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A Case Presentation On:

Bipolar 1 Disorder, MRE with

Psychotic FEARURES

Bipolar disorder involves extreme mod swings from episodes of mania to episodes of
depression. (Bipolar is also known as manic-depressive illness)During manic phases,
clients are euphoric, grandiose, energetic, and sleepless. They have poor judgment and
rapid thoughts, actions, and speech. During depressed phases, moods, behavior, and
thoughts are the same as y bipolar in people diagnosed with major depression.
Bipolar disorder is a life long illness. Episodes of mania and depression eventually
occur again if you don’t treatment. Many people sometimes continue to have symptoms,
even after getting treatment.


 Bipolar 1 disorder involves periods of severe mood episodes from mania to depression
 Bipolar II disorder is milder form of mood elevation, involving milder episodes of
hypomania that alternate with periods of severe depression
 Cyclothymic disorder describes brief periods of hypomanic symptoms alternating with
brief episodes depressive symptoms that are not as extensive or as long-lasting as seen
in full hypomanic episodes or full depressive episodes
 Mixed features refers to the occurrence of simultaneous symptoms of opposite
mood polarities during manic, hypomanic or depressive episodes. It’s marked by
high energy, sleeplessness, and racing thoughts. At the same time, the person
may feel hopeless, despairing, irritable, and suicidal.
 Rapid-cycling is a term that describes having four or more episodes within a 12
month period. Episodes must last for some minimum number of days in order to
be considered distinct episodes. Some people also experience changes in polarity
from high to low or vice-versa within a single week, or even within a single day,
meaning that the full symptom profile that defines distinct, separate episodes may
not be present (for example, the person may not have a decreased need for
sleep). Sometimes called “ultra-rapid” cycling and may occur at any time in this
course of illness.
A person affected by BIPOLAR 1 disorder had at least one manic episode in his/her
life. A manic episode is a period of abnormally elevated mood and high energy,
accompanied by abnormal behaviors and disrupts life. Most people with bipolar 1
disorder also suffer from episodes of depression. Often there is a pattern of cycling
behavior between mania and depression. This is where the term “manic depression”
come from. In between episodes of mania and depression, many people with
bipolar 1 disorder, many people with bipolar 1 can live normal lives.

STATISTICS: (Philippines)
- It is reported by the Global Burden of Disease Study that 3.3 million Filipinos
suffer from depressive disorders, with suicide rates in 2.5 % in males and 1.7%
females per 100,000 of Filipino population according to the National Center for
Mental Health.
- Prevalence of bipolar disorder across the world varies from 0.4 to 1.5 % by
country. Globally, an estimated 40 million people in the world had bipolar
disorder in 2017, with 55 and 45 % being female and male, respectively.

STATISTICS: (Philippines)
- It is reported by the Global Burden of Disease Study that 3.3 million Filipinos
suffer from depressive disorders, with suicide rates in 2.5 % in males and 1.7%
females per 100,000 of Filipino population according to the National Center for
Mental Health.

Bipolar disorder tends to get worse if it’s not treated it may cause other
problems like self directive-injury or they might also hurt other people.
Clients with mania can go days without sleep or food and not even realize if
they’re hungry or tired. They often ignore personal hygiene as boring when
they have other things to do and they tend to be unaware of health needs
that can worsen their condition This might cause them to harm themselves
and might lead injuries, imbalanced nutrition and self care deficit and might
lead to death.

The intention of this study is for us to gain more knowledge about

Bipolar disorder specially Bipolar 1. And to identify it’s manifestations, it’s
etiology, drugs that is taken by patients with this disorder, and what nursing
interventions is applicable to patients with this type of disorder

After 2 hours of comprehensive discussion the level III nursing students and
its readers will be able to gain knowledge and further understanding about Bipolar
1 disorder.
After the comprehensive discussion, other students present during the case presentation
will be able to:
• Differentiate the dissimilar types of Bipolar disorders
• Relate the Physical Assessment on client’s condition
• Identify the factors that might have contributed to the development of the disease
• Identify the different manifestations of bipolar 1 disorder
• Identify the prescribed medications, their action, side effects, indication and nursing
• Formulate appropriate nursing care plan.
Name: Alipio, Catherine M.
Age: 30 years old
Gender: Female
Provincial Address: Langub Guadalupe, Cebu City
Adress: c/o Vicente Sotto Memorial Medical Center
Birthday: Sept. 21 ,1988
Birthplace: Pantabangan, Nueva Ecija
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Occupation: N/A
Admitting Physician: Dr. Villasan, Gian Alchris
Admission Date and Time: Feb. 19, 2019 @ 11:04 am
“Nag wild sigeg panghilabot sa silingan, lakaw-lakaw ug mag yaw-yaw nga siya ra usa”
as verbalized by partner.


