L. F. Gonzales College of Science and Technology Institute Maharlika Highway, San Leonardo, ue!

a "ci#a

Su$%itted $y& Balajadia, Enrick D. Feliciano, Geruel D. Garcia, Patria Rose Anne O ere!, "ames Dohn G. Re#es, Glai!a M.

Su$%itted to& Florida Sarmiento RN, MAN, PhD Dean, College of Nursing

TABLE OF CONTENTS
I. Introduction II. Objectives III.Nursing Process
A. Assessment

1. General Data
a%e& 'ddress& (ate 'd%itted& (iagnosis& 'ge& Ci!il Status& Chief Co%)laint& Infor%ant&

2. Reason for hospitalization . !a"il# histor# of "ental illness $. %istor# of present illness &. Related events'situations to present health condition (. Pre)"orbid personalit# assess"ent *. +ourse in the ,ard -. Personal'educational'occupational'"arital histor# and significant person to patient .. /ental status e0a"ination
a* General descri)tion

(1) Appearance (2) Behavior and psychomotor activity (3) Attitude to ard e!aminer

$* +sycho)atho)hysiology and +sychodyna%ics B. Planning C. Nursing management Process recoding D. Evaluation and learning derived E. Conclusion / recommendation

I1.Drug stud#
A. Generic name B. Brand name C. Classification D. Mechanism of action E. Patient dosage F. Contraindications G. Adverse effect H. Nursing interventions

Bipolar disorder
"he illness tends to #e highly genetic, #ut there are clearly environmental factors that influences hether the illness is occur in a particular child$ Bipolar disorder can s%ip generations and ta%e different in different individuals$ "he small group of studies that have #een done vary in the estimate of the ris% to a given individual$ &or the general population a conservative estimate individual's ris% of having full(#loom #ipolar disorder one percent$ Disorder in the #ipolar spectrum may affect )(*+, ho one parent has #ipolar disorder, the ris% to each child is 1,(3-+, hen #oth parents have #ipolar disorder, the ris% increases to ,-(.,+$ "he ris% in si#lings and fraternal t ins is 1,(2,+, and the ris% of identical t ins is appro!imately .-+$ Bipolar disorder is classified into t o, the #ipolar / and the #ipolar //$ "he #ipolar / disorder in hich individual may e!perience one or more manic episodes or mi!ed episodes$ During a manic episode must #e present to a significant degree$ /mpairment in various of functioning, psychotic symptoms, and the possi#ility of self(harm e!ist$ Bipolar // disorder is characteri0ed #y recurrent ma1or depressive episodes ith hypomanic (a mood #et een euphoria and e!cessive elation) episodes$ /t is #elieve to occur fre2uently in omen than in men$

"his case study aims to3 4no the definition and the history of the development of

#ipolar manic disorder$ /dentify the facts that may contri#ute in ac2uiring #ipolar manic disorder$ &ormulate appropriate diagnosis on hich to #ase the necessary psychiatric nursing interventions$ /mplement interventions and psychodynamic approach$ 5valuate the actions done to clients and its effectivity$

A. Assessment
1. General Data
Name3 Age3 Address3 Civil 6tatus3 Date Admitted3 Chief complaint3 Nestor )2 Nueva 5ci1a 7arried August ,, 2--. 1$ 8anana%it 2$ 8oor sleep 3$ Nam#a#ato ng #ahay )$ Nag#a#asag ng gamit 9ife

/nformant3

2. Reason for %ospitalization

:er ife #rings him here at 7ariveles 7ental :ospital, August ,, 2--. 113-, in the morning$ 6he said that his hus#and Nestor is not in normal mental state again$ :e refused to ta%e his medicine, he had sleep distur#ance and the last time he forced his daughter to get money to her and #ought him cigarettes$ And #efore that day, his hus#and thre a stone at his neigh#ors' house$

. !a"il# %istor# of /ental Illness

According to his ife, he is the only one in the family having this mental illness$ :is parents and relatives have the normal state$ :is family or% and do their daily tas%s li%e any individual and possess good intention of living e!cept him$

