Bipolar Disorder

A Nursing Case Study Presented to the Faculty of College of Nursing

of the University of St. La Salle College of Nursing
Bacolod City

In Partial Fulfillment of the Requirements in

NCM 117 - Related Learning Experience

Submitted by:
Alcala, CJ Louise G.
Aplaon, Aidel Feb V.
Artillo, Aljean Altheo L.
Bañares, Marynelle A.
Barnacha, Hasmin Francesca L.
Barroa, Kheahna Faith P.
Bito-on, Bryle James B.
Bolivar, Jay Tom A.
Bravo, Ma. Christina Gabriela L.
Concha, Arianna Beatrice V.

BN3B - Group 1

July 2022
 Table of Contents

Page
I. Introduction 3
II. Objectives 4
a. Client-Centered Objectives 4
b. Nurse-Centered Objectives 4
c. Objectives of the Case Presentation 4
III. Baseline Data 5
IV. History of Present Illness 5
V. Mental Status Examination (MSE) 6
VI. Psychopathophysiology 11
VII. Anamnesis 12
VIII. Nurse-Client Interactions (NPI) 26
IX. Nursing Care Plans 39
X. Drug Studies 46
XI. Health Teaching Plan (Treatment) 51
XII. Recommendations 64
XIII. References 66

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I. Introduction
Numerous denotations for mental health include the literal absence of mental disorder,
emotional balance, ability to effectively play a social, physical, and emotional role, modification,
and improvement of the individual and social environment, and the ability to adapt to normalcy,
are definitions amongst a long list. Mental health can best be described as the capability of an
individual to realize their capacities, use it accordingly to become a productive member of
society, and can cope well with the adversities they encounter throughout their journey in life.
The World Health Organization (WHO) defines health as "complete physical, mental, and social
well-being," not "absence of illness or infirmity." An important facet of health, mental health is a
perceptual concept rooted in an individual's learning, values, and beliefs, which are influenced
by the environment, family, and community. If the concept of health is understood abstractly,
the implications for daily life are unclear.

Bipolar disorder is a mental health condition that exhibits extreme mood swings. These
mood swings range from emotional highs (e.g., mania and hypomania) to lows such as
depression. This abrupt shift in mood can have the person feel hopeless or sad and are inclined
to lose interest or pleasure in most activities. On the other hand, a mood shifting to mania or
hypomania has the person feeling euphoric, full of energy, or unusually irritable. A disorder that
affects people in the millions, it can drastically affect normal functioning for these individuals and
can have unfortunate effects on their lives and the relationships they maintain with peers.
According to the Department of Health, at least 3.6 million Filipinos are dealing with mental
health issues (e.g., depression), substance use disorders, and mood disorders such as bipolar
disorder during the pandemic (2021).

The client, B.A., was diagnosed with bipolar disorder with chief complaints of irritability
and behavioral change. The client exhibited disorientation, decreased concentration, short
attention span, mood swings, prolonged sadness, irritability, and inability to concentrate
throughout the duration of care. The client also stated that she has always had a temper, and
after a brief but abrupt pause, she returned to the conversation happily. The client used
monotone expressions when bored and was noted to be irritated in answering questions;
conversely, her tone rose when excited. A nun from a parish ministry brought client B.A to the
Bacolod City Mental Health Care Center for admission due to sudden behavioral changes and
irritability. She miscarried her three-month-old baby in 2021 due to depression over her
boyfriend's abandonment while pregnant. She is a high school graduate admitted to a mental
institution for nearly six months since the incident.

As it is a serious mental health problem that frequently goes undiagnosed, misdiagnosed,

and untreated, the student nurses believe there is a need to investigate the complexity of the
illness and the various ways to treat these individuals. Manic episodes of bipolar disorder can

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also be severe and dangerous; thus, it is critical to understand and learn how to properly handle
these situations.

II. Objectives
A. Client-Centered Learning Objectives
General Objective
After 5 weeks of Psychiatric Nursing Care experience, the client will be able to:
A. Demonstrate acknowledgement about her condition to achieve optimal mental
wellness.
Specific Objectives
After 3 days of actual Psychiatric Exposure, the client will be able to:

A. Identify positive coping mechanisms that can aid in dealing with sudden changes of behavior.
B. Express positive response to therapeutic interventions.
C. Demonstrate understanding about her condition.
D. Establish trust and speak freely to the student nurse about her emotions.
E. Participate in active therapeutic communication with the student nurse.

B. Student-Centered Learning Objectives

General Objective
After 5 weeks of Psychiatric Nursing Care Experience, the student nurse will be able to:

A. Recognize management strategies for appropriate maintenance of a client diagnosed

with an altered mental health.

Student-Centered Specific Objectives

Specific Objectives
After 3 days of Psychiatric Nursing Care Experience, the student nurse will be able to:

A. Identify the prevalence and comorbidities of Bipolar Disorder.

B. Discuss the possible lifestyle treatments for individuals with Bipolar Disorder.
C. Recognize manipulation tactics manifested by the client all throughout the exposure.
D. Formulate 3 priority nursing diagnosis for individuals with Bipolar Disorder.
E. Evaluate the student nurses’ knowledge about the possible effects of antipsychotic
medications.

C. Objectives of the Case Presentation

After one (1) hour of case presentation, the student nurses will be able to:
A. Recall the overview condition of the client including the disease process, the nursing
interventions, and nursing implications of Bipolar Disorder.
B. Identify and formulate actual nursing diagnoses relevant to the priority problems of the
client.

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C. Modify planned nursing interventions according to the needs and deficiencies of the
client.
D. Recommend enhanced, personalized, and evidence-based practices to improve the care
of an individual with Bipolar Disorder.
E. Justify the effectiveness of the nursing interventions performed on the client during
period of care.

III. Baseline Data

Name: B.A
Address: Barangay Handumanan, Bacolod City
Age: 20 years old
Sex: Female
Civil Status: Single
Date of Birth: January 15, 2002
Number of Siblings: 2 (1 older brother and 1 younger sister)
Number of Dependents/Children: N/A
Religion: Roman Catholic
Highest Educational Attainment: High School Graduate
Occupation: None
Person next-to-kin:
Date of Admission: December 2021
Date of Care: June 28, 2022
Attending Physician: Dr. Romeo A. Orcajada Jr.
Chief Complaints: Irritability & Change of behavior
Medical Diagnosis: Bipolar Disorder

IV. History of Present Illness

The 20-year-old female client from Barangay Handumanan was admitted to the Bacolod
City Mental Health Care Center on December 13 of 2021 due to sudden behavioral changes and
irritability. Prior to her admission, she miscarried her 3-month-old baby and was admitted to the
Corazon Locsin Montelibano Memorial Regional Hospital. In that same month, she and her
boyfriend broke up and noted that these circumstances contributed to her feeling depressed.
She was a high-school graduate, and a supposed-to-be continuing 12th grade student but
stopped schooling. She is now 7 months inside the facility.

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V. Mental Status Examination

MENTAL STATUS EXAMINATION

A. Baseline Data

Name: B. A Sex: Female Religion: Occupation:

Roman Catholic N/A
Address: Barangay Handumanan, Bacolod City
Educational Civil Status: Chief Complaint/s: Contact No:
Attainment: Single Irritability & Change of Behavior N/A
High School Graduate
Medical Diagnosis: Dr. Romeo A. Orcajada Jr.
Nursing Diagnosis: Disturbed Thought Process related to biochemical changes in the brain as
evidenced by sudden changes in behavior and irritability to stimulus.
B. Brief History of Present Illness
The 20-year-old female client from Barangay Handumanan was admitted to the Bacolod City
Mental Health Care Center on December 13 of 2021 due to sudden behavioral changes and
irritability. Prior to her admission, she miscarried her 3-month-old baby and was admitted to
the Corazon Locsin Montelibano Memorial Regional Hospital. In that same month, she and her
boyfriend broke up and noted that these circumstances contributed to her feeling depressed.
She was a high-school graduate, and a supposed-to-be continuing grade 12 student but
stopped schooling. She is now 7 months inside the facility.
C. General Appearance and Behavior
Client B.A. is about 5'2 tall, appears stout, and maintains a proper posture with distention of
the abdomen noted. She dresses in a very girly manner and always uses red lipstick and red
eyeshadow for her face. Nails are well-trimmed, and hair is always clean, but the client has a lot
of small wounds on both feet and approximately 1-2 inches of straight wound cut on the area
above the Achilles heel. She also has a tattoo on her right with letters on each of her fingers
spelled out as "DYOSA." She wears clean trendy clothes every day and wears perfume. Has
stretch marks on both thighs and seldom handwashes when handling and eating foods. In
regard to her facial expression, she exhibits an elated mood when excited and is irritable when
indifferent.
D. Character of Speech
The client sometimes has a sudden change in speech pattern, like using a monotone expression
when bored and irritated in answering. Her tone rises when she’s excited but lowers down
when irritated. The client is very manipulative and often asks for things from nurses. She is
coherent when talking and uses a soft tone when answering the nurses about what foods she
ate. There are no observed stuttering, stuttering, unusual accents, mumbling, or echolalia.
E. Mood and Affect

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Client B.A was noted to have a pleasant mood during NPI. She was friendly and cooperative
when it came to joining the activities. She was very interactive and always energetic. Most of
the time, she takes the initiative to think about topics that she wants to discuss. It enlightens
her mood when the topic is of her interest. However, she had this one random mood swing
when the topic was about her mother. She doesn't want to talk about her mother but when
she does, she becomes cold and uninterested. Her tone of voice changed from being
enthusiastic to being sarcastic. Also, it was claimed that she really hates the subject
Mathematics, according to her she doesn't want to talk about math because she is 'allergic' to
it and always tends to avoid topics like that.
F. Form of Thought
Client B.A. was dismissive when asked why her mother wouldn't visit her; she claimed "wala man
na sa labot sa akon, gusto ko lang ya ang madre mag bisita sakon." In addition, she was aloof
when talking about her mother and acted like a main character with the student nurses during
NPI. Her thought content was more concrete ideas and was coherent when asked with certain
questions. Client B.A. talks fast as she has flights of ideas, jumping from one topic to another.
With sudden shifts to her tone in voice as her mood changes, she tones back with an elated mood
when talking about her “crush”. A train of thought can be followed with client BA if given with a
certain topic that you need to know but often deviates with the topic as she doesn't want to
answer them, and the student nurse needs to shift the focus back to the question. When silence
she diverts back and is fixated on her “crush”.
G. Sensorium Function
• Level of Consciousness (LOC)/Orientation
1. Time - The client could accurately tell the time, date, month, and year when the student
nurse asked.
2. Place - The client knew where she was, stating the facility's name and which school the
student nurses were from based on their uniforms. She could identify which area of the facility
the student nurses were conducting the activities, therapeutic modes, and games.
3. Person - The client could easily state her name, the student nurse's name, and her parents'
name and identify the facilities' residents by their names.
4. Situation - The client comprehends why she was at the facility as she was aware of her
condition and diagnosis, Bipolar Disorder. She verbalized that she understands what to do and
is aware of the efforts she should exert to get herself into a better, stress-free headspace.