2 years PTA, patient noted to have an aggressive behavior “mag sigeg lakaw-lakaw
dayun manguha ug paninda sa silingan” easily get jealous and agitated noted. She got
jealous to her neighbor and her husband. Sought consultation to best institution with
unrecalled medication taken and poor compliance. Patient also lost follow-up check-up. 9
months PTA, the patient noted loss of appetite and usually looked strain. No consultation
done. 1 day PTA, the patient wears swimsuit and roaming outside their house. Sought for
consultation to the institution. 2 hours PTA, the patient noted to have an aggressive
behavior self-mediated with aripiprazole 5mg/tab 1 tab with temporary relief.

D. Past Health History

Patient has no known Hypertension, Diabetes Mellitus, Asthma and Coronary Artery
Disease. Last 2017, the patient noted to have an aggressive behavior.



: Deceased B1
: Female
: Male : Patient
A/W : Alive and Well
HPN : Hypertension B1 : Bipolar 1 Disorder
Heredofamilial disease is Hypertension on mother side but the patient’s current condition has no connection to
her family health history.
Patient ACS is unemployed and lives with his live in partner with 2 children.
 Alcohol: non alcoholic
 Tobacco: non smoker
 Drugs: denied ilicit drug use
 Alergies: seafoods


Patient ACS manifested behavioral changes already when she got admitted to the
Psychiatric Center. Patient has noted a distant relationship with her family.
Patient was conscious, ambulatory, well groomed with appropriate dress, with slight body
odor, dirty nails and long, hair is in black color, long length and with slightly foul odor, keeps on
mumbling, without abnormal posture and gait, and with vital signs as follows: Temp. 35.4⁰C BP-
110/80 mmHg, PR- 82 bpm, and RR- 19 cpm.

Patient has evidently brown and dry skin. Scars are noted in both upper and lower
extremities. With good skin turgor and mobility noted.

Head is round, normal in contour and symmetrical. Anicteric sclerae, pink palpebral
conjunctiva and without visual disturbances. No nasal and ear discharges, no nasal flaring noted
and with septum at midline noted. Lips are in dark color as well as her gums and with presence
of dental carries and cavities noted.
Neck is located at midline and without any presence of of lumps or masses. (-) LAD and no
neck distention.

With bilateral chest expansion, equal, eupneic and clear breath sounds with regular rhythm

Symmetric and with no nipple retraction noted.

With adynamic pericardium, distinct heart sound and no murmurs noted.

Abdomen is not distended with relatively nomoactive bowel sounds at 20 clicks per minute,
no palpable mass and no tenderness noted upon palpation.
No deformities noted, scars are noted on both lower and upper extremities. Extremities
are noted on full range of motion.
Patient is well groomed with appropriate dress and with slight body
odor. Patient has no abnormal posture noted and has no abnormal gait. She
has a good eye contact and doesn’t have any unusual body movements.
Patient talks a lot with disorganized thought. Patients affect is appropriate to
her mood, but changes mood and behavior very often. You can notice her
talking with you with good mood and the other moment angry. Patient is
argumentative, she often argues to nursing attendants and even to nurses.
Facial expression is appropriate to her mood, when she’s angry you can
see it to her face that she’s angry and if she’s happy you can see it
obviously that she’s happy.

Patient sometimes answer to questions appropriately but most of the time she
keeps on mumbling and changing the topic and said that there’s someone who’s
watching us during the interview. Patient ideas sometimes are related to the topic but
mostly she wanted to change the topic. Patients has disorganized thoughts and
doesn’t have clear ideas like it changes from time to time.


