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INTRODUCTION
Psychiatric area is one area of exposure of the nursing students. Our group
was lucky enough to be assigned at the psychiatric area at BGHMC (Baguio General
Hospital and Medical Center). The group had encountered several common
psychiatric disorders like the different types of schizophrenia and bipolar disorders.
The group had chosen to study Bipolar Affective Disorder, current episode, manic
with psychotic disorder. The group had chosen this type of disorder for us to
understand and appreciate this type of psychiatric ailment.
If the client is under mania, the common signs and symptoms includes feeling
that are unusually high, optimistic and very irritable, unrealistic, grandiose belief
about one’s abilities or powers, sleeping less but feeling extremely energetic,
talking so rapidly, racing thoughts, jumping quickly from one idea to the next,
highly distractible, impaired judgement and impulsiveness, acting recklessly without
thinking about the consequences and lastly in severe cases, delusions and
hallucinations may appear.
If the client is under depressive, the common signs and symptoms are
decreased energy, easy fatigability, lethargic, has diminished activities, insomnia or
even hypersomnia, usually lost of interest in pleasurable activities and lastly social
withdrawal.
B. PATIENT’S PROFILE
Name: Mr. I.E.R
Age: 56 years old
Birthday: July 4, 1953
Civil Status: Married
Address: Km8 Asin road, Tuba, Benguet
Religion: Roman Catholic
Nationality: Filipino
Date of Admission: June 11, 2010
Time of Admission: 7:35 PM
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Admitting Diagnosis: Bipolar Affective Disorder,
Current
Episode, Manic with Psychotic Disorder
C. ASSESSMENT
1. Psychiatric History/Developmental History
The patient is born via NSVD (normal spontaneous vaginal delivery), no
known complications and abortion attempts of the mother. According to
the patient he was both breastfed and bottlefed up to 1 ½ years of age.
He was also toilet trained by his parents. He further claimed that he was
pampered by his parents with love and affection as well as with other
things like toys, books and clothing. Basically, he had a good childhood
experience as claimed.
He was married at the age of 36 years old. After how many years, his
wife gave birth to a baby boy. They then decided that the husband will
go abroad in Saudi Arabia and work as a mechanical Engineer while his
wife is left with the son in the Philippines. After how many years, they
decided to switch, the husband was left with the baby and his wife went
abroad to Saudi to work as a nurse at a hospital. With this set up of a
long distance relationship which is too hard to handle. Being away from
your wife and being with your son for several years. His wife has only
quality time for them whenever she comes home for vacation. Whenever
his wife comes home for a vacation, he is usually very happy.
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He and his neighbor misunderstood each other, but not identified,
every now and then they are almost having an argument. The son saw
his change of reactions and behaviors 5 days prior to admission like
auditory hallucinations, illusions, mood swings, he keeps on digging at
their backyard and always saying that “may ginto sa likod ng bahay
natin”.
The patient could remember that his mother told him that when
he was sick with chickenpox and measles, he had high fever and
convulsion. Aside from this, patient claimed he was generally healthy as
a child.
During his school age, he claimed that he was shy. He does not
participate in school activities and seldom mingle with his classmates
but as he grows up, he further claimed that he feels more comfortable
with girls and so he has more female friends than boys. At the age of 15,
after he graduated from high school, he then have to be separated to his
family because he enrolled to one of the schools in Baguio to finish his
college degree. It was his first time to be separated from his family and
so he felt so sad.
In the case of our patient there was no mental illness in the family.
However, he was only diagnosed with hypertension before admission at
the Psychiatric Hospital. The time he was firstly observed with
manifestations of the disorder the patient was into treasure hunting. He
claimed that he met an old woman that was dictating him what to do and
where to hunt. He claimed that the old woman manipulated him to do it.
Since then, the patient would dig around their backyard and was
preoccupied with doing unnecessary things, but the patient wouldn’t
forget his position in the family and would do household chores and
would act accordingly. He was helpful with doing house chores but
noticed that he had lost his social life. His friends were not visiting him
anymore and vice versa. Soon after, the patient’s wife came home from
Saudi, and around that time he was observed to be normal again, the
patient stopped his treasure hunting activities and also claimed that he
stopped seeing the old woman. He was observed to be happy during
those times. The wife then went back to Saudi and after sometime the
patient resumed his usual activities of digging around their house. The
patient started to mumble, and would walk around the house to and fro
and he would utter incoherent words.
