year.
While most people will experience some emotional

HISTORY COLLECTION
I. IDENTIFICATION
Name: M. V

Sex: Female

Age: 25 years old

Marital status: Married

Place of birth: Eastern Province

Nyagatare District

Rwimiyaga Sector

Matunguru Cell

Nshoga village

Sibling’s position: 3rd

Profession: Jobless
Religion: Protestants

Nationality: Rwandese

Admission date:

II. CHIEF COMPLAINT

The patient has been brought by her husband because of having physical and verbal
aggressively, total insomnia, and logorrhea, psychomotor agitation, incoherence speech
with negative insight.

III. ANTECEDENT/PEVIOUS MENTAL HISTORY

It is the 6th crisis since 2003 and all were caused by stopping medications and taking
alcohol and other drugs.

IV. FAMILY HISTORY: The client was born in a family of 8 children, 5 boys and 3
girls, and she occupies the 3rd place. Her both parents and her 3 brothers were killed
during genocide against Tutsi in 1994. After genocide she stayed with uncle and 2 young
sisters.

No person known in her family who had mental problem.

Genogram:

1994 1994 +
+

+ + +
1994 1994 1994

V. MEDICAL AND SURGICAL: HIV/AIDS

VI. GYNECOLOGICAL HISTORY: She is married with 2 kids and no other

gynecological problems observed or mentioned.
VII. JUDICIAL HISTORY: None

VIII. PERSONAL HISTORY:

The patient was born in 1984 in a family of 8 children and grew up normally with her
both parents. She started primary school on time without any difficulty. But 1994 when
she was 10 years old, her parents and her 3 brothers have been killed in Genocide. After
that she continued to study and failed primary six examinations and she entered
secondary school in private school. In 2006 when she completed senior six, she started to
develop signs of mental disorders but not yet confirmed. In 2008 married with an old man
with 54 years old and live with but after 2 years of marriage which means in 2010 she
continue developing mental disorders and confirmed where thy bought at ndera neuro-
psychiatric hospital. From that she had a crisis at least every year. The patient has a
history of HIV Posive since 2011 just one year after marriage.

IX. PHYSICAL EXAMINATIONS

i) General appearance: she is weak due to side effects of drugs.

ii) HEENT: Patient does not have any problem in eyes with no jaundice, moisture
mouth; pink tongue with no sore throat neck is flexed, proper hairs.
iii) Respiratory system: no any problem in respiration presented or observed to the
client.
iv) Cardiovascular system: no problem indicated to the heart with normal heart sounds.

v) Nervous system: normal sensations, shaking due to side effects of drugs, pupils are
reacting to light, with GCS of 13/15 because she is not oriented on date and time.

vi) GI: No abdominal tenderness or distended

vii) Urinary system: no complaints of urination with normal urine output.

viii) Integumentary system: she has normal skin color without wounding or scars.

ix. Vital signs: Blood pressure: 126/72mmhg

 Pulse: 84 bpm

Temperature: 37.20c

Respiration rate: 18 bpm

X. PSYCHIATRIC CONDITIONS

General appearance: she is big in size with well dressed with no agitation or
hyperactivity.

Affect and mood: she is too silent and answers the nurse with few words.

Perception: she no longer has hallucinations and no illusion as before.

Thought and speech: Has a normal flow of speech compared to before where she had
logorrhea. Her thoughts full of hopelessness and low self-esteem but no delusions.

Orientation: she is oriented to time, place and to person.

Memory and concentration: she has the ability to recall past and recent history of her
life.

Judgment and impulse control: she has ability to plan for his future

Insight: negative

Vegetative symptoms: normal level of energy, nausea due to Haldol,

MULTIAXIAL DIAGNOSIS
Axis I: Schizophrenia

Axis II: neither mental retardation nor personality disorder.

Axis III: HIV Positive

AXIS IV: Family and jobless stressing

XI. COMPLEMENTARY EXAMS

-Full blood count (FBC): NORMAL RESULTS

-HIV Test: Positive

XIV. TREATMENT:

-Tegretol tab 200mg BID

- Haldol tab 5mg. BID

-Nozinan tab 100mg OD

Bactrim for HIV

NURSING MANAGEMENT

I. List of patient problem

1. Impaired social interaction related

2. Disturbed thought processes

3. Disturbed Sensory Perceptions

II.Priority

1. Impaired social interaction related

2. Disturbed thought processes

3. Disturbed Sensory Perceptions

 Genetics. Bipolar disorder is more common in people who have a first-degree relative,

such as a sibling or parent, with the condition. Researchers are trying to find genes that may
be involved in ca using bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the
first episode include:
  Having a first-degree relative, such as a parent or sibling, with bipolar disorder

 Periods of high stress, such as the death of a loved one or other traumatic event

 Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of
your life, such as:

 Problems related to drug and alcohol use

 Suicide or suicide attempts

 Legal or financial problems

 Damaged relationships

 Poor work or school performance

Symptoms

There are several types of bipolar and related disorders. They may include mania or
hypomania and depression. Symptoms can cause unpredictable changes in mood and
behavior, resulting in significant distress and difficulty in life.