Patient is oriented to date,place,and person. She can recall also her past
experiences but it changes day by day for example patient stated on Wednesday
“Naa koy tulo ka anak ako gipa ampon tanan” and she also stated on Thursday that
“Naa koy duha ka anak, naa sa akong bana”. Patient cannot concentrate well, you
can observe that when you're talking to her she keeps on walking back and forth and
doesn’t want to be interviewed for a quiet long.
Patient has poor judgement and is evidenced by observation and asking the patient
“Unsa man imo sa imong palibot catherine?” “Mga buang mani sili diri tanan oy,
nagno gisud man ko diri dili man ko buang” as verbalized by the patient.

According on the record of the patient she is the eldest siblings in their family. She has
3 siblings. There was no information gathered to reflect on patient family role and its
relationship to them because patient refuses to share things about her family


Patient eats 3x a day and eats what is being served by the staff of the facility. She
sleeps early at night and wakes up at around 5 in the morning. Patient has no other health
problems aside from her current condition. Patient needs to be attended upon taking
medications because she doesn’t want to take her medications. During the activities she
doesn’t want to participate and she keeps on saying “Di nako ninyo mga manloloko man
mo” as verbalized by the patient.
- Bipolar Disorder involves extreme mood swings from episodes of mania to episodes of depression. During
manic phase, clients are euphoric, grandiose, energetic, and sleepless.
(Copyright 2011, 2008 by Wolters Kluwer Health/ Lippincott Williams & Wilkins)

- Bipolar I disorder is a form of mental illness. A person affected by bipolar I disorder had at least one manic
episode in his or her life. A manic episode is a period of abnormally elevated mood and high energy,
accompanied by abnormal behavior that disrupts life.
(Smith Bhandari, (2017 November 8) Bipolar I Disorder. Retrieved from:

- Bipolar I Disorder is an illness which people have experienced one or more episodes of both mania and
depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I,
a person’s manic episodes must last at least seven days or be so severe that hospitalization is required.
(NAMI (2017, August) Bipolar I Disorder. Retrieved from: https: //
- Bipolar I Disorder a chronic, treatable mood disorder with relapsing and remitting course marked by
manic episodes, with most patients also experiencing major depressive episodes. Depressive
episodes re characterized by the triad of low mood, self attitude and vital sense.
(Janet Lee (29 October 2017) Bipolar I Disorder. Retrieved from: Guide/787045//all/Bipolar
I Disorder)

- Bipolar I Disorder requires symptoms to meet the full criteria for what is known a manic episodes.
You do not have to experience depression to be diagnosed with Bipolar I, but many people with the
diagnosis experience both kinds of mood episodes. Increased talkativeness, Increased self-esteem or
grandiosity, Decreased need to sleep.
(Kathleen Smith (23 Jan 2017) Bipolar I Disorder. Retrieved from:

Genetics Genetic studies implicate the transmission

in first-degree relatives, who are twice the
risk for developing Bipolar disorder

Deficit of serotonin Serotonin has many roles in behaviour:

mod, activity, aggressiveness, cognition,
pain, and neuroendocrine processes.
It’s precursor tryptophan or a metabolite of
serotonin found in the blood or in
cerebrospinal fluid occur in people with
bipolar/ mood disorder

Elevated glucocorticoids Elevated glucocorticoid activity is

associated with the stress response.

Postpartum depression Postpartum hormone alterations precipitate

mood disorders

Deficit in Norepinephrine Norepinephrine may be deficient in

depression and increase in mania.

Early life loss (Psychoanalytic) Mood disorder occurs (depression) as a result

of an early life loss

Behavioral Feelings of helplessness and unworthiness can

result to depression

Cognitive An individuals views all stressful events are

Intrapsychic conflict Conflicts that people have when they have
mixed emotions about a behavior, event or
Reactions to life events(Stress) Reactions particularly associated with life’s

Substance abuse Mental illness frequently co-occurring with

substance use.
Substance like alcohol which is depressant can
increase fatigue or feeling of sadness.
Conversely, people can experience depression
after the effects of drug wear off or as they
struggle to cope with how the addiction has
impacted their life.