• Memory
Client B.A was noted to recall things easily. She had memorable past events in her life that she
can recall and was able to share it to the student nurse openly. She can remember dates and
events that, according to her, made an impact in her life and most of the time she talks about it
in a time-sequencing manner. Although she was able to discuss these kinds of topics, there are
signs of inconsistency noted. There is specific information that changes from time to time,

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depending on who she is talking to. In line with that, the student nurses were trying to ask further
questions that are connected to her stories so that student nurses would be able to gather
relevant and reliable data.

• Level of Concentration
Client verbalized feelings of distaste when asked about doing arithmetic stating "indi lang ko na
kay na allergy ko sa math” She was asked to count to 20 by 2's and then reverse, she did so
mentally. Despite her distraught on the asked task, she performed well.

• Information and Intelligence Test

10 Kahn’s Questions X ✓
1. What is the name of this place? ✓
2. Where is it located? ✓
3. What day of the week is it? ✓
4. What is the month now? ✓
5. What is the year now? ✓
6. How old are you now? ✓
7. When were you born? (Month) ✓
8. When were you born? (Year) ✓
9. Who is the president now? ✓
10. Who was the president before him? ✓
Score: 10 = None/No OBS
Score: 1 – 5: Severe OBS
6 – 7: Moderate OBS
8 – 9: Mild OBS
10: None/No OBS
• Total Score from the 10 questions will determine the client is suffering from Organic Brain
Syndrome (OBS).
• Organic Brain Disease/Disorder – a syndrome or disorder of mental function whose cause is
alleged to be known as organic rather than purely of the mind.
H. Insight and Judgment
Client B.A is highly self-aware about her condition. She was able to talk about the reason as to why she
was admitted to BCMHCC without being in denial about it. She has a sound judgement noting that she
knows well about her situation and that she is doing her best to be discharged as soon as possible.
I. Reliability
Client B.A. is perceived to have some sense of reliability; however, student nurses cannot prove its
validity as we have no comprehensive data background on the client. She exhibits no grandiosity with

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her answers and is lucid and coherent enough to recall significant events in relation to the question
asked. A significant other or medical history would be needed to clarify events in time and sequence.
J. Prognosis

Criteria Poor Good

1. Onset of Illness
• Below 20 and Over 40 years old ✓
• Between 20 to 40 years old
2. Educational Attainment
• High School Level ✓
• College Level (At least finished
1 year in College)
3. Sex
• Male
• Female ✓
4. Familial History
• Familial
• None ✓
5. History of Admission
• Chronic ✓
• Acute
6. Socioeconomic Status
• Unstable ✓
• Stable
7. Family Support
• Without ✓
• With
8. Behavior in the Ward
• Non-Participative
• Participative ✓
9. Pre-Morbid Personality
• Introvert
• Extrovert ✓
10. Compliance to Medications
• Without Compliance
• With Compliance ✓
Score: 5/10 (Good Prognosis)
K. Evaluation

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Overall, client B. A has a pleasant appearance noting her efforts to look presentable in everyday
activities. She is conversant and responsive during nurse-client interaction (NPI) although her tone of
speech depends on the topic being talked about. She was noted to have a pleasant mood during the NPI
despite one random mood swing brought about by an irrelevant topic yet very cooperative in joining
every activity. Client B.A was noted to be dismissive and aloof when talking about things that does not
interest her. She is often observed to have flight of ideas when conversing, jumping between one topic
to another, her way of avoiding topics she doesn't want to be discussed. She is well-oriented and
conscious about the time, place, person, and situation being asked to her. In terms of memory recall,
she can remember things according to her past events in life however inconsistency of ideas and
information were observed during the NPI. Client is very firm when it comes to her beliefs and that she
always tries to get away from things that make her uncomfortable as it affects her concentration. For
the information and intelligence, Khan's 10 questions were utilized. She scored 10 out of 10, indicating
that Client B.A has no Organic Brain Syndrome (OBS). Client was noted to be fully self-aware and has
good judgement. In terms of reliability, she is perceived as being reliable, the only basis of which is the
NPI, however its validity cannot be proven since data is insufficient. Assessment of prognosis were done,
and she scored 5 out of 10 indicating a good prognosis.
L. References
• Client’s Chart
• Client’s Interview
• Clinical Instructors
• Bacolod City Mental Health Care Center’s Employees (Nurses)

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VI. Psychopathophysiology

PREDISPOSING FACTORS PRECIPITATING FACTORS

• Low Socioeconomic Status
• Sex (Female)
• Weak support system (Broken Family)
• Age (20) • Traumatic Event occurring when the
client was 19 years old (Miscarriage)
• Poor Coping Mechanism
• Stress

Decrease in inhibitory neurotransmitters (GABA)

LEGEND
Decreased inhibitory control of emotional circuit Causative Factors
Disease Process
Medical Diagnosis
Signs & Symptoms
BIPOLAR DISORDER Nursing Diagnoses

Disruption of emotional homeostasis

Alternation of moods

Manic Episode Depressive Episode

Manifestations: Manifestations:

• Elevated, irritable • Decreased

mood. concentration.
• Fast-paced talking. • Withdrawal.
• Flight of ideas. • Hopelessness.

Disturbed Thought Process Risk for Other-Directed Violence

related to biochemical changes in related to manic episodes and
the brain as evidenced by sudden poor impulse control.
changes in behavior and
irritability to stimulus.

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VII. Anamnesis
Psychosexual Theory by Sigmund Freud
1. Oral Stage (Birth to 1 year)
Erogenous Zone: Mouth
To help satisfy its libido and, by
extension, its id demands, the
baby enjoys putting all objects in
its mouth during the oral stages.
At this time of life are mouth-
focused or oral behaviors, such as
breastfeeding and sucking.
The primary conflict at this stage is
the weaning process--the child
must become less reliant on
caregivers. If fixation happens at
this point, Freud believed the child
would struggle with
Psychosocial Theory by Erik Erikson
1. Infancy
Birth to 18 months
Conflict: Trust vs. Mistrust
Value: Hope
Important Event: Feeding
During this stage, occurring
between birth to one year of age,
an infant is dependent and
develops a sense of trust when
caregivers provide them reliability, stop breathing and turn a bluish color, but
care, and affection. Wherein a
failure of this will turn to mistrust,
fear, and a belief that the world is
inconsistent and unpredictable,
Interpersonal Theory by Harry Sullivan Anamnesis
1. Infancy (0-2 years old) The resident's mother was the one
that took care of her at this stage. No
The tenderness received by the infant from
further information was able to be
the mothering one is what allows the infant
taken as the resident did not disclose
to be human according to Sullivan. Provision
anything further.
of food, shelter, moderate temperature,
physical contact, and the cleansing of waste
materials is the responsibility of the mother
for the survival of the infant. An infant
express both hunger and anxiety through
crying.
There are instances wherein the infant would
apathy and somnolent detachment are built-
in protections to keep the infant from death.
Apathy and somnolent detachment allow the
infant to fall asleep despite the hunger.
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aggressiveness or dependency. because if a child develops trust During the feeding process, the infant not
successfully, they will then feel only receives food but also satisfies some
safe and secure. tenderness needs.
Oral fixation can result in
problems with drinking, eating, Infants start to learn how to communicate

smoking, or nail-biting. through language during the middle of

infancy. Their language is initially confirmed
on an individual or parataxic level rather than
through consensus. Autistic language, or
private language that is unclear to others, is
what distinguishes this stage of infancy. Face
expressions and the utterance of diverse
phonemes are the primary means of early
communication. Both are picked up through
imitation, and eventually a newborn learns
that gestures and spoken sounds mean the
same thing as they do to other people. The
end of infancy and the beginning of syntaxic
language are both marked by this
communication.