Five days prior to admission, the patient felt abnormally good, high,
excited, hyperactive and irritable. This was extreme since the patient lost
contact with reality and started to believe strange things. He had poor
judgment and behaved in harmful ways which was dangerous. This was
accompanied by an elevated mood and he had reduced sleep. He had
optimistic ideas and plans were expressed. The patient developed
symptoms of hallucination and delusion. One day prior to admission, the
patient kept on saying S.B, who was the patient’s relative who worked in
a mining company. After he went to Balatoc Mines, during the night when
his son was watching t.v. the patient came close to him saying, “Sino
ka… sino ka?... P.F. (their neighbor whom he always had an argument
with). So, the son introduced himself. Afterwards, the patient went to his
room shouting over and over again. Out of fear, the son called their
relatives and asked help from the nearby police station to get the patient.
The patient was seen half naked, praying on the road, kissing the ground
and saying that he is the savior. The patient had a bag of stones and
books saying he would go home to Zamboanga leaving the treasure to
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his son. He was held and brought to the institution hence the admission.
Hence patient I.R., 56 years old was admitted and diagnosed with bipolar
affective disorder, current episode, manic with psychotic symptoms.
A. APPEARANCE
The client appears to be well groomed. Mr. I.R. has a noticeably
proper cut hair and is well combed. Mr. I.R. wears clothing appropriately
depending on his mood and with the weather. Mr. I.R. refers wearing long
sleeves but when it is hot, he wears the usual t-shirt along with his shorts
or any available pants he has. For 3 consecutive days of duty, it was
observed that he only took a bath on the third day then changed his
clothes; the patient is observed to brush his teeth before and after meals.
His nails are trimmed and his beard and mustache are neatly shaved. The
client appeared as the stated age of 56 years old with visibly white hair
and some noticeably wrinkles on his face.
B. BEHAVIOR
1. MANNER OF RELATING
Mr. I.R. is participative during discussion. He actively and openly
answers queries being asked to him by the student nurses. He
sometimes cracks jokes that make the conversation lively. He usually
prefers to talk with student nurses rather than to his co-patients inside
the ward.
2. PSYCHOMOTOR ACTIVITES
The patient has a good posture. However, he sometimes slouches
during conversation with his legs and arms crossed and sometimes
with his hands on his lap, swaying his feet while looking around the
room. He usually stay on bed sitting or if not, sleeping. Patient has
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good posture, gait and station. He was observed to walk straight. He
has mild hand tremors observed.
3. SPEECH/LANGUAGE
The client talks with normal rate, rhythm and intensity. He speaks
clearly and has good articulation of words. He elaborates his answers
to questions asked and sometimes, he shares some topics to be
discussed. It was also observed that he can easily find the right words
to use when lost during conversation. To explain further what are his
thoughts. Patient is able to talk in English, Tagalog and Ilokano
fluently.
4. RELEVANCE/COHERENCE
The client was able to answer relevantly and coherently. He
used simple, concrete and easy to understand responses to the topics
being discussed during the NPI (Nurse-Patient-Interaction).
5. DEVIATIONS
There were no deviation like inventing, rhyming, stammering,
clanging of words, repetition of words and speeches in particular
questions being asked by the student nurses noted.
6. VOCABULARY
The patient uses appropriate terms to use when conversing. He
sometimes use terms related to his field of engineering such as the
different machineries and gadgets he encountered while he is still
studying and working abroad. Patient is able to adjust his choice of
words depending on whom he is talking to. He would use simple words
to his co-patient while he uses more complex vocabularies to the
health care providers.