Seasonal Changes Episodes of mania and depression

often follow a seasonal pattern. Manic
episodes are more common during
the summer, and depressive episodes
are more common during the fall,
winter, and spring

FLIGHT OF IDEAS A person experiencing a flight of ideas

may be extremely excited or anxious.
Flight of ideas itself is not a mental
health condition, but can be a
symptom of one. People with bipolar
who are experiencing mania may
exhibit flight of ideas. Mania can feel
like being sped up, and manic people
may jump from idea to idea

PRESSURED SPEECH Pressured speech is a result of mania

or in manic episode. Its most
commonly seen in bipolar disorder.
However, a compulsive urge to talk
might also represent.
INATTENTION Inability to concentrate or focus on a
topic or activity, regardless of its
HALLUCINATIONS A false sensory perceptions.
Hallucinations are distinguished form
illusions which are misperceptions of
actual environmental stimuli

SLEEP Sleep disturbance is a core symptom of bipolar disorder.

DISTURBANCE The diagnostic criteria indicate that during manic episodes
(INSOMNIA) there may be a reduced need for sleep and during episodes
of depression, insomnia or hypersomnia can be
experienced nearly every day

GRANDIOSITY Clients claim to association with famous people or

celebrities, or clients belief that he or she is famous or with
great features

SEXUALY ACTIVE Also referred to as compulsive sexual behavior or sexual

addiction, hypersexuality is described as a dysfunctional
preoccupation with sexual fantasies, urges, or behaviors
that are difficult to control.

AGITATION Often occurs with mania or anxiety. It’s seen most often in
people with bipolar disorder. Psychomotor agitation can be
caused by other conditions too such as post traumatic
disorder or depression

IRRATIONAL SPENDING One of the most common symptoms

of bipolar disorder is impulsive and
irrational spending. The lifestyle of the
manic depressive who is in high tends
to be a glorious scattering of money

INCREASE ENERGY Bipolar disorder involves a swing

between high and low energy states.
When high energy state, patient
appears happy because they are
motivated and excitable.
As energy level of manic episodes
increases, the early happy mood
tends to change into a more agitated
and psychotic state
Drug Name Drug Class Mechanism of Indication Contraindication Side Effects Nursing
Action Considerations
Generic: Antipsychotic Blocks dopamine and Mono therapy or Contraindicated in CNS:  Monitor patient for
Risperidone 5-HT2 receptors in combination therapy patients hypersensitive to akathisia, somnolence, tardive dyskinesia,
the brain. with lithium or drug and breastfeeding dystonia, headache, which may occur after
valproate for 3 week women. Use cautiously in insomnia, agitation, prolonged use. It may
Brand: treatment of acute patients with prolonged anxiety, pain, not appear until months
Risperdal, manic or mixed QT interval, CV disease, parkinsonism, or years later and may
Risperdal Consta episodes from cerebrovascular disease, neuroleptic malignant disappear
syndrome, suicide spontaneously or
bipolar disorder. dehaydration,
attempt, dizziness, persist for life, despite
hypovolemia, history of
fever, hallucination, stopping drug. Life-
seizures, or conditions mania, impaired threatening
that could affect concentration. hyperglycemia may
metabolism or occur in patients taking
hemodynamic responses. CV: atypical antipsychotics.
Use cautiously in patients tachycardia, chest pain,  Monitor patients with
exposed to extreme heat. orthostatic hypotension, diabetes regularly.
Use caution in patients at peripheral edema, Periodically reevaluate
risk for aspiration syncope, hypertension. drug’s risks and
pneumonia. Use IM benefits, especially
injection cautiously in EENT: during prolonged use.
those with hepatic or renal rhinitis, sinusitis, Monitor patient for
impairment. pharyngitis, abnormal weight gain.
vision, ear disorder.