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2. Anal Stage (1 to 3 years)
Erogenous Zone: Bowel and
bladder control
Freud believed the libido's main
concentration during the anal
stage was managing bowel and
bladder function. Toilet training,
which requires the child to learn
to manage their bodily needs, is
the main source of conflict in this
period—gaining this control
results in a feeling of freedom and
accomplishment.
Sigmund Freud believed that this
type of conflict tends to come to a
head in potty training, in which
adults impose restrictions on
when and where the child can
2. Early Childhood No information was gathered
2. Childhood (2 to 6 years old)
2 to 3 years pertaining to the anal stage with the
same reason as with the oral stage.
Conflict: Autonomy vs. Shame and The mother continues to be the most
important other person throughout this era,
Doubt
although her job is no longer what it was
Value: Will
during infancy. The child's perception of the
Important Event: Toilet Training mother is now more in line with the "actual"
mother as the two personifications of mother
During this stage of early
have been combined into one. However, on a
childhood, the child develops a
parataxic level, the personifications of the
greater sense of personal control.
good-mother and bad-mother are typically
Where they start to gain
kept.
independence in performing basic
actions on their own and making When a child is young, feelings become
simple decisions. Parents and reciprocal; they can both offer and receive
caregivers can assist the child in love. The mother-child bond develops into
developing a sense of autonomy, one that is more intimate and reciprocal.
by allowing them to make choices
Preschool-aged youngsters frequently have
and gain control. If they complete
just one other important interaction besides
this stage, they will feel secure
and confident, while those who do their parents: an imaginary playmate.
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defecate. The nature of this first
conflict with authority can
determine the child's future
relationship with all forms of
authority.
Parents who praise and reward for
using the toilet at the appropriate
time encourage positive outcomes
and help children feel capable and
productive. If the approach is too
lenient, an anal-expulsive
personality could develop in which
the individual has a messy,
wasteful, or destructive character.
If parents are too strict or begin
toilet training too early, Freud
believed that an anal-retentive
personality develops when the
individual is stringent, orderly,
rigid, and obsessive.
not will turn to feeling a sense of Children can establish a calm, anxiety-free
inadequacy and self-doubt. A relationship with an eidetic pal. Childhood
balance between these will lead to was described as a time of fast acculturation
will, wherein the child can act with by Sullivan. Along with learning language,
intention. within reason and kids also pick up cultural norms for eating,
limits. cleaning up after themselves, and sex roles.
They also learn about dramatizations and
A vital part of this stage is toilet
preoccupations, two additional crucial stages.
training, where the child will need
Dramatizations are attempts to sound or
to develop a sense of personal
behave like important authorities, often
control, sense of independence,
parents. Preoccupations are coping
and a sense of autonomy.
mechanisms that keep people from engaging
Learning to control our bodily
in situations that might otherwise make them
functions will lead to a feeling of
anxious or fearful.
control and independence. Other
important events that are
important for a growing child
would include gaining control over
food choices, toy preferences, and
selection in clothing.
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3. Phallic Stage (3 to 6 years)
Erogenous Zone: Genitals
According to Freud, the libido's
major emphasis is on the genitalia
during the phallic stage.
Children learn about the
differences between males and
girls at this age setting the motion
of conflict between erotic
attraction, anger, rivalry, jealousy,
and anxiety that Freud referred to
in boys as the Oedipus complex
(feelings of desiring to possess the
mother and replace the father)
and in girls as the Electra complex
(the girl wants the father, but
realizes that she does not have a
penis).
3. Preschool
3 to 5 years
Conflict: Initiative vs. Guilt
Value: Purpose
Important Event: Exploration
During this stage of the child's
preschool years, the child will start level of competitiveness among kids this age
varies depending on the culture, but
to assert power and control over
the environment through play and
social interactions. When that
child is successful in this stage will
lead to a sense of purpose, in
feeling capable and able to lead
others. As for those who do not
obtain these will be left with self-
doubt, and a lack of initiative.
Those who will exert too much
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3. Juvenile Era (6 to 8½ years old)
The juvenile period starts with the Resident is the middle child of the
emergence of the demand for peers or family but no further information
playmates of equal rank and ends when one regarding the status of her
finds a solitary friend to satiate the desire for attachment to each parent and other
intimacy. According to Sullivan, a child should family members were acquired.
learn how to compete, negotiate, and
cooperate while still in the juvenile stage. The
According to the resident she had
several friends, and they were all
mostly girls at this stage. She was
according to Sullivan, Americans have
friendly with them, and they liked to
historically overemphasized it. Many young
do make-up sessions. In this age she
people think that to succeed, they must be
enjoyed singing and showed
competitive. Compromise can sometimes be
friendliness towards her peers.
used excessively. The socialization process is
hampered in a 7-year-old youngster who
learns to constantly surrender to others, and
this yielding attitude may stick with them
throughout their lives.
The process of identification,
which entails the child acquiring
the traits of the same sex parent,
resolves this.
power will go through disapproval
and a sense of guilt.
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All the actions required to get along with
others are acts of cooperation. The young
child must develop teamwork skills to
function in the actual world of interpersonal
interactions. The most significant challenge
facing kids at this period of development is
cooperating, which is a crucial step in
socialization. A child should have acquired an
orientation to life by the end of the juvenile
stage that makes it simpler to regularly
manage anxiety, satiate zonal and tenderness
needs, and form objectives based on memory
and foresight. A person is prepared for the
deeper interpersonal ties that will come after
adopting this way of living. According to
Sullivan love exists “when the satisfaction or
the security of another person becomes as
significant to one as is one’s own satisfaction
or security”.
4. Latent Period (6 years to puberty)
Erogenous Zone: Sexual feelings
are inactive
The fourth stage of psychosexual
development, known as the
latency stage, is a phase of
exploration during which the
sexual energy is suppressed or
inactive, known as the latent
period. This energy is still there
but has been transferred to other
activities like learning and
socializing. The growth of social
and communication skills, as well
as self-confidence, depends on
this period.
The superego continues to grow
throughout this stage,
4. School Age
6 to 11 years
Conflict: Industry vs. Inferiority
Value: Confidence
Important Event: School
During this stage of early school
years, the child will experience
social interactions and will
develop a sense of pride in these
abilities and accomplishments.
Coping with new social and
academic demands are important
for the child, and success from this as children.
will lead to a sense of competence
where they will develop a belief in Preadolescent life events are essential to the
their abilities to handle the tasks
set before them, while failure to
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4. Preadolescence (8½ to 13 years old) For the psychosexual theory, the
resident's sexual feelings are still
Preadolescence is notable for the
inactive as the client’s first concern
development of the capacity for love. Prior to
was self-improvement and
preadolescence, all interpersonal interactions
socialization as she was still in the
were centered on gratifying personal needs,
latent phase during this age. As for
but now friendships are fundamentally about
the psychosocial theory, her focus was
intimacy and love. Intimacy involves a
school causing her social world to
partnership in which the two individuals
expand. In the stage: Industry vs
mutually affirm their value as individuals.
Inferiority, the resident's confidence
Preadolescents can experience unconditional in her singing stems from the
attention and praise from her peers
love that is not yet clouded by lust. The
and classmates while her lack of self-
ability to work with others, not for one's own
confidence when it comes to
benefit but for the benefit of the other,
develops from the cooperation they learned computations stems from her dislike
of the subject, math.
future development of personality. Children's The resident loved singing songs when
later personality development is likely to be she was still in grade school. She
severely hampered if they don't learn would explore and sing songs in
contributing to the calm. Around
the time that kids start school,
they begin to focus more on their
interests, hobbies, and
interactions with their peers.
Children form connections, social
skills, and morals with peers and
adults beyond the home.
In this stage, Freud believed
children could get preoccupied or
"stuck." Fixation at this age can
lead to immaturity and the
inability to have satisfying
relationships later in life.
this will lead to feelings of
inferiority.
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intimacy at this age. However, the benefits of
a close connection can mitigate early harmful
effects.
different genres, constantly seeking to
improve her singing skills by imitating
the original singer's singing technique.
During her elementary school years,
she realized how much she loved
singing and, at the same time,
discovered how much she dislikes
math, numbers, and computations.
Since she is interested in music and
singing, she would find time to
participate in extracurricular activities
by joining singing programs arranged
by the school. Although she has many
friends of different genders, she is
much closer to her female friends.
There is insufficient data on her family
and home as she tends to avoid the
subject by changing the topic. She is
an outgoing and extroverted person
who easily gets along with others.
 There is insufficient data regarding
health, illnesses, accidents, and
operations.

20
5. Genital Stage (Puberty to Death)
Erogenous Zone: Maturing Sexual
Interests
The final stage of Freud's
psychosexual theory of personality
development, the genital stage,
starts during puberty. It's a period
of teenage sexual
experimentation, which may be
resolved successfully by
committing to a loving, one-on-
one relationship with a partner in
our 20s.
Instead of being motivated by self-
pleasure during the phallic stage,
the sexual instinct is focused on
heterosexual pleasure. According
to Freud, heterosexual sexual
5. Adolescence
12 to 18 years
Conflict: Identity vs. Role
Confusion
Value: Fidelity
Important Event: Social
Relationships
During this stage of turbulent
teenage years, it plays an essential
role in teens developing a sense of marks a turning point in a person's
self and personal identity,
influencing behavior and
development in the person's life.
Success from this will lead to the
ability to stay true to oneself.
However, failure from this will
lead to role confusion and a weak
5. Early Adolescence (13 to 15 years old) As for this stage, the resident is an
extrovert. She often goes out with her
Puberty and the longing for romantic love
friends who mostly are female, loves
with one person mark the end of early
to sing and put on makeup. Also like
adolescence. It is characterized by the
to style her clothes and wear trendy
emergence of lustful connections and the
ones.
eruption of genital attraction. Early
adolescence is when the need for intimacy
that was met during the previous stage is still The resident loves to sing and enjoys
present, but it is now accompanied by a joining programs that involve singing.
second, parallel need: lust.
Early adolescence, in Sullivan's opinion,
No further information was then
disclosed by both the resident and the
personality development. The person either
mother of the resident.
leaves this stage in control of the dynamics of
intimacy and lust or experiences significant
interpersonal challenges in later stages.
Sullivan believed that while sexual
adjustment is crucial to personality
development, getting along with others is the
21
activity is the best way adults
express their sexual urges. Conflict
and fixation may impede this,
leading to the emergence of
sexual perversions.
For instance, fixation at the oral
stage may cause a person to
prefer oral sex and kissing over
other forms of sexual activity.
sense of self. main challenge.
Children will explore their
independence and develop a
sense of self during adolescence.
Teens with proper encouragement
and reinforcement through
personal exploration will benefit
from this stage with a strong
sense of self, feelings of
independence, and control. For
those who remain unsure of their
desires and beliefs will feel
confused and insecure about
themselves and the future.
One's personality identity gives an
integrated and cohesive sense of
self that will endure throughout
life. A person's sense of personal
22
identity is shaped by experiences
and interactions with others, and
it is the identity that helps guide
actions, beliefs, and behaviors.

23
6. Young Adulthood
19 to 40 years
Conflict: Intimacy vs. Isolation
Value: Love
Important Event: Relationships
During this stage covering the
period of early adulthood where a
young adult is exploring personal
relationships. It is vital that they
need to develop close, committed, Late adolescence is distinguished by the
intimate, loving relationships with marriage of intimacy and lust. Early
other people. Success from this
stage will lead to strong, secure,
and enduring relationships, while
failure will lead to loneliness and
isolation. A valuable outcome
from this stage is love, which is
24
6. Late Adolescence (15 to 18 years old)
Young individuals enter late adolescence
when they can feel lust and closeness for the
same person, and it ends when they become
adults and have a committed love
relationship. Late adolescence refers to the
phase of self-discovery when teenagers are
figuring out their genital behavior
preferences, which often occurs during the
secondary school years, or between the ages
of 15 and 17 or 18.
adolescence's difficult attempts at self-
discovery develop into a consistent pattern of
sexual behavior in which the partner is also
the target of lustful interest.
As for this stage, the resident is fond
of talking about her crushes most of
the time, mentioning that her types
are those that are tall, dark, and
handsome.
The resident was 19 years old when
she had a boyfriend, who then left
after she got pregnant. However, the
resident stated that she wanted to be
a mother and was happy about the
pregnancy even though it was
unplanned. Prior to her admission to
BCMHCC, she suffered a miscarriage
of her 3-month-old baby and was
admitted to the Corazon Locsin
Montelibano Memorial Regional
Hospital. After her boyfriend broke up
with her, all of these circumstances
then resulted in her being irritable
marked by the ability to form and depressive.
lasting, meaningful relationships
with other people as well.
No further information was then
disclosed by both the resident and the
mother of the resident.

25
VIII. Nurse-Client Interaction

NURSE-CLIENT INTERACTION #1: Orientation Phase

DAY 1: June 28, 2022 (Tuesday)

I. Background Information
A. Name: B.A
B. Sex: Female
C. Age: 19 years old
D. Civil Status: Single
E. Educational Attainment: High School Graduate
F. Occupation: None
G. Religion: Roman Catholic
H. Address: Barangay Handumanan, Bacolod City

II. Objectives:
A. General Objectives (Long Term – duration of the exposure)
1. Client-Centered: Verbalize feelings comfortably to the nurse without
hesitancy and demonstrate acknowledgement about her condition.
2. Student-Centered: Recognize owns apprehensions and end the termination
phase satisfactorily.

B. Specific Objectives (Short Term – daily)

1. Client-Centered: Participate actively in the activities conducted and speak
openly to the student nurse about themselves.
2. Student-Centered: Establish good rapport with the client.