D. THINKING
During the conversation, Mr. I.R. was able to discuss topics
concerning religion, philosophy and history. He was able to discuss
recent events of the world and how these are predicted by previous
events. He also talks about his work and how was he as an employee
when he works abroad. He talks about his family often and mentioned
“Yung asawa ko nagwork sa Saudi at may isa akong anak.. Maaga
nakapag asawa. May isa na akong apo.” There was no paranoid
delusions observed from the client. However the patient was observe
to avoid topics which concern on the reasons why he was brought to
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the hospital. Mr. I.R. is oriented to person, place, time and self. He can
identify who brought him to the ward.
When the patient was asked to tell the name of one of our co-
student nurse that was introduced to him for no longer than 15
minutes, he said “ Si Earl, oo yung mataba. Siya yung una kong nakita
nung pagpasok niyo. Malaking tao kasi.”.
E. ABSTRACTION
When the patient was asked of how did he understand the saying
“A hard beginning maketh a good ending.” He responded immediately
“ Parang ganito sa situation ko, para akong nakakulong ngayon pero
there’s a purpose why I am here however taking that all into
consideration, I am positive that this turmoil is to make me and my
family stronger than before”.
2. INSIGHT
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3. JUDGMENT
G. SELF- CONCEPT
The patient has low self-esteem as he is shy and he doesn’t
mingle or talk with the other patients in the ward. When conversing
with him he often focuses on his positive behavior like being a good
husband to his wife and father to his son, which indicates that he is
trying to elevate his self-esteem.
H. PHYSICAL COMPLAINTS/PROBLEMS
The client doesn’t have any physical deformities. He is slow when
walking because of aging. He has tremors and claimed that “Ganito ‘to
kasi side effect ng gamot”, which indicates a circulatory problem because
of HPN.
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D. DIAGNOSTIC EXAMINATION
June 12, 2010 Urinalysis This test detects ion Color: yellow Normal The specific gravity of
concentration of the urine. your urine is measured
Small amounts of protein Transparency: Slightly Normal by using a urinometer.
or ketoacidosis tend to Turbid Knowing the specific
Normal
elevate results of the gravity of your urine is
Reaction/pH: 6.0
specific gravity. Specific Concentrated urine very important
gravity is an expression of Specific Gravity: 1.020 because the number
the weight of a substance Normal indicates whether you
relative to the weight of an Protein: Neg are hydrated or
equal volume of water. Normal dehydrated.
WBC: None
Normal
Epithelial Cells: Rare
Normal
Bacteria: None
There is a presence of
Amorphous urates/PO4: amorphous urates
Occasional due to prolong
refrigeration.
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Date of Diagnostic Description Results Normal Values Significance
Procedure Procedure
June 17, 2010 CBC (Complete The CBC is used as a RBC - 4.32 x 1012/L 4.6 – 6.2 x 1012/L The significance of this
Blood Count) broad screening test laboratory procedure is to
to check for such WBC -10.4 x 109/L 4.5 – 11.0 x 109/L mainly includes the care and
disorders as anemia, treatment of patients with
Lymph # -2.7 x 109/L 0.8 – 4.0 x 109/L
infection, and many conditions that will result in
other diseases. It is Mid # -0.9 x 109/L 0.1– 0.9 x 109/L increases or decreases in
actually a panel of the cell populations
tests that examines Gran # -6.8 x 109/L 2.0 – 7.0 x 109/L
different parts of the
blood. Lymph % -26.2 % 20.0 – 40.0 %
10
RDW-SD - 48.6/L 35 – 56/L
PLT - adequate
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E. PSYCHOPATHOLOGY
1. Biological Cause
A. Neurotransmitter Alteration
A.1 Increase Dopamine
- Overproduction of dopamine causes the nerve circuits to
misfire and create a split state in the mind where delusions and
hallucinations make the reality of the outside world easier to
accept
A.2 Increase Serotonin level
- An increase in serotonin levels indicates Mania / Manic in
Bipolar Disorder. Because he has the three signs of mania which
are Auditory Hallucinations, delusions and paranoia
A.3 Decrease Serotonin Level