constipation, nausea
,vomiting, dyspepsia,
abdominal pain
Drug Name Drug Class Mechanism of Indication Contraindication Side Effects Nursing
Action Considerations
Generic: Anticholinergic drug Synthetic Parkinsonian Untreated narrow angle CNS and peripheral • Assess
Biperiden anticholinergic syndrome especially glaucoma, intestinal effects, skin rashes, for Parkinsonism, EPS.
drug,blocks to counter act stenosis or obstruction, dyskinesia, ataxia, • Assess for mental
Brand: cholinergicr esponses muscular rigidity and mega colon, prostatic twitching, impaired status.
Akineton in the CNS. tremor; hypertrophy, life speech, micturition • Assess patient
extrapyramidal threatening tachycardia difficulties. Fatigue, response if anti
dizziness, at cholinergics are given.
higher doses, • Assess for tolerance
restlessness, agitation, over long term therapy,
anxiety, confusion. dosage may have to be
increased or changed.
• Avoid activities that
require alertness, may
cause dizziness,
drowsiness and blurring
of vision .
Drug Name Drug Class Mechanism of Indication Contraindication Side Effects Nursing
Action Considerations
Generic: Anti emetics, Anti Alters effects Schizophrenia and Hypersensitivity; CNS: • Assess mental status
Chlorpromazine psychotics. of dopamine (D2) psychoses. hypersensitivity to sulfites NEUROLEPTICMALIG prior to and periodically
inCNS. Has Hyperexcitable, (injectable) or benzyl NANTSYNDROME, during therapy.
Brand: significant combative, explosive alcohol (SRcapsules); sedation, • Monitor BP and pulse
Thorazine anticholinergic/alpha- behavior in cross-sensitivity with other extrapyramidalreactions prior to and frequently
adrenergic blocking children.Hyperactive phenothiazines may , TD. during the period of
child with conduct occur; angle-closure dosage adjustment.
disorder. Acute glaucoma; bone-marrow EENT: May cause QT interval
mania. Nausea and depression; severe Blurred vision, dry eyes, changes on ECG.
vomiting. Intractable liver/CVdisease; lens opacities. • The drug may be taken
hiccups. concurrent pimozide use. with or without food.
Preoperative CV: • Observe patient
apprehension. Acute Hypotension (↑ with IM, carefully when
intermittent IV),tachycardia. administering
porphyria. medication.
GI: • Monitor I&O ratios and
Off-Label Use: Constipation, drymouth, daily weight.
Vascular anorexia, hepatitis,
headache.Bipolar ileus, priapism.
Urinary retention.
Drug Name Drug Class Mechanism of Indication Contraindication Side Effects Nursing
Action Considerations
Derm: • Monitor for development
photosensitivity,pigment of neuroleptic malignant
changes,rashes. syndrome (fever,
respiratory distress,
Endo: tachycardia, seizures,
Galactorrhea,amenorrhea. diaphoresis, hypertension
or hypotension, pallor,
Hemat: tiredness, severe muscle
AGRANULOCYTOSIS,le stiffness, loss of bladder
ukopenia. control.
• Report symptoms
Metab: immediately.
Hyperthermia. • May also cause
leukocytosis, elevated liver
Misc: function tests, elevated So
Allergic reactions. that the nurse can
determine major or minor
changes after drug has
been taken.
• To observe for any changes
relevant. May be taken w/
meals to reduce GI
• To ensure that medication
is actually taken and not
• Assess patient for signs
and symptoms of be able to
watch out for any changes,
and report to physician
these changes.
Drug Name Drug Class Mechanism of Indication Contraindication Side Effects Nursing
Action Considerations
Generic: Anticonvulsant, Increases level of • complex partial hypersensitivity to drug or CNS: dizziness, • Take vital signs prior
SODIUM mood stabilizer, anti GABA in brain, seizure. tartazine drowsiness. shakiness to administration.
VALPROATE ( migraine agent reducing seizure Hepatic impairment (tremor), confusion, • Confirm medication
Depakote, Epilim, activity. • simple or Urea cycle disorder sedation, paresthesia, ticket, mediction sheet,
Episenta) complex Pregnancy. and doctor’s orders.
absence EENT: • Give with food if GI
Brand: seizure. blurred/double
upset occurs.
Carboxytic acid vision, ringing in the
• This drug may make
derivative • mania ears, shakiness
you dizzy or drowsy or
associated with (tremor),
bipolar. encephalopathy, blur your vision.
nystagmus. Alcohol
• to prevent or marijuana can make
migraine GI: you more dizzy or
Nausea, vomiting, drowsy.
diarrhea, abdominal • Do not drive, use
pain, dyspepsia, machinery, or do
pancreatitis. anything that needs
alertness or clear vision
HEMA: until you can do it
Leucopenia, safely.
thrombocytopenia. • This medication is not
recommended for use
during pregnancy. It
may harm an unborn
baby. See also Warning
Drug Name Drug Class Mechanism of Indication Contraindication Side Effects Nursing
Action Considerations
Generic: Anti-epileptic Prolonged Refractory seizure Primary generalized CNS: Dizziness, • Use only for
Carbamazepine inactivation of Na+ disorders: Partial epilepsy (may drowsiness, classifications listed.
channels No effect on seizures with induce status epilepticus) unsteadiness, disturban Do not use as a
Brand: glutamate or GABA complex symptoms Contraindicated with ce of coordination, general analgesic. Use
tegretol neurotransmission (psychomotor, hypersensitivity to confusion, headache, only for epileptic
Mechanism of action temporal lobe carbamazepine or TCAs, fatigue, visual seizures that are
not understood; epilepsy), history of bone marrow hallucinations, refractory to other
antiepileptic activity generalized tonic- depression, concomitant depression with safer agents.
may be related to its clonic (grand mal) use of MAOIs, lactation, agitation, behavioral • Give drug with food to
ability to seizures, mixed pregnancy. Use cautiously changes in children, prevent GI upset.
inhibit polysynaptic seizure patterns or with history of adverse talkativeness, speech • Do not mix
responses and block other partial or hematologic reaction to disturbances, abnormal suspension with other
post-tetanic generalized any drug (increased risk of involuntary movements, medications or
potentiation. Drug is seizures. Reserve severe hematologic paralysis and other elements—precipitation
chemically for patients toxicity); glaucoma or symptoms of cerebral may occur.
related to the tricyclic unresponsive to increased IOP; history of arterial insufficiency, • Ensure that patient
antidepressants other agents with cardiac, hepatic, or renal peripheral neuritis swallows ER tablets
(TCAs). seizures difficult to damage; psychiatric and paresthesias, whole—do not cut,
control or who are patients (may activate tinnitus, hyperacusis, crush, or chew.
experiencing latent psychosis). blurred vision, • Take drug with food as
marked side effects, transient diplopia andoc prescribed. Swallow ER
such as excessive ulomotor disturbances, tablets whole, do not cut,
sedation nystagmus, crush, or chew them.
Trigeminal neuralgia scattered punctate corti • Do not discontinue this
(tic douloureux): cal lens opacities, drug abruptly or change
Treatment of pain conjunctivitis, ophthalm dosage, except on the
associated with true oplegia, fever, chills; advice of your physician.
trigeminal neuralgia; SIADH. • Avoid alcohol, sleep-
also beneficial in inducing, or OTC drugs;
glossopharyngeal these could cause
neuralgia dangerous effects.
Drug Name Drug Class Mechanism of Indication Contraindicati Side Effects Nursing
Action on Considerations
Unlabeled uses: CV: CHF, aggravation of • Arrange for frequent
Neurogenic diabetes hypertension, checkups, including
insipidus (200 mg hypotension, syncope blood tests, to monitor
bid\u2013tid); certain and collapse, edema, your response to this
psychiatric disorders, primary thrombophlebiti drug. Keep all
including bipolar s, recurrence appointments for
disorders, schizoaffective of thrombophlebitis, checkups.
illness, resistant aggravation of CAD, • Use contraceptives at all
schizophrenia, and arrhythmias and AV times; if you wish to
dyscontrol syndrome block; become pregnant, you
associated with limbic CV complications should consult your
system dysfunction; Dermatologic: Pruritic a physician.
alcohol withdrawal nd erythematous rashes • Report bruising, unusual
(800\u20131,000 , urticaria, Stevens- bleeding, abdominal
mg/day); restless leg Johnson pain, yellowing of the
syndrome syndrome, photosensitiv skin or eyes, pale feces,
(100\u2013300 mg/day ity reactions, alterations darkened urine,
hs); non-neuritic pain in impotence, CNS
syndrome pigmentation, exfoliative disturbances, edema,
(600\u20131,400 dermatitis, alopecia, fever, chills, sore throat,
mg/day); hereditary or diaphoresis, erythema mouth ulcers, rash,
nonheriditary chorea in multiforme andnodosum pregnancy.
children (15\u201325 , purpura, aggravation
mg/kg/day). of lupus erythematosus.
Mechanism Contra- Nursing
Drug Name Drug Class of Action Indication indication Side Effects Considerations
GI: Nausea,
vomiting, gastric
distress, abdominal
pain, diarrhea,
constipation, anorexia,
dryness of mouth or
pharynx, glossitis, stom
atitis; abnormal liver
tests, cholestatic and he
patocellular jaundice,he
patitis, massive hepatic
cellular necrosis with
total loss of intact liver
GU:Urinary frequency,
acute urinary
retention, oliguria with
hypertension, renal
failure, azotemia,
impotence, proteinuria,
glycosuria, elevated
BUN, microscopic
deposits in urine
ic disorders (severe
bone marrow
Respiratory: Pulmonary