III. Actual Entry

Nurse Interaction Client Interaction Nurse Inference Client Inference
(Rationale/TheraCo
m)
“Maayong aga “Good morning Giving Client greeted
Bea, ako si Tin, nang, ako si Bea” back with a smile
recognition-
isa ka estudyante
halin sa La Salle” shows courtesy and
respect to client as a

fellow human being

26
“Kamusta ang “Okay lang ko di. Broad Client answered
tinir mo di sa Hambal ka doctor to the nurse
openings-
Paglaum? Ari mga 6 months positively
kami di para pako di matinir.” allowing the client to
take the initiative in
mamati kung ano
ang gusto mo nga introducing the topic
e share sa
amon?”

“Okay lang sa imo “Oo. Sugiran ta Placing the event in Client answered
kung mamangkot kamo nga-a na time or sequence- the student
kami kung paano depress ko? Kay asking for nurse while
ka naka kadto diri may boyfriend ko relationships among eating the bread
sa Center” bala sang una. events
Didto kami nag
kilalahay sa
isdaan”

“Sa isdaan? Ano “Sa isdaan bala, Restating- repeating Client explained
nga isdaan?” ang mga the exact words of accompanied
gabaligya na bala clients to remind with hand
mga isda sa them of what they gestures
palengke” said and to let them
know they are heard

“Tapos? ano “Nag busong ko Exploring- delving Client continues

dason natabo?” eh, tapos further into a subject to talk
nahulugan ko. or an idea
Halin ko to sa CL,
tapos diri ko gin
diretso ni sister”

*Silence “Didto gid ko na Silence- planned Client continues

depress kay absence of verbal to talk while
nahulog akon remarks to allow eating at the
baby. 3 months client and nurse to same time
palang to siya” think over what is elaborating
being discussed and names of babies
to say more

27
“Bea, ano imo “Mangkuton ko Exploring- delving Client elaborated
plano pagkatapos gani si doktor further into a subject names of babies
mo di ayo sa kung pwede ko or an idea while smiling
Center kag pwede na untatan ang widely
kana kapuli?” akon nga bulog
kung gusto ko na
magbusong kay
may mga gusto
nako di nga
ngalan para sa
babies ko. Gusto
ko 3 girl kag 3
man boy”

“Ma ask gid ta “Oo, mamangkot Giving information- Client nodded

anay kay doctor ko na bala kay providing information
kung san o na doctor” that will help clients
pwede untatan to make better
ang imo bulong choices.
Bea. Pero mintras
nga wala may gin
hambal ang
doctor nga e stop,
sigehon mo gid
na inom ang iya
nga prescribed
nga bulong sa
imo”

“May iban kapa “Wala na ah. Amo Broad Client stood up

nga gusto ta lang na. Lunch na and walked into
openings-
istoryahan? namon, makaon the kitchen area
allowing the client to
pwede mo man nako”
take the initiative in
ma share sa
amon ang imo introducing the topic
mga hobbies kag
kung ano
nanamian mo
ubrahon”

28
 “Salamat gid kay “Salamat nang. Reinforcement- Client continued
ka very Bye” giving feedback on to eat her lunch
cooperative gid positive behaviors and waved
sa imo today, goodbye to
mabalik naman student nurses
kami di tomorrow
morning.
Salamat”

IV. Evaluation: (For daily requirement, evaluate specific objectives only)

1. Client-Centered: After 4 hours of nurse and client interaction, the client was able
to participate actively and spoke openly about themselves to the student nurse as
verbalized by the client, “Gusto ko lang e i-storya nga nasubuan gid ko di ya!”. GOAL
MET.

2. Student-Centered: After 4 hours of nurse and client interaction, the student nurse
was able to establish good rapport with the client as evidenced by the client
continuously sharing her stories and emotions in detail. GOAL MET.

29
 NURSE-CLIENT INTERACTION #2: Working Phase

DAY 2: June 29, 2022 (Wednesday)

I. Background Information
A. Name: B.A
B. Sex: Female
C. Age: 20 years old
D. Civil Status: Single
E. Educational Attainment: High School Graduate
F. Occupation: None
G. Religion: Roman Catholic
H. Address: Barangay Handumanan, Bacolod City

II. Objectives:
A. General Objectives (Long Term – duration of the exposure)
1. Client-Centered: Verbalize feelings comfortably to the nurse without
hesitancy and demonstrate acknowledgement of her condition.
2. Student-Centered: Recognize owns apprehensions and end the termination
phase satisfactorily.

B. Specific Objectives (Short Term – daily)

1. Client-Centered: Participate actively and share positive insights about the
activities performed today.
2. Student-Centered: Assist the client all throughout the activity and gain
information about client’s insights on today’s activities.

III. Actual Entry

Nurse Interaction Client Interaction Nurse Inference Client Inference
(Rationale/TheraCo
m)
“Maayong aga “Maayong aga Giving broad Client answered
Bea, Amo na ni man nang, maayo openings- with a smile
ang ika duwa ta man tulog ko
Allowing the client to
nga adlaw nga kagab e”
take initiative in
inuporay.
introducing the topic
Kamusta man
tulog mo kagab
e? May ara ka
gusto mo liwat e
share sa amon

30
subong nga
adlaw?

“Nakapaligo kag “Oo eh. Kay aga Feedback- Pointing Client finger-
naka pang make- pa kami out specific behaviors combed her hair
up ka na ba. May gabugtaw, amo and giving while answering
mga activities na nakapaligo impressions of
naman ta subong nako” reactions
nga adlaw. Pwede
mo ma share sa
amon kung ano
ang gina expect
mo sa sini nga
adlaw parte sa
aton activities?”

“Nakapamahaw “Ah oo tapos na. Asking question- Client nodded

ka na? Ano inyo Ampalaya nga while answering
Using open-ended
gin sud-an may itlog kag the student
questions to achieve
subong nga aga?” lumpia amon sud nurse
relevance and depth
an kag may cake
in discussion
man”

“Ano ang flavor “Strawberry to Exploring - Delving Client answered

sang cake nga gin ang flavor ka further into a subject in monotone
kaon mo?” cake” or an idea.

“May gusto ka “Oo nang, kabalo Giving broad Client shared to

istorya sa amon kamo? Ex ko na openings- the student
subong?” bala c Bahil.” nurse while
Allowing the client to
smiling widely
take initiative in
introducing the topic

“Tuod na nga “Oo bala nang. 4 Voicing doubt - Client elaborated

natabo?” days lang na ang Voicing uncertainty
amon about the reality of
relationship gin client’s statements,
breakan ko sa perceptions, and
dayon” conclusions.

31
“Paano naging “Gin dare ko ni Placing the event in Client explained
kamo? Pwede mo Pyla tapos amo to time or sequence- while smiling
maistorya sa kami na, galing asking for widely and kept
amon kung paano kay daw tripping relationships among glancing on the
nag sugod nga-a man lang to amo events other resident
naging ex mo na gin breakan ko beside her
siya?” sya dayon”

“Te ano “Okay man lang Encouraging Client was back

nabatyagan mo kay tripping man descriptions of again to neutral
kay gin breakan lang to wala man perceptions- asking tone and facial
mo siya dason ko naluyag sa iya” the client to describe expression
pagkatapos sang feelings, perceptions
apat ka adlaw?” and views of their
situation

“Pero si Bahil ya “Oo, Seeking clarification - Client answered

naluyag sa imo?” ginpangaluyagan to restate, elaborate, using a boastful
ya pa ko gani” or give examples of tone
ideas or feelings to
seek clarification of
what is unclear

“Paano ya ka gin “Wala lang storya Verbalizing the Client’s voice

pangaluyagan?” storya lang kami implied - rephrasing raised a bit while
tapos kami na client’s words to answering
dayon pero dasig highlight an
man lang kami underlying message
ah!” to clarify statements.

“Bea diba indi na “Oo indi puwede Supportive Client answered

pwede nga ga pero wala man confrontation- while looking
boyfriend or sila nakabalo kay acknowledging the away at the
girlfriend kamo di 4 days man lang difficulty in changing student nurse
sa sulod sang naging kami” but pushing for
facility?” action.

“Oo. Indi kamo di “Ah, teh wala Giving information - Client clarified to
mag miga or migo naman kami tu providing information the student
kay ari kamo di nang ah. Sige that will help clients nurse and
para mag-paayo ” make better choices. walked away

32
 nang manyaga
nako”

“Bea, malakat na *Silence Feedback- Pointing Client walked

man kami out specific behaviors past the nurse
salamat gid sa gin and giving without saying
share mo subong impressions of any words
nga adlaw kag sa reactions
imo participation
kay active kagid
sa mga activities”

“Bea, mauna na “Sige, ba-bye” Giving information - Client nodded

kami. Mabalik providing information her head and
lang kami diri that will help clients waved goodbye.
liwat buas para sa make better choices.
aton culminating
activity.”

IV. Evaluation: (For daily requirement, evaluate specific objectives only)

1. Client-Centered: After 4 hours of nurse and client interaction, the client was able
to participate actively and shared positive insights about the activities performed
today as evidenced by her verbalization, “Kasadya man sa ila hampang kay nag daog
ko to sa paper dance!”. GOAL MET.

2. Student-Centered: After 8 hours of nurse and client interaction, the student nurse
was able to assist the client throughout the activity and gained information about
client’s insights on today’s activities as evidenced by client continuously engaging
and showing interest in telling the student nurses what she did during the paper
dance game and what she sang. GOAL MET.

33
 NURSE-CLIENT INTERACTION #3: Termination Phase

DAY 3: June 30, 2022 (Thursday)

I. Background Information
A. Name: B.A
B. Sex: Female
C. Age: 20 years old
D. Civil Status: Single
E. Educational Attainment: High School Graduate
F. Occupation: None
G. Religion: Roman Catholic
H. Address: Barangay Handumanan, Bacolod City

II. Objectives:
A. General Objectives (Long Term – duration of the exposure)
1. Client-Centered: Verbalize feelings comfortably to the nurse with no
hesitancy
2. Student-Centered: Recognize own apprehensions and end the termination
phase satisfactorily.

B. Specific Objectives (Short Term – daily)

1. Client-Centered: Demonstrate positive feedback regarding all the activities,
and on the last day of the exposure
2. Student-Centered: Summarize all the activities accomplished together with
the client all throughout the exposure.

