1.

INTRODUCTION

Bipolar disorder is a mood disorder that involves extreme mood swings from
episodes of mania to episodes of depression. It is formerly known as manic depressive
disorder. During the manic phase, clients are euphoric, grandiose, energetic, and
sleepless. They have poor judgement and rapid thoughts, actions and speech. During
depressed phases, mood, behavior and thoughts are the same as in the people
diagnosed with major depression.

Whereas a person with major depression slowly slides into depression that can last
for 6 months to 2 years, the person with bipolar disorder cycles between depression and
normal behavior (bipolar depressed) or mania and normal behavior (bipolar manic). A
person with bipolar mixed episodes alternates between major depressive and manic
episodes interspersed with periods of normal behavior. Each mood may last for weeks
or months before the pattern begins to descend or ascend once again.

Clients often do not understand how their illness affects others. They may stop
taking medications because they like the euphoria and feel burdened by the side
effects, blood tests, and physicians visits needed to maintain treatment. Bipolar I
disorder is treatable with a lifetime regimen of psychotropic drugs in combination with
psychotherapy.

Bipolar disorder ranks second only to major depression as a cause of worldwide

disability. The lifetime risk of bipolar disorder is at least 1.2%, with a risk of completed
suicide of 15%. Bipolar disorder occurs almost equally among men and women. It is
more common in highly educated people. Because some people deny their mania,
prevalence rates may be higher than reported.

As of January 2012, statistics have shown that US has the largest number of bipolar
cases reported all over the world in which about 2 million adults (roughly 1% of the adult
population) suffer from some form of bipolar disorder. According to several studies, a
significant proportion of the approximately 3.4 million children and adolescents with
depression in the United States may actually be experiencing the early onset of

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adolescent bipolar disorder, but have not yet experienced the manic phase of the
illness. In South Asia, out of 100,000 population 421 were diagnosed with Bipolar
Disorder. However, in the Philippines an extrapolated prevalence of 1,034,900 cases
has been reported from 2015 population.

Bipolar 1 Disorder is classification of the Bipolar which is characterized by at least 1

(one) manic episode which may be preceded by or followed by hypomania or major
depressive episodes. According to US National Comorbidity Survey, 1% of the
population had Bipolar 1 Disorder and may be higher due some unreported cases.

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2. Objectives
General Objectives:

After the completion of the case study, the student-nurse will be able to
gain adequate knowledge, skills, and attitude in the care of BIPOLAR TYPE 1
patient.

Specifically, the student-nurse will be able to :

2.1 Explain the nature and occurrence BIPOLAR TYPE 1 and its impact
to the Health Care Delivery System and in the community.
2.2 Define relevant terms:
2.2.1 Bipolar Disorder

-Bipolar Disorder, mental illness in which a persons

mood alternates between extreme mania and depression. It
is also called manic-depressive illness.
2.2.2 Bipolar 1 Disorder
- Bipolar 1 Disorder is classification of the Bipolar
which is characterized by at least 1 (one) manic episode
which may be preceded by or followed by hypomania or
major depressive episodes.
2.2.3 mania
- abnormal mental state characterized by an elevated
or irritable mood, exaggerated self-importance, racing
thoughts, and hyperactivity.
.
2.2.4 depressed

- feelings of despair, hopelessness, and

worthlessness, as well as thoughts of committing suicide.

2.2.5 central nervous system

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 -it is the part of the nervous system, consisting of the
brain and the spinal cord that controls and coordinates most
of the fuctions of the body and mind.
2.2.6 brain
-the control center of the body
2.2.7 neurotransmitters
-are chemicals which transmit signals from a neuron
to a target cell across a synapse.
2.2.8 insomnia

- condition in which a person has difficulty getting

sufficient sleep.
2.2.9 grandiosity
- seeming to be impressive or intended to beimpressivebut
not really possible or practical.
2.3 Review the profile as well as the nursing and health history of the
client.
2.4 Identify abnormal findings during physical examination.
2.5 Review the development tasks, milestone and changes (physical,
psychosocial, spiritual, moral, and cognitive) of a YOUNG ADULT.
2.6 Compare the expected ill behaviour of a YOUNG ADULT with that
of the actual clients reaction to her/his present condition.
2.7 Interpret the results of the diagnostic tests conducted and its
significance to the clients condition.
2.8 Discuss the anatomy and physiology of the Central Nervous
System
2.9 Conceptualize the psychopathology and psychodynamics of
BIPOLAR TYPE 1 through a schematic diagram.
2.10 Explain the diseases process of BIPOLAR TYPE 1.
2.11 Compare the classical symptoms and actual clinical manifestation.
2.12 Site the guidelines and general considerations of caring a client
with BIPOLAR TYPE 1.
2.13 Formulate and implement a comprehensive NURSING CARE
PLAN.
2.14 Discuss the pharmacodynamics and nursing considerations of the
prescribed medications.