Subjective: Ineffective coping After 4 days of • Assess level of • Appropriate Goal was met
“Dili ko mu apil sa related to situational nursing intervention understanding coping requires
inyong activity” As crisis the patient will be and readiness to accurate
verbalized. able to: learn expected information and
• Make decisions lifestyle changes. understanding.
Objective: Scientific basis: • Impulse self- Often patients
• Irritable • Inability to form a control who are
• Fatigue valid appraisal of • Information ineffectively
• Lack of social the stressors, processing coping are unable
skills inadequate • Verbalize to hear or
• Lack of purposeful choices of awareness of own assimilate needed
daily activity practiced coping abilities. information.
• Unsatisfactory responses, and • Meet • Establish a • A relationship
interpersonal inability to use psychological working establishes trust,
relationships available needs as relationship with reduces the
• Inability to ask for resources. evidenced by the patient. feeling of isolation
help appropriate and may facilitate
• Poor expression of coping.
concentration feelings, • Verbalizing
• Decreased identification of • Encourage open feelings is an
concentration, options and use of expression of initial step toward
short attention resources. feelings. dealing
span constructively with
her feelings.
• Validate the • Expressing
client’s frustration feelings
or anger in outwardly,
dealing with especially
problems. negative ones
may relieve some
of the client’s
stress and