III. Actual Entry

Nurse Interaction Client Interaction Nurse Inference Client Inference
(Rationale/TheraCo
m)
“Morning Bea. Ari “Maayong aga Giving broad Client answered
kami di para man nang, okay openings- with a smile
padayunon ang lang ko ah” Allowing the client to while standing
aton activities take initiative in
subong nga adlaw introducing the topic
kay last day na ni
siya. Pwede
namon mabal-an
ano ang gina

34
expect mo
subong nga
adlaw?”
“Nalipay ka gid “Oo nang. Feedback- Pointing Client answered
sang gin intrahan Sadyahan gid ko out specific behaviors cheerfully
mo nga activity basta gahampang and giving
kay ga smile smile kay ako gid na impressions of
ka gid kagapon. gina leader nila. reactions
Subong may ara Gasunod na sila
naman ta e sakon”
games”
“Naka breakfast “Oo tapos na. Asking question- Client answered
ka na? Ano imo Uga kag talong Using open-ended while sitting
gin sud-an akon nga sud-an” questions to achieve
subong nga aga?” relevance and depth
in discussion
“Ang uga nga sud- “Wala eh kay ka Exploring - Delving Client answered
an, namitan ka pait na, pero kay further into a subject in low voice
man na mag amo man lang na or an idea.
kaon? ukon may ginahatag di sa
ara ka ya nga mas amon. Indi kami
gusto nga sud- kapili
anon aside sa
uga?”
“Pwede ka gid “Mangkuta niyo Giving broad Client assured
subong ka istorya ko bala kay openings-
sa amon nga wala answer lang ko sa Allowing the client to
mo pa na share sa pamangkot niyo take initiative in
nanligad ta nga introducing the topic
inupuray”
“Te pwede mo “Nalipay man eh Asking question- Client explained
ma istorya sa kay daw same Using open-ended while smiling
amon kung ano lang ta edad. Kag questions to achieve
ang nabatyagan kabalo ka nang, relevance and depth
mo sugod sang iban bala nga in discussion
nag abot kami di school, gina gaan
sa facility? Ano ko di nila ya mga
man feeling mo bayo nga uso”
kay kami ang

35
naging student
nurse mo?”
“May gahatag di “Oo. Bongga to Verbalizing the Client answered
sa imo bayo nga sila ya gani mag implied - rephrasing in a bostful tone
mga student hatag kay damo. client’s words to
nurses man?” Pati pagkaon nila highlight an
damo man” underlying message
to clarify statements.
“Ah, kay sa amon “Ay, biskan secret Supportive Client asked
ya bi indi pwede. lang nang, indi confrontation-
Kung ano lang kapon pwede?” acknowledging the
ihatag ka school difficulty in changing
amo lang gid na e but pushing for
hatag namon sa action.
inyo kag dapat
palarehos kamo
namon nga gina
gaan”
“Oo indi pwede “Ahay, gusto ko Giving information - Client was a bit
kay kami na karon pa naman tani providing information sad
ang maakigan. lipstick kay ubos that will help clients
Ang gina hatag na to ang lipstick make better choices.
namon di sa inyo, ko”
gina meetingan
na namon sang
whole class para
tanan gid
matagaan
“Indi gid bi pwede “Salamat eh kay Asking question- Client was a bit
Bea. Pero subong kasadya na di sa Using open-ended sad
kay last nalang ni amon. Pero kay questions to achieve
namon nga bisita nasubuan naman relevance and depth
di sa inyo. Lain ko. Tak-an man in discussion
naman nga ko daan sa iban
section ang ma kay di sila kis-a
duty diri. Ano maistorya”
man mahambal
mo sa amon?

36
“Te ano ang imo “Wala sila Encouraging Client’s voice was
gakabatyagan gasabat eh. Kag descriptions of irritated
kung banta mo iban tulog” perceptions- asking
nga indi nila the client to describe
gusto mag istorya feelings, perceptions,
sa imo haw? and views of their
situation
“Kung amo na “Oo gakanta man Encouraging Client answered
nga indi nila ko di gani kung formulation of a plan
gusto mag naboringan nako. of action- probing for
istorya, indi mo Pero tani nang step-by-step actions
nalang pag piliton mabisita kamo di that will be needed
eh. Diba liwat no?”
nanamian ka mag
kanta, kanta ka
nalang eh. Diri ka
dason pwesto oh
kay nami di ya
ang hangin”
“Subong indi pa “Nalipay man ko Giving information - Client answered
namon mabal an nga nakilala ko providing information with a smile
kung may kamo nang ah. that will help clients
another exposure Basta ang secret make better choices.
kami di.” ko ha, indi niyo
pag sugid sa iban”
“Oo Bea. “Hahah oo nang. Feedback- Pointing Client informed
Makasalig ka gid See you again out specific behaviors while smiling and
sa amon. Salamat next time eh” and giving waving
gid sa impressions of
kooperasyon mo reactions
kay naging
successful ni ang
amo ni nga
exposure. Kanami
sa imo istoryahon
kay gasabat
kagid”

37
 “Bali tanan nga “Thank you man Summarizing- Client waved
activities nga gin nang ah. Bye reviewing the main goodbye
conduct namon di nang” points of discussions
sa inyo and making
naintrahan mo appropriate
gid. Halin sa conclusions.
hataw, morning
circle, coconut,
paper dance, fan
making kag aton
mga intermission
program. Salamat
gid kay gin gaan
mo kami bag o
nga experience.
Kag subong
naman kami ma
bye bye kay amo
na ni ang last nga
day namon.
Thank you gid
Bea.

IV. Evaluation: (For daily requirement, evaluate specific objectives only)

1. Client-Centered: After 8 hours of nurse and client interaction, the client was able
to demonstrate a positive outlook towards the culmination day as evidenced by the
client’s verbalization, “nasadyahan gid ko di nang kay nag daog ko, kag may gift pa
kamo sa amon”. GOAL MET.

2. Student-Centered: After 8 hours of nurse and client interaction, the student nurse
was able to summarize all the activities accomplished together with the client all
throughout the exposure as evidenced by discussing several activities where the
client participated in. GOAL MET.

38
IX. Nursing Care Plans (1 Actual & 1 Risk)
Disturbed Thought Process

Assessment Cues Nursing Diagnosis Pathophysiology Desired Outcome Nursing Intervention Justification Evaluation

Subjective: Disturbed Thought Short Term: INDEPENDENT Short Term:

Process Related to
“Kadasig na sakon After 8 hours of nursing a. Set and maintain limits a. To establish After 8 hours of nursing
Biochemical Changes In PREDISPOS PRECIPITA
matak-an, kag mag ilis interventions, the client on behavior that is limitations for the interventions, the
Brain As Evidenced By ING TING
modo. Subong bi nalipay will be able to: destructive or adversely client if unable to use client was able to:
Sudden Changed In FACTORS FACTORS
ko, dugay dugay mainit affects others. internal controls
Behavior and Irritability • Sex • Weak 1. Demonstrate 1. Demonstrate
naman ulo ko. Basta effectively.
(Female) support orientation to person, orientation to person,
kasabad.” Client place, and time. place, and time as
verbalized. • Age (20) system
Definition: (Broken evidenced by her
b. Reorient the client to b. To repeatedly
Family) verbalization, “Ako si
Disruption in cognitive the place, person, and present reality. This is
• Bea, ari ko subong sa
time as indicated (call also a concrete
● Mood swings operations and activities mental health care
Traumatic the client by name, tell reinforcement for the
● Prolonged sadness center diri sa Paglaum.
Event the client your name, client.
● Irritability June 30 na ta subong”.
(Miscarriag tell the client where
● Inability to Source/Reference GOAL MET.
e) she is).
concentrate
• Poor
NANDA 2. Verbalize to the nurse c. Spend time with the c. To be there with the 2. Verbalize to the
Coping
Mechanis about present reality. client. client since physical nurse about present
Townsend, M. C. (2011).
m presence is reality. reality as evidenced by
Objective: Nursing diagnoses in her verbalization, “Ari
• Stress
psychiatric nursing: Care ko di subong sa
● disorientation plans and psychotropic ↓ Paglaum Mansilingan, si
d. Evaluate the client’s d. To continually
● decreased medications (8th ed.). sister di nag dala sa
Due to etiological factors tolerance for group engage the client
concentration, short F.A. Davis Co.. akon para diri mag pa-
activities based on the because their
attention span ↓ ayo”. GOAL MET.
client’s level of attention span is short
● tangential speech
Neurotransmitter tolerance. Help the and her ability to deal
● push of speech
imbalances (Serotonin, client plan activities
39
 Norepinephrine, 3. Recognize and be aware within her scope of with complex stimuli is 3. Recognize and be
Dopamine) about sudden change of achievement. impaired. aware about sudden
LATEST VITAL SIGNS: behaviors. change of behaviors as
↓ evidenced by her
T: 36.9 ℃ e. Encourage the client’s e. To positively
Inhibitory control of verbalization,
PR: 92 bpm appropriate expression support and reinforce
emotional circuitry “mabatyagan ko man
of feelings regarding client’s healthy
nga gulpi lang ko
BP: 110/80 mmHg treatment or discharge expression of feelings,
↓ masubuan, dason pagka
plans. realistic plans, and dugay dugay malipay
O2 Sat: 98%
Disruption of emotional responsible behavior naman ko”. GOAL MET.
homeostasis after discharge.
↓ 4. Demonstrate increased 4. Demonstrate
attention span and talk to increased attention
Strengths: Oscillations between the nurse. span and talk to the
f. Use a firm yet calm, f. To effectively
mood states nurse as evidenced by
• Religious relaxed approach. communicate your
her verbalization, “ano
↓ interest, expectations,
• External support from pagid ang gusto niyo
and limits, as well as ipamangkot sa akon?”.
a nun Manic episodes occur
self-control. GOAL MET
(elevated, irritable mood,
• Intelligent
pressured speech, and
racing thoughts) or Long Term: Long Term:
g. Refrain from forcing g. To avoid feelings of
Depressive episodes activities and
Weaknesses: After 3 days of nursing being threatened and After 3 days of nursing
(decreased concentration, communications.
interventions, the client anxiety to develop. interventions, the
• Poor coping increased withdrawal,
will be able to: client was able to:
mechanism/s. increased hopelessness)

• Weak support system ↓ h. Teach client about h. To help client

(broken family) 5. Display concentration visualization techniques improve self-image 5. Display concentration
Disturbed Thought that replace negative
and attention to complete and confidence and attention to
• Emotionally fragile Process Related To images to positive
tasks and function complete tasks and
over the loss of her Biochemical Changes In independently. images. function independently
unborn child. Brain As Evidenced By as evidenced by her
COLLABORATIVE: verbalization, “Kaya ko
na ni ubrahon, ako
40
 Sudden Changed In i. Administer medication i. To stabilize mood. nalang ni matapos fold
Behavior and Irritability as prescribed. sang papel”. GOAL
MET.
j. Collaborate with j. To have the client
6. Identify appropriate nutritionist about achieve proper 6. Identify appropriate
Reference: actions for managing appropriate food for the nutrition while on actions for managing
emotions. client. medication. emotions as evidenced
Sgaggi, S. (2015, May 29). by her verbalization,
Bipolar Disorder: “Kung banta ko nga ga
Pathogenesis and Clinical lain na akon mood, ga
Findings | Calgary Guide. kanta nalang ko sang
The Calgary Guide to mga favorit songs ko
Understanding Disease. upod si Pyla”. GOAL
MET.
https://calgaryguide.ucalg
ary.ca/bipolar-disorder-
pathogenesis-and-clinical- 7. Demonstrate coping
7. Demonstrate coping
findings/ techniques as
techniques.
evidenced by her
verbalization, “Kung
nasubuan ko gani ga
pang make-up lang ko
para indi nako
masubuan”. GOAL MET.

