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BIPOLAR DISORDER
General objective:
To provide knowledge about bipolar in relation to the condition of the client including
history, assessment, treatment and management.
Specific objectives:
To define bipolar disorder and identify the course of the disease process
To examine and correlate actual assessment findings to the assessment of the patient
with bipolar disorder
To appreciate nursing interventions to put into practice in rendering care to the elderly
I. INTRODUCTION
Bipolar disorder is a very interesting case to analyze. Since this is the first time to
encounter the disorder, we decided to study this case to prepare ourselves in dealing and
handling psychiatric patients.
The significance of our study is to know and understand this kind of disorder (bipolar)
specifically to the promotion of health, prevention of complication and treating or managing
the disorder symptoms. In addition, the importance of this study is to make ourselves ready to
reencounter bipolar disorder and other psychiatric disorders in succeeding clinical exposures so
that we can able to provide effective and holistic nursing care.
Conceptual Theory
2) Partial Compensatory - The nurse must assist in the care of the patient but the patient and
family can assist as well. A pneumonia patient, who is very short of breath, may require the
nurse to monitor vital signs, oxygen saturations, assist in ADL’s and ambulation. The patient will
be able to resume their own care when they are better but need the assistance and education a
nurse can provide at this time.
3) Educative-developmental system -The patient has primary control over their health; the
nurse assists with education and promoting safe health practices. The patient who has high
cholesterol may fit into this category, diet, exercise regimen and medication is important
education for this patient. The nurse would teach the patient how to properly maintain good
health practices.
Related Literature
• In the early 1900s, the German psychiatrist Emil Kraeplin was the first to formally
describe bipolar disorder. He used the term "manic depressive" to explain how mania
and depression both affect the patient. His work in the early 20th century led to
advancements in classifying, treating, and predicting the course of mental illness, which
ushered in the formal discipline of psychiatry.
Bipolar II: history of major depression and much less severe episodes of mania
(hypomania)
Bipolar I
• An onset before the age of 30 usually results in frequent, severe episodes. Psychosis is
more common in this group and symptoms tend to linger between episodes. An onset
after the age of 40 has a better prognosis. Generally, short episodes, late onset, the
absence of other medical or psychiatric conditions, and early treatment have a better
prognosis.
• Most people are symptom free for months or even years between episodes of
depression and mania. Approximately 25% of people never fully recover from an
episode. Nearly 33% of people have great difficulty functioning at work and in social
settings.
• Three-fourths of manic episodes occur before or right after a major depressive episode.
After the first manic episode, there's a 90% chance that a second one will occur.
Typically, a greater number of manic episodes are experienced over a lifetime.
Approximately 40% of people with bipolar disorder have an average of one episode
every 2 1/2 years, or four in every 10 years.
Bipolar II
• People with bipolar II disorder experience major depressive episodes that alternate with
hypomania (milder manic episodes). During hypomanic episodes, patients may become
more productive or noticeably goal driven, but their ability to function well in their
normal daily activities is not impaired.
• About 10% of people who experience hypomanic episodes eventually have manic
episodes
Name: patient A
Sex: female
Age: 85 y/o
Birth date: April 15, 1925
Birth place: Calauag, Quezon
Citizenship: Filipino
Civil Status: Widowed
Religion: Roman Catholic
(BIOPHYSICAL THEORY)
PSYCHOSOCIAL THEORIES
Sigmund Freud
This theory of Sigmund Freud was said that energy is directed toward full sexual
maturity and functioning and development of skills needed to adopt with the environment.
People in this stage want to have a joyful and fulfilling family life. In the case of our patient, she
is included in this stage that deals with separation and death. She loosed her spouse and her
son left her in the home for the aged. The nurse or caregiver should help the patient in dealing
with the environment and relationships to the other residents of the health home for the aged.