• Help the client • Competitive

plan activities situations can
within her scope exacerbate the
of achievement client’s hostile
feelings or
reinforce low self-
• Teach the client • If the client tries to
about positive build skills in the
coping strategies treatment setting,
and stress she can
management experience
skills i.e, physical success and and
exercise, receive positive
meditation feedback for her
• Teach the client • Modeling the skills
social skills. provides a
Describe and concrete example
demonstrate of the desired
specific skills, skills.
such as eye
contact, active
listening and
nodding. Discuss
the topics that are
apropriate for
conversation such
as weather.

• Give positive • Positive feedback

support to the will encourage the
client for client to continue
appropriate use of socialization
social skills. attempts.
Subjective: Disturbed thoughts After 4 days of nursing Goal met.
“May mga time na process r/t mood alteration. intervention, the patient will • Established rapport. • To promote client’s
pakiramdam ko talaga may responds coherently to cooperation.
tumitingin sakin at simple, concrete statement • Provide validation of
sumusunod” as verbalized Scientific Basis: as evidenced by : thoughts and feelings of • Validation seeks to help
by the patient. Bipolar Disorder involves client. the nurses, encouraging
extreme mood swings from - Exhibiting judgment, empathy.
Objective: episodes of mania to insights, coping skills, • Do not attempt to argue
episodes of depression. and problem solving or change the client’s • Acceptance promotes
• Distractibility During manic phase, abilities. beliefs. trust.
• Inappropriate thinking. clients are euphoric, - Patient’s expresses
• Hallucinations grandiose, energetic, and logical, goal-oriented • Administer antipsychotic • May block postsynaptic
• Delusions sleepless. thoughts with absence drug: Chlorpromazine dopamine receptors in
(Copyright 2011, 2008 by of delusions. Hydrochloride. the brain.
Wolters Kluwer Health/
Lippincott Williams & • Administer mood • Normalizes the reuptake
Wilkins) stabilizing drug: Lithium of certain
Carbonate. neurotransmitters and
reduces the release of

• Set and maintain limits • Limits must be

on behavior that is established by others
destructive or adversely when the client is unable
affects others. to use internal controls
• Encourage the client’s • Positive support can
appropriate expression reinforce the client’s
of feelings regarding healthy expression of
treatment or discharge feelings, realistic plans,
plans. and responsible
behavior after discharge.