8. Demonstrate
8. Demonstrate adequate
adequate cognitive
cognitive functioning.
functioning as
evidenced by her
verbalization, “Kabalo
man ko mag math. 1-20
kag halin naman 20
pakadto 1”. GOAL MET.

41
Risk for Other-Directed Violence

Assessment Cues Nursing Diagnosis Pathophysiology Desired Outcome Nursing Intervention Justification Evaluation

Subjective: Risk for other directed Predisposing Factors: Short Term: Short Term:
violence related to Independent Nursing
Client verbalized, "wala • Sex (Female) Interventions
manic episodes and
man na sa labot sa akon,
poor impulse control • Age (20) After 8 hours of nursing After 8 hours of
gusto ko lang ya ang madre a. Manipulate the client’s a. Anxiety and agitation rise
interventions, the in a stimulating nursing
mag bisita sakon." while Precipitating Factors: environment to a low-
client will be able to: level stimulus (low environment. Individuals interventions, the
arms crossed and in an
• Miscarried at an early lighting, few people, may be perceived as client will be able
irritated tone of voice.
age simple decor, low noise threatening by a suspicious, to:
Definition:
1. Client’s agitation level - No Demand agitated client.
• Poor coping 1. Client’s agitation
At risk for behaviors in will be approach to de-escalate
Objective: mechanism maintained at a when a situation arises). maintained at a
which an individual
manageable manageable level.
Appearance: demonstrates that he or • Weak support system
level. b. Observe client’s b. Close observation is Client was able to
she can be physically, (broken family)
• Resident wears girly behavior frequently required so that stimulate own
emotionally, and or intervention can occur if
clothes and uses red ↓ (every 15 minutes). environment to
sexual harmful [either to required to ensure client’s
lipstick. create a low-level
self or to others] Due to etiological (and others’) safety. stimulus. GOAL
• Hair and nails were clean factors
MET.
and well-groomed.
↓
Reference: 2. Client will
c. Remove all dangerous c. If the client is in an 2. Client verbalized
Neurotransmitter verbalize control
Townsend, M.C (2011). objects from client’s agitated, hyperactive state, control of feelings.
Behavior: Imbalances of feelings.
Nursing diagnoses in environment (sharp client may not use them to GOAL MET.
• Resident is manipulative. psychiatric nursing: Care (Serotonin, objects, glass or mirrored harm self or others.
plans and psychotropic norepinephrine, items, belts, ties, smoking
• She wants everyone to materials)
medications (8th ed.). dopamine) 3. Client will
follow and comply with 3. Client responds to
F.A Davis Co. respond to
whatever she has to say. ↓ external controls
external controls
(medications,
Abnormal (medications,
42
• She is easily irritated Neurocircuitry seclusion, d. Try to redirect the d. Physical exercise is a safe seclusion, nursing
when talking about nursing violent behavior with and effective way of interventions) when
Dysregulation in frontal interventions) physical outlets for the relieving pent-up tension
something/someone she potential or actual
and limbic circuitry when potential client’s hostility (e.g., with benefits to the client.
isn't interested in. loss of control
↓ or actual loss of jogging or volleyball). occurs. GOAL MET.
• Crossing of arms and control occurs.
rolling of eyes indicating Environmental factors e. Intervene at the first e. Validation of the client’s
she is irritable. sign of increased anxiety, feelings conveys a caring
(Traumatic events, life 4. Client will seek
4. Client will seek agitation, or verbal or attitude and helping
stressors) help when help when
behavioral aggression. reinforces trust.
experiencing experiencing
Offer empathetic
Communication: ↓ aggressive aggressive impulses.
response to client’s
• Resident lowers down ↓ Inhibitory control of impulses. feelings: “You seem GOAL MET.
her tone of voice when she emotional circuitry anxious (or frustrated, or
is irritated. angry) about this
↓ Long Term:
situation. How can I Long Term:
• She raises her tone of help?”
Disruption of emotional After 3 days of nursing After 3 days of
voice when interested in interventions, the
homeostasis nursing
the topic. client will be able to:
↓ f. As agitation decreases, f. This procedure minimizes interventions, the
assess client’s readiness the risk of injury to client client will be able
Oscillation between for restraint removal or and staff. to:
VS: (Morning & Lunch)
mood states reduction. Remove one
Day 1 restraint at a time, while
Individual variability in
assessing client’s 5. Client was safe
T: 36.6°C & 36.6°C disease course 5. Client will be
response. and free from injury.
safe and free
HR: 69 bpm & 56 bpm ↓ from injury. there may be visible
BP: 110/80 mmHg & Manic episode occurs scars and wounds
110/70 mmHg (elevated, irritable Collaborative Nursing but no evidence of it
mood, pressured Interventions being self-inflicted.
O2 Sat: 99% & 99% GOAL MET.
speech, and racing g. Anxiety is contagious and
g. Staff should maintain
thoughts) or Depressive can be transmitted from
and convey a calm
episodes (decreased staff to client.
attitude to the client.
43
Day 2
T: 36.4°C & 36.9°C
HR: 86 bpm & 96 bpm
BP: 130/80 mmHg & ↓
120/80 mmHg
O2 Sat: 99% & 99%
Day 3
T: 36.5°C & 36.9°C
HR: 76 bpm & 92 bpm
BP: 110/70 mmHg & established by the
110/80 mmHg
O2 Sat: 96% & 98%
Strengths:
• Physically and financially
supported by a nun.
• Complete assessment
taken.
• Given proper treatment /
management.
• Have strong faith by
praying every night.
concentration, 6. Client will not Respond matter-of-factly 6. Client will not
increased withdrawal, harm self or to verbal hostility. harm self or others.
others.
increased Client did not exhibit
hopelessness) any signs of
h. Have sufficient staff aggression towards
h. This conveys to the client
available to indicate a evidence of control over the others and was able
Risk for other show of strength to client situation and provides some to manage own
if necessary. physical security for staff. thoughts and
directed violence
actions. GOAL MET.
related to manic
episodes and poor
impulse control. i. If restraint is deemed i. Client safety is a nursing
necessary, ensure that priority.
sufficient staff is available
to assist. Follow protocol
References.
institution. Some facilities
requires that an in-person
Bipolar Disorder: evaluation (by a
Pathogenesis and physician, clinical
Clinical Findings | psychologist, or other
Calgary Guide. (2015, licensed independent
May 28). The Calgary practitioner responsible
Guide to for the care of the client)
Understanding Disease; be conducted within 1
calgaryguide.ucalgary.c hour of initiating restraint
a. or seclusion. The
physician must reissue a
https://calgaryguide.uc
new order for restraints
algary.ca/bipolar-
every 4 hours for adults
disorder-pathogenesis-
and every 1 to 2 hours for
and-clinical-findings/ children and adolescents.
44
Weaknesses:
• Uncontrolled mood
swings.
• Poor impulse control.
• Easily irritated.
Dependent Nursing
Intervention
j. Administer tranquilizing j. Antipsychotic drugs are
medications as ordered commonly prescribed for
by physician. Monitor rapid relief of agitation and
medication for hyperactivity
effectiveness and for
adverse side effects.

45
X. Drug Studies
Dosage/Frequency/ Mechanism of
Name of Drug Indication Contradiction Adverse Effects Nursing Responsibilities
Timing/Route Action
Generic Name: Dosage: The active This medication is Hypersensitivity to • Dizziness Intervention/evaluation
Haloperidol 5 mg/tab, ½ tab mechanism of used treat certain haloperidol, CNS • Lightheadedness • Monitor B/P, heart
Haldol is to block mental/mood depression, coma, • Drowsiness rate/rhythm, QT
Brand Name: Frequency: postsynaptic disorders (such as Parkinson’s disease, • Difficulty interval.
Haldol PRN dopamine (D2) schizophrenia, severe urinating • Supervise suicidal-risk
receptors in the schizoaffective cardiac/hepatic • Sleep client closely during
Classification: Timing: mesolimbic system disorders). This disease. disturbances early therapy (as
First-generation of the brain. medicine helps the • Headache depression lessens,
(typical) Route: client to think • Anxiety energy level improves,
antipsychotic PO more clearly, feel • Vomiting increasing suicide
less nervous, and • Photosensitivity potential).
take part in Client/family teaching
everyday life. • Avoid exposure to
sunlight, overheating,
dehydration.
• Do not abruptly
withdraw from long-
term therapy.

46
 Dosage/Frequency/ Mechanism of Nursing
Name of Drug Indication Contradiction Adverse Effects
Timing/Route Action Responsibilities
Generic Name: Dosage: Works by providing It is intended for It is • Gastrointestinal • Advice client to
Multivitamins + Zinc 1 tab nutritional use in the contraindicated intolerance take their
requirements of the correction of in clients known • Diarrhea multivitamin with a
Brand Name: Frequency: body to maintain vitamin to be • Feeling of full glass of water.
Cecon Plus ODAM physiological B-complex, hypersensitive to swelling of entire • Use multivitamins
balance. Regulates vitamin C, and any of its body regularly to get the
Classification: Timing: the intestinal fluid zinc deficiencies. components. This • Temporary most benefit.
Vitamins & Minerals 8 AM transport, mucosal is not faintness • Take the medicine
integrity, immunity, recommended • Dizziness as soon as possible,
Route: gene expression for use in • Vomiting but skip the missed
PO and oxidative pediatric clients. • Loss of appetite dose if it is almost
stress. High doses of • Stomach time for the next
pyridoxine cramps dose. Do not take
should be avoided • Headache two doses at one
during pregnancy. time.
• Best taken after
meal

47
 Dosage/Frequency/ Mechanism of Nursing
Name of Drug Indication Contradiction Adverse Effects
Timing/Route Action Responsibilities
Generic Name: Dosage: May produce To treat acute Aripiprazole is • Accidental injury, • Assess client’s
Aripiprazole 5 mg/tab, 1 tab antipsychotic manic and mixed contraindicated in • Constipation, hypersensitivity to
effects through episodes in bipolar clients with • Akathisia, the drug or any of its
Brand Name: Frequency: partial agonist and I disorder with or documented • Headache, components before
Abilify AM antagonist actions. without psychotic hypersensitivity to it • Peripheral edema, starting therapy.
Aripiprazole acts as features; to or any component of • Hypertension, • Ensure to follow
Classification: Timing: a partial agonist at maintain stability the dosage form. • Nausea, the rights of
Atypical 8 AM dopamine in clients with • Dyspepsia, & administering
Antipsychotic (especially D2) bipolar I disorder • Vomiting. medications.
Route: receptors and as adjunct with • Inform the client
PO serotonin lithium or about the drug that
(especially 5- HT1A) valproate in clients she is about to take
receptors. The drug with bipolar I along with its
acts as an disorder. adverse effect.
antagonist at 5- • Monitor client for
HT2A serotonin As adjunct to treat difficulty swallowing
receptor sites. depression in or excessive
clients already somnolence, which
taking an could predispose to
antidepressant. accidental injury or
aspiration.