$. %istor# of Present Illness

"he patient is previously confined in 7ariveles 7ental hospital last 7arch 2--1, the client flo up until ;cto#er 2--3$ "he last admission as August ,, 2--. ( ith relatives)$ According to his ife, hen they got home after the first e!clusion, his hus#and as a#le to help in their financial needs$ :e or% as a tricycle driver #ut still the money that they earned is not enough to continue and support his medication that is hy they decided to stop ta%ing his medicine$ After a fe ee%s, he started to have signs and symptoms of relapses$ :e #ecame destructive <Nag#a#asag ng %asang%apan at Nam#a#ato ng %apit#ahay$= :e al ays al%s and %ept panic$ 9hen his mother seen his situation, she #rought him medicines #ut the patient refuses to ta%e it #ecause he thin%s it as a poison$ 6he heard their neigh#or said <8apatayin na lang namin yan$= "herefore, she decided to ta%e him here in this mental institution again$

&. Related 2vents'3ituations to Present %ealth +ondition

According to the medical doctor, 7r$ Nestor has mental illness #ecause of trauma he e!perienced$ ;ne day, he said that he sa his father sta##ed #y his father's friend and after that incident, he never forget that$ :e also said that they have financial pro#lem and he thin%s that their younger 11(year(old son as not his son$ :e thin% that his ife having an affair ith another man$ :o ever, he never confronted his ife a#out it in afraid that his ife got angry$

(. Pre)/orbid Personalit# 4ssess"ent

During our interaction ith the patient, he seems to #e %ind to us and eager to ans er our 2uestion$ :e does not hesitate to ans er although e as% a#out his personal life$ 9e also noticed his %indness during the session$ 9e almost thin% that e are tal%ing to a normal person$ /n addition, he possesses silence 2uite some time as he is thin%ing something that e do not as%$

*. +ourse in the 5ard

&rom August 2--. until no , according to 7r$ Nestor, he only got one trou#le inside the hospital$ "he reason of that commotion is a stic% of cigarette$ &rom then on, he never do that again #ecause he ants to go home and return to his normal life$

-. Personal'2ducational'Occupational'/arital %istor# and 3ignificant Person to the Patient

"he client is a high school graduate, a farmer and tricycle driver in occupation$ 6ometimes, he is also a #alut vendor at night to sustain their financial needs$ :e has a dou#t on his ife that she is having an affair$ "hey have seven children> his sister adopts t o of them$ :e never tried to have an affair to other oman #ecause he only ants to have a simple and happy family$ :is t o daughters are the special person in his life$

.. /ental 3tatus 20a"ination

a* General (escri)tion

(1) Appearance
6een this adult male in #lue 77: uniform ith short hair and nails, poorly %ept ith #ody odor$ 9ith no slippers, li%e any #ody inside the hospital$ Not so nourished, and slim in #uilt$

(2) Behavior and 8sychomotor Activity

:e is not harmful as e first thought a#out him$ :e responds in every 2uestion that e gave$ :e also participates in e!ercise, games, dra ings, or any program or activities that e planned for them$ :e on in the <pinoy henyo= game$

(3) Attitude to ard 5!aminer

:e is sitting straight in front of us$ :e 1ust staring to us at first, #ut in fe moments, he ans ers our 2uestions$ :e respects our presence in e!cusing himself every time he ill go to the comfort room or hen he ants to al% for a hile$

$* +sycho)atho)hysiology Modifia$le Factors 6u#stance a#use 6leep deprivation 6tress on,Modifia$le Factors Aenetic factors

/m#alance 6erotonin and Norephinephrine level

/ncrease in 6erotonin and Norephinephrine

Chemical changes in the #rain

4indling

6pontaneous sei0ure activity in the #rain

:yperactivity Signs and Sy%)to%s 9al%ing aimlessly Decreased sleep /ncreased involvement in pleasure see%ing activity :allucinations Agitation Delusions Signs and Sy%)to%s -.ook $ased* A#normal and persistent elevation of mood Agitative Aradiosity Decreased need for sleep /ncrease involvement in goal directed activity :allucinations

+sychodyna%ics Balance #et een physiological safety needs (lo 6ocio(economic) A#raham 7aslo :ierarchy of Needs

;rally fi!ated (smo%ing and drin%ing) (;ral stage ? @ean 8iaget)

Distur#ed 8sychological Aspects (Chained #y his ife) (7aslo :ierarchy of Needs)