- A decrease in serotonin levels indicates depression. He has
the symptoms of depression like social withdrawal, low self-
esteem and persistent sadness
B. Genetic Predisposition
B.1 Being Shy
- He has the presence of the type A personality, which is
inherently acquired thus he has poor IPR to others
2. Psychosocial Causes
A. Development of Mistrust
- It is according to Freud’s Psycho-social theory. Presented by poor
IPR to other people, unable to express feelings, lack of close
friends, isolates self, social withdrawal
B. Cultural Norms
- Because they have a close-knit family
C. Traumatic Experience
C.1 Separation from family members
- Being alone and independent in an area that is unfamiliar
C.2 Death of his Sister
- As presented by Long term depression
C.3 Living alone for several years
- As manifested by anxiety and fear
D. Use of Defense Mechanism
- Ineffective use of Denial as manifested by unrealistic perception
of the situation
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PSYCHODYNAMICS
Denial Stress
Unrealistic
Blood Pressure, pulse
perception of
Bipolar Affective Disorder, Current rate, respiration
the situation
Episode, Manic with Psychotic Disorder
Causing Altered
Risk for disturbed Hypertensio cardiovascu
injury visual field n lar status
and postural
Poor compliance Possible imbalance
to treatment separation to
regimen wife
-medicine
Amlodipine Calcium Dosage: Blocks the >Essential CNS: >Monitor the patient’s
besylate channel 10 mg 1 tab transport of hypertension, dizziness, BP, cardiac rhythm, and
blocker OD calcium into the or in light- output while adjusting
smooth muscle combination headedness, drug to therapeutic
Antianginal Date started: cells lining the with other headache, dose.
Norvasc drug 06/17/10 coronary arteries agents fatigue >instruct client to
and other CV: swallow the tablet
Antihyperten arteries of the peripheral whole with or without
sive body. Since edema, food as directed by the
calcium is arrhythmias physician.
important in DERMATOL >Instruct client to take
muscle OGIC: with meals if stomach
contraction, Flush, rash upset occurs.
blocking calcium GI: nausea, > tell the client to
transport relaxes abdominal report irregular
artery muscles discomfort. heartbeat, shortness of
and dilates breath, swelling of
coronary arteries hands and feet,
and other pronounced dizziness or
arteries of the constipation.
body. coronary
artery disease
14
Generic Classificatio Dosage Mechanism of Indication Side Effects Nursing
name n Start and Action Consideration
Completion
Trade name of
Medication
15
Clonidine Antihyperten Dosage: 75 Stimulates CNS >For CNS: >monitor BP carefully,
hydrochloride sive mg. 1 tab SL alpha2 hypertension drowsiness, when discontinuing
fo BP ≥ adrenergic sedation, clonidine, hypertension
140/90 receptors, dizziness usually returns within
Catapres inhibits CV: CHF, 48 hours.
Date started: sympathetic orthostatic >Take the drug exactly
06/14/10 cardioaccelerator hypotension, as prescribed. The drug
and tachycardia, should be put under the
vasoconstrictor palpitations tongue.
centres, and GI: dry >Do not discontinue
decreases mouth, drug unless so
sympathetic constipation, instructed.
outflow from nausea > tell the patient that
CNS. GU: discontinuing abruptly,
impotence, life threatening adverse
decreased effects may occur.
sexual
activity,
diminished
libido
Lithium Antimanic Dosage: Alters sodium Treatment of CNS: >Give drug with food or
carbonate drug 450 mg 1 tab transport in nerve manic lethargy, milk after meals.
BID and muscle cells, episodes of slurre d >Monitor clinical status
inhibits release of manic- speech, closely
Date started: norepinephrine depressive muscle >take this drug exactly
Carbolith 06/12/10 and dopamine, illness. weakness as prescribed, after
but not serotonin GI: nausea, meals or with food or
from stimulated vomiting, ,milk
neurons, slightly diarrhea >Instruct client to open
increases GU: pyloria mouth and lift tongue to
intraneural stone check for the drugs.
of
cathecolamines; >tell the patient to eat
decrease a normal diet with a
intraneuronal normal salt intake,
content of second maintain adequate fluid
messengers and intake.
may the by
selectively
modulate the
responsiveness of
hyperactive
neurons that
might contribute
to the manic
state.