 Bipolar I disorder. You've had at least one manic episode that may be preceded or
followed by hypomanic or major depressive episodes. In some cases, mania may trigger a
break from reality (psychosis).

 Bipolar II disorder. You've had at least one major depressive episode and at least one
hypomanic episode, but you've never had a manic episode.

 Cyclothymic disorder. You've had at least two years — or one year in children and
teenagers — of many periods of hypomania symptoms and periods of depressive symptoms
(though less severe than major depression).

 Other types. These include, for example, bipolar and related disorders induced by certain
drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis
or stroke.
Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis.
While the manic episodes of bipolar I disorder can be severe and dangerous, individuals
with bipolar II disorder can be depressed for longer periods, which can cause significant
impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage
years or early 20s. Symptoms can vary from person to person, and symptoms may vary
over time

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved,
such as:

 Biological differences. People with bipolar disorder appear to have physical changes in

their brains. The significance of these changes is still uncertain but may eventually help
pinpoint causes.
 Assessment Nursing Goals Intervention Rationale Implimentatio Evaluati
Diagnosis n
Subjective data Impaired social Short-term -Assess the level of -For understand how -Interaction Client is
She says I do not interaction Goal patient interaction we can assist her with others positive a
want any body related to Self- Client will with others. with proper assessed. accepts r
here front of me concept verbalize intervention. own beha
please go away. If disturbance as which of her days but
you do understand evidenced by interaction -Recognize the -Understanding the -Purpose of others fo
what am saying I Discomfort in behaviors purpose these motivation behind behaviors of own n
show you what I social situations are behaviors serve for the manipulation recognized. inapprop
do immediately. appropriate the client: to may facilitate interactio
Objective data and which reduce feelings of acceptance of the Continue
She has physical are insecurity by individual and his and givin
and verbal inappropriat increasing feelings Or her behavior. -Manipulative a prescrib
aggressively, e within 5 of power behaviors
logorrhea, days. And control. -Client is unable to limited and
psychomotor Long-term -Set limits on Establish own limits, explanation to
agitation, Goal manipulative so this must be done client done.
incoherence Client will behaviors. Explain to for him or her.
speech with demonstrate client what you Unless
negative insight use of expect and what the administration of
appropriate consequences are if consequences for
Vital signs interaction the limits are violation of limits is
BP= 124/74 skills as violated. consistent,
mmHg evidenced manipulative -Positive
Pls=69 Bpm by lack of, behavior will not be reinforcement
To=36.9oC or marked eliminated. for non-
RR= 18 BpM decrease in, manipulative
manipulatio -Positive behavior
n of reinforcement provided.
Others to -Provide positive enhances self-esteem
fulfill own reinforcement for and promotes
desires. non-manipulative repetition of -Client was
behaviors. desirable behaviors. helped to
Explore feelings, and identify herself
help the client seek -As self-esteem about positive
more appropriate is increased, client aspects.
ways of dealing with will feel less need to
them. manipulate others for
-Help client identify own gratification. -Tegretol tab
positive aspects 200mg BID
about self, recognize -Nozinan tab
Accomplishment, -For stabilize and 100mg OD
and feel good about treat the client. - Haldol tab
them. 5mg. BID was
given as
prescribed.
-Administer a
prescribed
medication

essment Nursing Objectives Planning Rationale Evaluation

diagnosis
bjective Disturbed That after 3 1. Interact with interacting Patient was
a: thought weeks of the client on about reality able to recognize
the presence of 
processes Nursing Care the basis is healthy for hallucinations, and
m seeing a related to Management, of real things; the client verbalized feelings
ke here” as psychological Patient will do not dwell of comfort, wanted
balized by and cognitive be able to on the -determines to go home and
client. disturbances as Demonstrate hallucination ability to continue his work
jective data: manifested by behavior/life material. participate in
aring a limited attention style changes planning/exe
ja-like outfit span, to prevent, 2 . Assess cuting care
th the visual hallucination, minimize attention
ucination and laughing changes in span/distractibi -provides
mited and talking to mentation lity and ability stimulation
ntion span himself without and Respond to make while
ghing and any reason to reality- decisions/probl reducing
ing to based em solution fatigue
mself without interactions
arent reason initiated by 3 . Schedulestr -to avoid
bjective others ucturedactivity triggering
a: and rest fight/fight
periods responses
m seeing a
ke here” as 4.Reduce
balized by provocative
client. stimuli,
jective data: negative
aring a criticism,
ja-like outfit arguments and
th the visual confrontation
ucination
mited
ntion span
ghing and
ing to
mself without
arent reason