• Use a firm yet calm, • Your presence and

relaxed approach. manner will help to
communicate our
interest, expectations,
and limits, as well as
your self-control.
• Show acceptance of the
client as a person. • The client is acceptance
as a person regardless
of his or her behaviors,
which may or may not
be acceptable.

• Solves problems and • Continue to support and

makes decisions monitor psychosocial
appropriate for age and treatment plans.
Subjective: Risk for suicide r/t mood After 4 days of nursing • Listen actively to the • Allowing the client to Goal met
“ Ganahan nako mamatay” alteration secondary to intervention, the patient will client’s story regarding verbalize helps the
as verbalized by the bipolar disorder. demonstrate absence of how the client came to client relieve pent-up
patient. suicidal attempts, and the point of suicide, thoughts, feelings and
Scientific Basis: display consistent, using therapeutic skills emotions related to
Objective: Clients who expresses optimistic, and hopeful such as reflection, suicide and is in itself
feeling of hopelessness, attitude. The patient will clarification, and therapeutic. It gives
• Frequently agitated worthlessness, desire to live. Display validation, and indicate the nurse information
hopelessness, and other consistent, and optimistic, acceptance of the about the critical
feelings associated with and hopeful attitude. client’s thought and events that influenced
depressive state are risk feelings. the client’s story
for suicide. Depressed promotes trust and
person see suicide as instill hope.
means of escaping from • Tell the client to come • Constant staff support
anxiety provoking and to staff whenever the and protection reduce
intensely frightened by client experiences the client’s fear of
their overwhelming anxiety, such s thoughts and suicidal impulses and
isolation. Clients feelings. offer hope for survival.
considering suicide may
also experience feelings of • Help the client to see • Educating the client
excessive guilt, self blame, that suicide is not an about the temporary
and frustration. Suicidal alternative to life’s nature/experience of
clients often experience problems but is rather suicide and depression
severe anger. a temporary promotes the client’s
experience often insight bout the
brought by an actual treatability of disease
illness and process and offer hope
exacerbated by life for the future.
• Administer lithium as • To stabilizes the mood
ordered. of the patient.

• Continue support and • Prevent anxiety from

monitor psychosocial escalating to
treatment plans. unmanageable levels.

Set and maintain limits on behavior that is destructive or Limits must be established by others when the
adversely affects others patient is unable to use internal controls
effectively. Physical safety of other patient is also

Reorient the patient to person,place, and time as Repeated presentation of reality is concrete
indicated(call the patient by her name, tell the client reinforcement for the client
where he/she at and also introduce yourself to the

Spend time with the client Your physical presence is reality

Show acceptance of the client as a person The client must be accepted as a person despite
her/his condition, which may or may not be
Use a firm and calm approach Your presence and manner will help to
communicate your interest, expectations, and
limits as well as your self-control

Encourage the clients appropriate expression of feelings Positive support can reinforce the clients healthy
regarding treatment or discharge plans. Support any expression of feelings, realistic plans, and responsible
realistic plan the client proposes behavior after discharge

Give simple instructions Because patients with this disorder have difficulty upon
following multiple instructions

Do not argue with the client Arguing with the client undermines limits

Praise the client when he or she is able to discuss the Positive feedback can reinforce the clients insight and
physical symptoms as method used to cope with conflict help the client as related to emotional issues in the future
recognize physical symptom

Secure patients safety I.e. escape, suicide, and homicide Because patient might cause harm to others, to
precaution themselves and might plan to escape

Encourage verbalization of feelings Verbalizing feelings is an initial step toward dealing

constructively with those feelings
 12-month prevalence
DSM-IV/WMH-CIDI disorders by sex and cohort
 Sheila Videbeck(2011) Psychiatric-Mental Health Nursing
 (Smith Bhandari, (2017 November 8) Bipolar I Disorder. Retrieved from:
 (NAMI (2017, August) Bipolar I Disorder. Retrieved from: https:
 (Janet Lee (29 October 2017) Bipolar I Disorder. Retrieved from:
atry Guide/787045//all/Bipolar I Disorder)
 (Kathleen Smith (23 Jan 2017) Bipolar I Disorder. Retrieved from: