| Diagnosis Bipolar Disorder: "Bipolar disorder | | | | |
| is a severe biologic illness characterized by | | | | Textbook Characteristics: |
| recurrent fluctuations in mood. Typically, | | | | |
| patients experience alternating episodes in | | | | Pure Manic Episode |
| which mood is abnormally elevated or | | | | |
| abnormally depressed-separated by periods in | | | | Hypomanic Episode |
| which mood is relatively normal." (Lehne, | | | | |
| 2004, p. 321) | | | | Major Depressive Episode- |
| | | | |
| The following is a short synopsis according | | | | Affective Flattening |
| to the DSM-IV-TR, "Criteria for Bipolar | | | | |
| Disorder" includes a distinct period of | | | | Alogia |
| abnormality and persistently elevated, | | | | |
| expansive, or irritable mood for at least: | | | | Avolition-apathy |
| | | | |
| - 4 days for hypomania | | | | Anhedonia |
| | | | |
| - week for mania | | | | Mixed Episode |
| | | | |
| During the period of mood disturbance, at | | | | Rapid-Cycling Bipolar Disorder- Patients |
| least three or more of the following symptoms | | | | experience four or Client |
| have persisted and have been present to a | | | | |
| significant degree: | | | | Characteristics Observed: |
| | | | |
| - Inflated self-esteem or grandiosity | | | | No current symptoms |
| | | | |
| - Decreased need for sleep | | | | Rapid breathing, rapid speech, however due to |
| | | | medication a client was concurrently |
| - More talkative than usual or pressure to | | | | exhibiting lethargy |
| keep talking | | | | |
| | | | Client acknowledged sadness/ worthlessness |
| - Excessive involvement in pleasurable | | | | |
| activities that have a high potential for | | | | Facial expression flat |
| painful consequences. | | | | |
| | | | Thoughts of dying, hard to focus |
| (American Psychiatric Association [APA], | | | | |
| 2000). | | | | Hair/clothes unkempt |
| | | | |
| Psychodynamics of the Disease The onset of | | | | Expressed no interest in children or own |
| the disease usually occurs during late | | | | |
| adolescence or in the mid twenties. However, | | | | Client's Symptoms |
| the disease has been known to occur up into | | | | |
| the fifth decade of life. The mood swings | | | | 1. Hypomania |
| that accompany this disorder are of several | | | | |
| types. They are as follows: the Pure Manic | | | | 2. Depressiona.) Affective Flatteningb.) |
| Episode, evidenced by hyperactivity, | | | | Alogiac.) Avolition & Apathyd.) Anhedonia |
| excessive enthusiasm, and flight of ideas, | | | | |
| constant wakefulness without sleep, | | | | 3. Mixed Episode |
| | | | |
| Impairment in normal social functioning | | | | 4. Rapid Cycling |
| usually requiring hospitalization; Hypomanic | | | | |
| Episode, evidenced by a milder form of the | | | | (Varcarolis, 2004, p. 485) |
| Pure Mania, without the loss of normal | | | | |
| functioning that would require | | | | Nursing Interventions |
| hospitalization; Major Depressive Episode, | | | | |
| characterized by depressed mood consisting of | | | | 1. Observe the client every 15 minutes while |
| symptoms such as anhedonia, avolition, | | | | suicidal, remove all dangerous, sharp objects |
| alogia, affective flattening and thoughts of | | | | from room. |
| suicide and death; the last episode | | | | |
| associated with Bipolar disorders is the | | | | 2. Reinforce that she is worth while,a.) |
| Mixed Episode in which, patients experience | | | | Assist the client in evaluating the positive |
| symptoms of mania and depression | | | | as well as the negative aspects of her |
| simultaneously. The combination of high | | | | lifeb.) Encourage the appropriate expression |
| energy and depression puts them at | | | | of angry feelings.c.) Schedule regular |
| significant risk of suicide. (Lehne, 2004, p. | | | | periods of time throughout the day for |
| 321) | | | | recreational/occupational therapy, encourage |
| | | | client to groom self, offer praise for |
| Case Presentation | | | | completing grooming.d.) Ensure client's |
| | | | participation in taking mood stabilizing |
| A Caucasian woman in her mid twenties | | | | medications. Watch client swallow medication. |
| presented signs and symptoms of self | | | | |
| mutilation with a straight edge razor | | | | 3. Engage client in interpersonal therapies, |
| inflicted gash across her lower abdomen | | | | cognitive-behavioral therapy, |
| approximately six inches below the umbilicus. | | | | |
| The depth of the gash just stopped at the | | | | 4. Encourage client to attend group therapy, |
| abdominal fascia. The patient was sent from | | | | and journal episodes. |
| the emergency room to the psychiatric floor. | | | | |
| Upon meeting the patient one day after her | | | | Table 2 |
| admission to E.R., she appeared dressed in | | | | |
| pajama bottoms and a t-shirt, shuffling down | | | | Medical Interventions, Bipolar Disorder |
| the hall in her socks. She was holding her | | | | |
| abdomen with one hand and appeared in some | | | | Drug therapy using |
| discomfort. Her black hair was short and | | | | |
| disheveled. When the patient arrived at her | | | | Mood stabilizer |
| room she sat down on her bed. | | | | |
| | | | Antidepressants |
| She acknowledged with blunted affect that she | | | | |
| cannot stop self mutilation, and described | | | | Antipsychotics |
| how she cut herself through the muscles in | | | | |
| her abdomen almost down to the fascia. Her | | | | Education and Psychotherapy |
| voice was tremulous and fast paced. This | | | | |
| could be due to the fact that she had just | | | | ECT |
| been given her first dose of Clozaril. She | | | | |
| stated that her mouth was dry and that she | | | | (Varcarolis, 2002, p. 483) |
| needed to drink some water. She then went on | | | | |
| to say that she was getting very sleepy. The | | | | Clients Medical Interventions |
| client felt comfortable with the interview. | | | | |
| | | | Drug therapy includes |
| She shared personal information in regards to | | | | |
| being sexually abused by her bother beginning | | | | Lithium 300mg every h.s. |
| at the age of seven until the age of fifteen. | | | | |
| Her brother was two years older than her and | | | | Not taking any Clozaril |
| died in an automobile accident at the age of | | | | |
| eighteen. She went on to say that her mother | | | | Client is receiving psychotherapy, family |
| never knew or acknowledged the sexual abuse | | | | counseling, group therapy while in hospital, |
| and that she could not tell her because the | | | | and cognitive restructuring. |
| mother idolized the son. The client was | | | | |
| receptive to cognitive reframing; however she | | | | None |
| was very critical of herself and stated that | | | | |
| she felt worthless and ashamed. She appeared | | | | References |
| very tired and stated that she wanted to | | | | |
| sleep. | | | | Lehne, R. (2004). Pharmacology for Nursing |
| | | | Care. Missouri: Saunders |
| Table 1 | | | | |
| | | | Varcarolis, E. (2002). Foundations of |
| Textbook characteristics of Bipolar disorder | | | | Psychiatric Mental Health Nursing: A Clinical |
| versus client characteristics observed | | | | Approach. |