A client diagnosed with Bipolar I disorder, such as Mary Ann Garces, intrigues and challenged the student nurses to applying onto the practical field, their acquired knowledge, attitude and skills from preceding lessons in order to function as an operative and effective member of the multidisciplinary team. The group members are determined to broaden their knowledge concerning the disorder, particularly in the various methods in which they are supposed to interact with the patient, utilizing the various appropriate therapeutic approaches, therefore rendering holistic caring care to the said client. The group also aspires to gain a concrete and total exemplar of the treatment of the disease condition, having only encountered such condition in texts. Also, the group feels that and successful intervention is crucial during manifestations of signs and symptoms of the Bipolar I disorder so as to ensure that the client will not have difficulties in functioning in his daily life. If the students are to be efficient nurses, the student nurses should be educated in such matters. Bipolar disorder is a recurrent illness that involves long-term, drastic changes in mood.
A person with bipolar disorder experiences alternating highs (mania) and lows (depression). A manic period can be brief, lasting from three to fourteen days, or longer, lasting up to several weeks. The depressive periods may also last from days to weeks or even six to nine months. The periods of mania and depression range from person to person many people may only experience very brief periods of these intense moods, and may not even be aware that they have bipolar disorder. The highs or manic episodes are characterized by extreme happiness, hyperactivity, little need for sleep and racing thoughts, which may lead to rapid speech. Symptoms of the lows or depressive periods include extreme sadness, a lack of energy or interest in things, an inability to enjoy normally pleasurable activities and feelings of helplessness and hopelessness. On average, someone with bipolar disorder has three years of normal mood between episodes of mania or depression.
Those with bipolar disorder often describe their experience as being on an emotional roller coaster. Cycling up and down between strong emotions can keep a person from functioning normally. The emotions, thoughts and behavior of a person with bipolar disorder are beyond his control friends, co-workers and family must intervene to protect his interests. This makes the condition exhausting not only for the sufferer, but for those in contact with him as well. Bipolar disorder can create many difficulties. Manic episodes can lead to family conflict or financial problems, especially when the person with bipolar disorder appears to behave erratically and irresponsibly.
During the manic phase, people often become impulsive and act aggressively. This can result in high-risk behavior, such as repeated intoxication, extravagant spending and risky sexual behavior. During severe manic or depressed episodes, people with bipolar disorder may have symptoms that overwhelm their ability to deal with reality. This inability to distinguish reality from unreality results in psychotic symptoms such as hearing voices, paranoia, visual hallucinations, and false beliefs of special powers or identity. They may have distressing periods of great sadness alternating with euphoric optimism (a natural high) and/or rage that is not typical of the person during periods of wellness. These abrupt shifts of mood interfere with reason, logic and perception to such a drastic degree that those affected may be unaware of the need for help. However, if left untreated, bipolar disorder can seriously affect every aspect of a persons life.
Identifying the first episode of mania or depression and receiving early treatment is essential to managing bipolar disorder. In most cases, a depressive episode occurs before a manic episode, and many patients are treated initially as if they have major depression. Usually, the first recognized episode of bipolar disorder is a manic episode. Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods. Because of this difficulty with diagnosis, family history of similar illness and/or episodes is particularly important. Patients who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treatment of depressed bipolar patients with antidepressants can trigger a manic episode in some patients.
At the end of this case study, the student nurse will be able to:
1. discuss about the personal, social and familial history of the patient
2. recall and review on the normal growth and development of an elderly
3. discuss bipolar disorder
4. trace the pathophysiology of bipolar disorder
5. cite the classical signs and symptoms of disorder
6. make use of the nursing process in caring for a patient with disorder
7. instruct health teaching to the patient with the disease condition
At the end of this case study, the patient and his significant-others will be able to:
1. establish trust and rapport with the student nurse
2. express their feelings and concerns with the current condition
3. state the reason for her stay in the institution
4. utilize coping skills during her stay in the institution
5. exhibit positive attitude towards the therapeutic treatment regimen
6. carry out activities of daily living such as self-care
III. NURSING ASSESSMENT
1. PERSONAL HISTORY
1.1 Patients Profile
Name: Mary Ann Garces
Age: 41 years old
Civil Status: Single
Religion: Roman Catholic
Date of Admission:
Ward: Psychiatric Waling-Waling Ward
Impression/ Diagnosis: Bipolar I Disorder Manic Phase
1.2 Family and Individual Information
The client originally came from Talisay City, Cebu. She has 2 sisters of whom she claims are now in Manila. Prior to her stay in the institution, the client had been drinking 2 liters of Pepsi Cola. She had been admitted to the instituition by her mother to a mischievious conduct of hers. Further examination in the instituon revealed that the patient had Bipolar Disorder I Manic Phase. During her stay in the Psychiatric Ward, the client had received visits coming from her family. She have many friends in the instituition and had known a lot of patients in their.
1.3 Level of Growth and Development
1.3.1 Normal Development (Elderly)
Dramatic physical changes occurs among elder people. Their physical appearance changes in a way which is obvious. Such changes include that of their skin which has become dry and wrinkled and in some presence of age spots are seen. White hair and hair loss are also evident among the elderly. The development of presbyopia and presbycusis are also noted and such has resulted to difficulties of the elderly in maintaing theie activites of daily living. As for the functions of the several systems in the body such as the cradiovascular, neurological and gastrointestinal systems, their functional capability decreases due to the efffect of the aging process. Such is evident in cases of dementia, confusion, frequent constipation and cardiovascular problems occuring during the old age.