48
 Dosage/Frequency/ Mechanism of Nursing
Name of Drug Indication Contradiction Adverse Effects
Timing/Route Action Responsibilities
Generic Name: Dosage: May promote To reduce blood Hypersensitivity to • Urinary tract • Assess client’s
Metformin 500 mg/tab, 1/2 tab storage of excess glucose level in metformin or its infection, hypersensitivityto
glucose as glycogen type 2 diabetes components. • Headache, the drug or any of
Brand Name: Frequency: in the liver, which mellitus • Backpain, its components
Fortamet BID reduces glucose • Hyperglycemia, before starting
production. • Fatigue, therapy.
Classification: Timing: Metformin also • Sinusitis, • Inform the client
Antidiabetic 7 AM & 7 PM may improve • Diarrhea, about the drug that
glucose use by • Nausea, she is about to take
Route: skeletal muscle and • Vomiting, & along with.
PO adipose tissue by • Abdominal • Give metformin
increasing glucose cramping. tablets with food,
transport across which decreases and
cell membranes. slightly delays
absorption, thus
reducing risk of
adverse GI reactions.
• Monitor client’s
blood glucose level
to evaluate drug
effectiveness. Assess
for hyperglycemia
and the need for
insulin during times
of increased stress,
such as infection.

49
 Dosage/Frequency/ Mechanism of Nursing
Name of Drug Indication Contradiction Adverse Effects
Timing/Route Action Responsibilities
Generic Name: Dosage: Anticonvulsant Treatment of • Pregnancy • Hemorrhage, Assessment:
Valproic Acid 500 mg/tab, 1/2 tab activity may be by generalized (Category D) and • Bruising, • Assess client’s
increasing levels of convulsive • Hepatic disease or • Coagulation condition before
Brand Name: Frequency: y-aminobutyric acid seizures, tonic- significant disorders, therapy and regularly
Depacon ODAM (GABA) in brain, clonic (grand mal), dysfunction. • thereafter to
which decreases absence (petit Hyperammonemia, monitor drug
Classification: Timing: seizure activity. mal), and partial • Sedation, effectiveness.
Antimanic, 8 AM Other possibilities (focal and motor). • Transient • Assess mental
Anticonvulsant, include acting on alopecia, status: mood,
Antimigraine Route: the postsynaptic • Nausea, sensorium, affect,
PO receptor sites to • Vomiting, memory (long,
mimic or enhance • Indigestion, short).
the inhibitory • Increased • Assess for any
effects of GABA. appetite, respiratory
• dysfunctions.
Thrombocytopenia,
• Anemia, and
• Bone marrow
suppression.

50
XI. Health Teaching Plan

MEDICATIONS EXERCISE TREATMENT HYGIENE OUTPATIENT DIET

Generic Name: In complement to its
psychological advantages,
Haloperidol
exercise has bodily
Brand Name: advantages as well. For
Haldol anyone with a mental health
condition, particularly bipolar
C (Classification):
disorder, the physical
First-generation (typical)
advantages of exercise are
antipsychotic
significant. Unfortunately,
H (How will you know the using mood stabilizers,
drug is effective?) antipsychotics, and
antidepressants is linked to
It works by rebalancing
weight gain and a higher risk
dopamine to improve
of dying from cardiovascular
thinking, mood, and
disease.
behavior. A typical
antipsychotic drug used to
treat schizophrenia and Client B.A. was instructed to
schizoaffective disorder, exercise for 30 minutes every
psychosis, agitation, and day. The client should
Psychopharmacology Bath/ Shower Regularly Managing Medications Foods to avoid
Treatment for bipolar • Bathing has been linked to Lithium is not metabolized; Caffeine - Stimulant
disorder involves a improved mental health. This is rather, it is reabsorbed by the ● Caffeine raises dopamine
lifetime regimen of because taking a warm shower can proximal tubule and excreted
levels in the brain, which can
medications— either an reduce symptoms of depression in the urine. Periodic serum
cause increased anxiety,
antimanic agent called and anxiety. The body's reaction to lithium levels are used to
restlessness, and thus induce
lithium or being warm naturally relaxes your monitor the client’s safety
mania or hypomania
anticonvulsant muscles and thoughts. It also and to ensure that the dose
● Can impair sleep, sleep
medications used as washes away bacteria and other given has increased the deprivation is a notorious
mood stabilizers. irritants that could cause rashes serum lithium level to a trigger for bipolar mood
and other skin problems. treatment level or reduced it swings and mania.
Lithium. The
to a maintenance level. There ● Affects lithium metabolism
response rate in
is a narrow range of safety Alcohol – CNS Depressant
acute mania to Oral Hygiene
among maintenance levels
lithium therapy is ● If you have, substance use
• Some drugs taken orally may (0.5–1 mEq/L), treatment
70% to 80%. In disorder then you are less
levels (0.8–1.5 mEq/L), and
addition to treating cause a bad taste in the mouth or likely to stick with the
toxic levels (1.5 mEq/L and
form a coating around the tongue.
the range of bipolar treatment.
above). It is important to
Proper mouth care is needed to
behaviors, lithium ● Alcohol dependence and
assess for signs of toxicity
prevent bad breath and infections,
can also stabilize withdrawal are likely to

51
acute manic episodes
associated with bipolar
disorder.
E (Exact time to be given):
PRN
C (Client teaching – drug
reaction):
Educate the client of the
adverse effects that may
cause some people to
become dizzy, drowsy, or
may cause trouble with
thinking or controlling body
movements, which may lead
to falls, fractures, or other
injuries. Taking haloperidol at
bedtime, may then feel
drowsy or less alert on
arising.
K (Keys to remember/
nursing
perform the activities listed bipolar disorder by reducing the risk for tooth decay and to ensure that clients and worsen mood symptoms,
below. reducing the degree and gum disease. their families have this thereby forming a vicious
and frequency of information before discharge. cycle of alcohol use and
cycling or Older adults can have mood instability.
● Walking: a 10- to 15- eliminating manic Hand Hygiene symptoms of toxicity at lower ● Increased risk of suicide
minute stroll each day episodes. • One of the best ways to keep serum levels. Lithium is especially during depressive
will help and get some
potentially fatal in overdose. phase
Anticonvulsant yourself from getting sick is to
fresh air and relax the
● May negatively increase side
Drugs. Their keep your hands clean. —
mind. effects of medication
mechanism of
● Jogging: After a Encourage to keep their Outpatient treatment for ● Causes dehydration
workout, this activity action is largely
bipolar disorder can provide Sugar
hands clean.
can help the client unknown, but they
support, structure, and
may raise the ● A spike in blood sugar can
sleep better at night therapeutic benefits while
brain’s threshold for mimic the physical symptoms
and has a relaxing Cut Fingernails & Toenails the person continues to live
dealing with of anxiety: increased heart
impact. regularly at home. Psychotherapy may
stimulation; this rate, sweating, confusion,
● Stretching: stretching include identifying triggers,
• It's important to trim your nails impulsivity, and irritability.
for 15 minutes in the prevents the person
coping with day-to-day
regularly. Nail trimming together ● Increased risk for developing
morning might help the from being
challenges, and practicing
with manicures makes your nails type 2 diabetes. It can
client to feel more in bombarded with
healthy communication skills.
external and look well-groomed, neat, and tidy. negatively affect mental
control of their Bipolar disorder is commonly
internal stimuli. If your nails aren't cut and allowed clarity, memory, and mood.
muscles, especially treated with the following
to grow, dirt and germs can get ● Sugar combined with the
when antipsychotic psychotherapies:
Psychotherapy under them, causing infections caffeine in chocolate can
medicines can make
52
responsibilities/consideratio
n):
In addition to exercising, the
• Monitor progression of zinc
client could engage in the
deficiency symptoms
following leisure activities:
(impaired wound healing,
growth retardation,
decreased sense of
taste, decreased sense of
smell) during therapy.
• Advice patient to take their
multivitamin with a full glass
of water.
• Use multivitamins regularly
to get the most benefit.
• Take the medicine as soon
as possible but skip the
missed dose if it is almost
time for the next dose. Do
not take two doses at one
time.
• Best taken after meal
people gain weight Psychotherapy can be ● Talk therapy cause insomnia. Since you
when taken regularly. useful in the mildly ● Cognitive behavior are tired, your body craves
Use Deodorant
depressive or normal ● Family therapy for energy.
portion of the bipolar • A deodorant is applied to the ● Craving happens because of
cycle. It is not useful body to prevent body odor caused emotional need or nutritional
Medication and
by the bacterial breakdown of
during acute manic deficit.
● Gardening: According psychotherapy are the two
perspiration in armpits, feet, and
stages because the Salt
to some research, main components of the
other areas of the body.
person’s attention span
bipolar illness sufferers most effective bipolar ● Sudden increase or decrease
is brief, and he or she
may benefit from disorder treatment programs. in the amount of sodium you
can gain little insight
gardening or other Typical medications include: ingest can affect lithium
during times of
forms of green therapy. levels.
● Mood stabilizers to
accelerated
Numerous studies have ● Side effect of lithium is
treat manic and
psychomotor activity.
revealed that spending dehydration and high sodium
Psychotherapy hypomanic
time in a garden, park, can worsen it.
combined with symptoms.
or forest provides a Fat
● Antidepressants to
medication can reduce
variety of health
treat depressive ● Extra weight can make
the risk for suicide and
advantages. But in
episodes. bipolar disorder treatment
injury, provide support
addition to working
● Antipsychotics to less effective.
to the client and family,
wonders for one's
control hallucinations, If you take an MAOI and you eat
and help the client
physical health, it is
delusions, and other high-tyramine foods, tyramine
accept the diagnosis and
also reported to have
treatment plan. psychotic symptoms. can quickly reach dangerous
considerable positive
53
 effects on one's mental Providing for Safety Outpatient bipolar disorder levels.
condition. treatment options range
Generic Name: A primary nursing Common in aged, cured,
● Meditation- although from more restrictive to
responsibility is to processed, dried, fermented, and
Multivitamins + Zinc
this can't cure bipolar, more flexible, depending on
provide a safe smoked products
Brand Name: this can help the client the individual's needs,
environment for clients Diet
relax and disengage symptoms, and level of
Cecon plus and others. The nurse
from anxious thoughts. independence. These are Anti-inflammatory foods
C (Classification): assesses clients directly
It can also make better some examples:
for suicidal ideation and Patients who follow a diet rich in
Vitamins and Minerals control of mood.
plans or thoughts of ● Partial hospitalization anti-inflammatory properties