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Generic Classificatio Dosage Mechanism of Indication Side Effects Nursing
name n Start and Action Consideration
Completion
Trade name of
Medication
Haloperidol antipsychotic Dosage: 10 Haloperidol Management CNS: >Take the drug with
mg deep IMx interferes with of drowsiness, food or exactly as
haldol 3 doses PRN the effects of manifestation insomnia, prescribed.
for severe neurotransmitter of psychotic headache >Do not dilute this with
psychotic s in the brain disorders. autonomic: coffee, tea, colas or
agitation. which are the drymouth, apple juice - the
chemical salivation, medication may lose
Date started: messengers that nasal effectiveness.
06/11/2010 nerves congestion >Do not stop taking this
manufacture and CV: drug suddenly without
release to hypotension consulting your doctor.
communicate hematologic >Instruct client to open
with one another. : mouth and lift tongue to
It blocks eosinophilia, check for the drugs.
receptors for the leukopenia >Instruct client to Avoid
neurotransmitter engaging in other
s (specifically the dangerous activities. If
dopamine and dizziness or drowsiness
serotonin type 2 or vision changes
receptors) on the occurs.
nerves. As a
result, the nerves
are not
"activated" by
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the
neurotransmitter
s released by
other nerves
Chlorpromazi Antipsychoti Dosage: Block dopamine Management CNS: >Assess mental status
ne cs 200 mg. ½ receptors in the of neuroleptic prior to and
tab AM; 1 tab brain; also alter manifestation malignant periodically during
Thorazine in HS dopamine release of psychotic syndrome, therapy.
and turnover. disorders; sedation, >Monitor BP and pulse
Date Started: control of CV: prior to and frequently
06/12/10 manic phase of hypotension during the period of
manic EENT: blurred dosage adjustment.
depressive vision, >Observe patient
illness. GI: carefully when
constipation, administering
dry mouth, medication.
anorexia, >Instruct client to
GU: urinary open mouth and lift
retention tongue to check for
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Hematologic: the drugs.
leukopenia >Advice patient to
take medication as
missed doses as soon
as remembered, witih
remaining doses
evenly spaced
throughout the day.
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G. PRIORITIZATION
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H. NURSING CARE PLAN
NCP ACTUAL #1: ALTERED CARDIOVASCULAR STATUS R/T INCREASE PRESSURE SECONDARY TO HYPERTENSION
ASSESSMENT EXPLANATION OF GOALS AND NURSING INTERVENTION RATIONALE EVALUATION
THE PROBLEM OBJECTIVES
S>” Problema Patient has a history STO: After 1 hour of Dx: >Monitored vital signs >Note response to STO: Goal met,
ko tong BP ko, of hypertension. health teaching, especially BP activities patient was able to
tumataas” Bp- During admission until patient will be able to >Assessed contributory >To know the demonstrate
factors of increase BP appropriate
150/100 the third day patient demonstrate understanding and
intervention
has a fluctuating BP of understanding of Tx: >Assisted in getting up >Patient might be techniques to
O> Fluctuating 130/100 to 150/100, techniques and ways to prevent increase of
BP of 140/100 slowly from bed to bedside getting up of bed in
this was caused by prevent further or from supine to moderate the wrong way which BP
to 150/100
over excitement increase of blood high back rest may add up in the
>Feeling of when his wife came pressure like: >Assisted in going to the increase BP
dizziness like home from Saudi and comfort room or using the
when going to a. Waking up commode if necessary >To provide safety
stress that causes
the comfort slowly on bed >Promoted adequate rest
sympathetic nervous by decreasing stimuli,
room and resting
system (that before walking providing quiet >To maximize sleep
>Increase stimulates the fifgt or b. Proper Deep environment and periods that provide
respiratory flight response) over breathing scheduling activities good energy source
rate LTO: Goal met,
activity increasing exercises Edx: >Instructed to report
shortness of breath, chest >Immediate patient’s Bp was
>Fast hearts contractility
pain or any discomfort interventions will be maintained at
breathing over stress.
