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I. GENERAL OBJECTIVES
We the presenters aim to share to our participants the knowledge and understanding that we have gained about Bipolar disorder I, its management and the attitude that we must obtain to be an effective and efficient nurse in the future.
At the end of the case presentation the audience will be able to: Define bipolar I disorder Enumerate the signs and symptoms of bipolar disorder Recall the patients health history Review the anatomy and physiology of the affected part of nervous system Trace the psychopathology of the disorder Interpret the laboratory result of the patient Formulate a nursing care plan for our patient Discuss the medication taken by the patient Present the nurse patient interaction we
Bipolar disorder (manic depression) a mental disorder that is characterized by severe mood swings cycling between periods of intense ³highs´ (mania or hypomania) and periods of intense ³downs´ .
2.Types of bipolar disorder Bipolar disorder is divided into two main subtypes: 1. 3. Bipolar I disorder: Had at least one manic episode. Bipolar II disorder: Had at least one episode of depression and at least one hypomanic episode. the periods of depression are typically much longer than the periods of hypomania. Cyclothymia includes mood swings but the highs and lows are not as severe as . In bipolar II disorder. with or without previous episodes of depression. Cyclothymia: Is a mild form of bipolar disorder.
Causes: Scientists don¶t really know what causes bipolar disorder (unknown causes) Genetic factors Hormones are chemicals in the body Other illnesses .
over-the-counter cold medicine. and spring. appetite suppressants. ecstasy. such as the death of a loved one 7) Having other biological family members with . 4) Sleep Deprivation 5) Seasonal Changes Manic episodes are more common during the summer. and amphetamines can trigger mania.1) Severe stress or emotional trauma Stress can also worsen a bipolar mood episode or extend its duration. Alcohol and tranquilizers can trigger depression. 2) Substance Abuse Drugs such as cocaine. and thyroid medication can trigger mania. caffeine. winter. 3) Medication Antidepressant drugs. Depressive episodes are more common during the fall. 6) Major life changes.
Antidepressants: These are often used with a mood stabilizer in people with depressive episodes. . Mood stabilizers: These may delay or relieve episodes of mania (highs) or depression (lows). which is FDA approved for the treatment of acute mania. antidepressants may increase the chances of a person with bipolar disorder switching into mania. Lithium (Eskalith or Lithobid): has long been used as a first line treatment for acute mania in people with bipolar disorder Divalproex sodium (Depakote) 2. If used alone.Diagnosis: Complete Detailed History Treatment: 1. Olanzapine (Zyprexa).
3. Anticonvulsant medications: such as carbamazepine (Tegretol). 4. Antipsychotics may be used alone or with other medicines for treating bipolar disorder: Clozapine (Clozaril) Quetiapine (Seroquel) Ziprasidone (Geodon) Other medicines: Might be suggested by the healthcare provider when a person with bipolar disorder cannot sleep or feels nervous. They may also be used to treat psychosis that can occur during severe episodes of mania or depression. also can have moodstabilizing effects and may be especially useful . Antipsychotics: These are medicines that are mostly used to treat mania.
Cagayan Valley Medical Center. . there were 7 cases of Bipolar Disorder. The table shows that Bipolar Disorder is the 3rd common mental disorder. as of January-June 2010.STATISTICS: Statistics as (January-June) Mental Disorder Schizophrenia Undifferentiated Type Brief Psychotic Disorder Bipolar Disorder Schizophrenic Disorder Alcohol Induced Psychosis Seizure Disorder with Psychosis Mood Disorder Mental Retardation Total of Total 97 10 7 5 7 5 2 1 134 2010 According to the records of Psychiatric Department.
REASON FOR CHOOSING THE CASE: We choose this case because we want to broaden our knowledge on the disorder. present an effective management for patients with this disorder in which we can use in the future and understand our roles as health care providers in .
2010 Time of Admission: 8:26 AM Chief Complaint/s: ³sau nga sau´ ³pagna nga pagna´ Final Diagnosis: Bipolar I Disorder Attending Physician: Dra. Solana. English and Tagalog Date of Admission: February 25. Itawes. Cagayan Citizenship: Filipino Religion: Roman Catholic Educational Attainment: Elementary Level (Grade 5) Occupation: None Language/Dialect: Ilocano. Patients Profile Name: M. HEALTH HISTORY A.III. Age: 45 Years Old Gender: Female Marital Status: Single Address: Andaraya. Ybanag.N. Leonor Juliana Source of Information: Client and Chart Data .
colds and fever. neozep and paracetamol.1.. Past Medical History According to patient M. when she was a child she experienced mild illnesses like cough. She takes over the counter (OTC) drugs such as tuseran forte.N. She first underwent surgery due . patient was not able to to remember it. When asked about vaccines.