H (How will you know the hurting others. In (PHP) – Involves respond better to supplemental
drug is effective?): addition, clients in the structured treatments than those who eat a
manic phase have little programming 8 hours diet that is high in sugar,
It works by providing
insight into their anger a day, 5 days a week. unhealthy unsaturated fats, and
nutritional requirements of
and agitation and how ● Intensive outpatient highly processed foods, that
the body to maintain
their behaviors affect (IOP) – Involves more promotes inflammation.
physiological balance;
others. flexible programming,
administering required 1. Whole grains
usually 3 hours a day,
vitamins for the body; both Meeting Physiological 3 to 4 days a week. Calming effect - Carbohydrates
providing ascorbic acid and Needs ● Therapy are thought to boost your brain’s
reversibly oxidizing to
appointments – production of serotonin. This
dehydroascorbic acid in the Clients with mania may
Depending on the feel-good brain chemical helps to
body; regulating the get little rest or sleep,
individual, these may ease anxiety and may leave you
intestinal fluid transport, even if they are on the

54
mucosal integrity, immunity,
gene expression and
oxidative stress.
E (Exact time to be given):
1 tab OD AM (7AM)
C (Client teaching – drug
reaction):
• Educate client to possible
adverse effects of the drug
such as gastrointestinal
intolerance, diarrhea, feeling
of swelling of entire body,
temporary faintness,
dizziness, vomiting, loss of
appetite, stomach cramps,
and headache.
K (Keys to remember/
nursing
responsibilities/consideratio
n):
brink of physical
exhaustion. Decreasing
environmental
stimulation may assist
clients in relaxing. The
nurse provides a quiet
environment without
noise, television, or
other distractions.
Establishing a bedtime
routine, such as a tepid
bath, may help clients
calm down enough to
rest
Providing Therapeutic
Communication
Clients with mania have
short attention spans,
so the nurse uses clear,
simple sentences when
communicating. It helps
55
take place weekly or a feeling more in control.
few times a week and
Oatmeal - Prevents sluggishness
may include life skills
and lethargy, controls blood
training, substance
pressure, antioxidant properties
abuse recovery, or
Corns - High in antioxidants and
other support
is a good source of fiber
services.
Brown rice - Contains
phosphorus, magnesium, and B
vitamins – reduces anxiety,
reduces symptoms of depressive
disorders respectively
2. Omega-3 fatty acids
The omega-3 fatty acids
eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA) play
an important role in your brain.
They’re an essential part of
nerve cells and help facilitate
signaling between those cells.
Adding omega-3s to mood
• Monitor progression of zinc
deficiency symptoms
(impaired wound healing,
growth retardation,
decreased sense of taste,
decrease sense of smell)
during therapy.
• Advise client to take their
multivitamin with a full glass
of water.
• Use multivitamins regularly
to get the most benefit.
• Do not take two doses at
one time.
• Encourage client to take
multivitamins after meal.
• Monitor for allergic
reactions upon administering
the drug.
to ask clients to repeat stabilizers does seem to help
brief messages to with symptoms of depression,
ensure they have heard although it doesn’t have much
and incorporated them. effect on mania.
Promoting Appropriate ● Eggs
Behaviors ● Sardines
● Oysters
These clients need to be ● Fruit juices
protected from their
● Powdered milk
pursuit of socially
● Yogurt
unacceptable and risky ● Butter, Margarine, and
behaviors. The nurse Spreads
can direct their need for 3. Selenium-rich foods
movement into socially
Selenium helps to stabilize
acceptable, large motor
mood, a trace element that’s
activities, such as
essential for a healthy brain.
arranging chairs for a
community meeting or ● Seafood
walking. In acute mania, ● Organ foods
clients lose the ability to 4. Nuts
control their behaviors
It has a positive effect on mania,
and engage in risky
contains magnesium which helps
56
Generic Name: activities. Because to calm an overactive nervous
acutely manic clients system and plays a role in
Aripiprazole
feel extraordinarily regulating the body’s stress
Brand Name: powerful, they place response by keeping cortisol

Abilify few restrictions on levels in check.

themselves.
C (Classification) 5. Probiotics

Atypical Antipsychotic Probiotics, or "good bacteria,"

may lower levels of
H (How will you know the
inflammation. People with mood
drug is effective?)
disorders tend to have higher
May produce antipsychotic levels of inflammation.
effects through partial
● Yogurt
agonist and antagonist
● Yakult
actions. Aripiprazole acts as a
6. Herbal tea
partial agonist at dopamine
receptors and serotonin Hot drinks may soothe your

receptors. The drug acts as an mind thus reducing upset

antagonist at 5-HT2A stomach, anxiety, and insomnia.

serotonin receptor sites.

E (Exact time to be given):

5mg tab 1 tab AM

57
(7AM), PO

C (Client teaching – drug

reaction):

• Educate client to possible

side effects of medication
such as headache,
nervousness, restlessness,
dizziness, heartburn,
constipation, diarrhea,
stomach pain.

K (Keys to remember/
nursing
responsibilities/consideratio
n):

• Monitor client vital signs for

any changes within normal
values.

• Notify physician
immediately if patient
exhibits signs of depression
or other changes in mood

58
and behavior such as
nervousness, restlessness,
hostility, confusion, or manic
reactions.

• Assess levels of drowsiness

or lightheadedness,
especially in older adults.

Generic Name:

Metformin

Brand Name:

Fortamet

C (Classification)

Antidiabetic, Biguanides

H (How will you know the

drug is effective?)

Decreased hepatic glucose

production and intestinal
absorption of glucose and

59
improves insulin sensitivity
(increases peripheral glucose
uptake and use)

E (Exact time to be given):

8 AM & 8 PM

C (Client teaching – drug

reaction):

• Teach patient the

importance of following
therapeutic regimen,
adhering to specific diet,
losing weight, getting
exercise, following personal
hygiene programs, and
avoiding infection.

• Advise patient not to cut,

crush, or chew extended-
release tablets; instruct
patient to swallow them
whole.

60
K (Keys to remember/
nursing
responsibilities/consideratio
n):

• Monitor patient's glucose

level regularly to evaluate
effectiveness of therapy.

• Notify prescriber if glucose

level increases despite
therapy.

Generic Name:

Valproic Acid

Brand Name:

Depacon, Depakene

C (Classification)

Antimigraine, Anticonvulsant,
Antimanic

H (How will you know the

61
drug is effective?)

• Decreased seizures and

patient do not develop injury
related to drug induced
adverse reactions.

Onset: ½ hour

Peak: Unknown

Duration: 6 hours

E (Exact time to be given):

ODAM (8 AM)

C (Client teaching – drug

reaction):

• Advise the patient that drug

may be taken with food or
milk to reduce adverse GI
effects.

• Instruct patient not to chew

or crush extended-release
tablets.

62
• Advice patient to report
drug induced adverse
reactions.

K (Keys to remember/
nursing
responsibilities/consideratio
n):

• Assess patient’s condition

before therapy and regularly
thereafter to monitor drug
effectiveness.

• Assess mental status:

mood, sensorium, affect,
memory (long, short).

• Assess for any respiratory

dysfunctions.

63
XII. Recommendations
For the University of St. La Salle - College of Nursing. We greatly recommend the study
to be distributed towards another field of knowledge of the health care sector, which is the
psychiatric field, as well as for the expansion of what we currently know. Explicit information
provided in the paper is guaranteed to be accurate as the information is derived directly from
the subject of the case study. This study can serve as another new set of knowledge that will
prove beneficial, skills and knowledge-wise, in the following Psychiatric Nursing Exposures to be
conducted in the foreseeable future.

All in all, we applaud the College of Nursing of the University of St. La Salle for
facilitating and making an actual psychiatric exposure possible for the students to be immersed
in.

For the Bacolod City Mental Health Care Clinic Facility. We greatly recommend the
consolidation of the physical activities and friendly environment for the clients inside the
facility. As the environment is a substantial fragment in the healing process for the clients, this
also needs to be reconsidered for promoting a safe place for our mentally unstable family.

All in all, we applaud the Bacolod Mental Health Care Clinic for authorizing the College
of Nursing of the University of St. La Salle to conduct the exposure in their facility.

For the Client. We greatly recommend the incorporation of pharmacologic therapy and
psychotherapy into the client’s daily activities. This can aid in stabilizing the client’s mood, aid in
processing feelings and emotions, help develop healthy coping mechanisms, treat depressive
episodes, and control hallucinations, delusions, and other psychotic symptoms. Engaging in
psychotherapy can prove beneficial to the client’s overall health.

All in all, we applaud the client for her swift health-seeking behaviors, cooperation, and
trust in the health care sector.

For the Student Nurses. We greatly recommend sufficient time to properly perform a
comprehensive assessment of the case and proper allotment of time to interview family
members as well as gather further data regarding the client’s history, which in turn, would
allow for a more well-executed case study. We also recommend that the student nurses be fully
aware of the client’s tendencies and behavior to ensure the safety of everyone involved in the
care of the client, including the client themselves.

All in all, we applaud the student nurses for properly handling the case study even with
limited means, time, and data.

64
 For the Significant Others. We greatly recommend having them be properly educated
with the client’s tendencies, triggers, coping mechanisms, and other things that contribute to
the client’s decline of health and wellbeing. By actively listening and displaying proper reactions
and appropriate verbal and body language to the client, this shows the client that the other
person shows empathy and a profound understanding of their situation, thus encourages
proper processing of apprehensive feelings that hinders their holistic healing. We also
recommend in accompanying the client while interacting in group psychotherapy sessions since
the simple act by itself can become beneficial in healthy communication, provides support, and
promotes socialization.

All in all, we applaud the client’s significant others for having the initiative to bring the
client to the facility for further medical attention.

65
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Bipolar Disorder: Pathogenesis and Clinical Findings | Calgary Guide. (2015, May 28). The
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Mcleod, S. (2018, May 3). Erik Erikson’s Stages of Psychosocial Development. Simply Psychology.
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20euphoria,distractibility%2C%20and%20impulsive%20reckless%20behaviour.
Mental Health on the Move in the Philippines – Meet the Lusog-Isip App - URC. (2021, December
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Sodeify, P. R., & Moghaddam Tabrizi, P. F. (n.d.). Nursing Students’ Perceptions of Effective
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Understanding Erikson’s Stages of Psychosocial Development. (2021, July 18). Verywell Mind.
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millennial-with-bipolar-disorder/

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