Acquiring a Sense of Integrity While Avoiding Despair (Old Age) As the aging process creates physical and social losses, the adult may also suffer loss of status and function, such as through retirement or illness. These external struggles are also met with internal struggles such as the search for meaning of life. Meeting these challenges creates the potential for growth and wisdom. Many elders view their lives with a sense of satisfaction even with the inevitable mistakes. Others see themselves as failures with marked attempt and disgust.
Universal Ethical Principle Orientation
This stage defines right by the decision of conscience in accord with self-chosen-ethical principles. These principles are abstract, like the golden rule and appeal to logical comprehensiveness, universality and consistency. It also defines the principles by which agreement will be most just.
Period IV: Formal Operations
With the individuals thinking moves to abstract and theoritical subjects in the formal operation period, thinking can venture into such subjects as achieving world peace, finding justice and seeking meaning in life. 1.3.2 The ill person at particular stage of the client
Bipolar disorder causes dramatic mood swings”from overly high and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
1.3.3 Actual Ill Behavior
¢ Increased energy, activity, and restlessness
¢ Excessively high, overly good, euphoric mood
¢ Extreme irritability
¢ Racing thoughts and talking very fast, jumping from one idea to another
¢ Distractibility, cant concentrate well
¢ Little sleep needed
¢ Unrealistic beliefs in ones abilities and powers
¢ Poor judgment
¢ Spending sprees
¢ A lasting period of behavior that is different from usual
¢ Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
¢ Provocative, intrusive, or aggressive behavior
¢ Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
¢ Lasting sad, anxious, or empty mood
¢ Feelings of hopelessness or pessimism
¢ Feelings of guilt, worthlessness, or helplessness
¢ Loss of interest or pleasure in activities once enjoyed, including sex
¢ Decreased energy, a feeling of fatigue or of being slowed down
¢ Difficulty concentrating, remembering, making decisions
¢ Restlessness or irritability
¢ Sleeping too much, or cant sleep
¢ Change in appetite and/or unintended weight loss or gain
¢ Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
¢ Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer. A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
A physician makes this diagnosis based on the patients symptoms. Other conditions that might also cause these symptoms will be considered and ruled out. The patients medical history, including whether there have been previous episodes of mental illness, will be evaluated. Family medical history, particularly of mood disorders, is important information. Blood tests are not routine at present but are being researched as a future aid in diagnosing.
There are several different pathways into the set of symptoms given the diagnosis Bipolar Affective Disorder. Among the explanations indicated by research and generally accepted are the following: 1. Genetic abnormalities, Bipolar affective disorder has clearly been shown to run in families. (Genetic abnormalities on chromosomes 18 and 21 are suspected.) 2. Chemical imbalance in the brain, particularly related to leaking membranes in the pathways used for delivering messages within the brain. 3. A seizure disorder in the brains frontal cortex. No convulsions occur with frontal cortex seizures because there are no psycho-motor centers located in the frontal cortex. Seizures occurring in this area affect mood and judgment. 3. Present profile of Functional Health Patterns
3.1 Health Perception/ Health Management Pattern
The client despite her current condition does not have any vitamins and only recieves a monthly dose of an antipsychotic drugs monthly. She claims that she is not well and when asked why she is in the institution, laughs and says that she does know.
3.2 Nutritional- Metabolic Pattern
The client eats what the instituition has to offer, from breakfast to dinner. Occassionaly, she ate foods given by student nurses. Unfortunately, such foods are not that nutricious to meet her metabolic needs as evidenced by her pale color and her body built.
3.3 Elimination Pattern
The client normally defecates once every day. For her urination, she verbalized to urinate at least 4 times a day.
3.4 Activity- Exercise Pattern
Her activity- exercise pattern greatly depends on her mood. During our time with her, there are days when she actively join the activities prepared by the student nurses and enjoys walking in the grounds. While in some days, the client all wants is to sit down in her place and remains away from the company of others.
3.5 Cognitive Perceptual Pattern
The client cognitive and perceptual pattern is distorted, especially in cases mood swings. She falsely believes that they are all artists and that they had a show. She also had misperceptions of having a store in front of her which in reality is just a window. Shes also oriented to time and date.
3.6 Sleep-Rest Pattern
As been claimed by the client, she doesnt sleeps well during night which starts from around 10 pm 5 am. During the afternoons, she naps a liittle bit.
3.7 Self-Perception Pattern
The client sees herself as a well individual and says that nothing is wrong. She oftenly says that she speaks with the resident physician with regards to her stay in the institution.
3.8 Role-Relationship Pattern
There are problems with the clients relationship to others. This had been due to her condition and the sign and symptoms accompanying it. During her stay in the institution, there had been visits coming from her family. As to her relationship with fellow clients in the instituition, she does have close friends.
3.9 Sexuality-Sexual Functioning
The client is an elder woman who long time had her menopausal. She is single and doesnt have any children at all.
3.10 Coping-Stress Management Pattern
The client whenever provoked or when she hears unpleasant things, easily gets angry and irritable. To cope up, she frequently shouts to the people around her and when shes happy, she joins with the activities prepared by student-nurses.