Erik Erikson
Acceptance of
death
This theory of Erik Erickson proposes that life is a sequence of developmental stages or
levels of achievement. In maturity stage shows that integrity vs. despair happened. It describes
the physical, emotional and psychological stages of development and relates specific issues, or
developmental work or tasks, to each stage. Review life accomplishments, deals with loss and
preparation for death. The person best able to undergo psychoanalysis is someone who, no
matter how incapacitated at the time, is basically, or potentially, a sturdy individual. This person
may have already achieved important satisfactions—with friends, in marriage, in work, or
through special interests and hobbies—but is nonetheless significantly impaired by long-
standing symptoms: depression or anxiety, sexual incapacities, or physical symptoms without
any demonstrable underlying physical cause. One person may be plagued by private rituals or
compulsions or repetitive thoughts of which no one else is aware. Another may live a
constricted life of isolation and loneliness, incapable of feeling close to anyone. Some people
come to analysis because of repeated failures in work or in love, brought about not by chance
but by self-destructive patterns of behavior. Others need analysis because the way they are—
their character—substantially limits their choices and their pleasures. The patient experienced
loss and grief when his husband died and she was abandoned by her son.
The client’s environment in the area of Lucban, Quezon has the spirit of peace and
humility as observed. As a high altitude place, it has a very cold surrounding that is suitable for
the living process of the client. We also observed that the environment was clean and well
ventilated which contributed to their health aspect. Silence of the place also observed and it is
one factor that our client need in a way that elderly should have a peace of mind and be free
from noise pollution.
PHYSICAL ASSESSMENT
Parameters Normal Actual Findings Interpretation
Findings
Increased skin Dry skin Normal because as we grow
1. Integumentary dryness old our subcutaneous gland
SKIN activity and tissue fluid
decreases.
Normal: because of
Increased skin Pale skin decreasing vascularity
pallor
Normal: Because of
Impaired Cannot demonstrate decreased muscle strength,
balance flexion of knees reaction time, and
coordination, change in
Cannot perform ADL center of gravity
without assistance.
Normal: because of fewer
Greater cells in cerebral cortex
difficulty in
complex Delayed understanding
3.Sensory learning and on situations and
/Perceptual abstraction cannot verbalize clearly
her statements Normal: because of
Decreased Degeneration leading on
visual acuity lens opacity (cataracts),
Blurred vision thickening and inelasticity
(presbyopia)
BP – 150/80mmHg
Orthostatic Normal: Reduced sensitivity
hypertension of the blood pressure-
regulating baroreceptors
PATTERNS OF FUNCTIONING
FUNCTIONAL HEALTH DURING RESIDENCY INTERPRETATION/
PATTERN IMPLICATION
Nutritional/Metabolic Patient eats rice, fruits and Fewer calories are needed by
vegetables, fish, chicken, the elderly because of their
meat and bread. During meal, lower metabolic rate and
1 cup of rice is enough for her. decreased in physical activity.
She drinks 4-5 glasses of The patient should continue
water daily. to comply adequate
hydration.
Activity and Exercise Patient’s exercise is walking Exercise helps in diverting and
and some mild ROM exercise preventing the patient’s mood
provided by the student swings. It also provides
nurses. The patient is willing strength for muscles and
to participate and cooperate bones.
to the activities.
Roles and Relationship The patient has a slightly good The patient is sometimes hard
relationship with other to deal with, which depends
patients. When the patient on her mood. The patient is
hears other patients saying easily to make laugh and cry.
something about her that
makes her mood to change
easily. The client
demonstrated hostile reaction
when she gets mad to the
other elders.
Values and Belief The patient prays, believes The patient has good religious
and has faith in GOD. beliefs. She is also willing to
cooperate and participate in
bible studies. Elderly has high
spiritual beliefs.
Self-Perception She views herself positively The disease process and the
but views on some things aging process greatly affect
negatively depend on her the self- perception of the
moods. client.
IMPRESSION/ DIAGNOSIS:
Bipolar disorder
• Cerebrum
• Cerebellum
• Brain stem
• Limbic system
CEREBRUM
• Left hemisphere is responsible for mathematical skills, language, reading, writing and
controls the right part of the body
CEREBELLUM
• “little brain”
CEREBELLUM...
• Receives & integrates information from all areas of body such as: muscles, joints, organs
& other components of CNS
BRAIN STEM
-MEDULLA- located at top of spinal cord, contains vital centers for respirations &
cardiovascular function.
-PONS- bridges the gap both structurally & functionally serving as primary motor
pathway.
LIMBIC SYSTEM
• “Emotional brain”- emotional responses such as; anger, fear, anxiety, pleasure, sorrow
& sexual feelings generated in limbic system but interpreted in frontal lobe.
DOPAMINE
SEROTONIN
• Its function is mostly inhibitory that includes induction of sleep and wakefulness, pain
control, temperature regulation, control of mood, memory, and sexual behavior.
• Inhibitory
• Serotonin is produced in brain from amino acid tryptophan- derived from foods high in
CHON.
HISTAMINE
GLUTAMATE
• Excitatory amino acid that at high levels that can have major neurotoxic effects.
GABA
Interpretation:
Clients with:
• Life Events and Experiences which are traumatic for the client may have higher risk for
having Bipolar Disorder. In our interpretation our client had experienced life events and
experiences which triggered the onset of Bipolar disorder.
The client would first experience abnormalities in the structure and/or function of a
certain brain circuit where in the brain malfunction and would have problems in releasing or
controlling the neurotransmitters in the brain. There would be imbalance in
neurotransmitters in the brain:
Acetylcholine- affects the sleep and wake pattern on the client this happens on the
onset of the disorder where in the client experiences difficulty in her sleep.
Dopamine- affects the elevation of moods and emotions, during the manic and
depressive episodes Dopamine is involved
Norepinephrine and Epinephrine (Adrenalin) - play a role in attention, learning &
memory, sleep and wakefulness and mood regulation.
Serotonin- Its function is mostly inhibitory that includes induction of sleep and
wakefulness, pain control, temperature regulation, control of mood, memory, and
sexual behavior.
The client would also experience shifting to extreme moods during the manic episodes of the
client she may experience elevation of moods, irritability, excitability, racing thought and
speech and hyperactivity. And in her depressive episodes she may experience extreme sadness,
withdrawal, despair and suicidal thoughts. This would lead to the altered functioning of her
daily living activities and relationships to others. She may experience violence to others and to
herself also may lead to suicide.
The complications are just perceived scenarios that may happen if the disorder is not
properly managed.
(BIPOLAR)
(BIPOLAR)
Elevated or Prime Symptoms:
irritable mood
Depressed mood or loss of
Grandiosity, insomnia, interest or pleasure
verbosity, flight of ideas, Change in level of
distractibility, functioning:
psychomotor agitation,
Change in weight, insomnia,
excessive involvement in
pleasurable activities psychomotor agitation, fatigue,
worthless feelings, concentration
without regard for
consequences difficulties, death thoughts, has
tendency to commit physical
Impairment in violence to others
occupational or
Constipation and urinary
social activities
& in relationship retention
Impairment in
functioning
DRUG STUDY
Give positive
reinforcemen
t for client’s
efforts. To
encourage
continuation
Maintain of desired
calm, matter- behaviors.
of-fact, non-
judgemental Decreases
attitude. defensive
response.
Provide a
safe/ quiet
environment
and remove To promote
items from safety in
the client’s event of
environment violent
that could be behavior.
use to inflict
harm to
others.
Encourage
walking or
exercise as
activities that To promote
may diffuse wellness
aggression
Provide privacy
and equipment To assist in
within easy dealing with
reach during situation.
personal care
activities.
Support client
in making
health related To promote
decisions and wellness
assist in
developing self-
care practices
that promote
health.
Impart health
teachings
about self-care
and emphasize
the importance
of it.
Health Teaching
• Exercise daily.
Exercise is an important part of promotion of health and prevention of other illnesses related to
aging. It is important to strengthen bones and muscles, to gain weight and maintain well-being.
During group exercise in the nursing home, they tend to socialize with other residents, thus,
improving their socialization skills.
Sleep Management. Good sleep hygiene is particularly important for patients. Techniques used
to enforce healthy sleep may help reduce mood cycling and promote wellness.
Diet. A healthy diet low in saturated fats and rich in whole grains, fresh fruits, and vegetables is
important for anyone. People with bipolar disorder should be sure to maintain a regular healthy
diet. They may need to restrict calories if they are on medications that increase weight.
Teach patients to recognize and manage early warning symptoms of imminent manic or
depressive episodes
Intervene early in manic and depressive episodes to reduce the severity of the attack
Psychotherapy adjusts to the reality of the illness and understands the negative consequences
of mania -- particularly important for patients who consider their mania to be positive, creative,
and exhilarating
Cope with feelings of guilt and remorse that occur after manic episodes
While no cure exists for bipolar disorder, effective management of this illness can enable most
people to lead highly functioning, healthy lives. Managing bipolar disorder is complex and may
include psychotherapy, medication and lifestyle changes. The support of loved ones and a
strong commitment to your own wellness are key elements to disease management as well.