Download 2. Self-care assistance- list of hygiene tasks and the steps, times

Bipolar disorder
Bipolar disorder involves periods of excitability (mania)
alternating with periods of depression. The "mood swings"
between mania and depression can be very abrupt.
Alternative Names
Manic depression; Bipolar affective disorder
Causes
Bipolar disorder affects men and women equally. It usually
appears between ages 15 - 25. The exact cause is
unknown, but it occurs more often in relatives of people
with bipolar disorder.
Bipolar disorder results from disturbances in the areas of
the brain that regulate mood.
There are two primary types of bipolar disorder. People
with bipolar disorder I have had at least one fully manic
episode with periods of major depression. In the past,
bipolar disorder I was called manic depression.
People with bipolar disorder II seldom experience fullfledged mania. Instead they experience periods of
hypomania (elevated levels of energy and impulsiveness
that are not as extreme as the symptoms of mania). These
hypomanic periods alternate with episodes of major
depression.
A mild form of bipolar disorder called cyclothymia
involves periods of hypomania and mild depression, with
less severe mood swings. People with bipolar disorder II
or cyclothymia may be misdiagnosed as having
depression alone.
Symptoms
The manic phase may last from days to months and
can include the following symptoms:
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Agitation or irritation
Elevated mood
o Hyperactivity
o Increased energy
o Lack of self-control
o Racing thoughts
Inflated self-esteem (delusions of grandeur, false
beliefs in special abilities)
Little need for sleep
Over-involvement in activities
Poor temper control
Reckless behavior
o Binge eating, drinking, and/or drug use
o Impaired judgment
o Sexual promiscuity
o Spending sprees
Tendency to be easily distracted
These symptoms of mania are seen with bipolar
disorder I. In people with bipolar disorder II,
hypomanic episodes involve similar symptoms that
are less intense.
The depressed phase of both types of bipolar disorder
involves very serious symptoms of major depression:
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Difficulty concentrating, remembering, or making
decisions
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Eating disturbances
o Loss of appetite and weight loss
o Overeating and weight gain
Fatigue or listlessness
Feelings of worthlessness, hopelessness and/or guilt
Loss of self-esteem
Persistent sadness
Persistent thoughts of death
Sleep disturbances
o Excessive sleepiness
o Inability to sleep
Suicidal thoughts
Withdrawal from activities that were once enjoyed
Withdrawal from friends
There is a high risk of suicide with bipolar disorder. While
in either phase, patients may abuse alcohol or other
substances, which can worsen the symptoms.
Sometimes there is an overlap between the two phases.
Manic and depressive symptoms may occur
simultaneously or in quick succession in what is called a
mixed state.
Exams and Tests
A diagnosis of bipolar disorder involves consideration of
many factors. The health care provider may do some or all
of the following:
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Ask about your family medical history, particularly
whether anyone has or had bipolar disorder
Ask about your recent mood swings and for how long
you've experienced them
Observe your behavior and mood
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Perform a thorough examination to identify or rule out
physical causes for the symptoms
Request laboratory tests to check for thyroid
problems or drug levels
Speak with your family members to discuss their
observations about your behavior
Take a medical history, including any medical
problems you have and any medications you take
Note: Use of recreational drugs may be responsible for
some symptoms, though this does not rule out bipolar
affective disorder. Drug abuse may itself be a symptom of
bipolar disorder.
Treatment
For the manic phase of bipolar disorder, antipsychotic
medications, lithium, and mood stabilizers are typically
used. For the depressive phase, antidepressants are
sometimes used, with or without the manic phase
treatment.
There is very little long-term evidence suggesting that any
medication has great success in the maintenance phase.
However, in studies that followed patients for 2 years,
lithium and some antipsychotics were found to be
moderately successful.
Antipsychotic drugs can help a person who has lost touch
with reality. Anti-anxiety drugs, such as benzodiazepines,
may also help. The patient may need to stay in a hospital
until his or her mood has stabilized and symptoms are
under control.
Electroconvulsive therapy (ECT) may be used to treat
bipolar disorder. ECT is a psychiatric treatment that uses
an electrical current to cause a brief seizure of the central
nervous system while the patient is under anesthesia.
Studies have repeatedly found that ECT is the most
effective treatment for depression that is not relieved with
medications.
Getting enough sleep helps keep a stable mood in some
patients. Psychotherapy may be a useful option during the
depressive phase. Joining a support group may be
particularly helpful for bipolar disorder patients and their
loved ones.
Outlook (Prognosis)
Mood-stabilizing medication can help control the
symptoms of bipolar disorder. However, patients often
need help and support to take medicine properly and to
ensure that any episodes of mania and depression are
treated as early as possible.
Some people stop taking the medication as soon as they
feel better or because they want to experience the
productivity and creativity associated with mania. Although
these early manic states may feel good, discontinuing
medication may have very negative consequences.
Suicide is a very real risk during both mania and
depression. Suicidal thoughts, ideas, and gestures in
people with bipolar affective disorder require immediate
emergency attention.
Possible Complications
Stopping or improperly taking medication can cause your
symptoms to come back, and lead to the following
complications:
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Alcohol and/or drug abuse as a strategy to "selfmedicate"
Personal relationships, work, and finances suffer
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Suicidal thoughts and behaviors
This illness is challenging to treat. Patients and their
friends and family must be aware of the risks of neglecting
to treat bipolar disorder.