&ear (auditory hallucination) (Collective unconscious ? Carl @ung's "heory)

&amily constellation ? Alfred Adler

/ntimidate (:igh 6chool graduate only) (Cognitive /mpairment ? @ean 8iaget)

An!iety ? 6elf(searching, unproductive (una#le to sustain the family needs) (Aeneratively versus stagnation ? 5ric 5ri%son)

&rustration and self(deficit (Dorothea ;rem)

Bipolar manic

B. Planning
NURSING CARE PLAN C/"S 6u#1ective3 <puro mga sinungaling ang andito,= as ver#ali0ed #y the patient$ /0SI G (I'G 1SIS Distur#ed thought process related to ina#ility to trust as evidenced #y suspiciousness of others, resulting in alteration in societal participation$ G1'L21.3"CTI4"S I T"04" TI1 S
8rioriti0e safety of the client$

0'TI1 'L"
Client may harm self or others in disoriented, confused state$

"4'L/'TI1

Short-Term Goal 9ithin 1 ee%, client ill start to recogni0e and ver#ali0e hen thin%ing is non(reality #ased$ Long-Term Goal Client ill e!perience no delusional thin%ing #y discharge from treatment$

&re2uently orient client to reality and surroundings$

Disorientation may

"ry to redirect violent #ehavior ith physical outlets for the clientBs an!iety$

endanger client safety if he or she un%no ingly anders a ay from safe environment$

Aoal met$ After a ee% of intervention, the client a#le to recogni0e and ver#ali0e hen thin%ing is non( reality #ased$

8hysical e!ercise is a safe and effective ay of relieving pent(up tension$ Cer#ali0ing feelings ith a trusted individual may help client or% through unresolved issues$

5ncourage the client to ver#ali0e true feelings$ "he nurse should avoid #ecoming defensive hen angry feelings are direct at him$

C. Nursing management
+rocess recording Client initials3 6e!3 Age3 Date of #irth3 Address3 Nationality3 8hysical appearance3 Description of the environment3 "entative diagnosis3 Aoals of interventionE;#1ective3 6tudent 2uestion A%o po ay si 8atria$ 4ayo po #a, p ede %o po #a malaman ang inyong pangalanG Nestor 7ale )2 years old 7arch 2*, 1D*. @aen, Nueva 5ci1a &ilipino /n #lue 77: uniform, short hair, short nails, poorly %ept and no slippers$ 6unny day, clear environment and good atmosphere under the #ig mango tree$ Bipolar manic ith psychotic features "o help the client to e!press thought and feeling$ 8atient response A%o si Nestor$ "herapeutic communication Aiving information FationaleEDefense mechanism /nforming the client of facts increases his %no ledge a#out a topic or let the client %no hat to e!pect$ "he nurse is functioning as a resource person$ Aiving information also #uilds trust ith the client$ Accepting response indicates that the client has heard and follo ed the train of thoughts$

7aari po #a %ayong ma%inig at sumagot sa mga #agay( #agay na itatanong %o sa inyoG

6ige$

Accepting

 Ano po #a ang tra#aho ninyo #ago %ayo mapunta ditoG

Dati a%ong tricycle driver tapos nagtitinda din a%o ng mais %asama ang asa a %o$

5!ploring

9hen client deals ith topic superficially, e!ploring can help them e!amine the issue more fully$ 7a%e e!plicit that the client has the lead in the interaction$ &or the client ho is hesitate a#out tal%ing, #road opening may stimulates him or her to ta%e the initiative$ "o understand the client$ "he nurse must see things from his perspective$ 5ncouraging the client to descri#e the ideas fully may relieve the tension the client is feeling, and he might not #e less li%ely to ta%e action or ideas that are harmful or frightening$

4uya, mayroon po #a %ayong gustong i%u ento o sa#ihin sa 9ala$ 7agtanung %a na lang$ a%inG

Broad openings

Ano ang ginaga a mo %apag nalulung%ot %aG

Na%i%ipag% entuhan a%o sa %ai#igan %o na si /nggo$

5ncouraging description of perception

D.Evaluation and learning derived

1$ "he client physical appearance improved from poor to good hygiene$ 2$ "he students had learned ho and coping mechanism$ 3$ "he client sho ed interest in each therapy$ )$ "he client as a#le to e!press hisEher o n feelings and thoughts to interact and understand the emotions

during nurse(client interaction$

E. Conclusion /

ecommendation

As a conclusion, #ipolar is a serious mental disorder that could lead to serious of harmful situation or even complications that they could #e manic or depressed$ According to the stimuli, that they encounter this disorder needs careful handling and attentive support emotionally, #ecause they could #e lac%ing from emotional support or attention from immediate family$ Hi%e our client ith the help also of other mental personnel$ "hese mental institution patient can #e managed ell and #e free from the said disorder$ 9e recommend careful management and careful attention plus support to those affected #y the disorder and for those institution$ ith symptoms of said disorder, %indly report immediately into different or nearest mental

Generic na%e Hithium car#onate

.rand na%e 8riadel

Classification Antimanic drug

Mechanis% of 'ction "hought to disrupt sodium e!change and transport in nerves and muscles and control re( upta%e of neurotransmitters$

+atient (osage *--mg B/D

Contraindications (none)

'd!erse "ffect

ursing Inter!entions

CN63 Di00iness, Advise patient to ta%e dro siness, headache, ith food or mil% to tremor, ata!ia, slurred minimi0e A$/$ upset$ speech, hallucination Advise to limit foods CC3 #radycardia, and #everages hypotension containing caffeine$ "ell patient to maintain ade2uate fluid inta%e$ 5mphasi0e importance of having regular #lood tests to help detect and prevent serious adverse reactions$ Dry mouth Advise the client to avoid dry, #ul%y, and irritating foods and fluids such as to#acco and alcohol$ Advise client to tal%ing too much if not necessary$

Biperiden

A%ineton Anti( par%insonian

Biperiden has an antropine(li%e #loc%ing effect on all peripheral structures that are parasympathetic innervated$

2mg ;D

Caution should #e o#served in patient ith manifest glaucoma thought no prohi#itive rise in intraocular pressure has #een noted follo ing either oral or parenteral administration$ 8atient ith prostatism epilepsy or cardiac arrhythmia should #e given this drug ith caution$

Aeneric name
Diphenhyramine

Brand name

Classification

7echanism of Action

8atient Dosage

Contraindications
:ypersensitivity to drug Alcohol intolerance Acute asthma attac% 7A; inhi#itor use ithin 1) days Breastfeeding Neonates, premature infants

Adverse 5ffect

Nursing /nterventions

Benadryl Antihistamine , antitussive, antiemetic, antivertigo agent, antidys%inetic

/nterferes ith 2,mg 8; histamine effect at :6 histamine receptor sites> prevents #ut does not reverse histamine(mediated response$ Also possesses CN6 depressant and anticholinergic properties$ 7ay #loc% postsynaptic dopamine receptors in #rain and depress areas involved in a%efulness and emesis$ Also possesses anticholinergic, antihistaminic, and adrenergic(#loc%ing properties$ 1-mg B/D

CN63 dro siness, Advise patient to avoid headache, parado!ical alcohol and other stimulation depressant such as sedatives$ CC3 hypotension, tachycardia, Caution patient to palpitations avoid driving and other ha0ardous activities 55N"3 #lurred vision, until he %no s ho tinnitus drug affects A/3 diarrhea, concentration and constipation, dry alertness$ mouth CN63 sedation, dro siness, e!trapyramidal reaction, tardive dys%inesia, pseudopar%insonism, sei0ure CC3 tachycardia, hypotension 55N"3 #lurred vision, dry eyes, lens opacities, nasal congestion A/3 constipation, ileus, anore!ia, dry mouth :epatic3 1aundice, hepatitis "ell patient to ta%e capsule or ta#lets ith a full glass of ater, ith or ithout food$ /nstruct patient not to crush sustained(release capsules$ "ell patient to mi! oral concentrate in 1uice, soda, applesauce, or pudding$ Caution patient to avoid driving and other ha0ardous activities until he %no s ho drug affects concentration and alertness$

Chlorproma0ine hydrochloride

Antipsychotic , an!iolytic, antiemetic

:ypersensitivity to drug Angle(closure glaucoma Bone marro depression 6evere hepatic or cardiovascular disease