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 2.15 Craft a Health Teaching Plan on the nature of BIPOLAR TYPE 1, its
promotion and preventive measures and general care considerations.
2.16 Evaluate the effectiveness of nursing and medical management
based on manifested changes of clients condition.
2.17 Give recommendations of possible evidence-based practices to
improve the patients conditions and to prevent complication and disability.
2.18 Give the implication of the study to:
2.18.1 Nursing Research
2.18.2 Nursing Education
2.18.3 Nursing Practice

3. Nursing Assessment

3.1 Patients Profile

A case of patient CB, 25 years old, single, male and a Roman Catholic
who was born on December 30, 1991 which was currently residing at Sitio
Santol , Barangay Mangga, Carcar City, Cebu and currently studying 3rd
year AB English in Carcar Institute of Technology. He was admitted last
January 13, 2017 at 01:38 pm in Vicente Sotto Memorial Medical Center with
chief complaints of agitation, decreased need for sleep, and change in

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behaviour. Upon admission, he was diagnosed and was attended by Doctor
Adolfo with Bipolar Type 1 Disorder.
3.2 Nursing Health History
3.2.1 Present Health History

Two weeks prior to admission, patient was noted talk about school
topics with a loud voice and also noted to sing loudly in their home.
Patient was also noted to roam around their neighbourhood which
made patients sister decide to chain the patient in their home. Patient
was also noted to undress and throw his clothes to the people in their
home. Patient claims desire of using drug (shabu).

Three days prior to admission, patients behaviour persisted.

Patient verbalized that he hear voices CH*****, CH****** sayup ka.

One day prior to admission, patients behaviour persisted. This made

his elder brother to reprimand him which made the patient irritable and
angry and led to a fist fight with his brother. Patient was then brought to
Vicente Sotto Memorial Medical Center- Center for Behavioural
Sciences for readmission.

3.2.2 Past Health History

Patient CB was first admitted at Vicente Sotto Memorial
Medical Center- Center for Behavioural Sciences on October 25, 2013
with chief complaint of agitation and irritability. He was seen and
diagnosed by Dr. Adolfo with Bipolar Type 1 Disorder. After 2 months,
of confinement, he was advised that he can go home and was given
Lithium 450 mg once a day to decrease the symptoms he manifested.
His uncle claimed that he had no surgeries undergone and no other
diagnosed disease/s noted.
3.2.3 Family Health History

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 Patient CBs uncle claimed that they had a heredo-familial
history diseases of Diabetes and Hypertension on CBs paternal side
and Hypertension and Bipolar Disorder on CBs maternal side and no
other heredo-familial diseases as claimed and noted. Her uncle stated
that CBs uncle and grandfathers brother was then both diagnosed
with Bipolar Disorder.

Mental Health Status Exam

Patient Name: CB Date: 01/17/17
OBSERVATIONS
Appearance Neat Disheveled Inappropriate Bizarre Other
Speech Normal Tangential Pressured Impoverished
Eye Contact Normal Intense Avoidant Other
Motor Activity Normal Restless Tics Slowed Other
Affect Full Constricted Flat Labile Other
MOOD
Euthymic Anxious Angry Depressed Euphoric Irritable Other
COGNITION
Orientation None Place Object Person Time
Impairment
Memory None Short-Term Long-Term Other
Impairment

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Attention Normal Distracted Other
PERCEPTION
Hallucinations None Auditory Visual Other
Other None Derealization Depersonalization
THOUGHTS
Suicidality None Ideation Plan Intent Self-Harm
Homicidality v None Aggressive Intent Plan
Delusions None Grandiose Paranoid Religious Other
BEHAVIOR
Cooperative Guarded Hyperactive Agitated Paranoid
Stereotyped Aggressive Bizarre Withdrawn Other
INSIGHT Good Fair Poor
JUDGMENT Good Fair Poor

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