N. She made mentioned that she experienced physical abuse by her mother when she was accused of stealing money though .M. According to the patient. stated that she experienced episodes of depression when she got raped by her neighbor. The patient never had any suicidal tendencies but has mood swings. she just sings her favorite song entitled ³Katarungan´ to cope up with her depression.
This experienced made her think that her life was ruined. The patient doesn¶t have enough force what was happening. After the incident.house and then after several hours of conversation.N. has no meaning and direction. ³Dinugo ako at parang nasilihan ang pakiramdam ko. She could not sleep for consecutive days and this behaviour lasts for almost a week. The patient verbalized ³One month ako dun sa . decided to let them marry but she refused to do so because she was in love with someone else. She was always preoccupied with the incident and came to a point that she was not able to continue her daily activities. parents of M. her neighbour suddenly forced her and rape M. her mother and aunt decided to consult in Cagayan Provincial Hospital.N. Due to her inability to cope. Masakit ngam´ as verbalized by the patient.
She verbalized ³Naninigarilyo ako kasi mabaho yung ihi sa loob´. she still engaged in smoking and consumes 2 sticks of cigarette (Marlboro) per day. She consumes 2 tobacco sticks in a day. started smoking at the age of 14 because she was greatly influenced by her grandmother. According to the patient. stated that she studied at Andarayan Elementary School in Solana but did not finish schooling. M. She made mentioned that she doesn¶t drinks liquor. Now.N. she is the only member of the family who suffered mental illness.Personal and Social Economic History M.N. .
She said she was particularly fortunate for having no other disease. There were 5 girls and 2 boys.3. She made mentioned that her brother died because of asthma. Family History They were seven siblings and she was third from the eldest. . A history of hypertension was present on his paternal side and no particular disease or illness on his maternal side.
She verbalized ³Hindi ako pasaway´. The patient was not able to recall her early motor and language development. The patient said that she loves to play but not with her older siblings. The patient describes herself as kind and friendly to her sibling/playmates. The patient was breastfed adequately. The patient was an active pupil who was once a leader. she was confused with her identity but she claimed that she was a ³tomboy´ before but she did not have any attractions with girls. She loves to sing and dance in their classroom and join athletic activities. . She said that her parents support and try to meet their needs. She prefers toys such as dolls. She also said that she has a good sleeping pattern when she¶s still a child. She was a leader and peace maker in the group. She said she was very obedient that made her as one of the favorites of her teacher. Filipino was her favorite subject. She was not rebellious. She cannot remember the number of her friends. she was born through normal spontaneous delivery and her birth was planned and wanted by her parents. She said that she was usually scolded and hit with a belt by her mother everytime she does wrong.According to the patient. According to the patient. The patient has a good relationship with other people.
she describes her illness by stating ³Magaling na ako´ but when the patient was asked to pray. She seldom attends mass but she prays always.a. rice and other vegetables. Self-esteem. They used to plant corn. self concept M. she prayed for her healing ³Panginoong Diyos. tulungan niyo po ako na tuluyang gumaling´. Their source of income was from farming. She attended at school until grade 5. She strongly believes in miracles and power of God. When ask about herself.N. The patient is a Roman Catholic. The Lord is . did not finish schooling. According to the patient their family have a huge farm.
According to the patient. she performs any household chores or any typical leisure work such as gardening and cleaning house premises. She used to wash her clothes and the clothes of other psyche patients. her usual activities are cleaning the surroundings and doing laundry. Now that she in the psychiatric ward. She doesn¶t need any assistance in doing her daily activities and she is not using any mobility aids . She also said that she used to walk and considers walking around as his form of exercise.
she usually sleeps 8:00 in the evening and wakes up at 5:00 but most of the time her sleep pattern was disrupted because of other patients that are not behaved and also when giving medications. She made mention that she also experiences nightmares. She seldom takes a nap in the afternoon but takes time to . ³Hindi ako makatulog kasi ang ingay ng mga kasama ko.According to the patient.sinusumpong kasi sila´ as verbalized by the patient.