Nursing care
CLIENT ASSESSMENT DATA BASE (MANIC
EPISODE)
Activity/Rest
Disrupted sleep pattern or extended periods without
sleep/decreased need for sleep (e.g., feels well rested
with 3 hours of sleep)
Physically hyperactive, eventual exhaustion
Ego Integrity
Inflated/exalted self perception, with unrealistic selfconfidence
Grandiosity may be expressed in a range from unrealistic
planning and persistent offering of unsolicited advice
(when no expertise exists) to grandiose delusions of a
special relationship to important persons, including God,
or persecution because of “specialness”
Humor attitude may be caustic/hostile
Food/Fluid
Weight loss often noted
Hygiene
Inattention to ADLs common
Grooming and clothing choices may be inappropriate,
flamboyant, and bizarre; excessive use of makeup and
jewelry
Neurosensory
Prevailing mood is remarkably expansive, “high,” or
irritable
Reports of activities that are disorganized and flamboyant
or bizarre, denial of probable outcome, perception of
mood as desirable and potential as limitless
Mental Status: Concentration/attention poor (responds to
multiple irrelevant stimuli in the environment), leading to
rapid changes in topics (flight of ideas) in conversation
and inability to complete activities
Mood: labile, predominantly euphoric, but easily changed
to anger or despair with slightest provocation; mood
swings may be profound with intervening periods of
normalcy
Delusions: paranoid and grandiose, psychotic
phenomena (illusions/hallucinations)
Judgment: poor, irritability common
Speech: rapid and pressured (loquaciousness), with
abrupt changes of topic; can progress to disorganized and
incoherent
Psychomotor agitation
Safety
May demonstrate a degree of dangerousness to self and
others; acting on misperceptions
Sexuality
Increased libido; behavior may be uninhibited
Social Interactions
May be described or viewed as very extroverted/sociable
(numerous acquaintances)
History of over involvement with other people and with
activities; ambitious, unrealistic planning; acts of poor
judgment regarding social consequences (uncontrolled
spending, reckless driving, problematic or unusual sexual
behavior)
Marked impairment in social activities, relationship with
others (lack of close relationships), school/occupational
functioning, periodic changes in employment/frequent
moves
Teaching/Learning
First full episode usually occurs between ages 15 and 24
years, with symptoms lasting at least 1 week
May have been hospitalized for previous episodes of
manic behavior
Periodic alcohol or other drug abuse
DIAGNOSTIC STUDIES
Drug Screen: Rule out possibility that symptoms are
drug-induced.
Electrolytes: Excess of sodium within the nerve cells may
be noted.
Lithium Level: Done when client is receiving this
medication to ensure therapeutic range between 0.5 and
1.5 mEq/liter.
nursing diagnosis
(a.) risk for suicide related to depression
associated with bipolar disorder as evidenced
by feelings that his family can’t deal with him
anymore and he feels like “everyone is shitting
on me”,
(b.) risk for violence directed at others related to
manic excitement as evidenced by agitated
behaviors,
(c.) defensive coping related to an inadequate level
of perception of control as evidenced by
grandiosity and argumentative behavior,
(d.) chronic low self-esteem related to shame and
impaired self-appraisal as evidenced by
hypersensitivity to slights of criticism, and
(e.) impaired memory related to neurologic
disturbance as evidenced by incidences of
forgetting information caused by Electroconvulsive
Therapy.
Nursing Interventions
1. Initiate a nurse-patient relationship by demonstrating
an acceptance of JR as a worthwhile human being
through the use of nonjudgmental statements and
behavior. Suicide precautions per hospital policy.
2. Self-care assistance- list of hygiene tasks and the
steps, times
3. Suicide prevention-assess command hallucinations
and teach client what to do
4. Observe the client every 15 minutes while suicidal,
remove all dangerous, sharp objects from room.
• Violence prevention encourage to talk rather than act
out feelings, identify triggers, give personal space to
client who is escalating,verbally set limits on aggressive
behavior, avoid touching client who is scared
4. Reinforce that she is worth while,
a.) Assist the client in evaluating the positive as well
as the negative aspects of her life
b.) Encourage the appropriate expression of angry
feelings.
c.) Schedule regular periods of time throughout the
day for recreational/occupational therapy, encourage
client to groom self, offer praise for completing
grooming.
d.) Ensure client's participation in taking mood
stabilizing medications. Watch client swallow
medication.
6. Engage client in interpersonal therapies, cognitivebehavioral therapy,
7. Encourage client to attend group therapy, and
journal episodes.
8.Teach family-convey message they are not the cause,
teach signs of relapse, medications, how to deal with
active symptoms, role play with them, teach about
keeping a moderate level of expressed emotion,
establish family rules,support groups, and family
therapy
NURSING PRIORITIES
1. Protect client/others from the consequences of
hyperactive behavior.
2. Provide for client’s basic needs.
3. Promote reality orientation, realistic problem-solving,
and foster autonomy.
4. Support client/family participation in follow-up
care/community treatment.
DISCHARGE GOALS
1. Remains free of injury with decreased occurrence of
manic behavior(s).
2. Balance between activity and rest restored.
3. Meeting basic self-care needs.
4. Communicating logically and clearly.
5. Client/family participating in ongoing treatment and
understands importance of drug therapy/monitoring.
6. Plan in place to meet needs after discharge.
‫ هاني أسعد البليشي‬/ ‫عمل الطالب‬
120112837 /‫الرقم الجامعي‬