B.

MENTAL HEALTH ASSESSMENT FINDINGS

ASSESSMENT FINDINGS DISCUSSION

45 years old A new study found a relationship between
telomere length, a marker of biological aging,
and the likelihood of bipolar disorder.
Female Women are more likely than men to develop
bipolar illness later in life, and they are more
likely to have a seasonal pattern of mood
disruption.
Family mental history positive for Bipolar disorder is the most common
bipolar ( maternal grandmother, sister) no one psychiatric disorder that is passed down from
in patients’s family has been admitted for
psychiatric case admission. generation to generation.

Unemployed and unable to pay rent Unemployment and job-related issues are
common in people with bipolar disorder.
Inability to support self, had a People with depression and bipolar disorder
feeling worthlessness with little have less dopamine and it is associated to
motivation to seek for an feeling of being less motivated.
employment.
Patient experienced increase level of agitation, Bipolar disorder causes drastic changes in
anhedonia and difficulty concentrating according mood, as well as outlook, behavior, and
to her brother these symptoms exist 9 months
ago prior to present consultation
energy level.
Patient chief complains “I Just can’t sleep no Bipolar Disorder is linked to irregular sleep-
more, Nobody can talk to me- “ I don’t want to wake patterns, which can occur as a result of
be around; they all get on my nerves.”
a nighttime lifestyle that entails excessive
activity.
Patient was agitated, shouting at the Agitation is common in mixed and depressed
clinic. 
moods, which are marked by variable energy
levels and irritability.
History of past illness: Patient’s history of past illness precipitates
- History of substance abuse- marijuana an increased risk in developing Bipolar
2-3x a week aid in her insomnia episode Disorder, all stressful events mentioned
as claimed towards the client are factors that dense the
- careful inquiry suggest that she illness that she has currently.
experience hypomanic episodes.
- During her 20’s the patient describe
herself as unusually productive, creative
and sociable and able to go all night on
3 hours of sleep. She even get troubled
with traffic enforcer and she loves do
shopping and at several times she was
facing troubled using her credit cards.
- treated with monotherapy
antidepressants and benzodiazepine.
-  received tradozone treatment for her
insomnia
- Received treatment for her mood three
years ago , she’s not compliant to his
treatment regime
C. PSYCHOSOCIAL STAGE

CASE 3
(Continuation)

In relation to the case presented, the situation falls in the negative resolution for the reason
that the patient failed to obtain and maintain good relationship towards others in terms of
having children and supporting constructive social change. To elaborate, the patient had done
some actions that contradicts to the good side of the development, specifically, she had a bad
relationship towards her supervisor, inability to support self, and had a feeling of
worthlessness. Her coping mechanisms do not lead to improvement of the situation and her
condition.

Source:

D. DIAGNOSIS

Diagnosis: Bipolar II Disorder

There is no established pathophysiology for bipolar disorder, also known as manic-depressive

illness (MDI), and no objective biologic signs that correspond to the disease state. Twin, family,
and adoption studies, on the other hand, all suggest that bipolar disorder has a strong genetic
component. In fact, first-degree relatives of someone with bipolar illness are about 7 times
more likely to get the disorder than the general population, and bipolar I disorder (BPI) has
recently been estimated to have a heritability of 0.73.

Source: https://emedicine.medscape.com/article/286342-overview?reg=1#a3
E. MEDICATION REVIEW (DRUG STUDY)

MEDICATION INDICATION MECHANISM OF ACTION CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITIES

Generic treatment of major The mechanism of Known history of CNS: drowsiness,  Obtain and monitor vital signs
Name: depressive disorder action of trazodone is hypersensitivity to confusion, dizziness, especially blood pressure and
(MDD), off-label for not fully understood, fatigue, hallucinations,
Trazodone and Co- heart rate.
adjunct therapy in however, it is known to headache, insomnia,
Trazodone alcohol dependence, inhibit the reuptake of administration with  Assess and monitor patient for
nightmares, slurred increased depression and
and off-label to treat serotonin and block both serotonergic drugs speech, syncope, suicidal thoughts and ideology
anxiety and insomnia. histamine and alpha-1-
Brand Name: adrenergic weakness.   Assess patient for symptoms of
receptors.20 Despite the confusion, slurred speech,
Desyrel, Desyrel fact that trazodone is EENT: blurred vision, hallucinations, or other
Dividose, Oleptro, and frequently considered a tinnitus.  alterations in mood and behavior
Trazodone D selective serotonin
 Implement fall precaution
reuptake inhibitor, CV: hypotension,
several reports have strategies.
arrhythmias, chest pain,
Dosage shown that other hypertension,  Educate patient to should move
mechanisms including palpitations, QT interval slowly when assuming a more
25mg/qhs
antagonism at serotonin upright position
prolongation,
5-HT1a, 5-HT1c, and 5-
tachycardia. 
HT2 receptor subtypes
may occur.
GI: dry mouth, altered
taste, constipation,
diarrhea, excess
salivation, flatulence,
nausea, vomiting.
Source: https://go.drugbank.com/drugs/DB00656
 Medication Indication Mechanism of Action CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITIES
Generic treatment of acute The “Inositol Known history of CNS: Dizziness, headache,  Monitor response to drug and signs and
Name: manic and mixed depletion theory” lethargy, drowsiness, fatigue, 
hypersensitivity to symptoms for toxicity manifested by
episodes suggests lithium the drug, Significant slurred speech, psychomotor vomiting, diarrhea, lack of coordination,
associated with behaves as an retardation, giddiness, drowsiness, muscular weakness, slurred
 lithium carbonate cardiovascular or
bipolar 1 disorder uncompetitive incontinence, restlessness, speech 
in patients ≥7 inhibitor of inositol kidney disease, brain
Brand Name: damage, severe seizures, confusion, blackout  Weigh patient daily; check ankles, tibiae,
years of age and monophosphatase in spells, disorientation, recent
maintenance a manner inversely debilitation, and wrists for edema.
dehydration or memory loss, stupor, coma,  Monitor I&O
treatment proportional to the
Eskalith, and sodium depletion; EEG changes. 
degree of stimulus3.  Educate patient to Avoid self-
Lithobid This inhibition lowers patients on low-salt prescribed low-salt regimen, self-dosing
levels of inositol diet or receiving CV: Arrhythmias,
with antacids containing sodium, and
triphosphate6. diuretics hypotension,
Dosage high-sodium foods 
However, stronger vasculitis, peripheral
circulatory collapse, ECG  Instruct patient to not drive or engage in
inhibitors of inositol other potentially hazardous activities
3 mg/ OD monophosphatase changes
until response to drug is known.
are not as clinically
effective and low GI: Nausea, vomiting,
levels of inositol anorexia, abdominal pain,
triphosphate are diarrhea, dry mouth, metallic
associated with taste
memory impairment.

Source: https://go.drugbank.com/drugs/DB14509
PROBLEM RATIONALE
 F. NURSING CARE PLAN

DEFINING CHARACTERISTICS NURSING DIAGNOSIS SCIENTIFIC ANALYSIS GOALS OF CARE NURSING RATIONALE
INTERVENTION
SUBJECTIVE DATA:

Patient verbalizes “I don’t want to be

around; they all get on my nerves”

OBJECTIVE:

-agitated
-shouting at the clinic
- difficulty concentrating