She eats the food that is being served to them in the ward. According to the patient she . she loves to eat cooked liver and adobong baboy.The patient eats 3x a day. According to the patient. she drinks 6-8 glasses of water with 2 cups of coffee per day. She defecates once a day usually in the morning. she urinates 3-5 times a day (about 250 ml per urination) in a light yellow color and has a clear appearance. She also likes fish such as tilapia and galunggong and also vegetables like ampalaya. With regards to the urination. and semiformed. According to the patient. Her stool is foul. dark.
Resources The patient claims that she has a good relationship with her family.N. Patient M. She loves to mingle with different kinds of people. is married and she had six children. her family is also visiting her in the ward once in awhile. She values the existence of a great social support especially in times of need. friends and neighbors. Patient M. is the third among the 7 siblings. According to the patient. She said that she is very happy everytime .N.
she used to smoke 2 ± 3 sticks of cigarette a day. ³Ayaw ko uminom ng alak´ as verbalized by the patient. She also said that if she has problems she used to sing her favorite song ³KATARUNGAN´ to feel relieve.f. She started this when she was about 14 years old because she was greatly influence of her grandmother. Coping and Stress Management Whenever she felt stressed. . She doesn¶t used to drink any liquor.
g. thus she had an operation ³Nicotine Lyphoma Chest´ when she was 38 year old. The patient is aware of the risks of smoking.N. . Personal Habits Patient M. used to smoke 2 cigarette sticks a day. She started smoking at the age of 14 years old because she was greatly influenced by her grandmother. ³Mabaho kasi yung ihi kaya ako nagsisigarilyo´ as verbalized by the patient. The patient did not take any drugs such as marijuana nor alcohol.
She also has a direct eye contact whenever we communicate. .N. According to her. When it comes to the manner of dressing. She is in an upright posture and has no problem with gait. M.N. she is neat and appropriate. thus. is always alert and awake. GENERAL APPEARANCE Patient M.IV. MENTAL STATUS EXAMINATION A. She is always clean. she is always happy. practice proper hygiene. The patient is always smiling. she always takes a bath.
N. . M. rapid voice. SPEECH The patient talks in a moderate. She talks non-stop and her responses are in detailed.B. elaborates her answers and expresses her thoughts and feelings freely. Her words are very clear but she skips one topic to another.
.C. Whenever she was interrupted she often starts all over again. MOTOR ACTIVITY The patient talks fast without pauses. Most of the time the patient ignores the person who wish to speak and continue talking even no one is paying attention on her. thinks and moves rapidly.
She verbalized ³Wala akong naririnig Ma¶am´. F. THINKING The patient has delusions specifically grandiose delusion. She claims that she is . E. EXPERIENCES The patient did not have plans or a history of harming others. Both words and actions are congruent to the situation. EMOTIONAL STATE The patient has general feeling of happiness. She made mentioned that she doesn¶t have any hallucinations. The patient has an appropriate affect.D.
M. was able to identify the similarities and differences of some objects (pencil and paper) and foods/dinks (milk and coffee).yung kape . The patient was not able to explain properly proverbs such as ³ Aanhin pa ang damo kung patay na ang kabayo´. can count from 1-20 rapidly. place and people around her. can do simple calculations. Ang milk yung kulay white. She verbalized ³Ang lapis yung ginagamit pansulat tapos yung papel yung susulatan.N.N. she verbalized ³ Ibabalik ko yung wallet tapos di ko kukunin yung pera kasi hindi naman akin. When asked what actions she will take when she sees wallet on the ground. M. Masama kumuha ng pera ng iba´.FUNCTIONING The patient is oriented to time.
V. ANATOMY AND PHYSIOLOGY .
6 33.3 0.2 NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL .84 54.PARAMETERS Hemoglobin mass concentration Erythrocyte Volume Fraction Erythrocyte Number Concentration Thrombocyte Number Concentration Mean Corpuscular Volume Mean Corpuscular Hgb Mean Corpuscular Hgb Content Leukocyte Number Concentration Neutrophils Lymphocytes Monocytes Eosinophils Basophils VII.40 5 262 ANALYSIS NORMAL NORMAL NORMAL NORMAL 86-100 26-31 310-370 5-10 35-65 20-40 2-8 0-5 0-1 89 26 329 5. 2010 09:17:50am RESULT NORMAL VALUES 120-160 0.5 150-400 130 0.37-0.47 4-5.7 7. LABORATORY AND DIAGNOSTIC EXAMS HEMATOLOGY RESULT February 28.2 4.
COMMUNICATION PROCESS RE .VIII.
IX. NURSING CARE .
THANK YO .
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