>Emphasized importance done 130/90
of diet low fat, low sodium
A> Altered Source:
LTO: After 3 days of >Reiterated religious >To maintain normal
cardiovascular
Brunner and nursing intervention, taking of medication BP
status related
the Blood pressure will >Encouraged rest periods
to increase Suddarth’s Medical-
be maintained at as necessary >To help regulate BP
pressure Surgical Nursing 7th
secondary to edition 130/90 from 150/100 >To prevent sudden
Hypertension
increase of BP
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NCP ACTUAL #2: CHRONIC LOW SELF-ESTEEM R/T IMPAIRED COGNITIVE SELF-APPRAISAL AEB NEGATIVE FEEDBACK ABOUT SELF
EXPLANATION OF THE GOALS AND
ASSESSMENT INTERVENTION RATIONALE EVALUATION
PROBLEM OBJECTIVES
S>“ang asawa Mr. ICI wife is a nurse LTO: After 3 days of PDx > Established Individuals with low LTO: Goal met if
ko ang working in Saudi. She is the nursing self-esteem are
nagtratrabaho one who’s working for their Rapport reluctant to discuss The client is able
interventions, the client
para sa min, ako family, taking charge for all will be able to verbalize true feelings to verbalize
pa man din ang understanding of
their expenses, providing understanding of
lalaki wala akong individual’s role in the
support for their family and individual’s role in the >Assessed presence Re-enforcement of society regardless of
magawa”
taking already the seat as the society regardless of of negative attitude communicating
O> Feels guilty bread winner of their family. their gender and or self talk their gender
and interacting
and shame when Mr. ICI felt so bad with that with others could
talking about his because he should be the one STO: After 8 hours of stimulate to
wife who works who’s doing all of that stuff. appropriate nursing enhance self-
for them esteem
He felt shame and guilty to
interventions, the client STO: Goal met
>Noted attitude his present situation. To
will be able to increase > Assessed existing
of shyness compensate to his Incongruence’s
self-esteem through: strengths and coping
shortcomings he made use between
> Unable to himself by doing household abilities, and provide verbal/non-
a. Giving positive The client was
communicate opportunities for verbal
chores and becoming able to increase self-
with this co- feedback their expression and communications
responsible in taking care of esteem through giving
patient recognition require
his son but these were not positive feedback, was
b. Focusing topics clarification.
> Took a bath on enough to show that he is able to appreciate his
such as on the client’s >Noted
the third day useful and not enough to To assist client to accomplishments in life
accomplishments in life non-verbal
only show his worth as father. All develop internal and was able to
behavior
of the things that he did were sense of self-
A> Chronic low c. Reinforcing the identify his strengths
in turn inadequate for him >Used esteem
self-esteem personal strengths and
which led him to have a positive and positive perceptions
related to positive perceptions
impaired chronic low self-esteem. messages
that the client identifies Supporting a
cognitive self- rather than
26
appraisal AEB Source: praise. client’s beliefs and
negative self-rejection and
feedback about Tx>Maintained helping them cope
self therapeutic can affect self-
www.medscape.com/viewpro communication esteem
gram
> Rendered positive
feedback To facilitate trust
during interaction
>Focused on
accomplishments To increase self-
esteem
Edx> Encouraged
participation in group
activities. Caregiver To lift self-esteem
may need to
accompany client at
first, until he or she Positive feedback
feels secure that the from group
group members will members will
be accepting, increase self-
esteem
regardless of
limitations in verbal
communication
>Encouraged client's
attempts to
communicate. If
verbalizations are not
The ability to
understandable,
communicate
express to client effectively with
27
what you think he or others may
she intended to say. enhance self-
It may be necessary esteem
to reorient client
frequently
>Reinforced the
personal strengths
and positive
perceptions that the
client identifies. Clients with low
self-esteem need
>Gave to have their
reinforcement existence and
value confirmed
for progress
noted.
Give
reinforcement
for progress
noted.
28
29
NCP ACTUAL #3: INEFFECTIVE DENIAL R/T INABILITY TO TOLERATE THE CONSEQUENCES OF KNOWN DISORDER
ASSESMENT EXPLANATION OF THE GOALS AND INTERVENTIONS RATIONALE EXPECTED
PROBLEM OBJECTIVES OUTCOME
31
> antihypertensive
agents usually causes
Edx> Cautioned the drowsiness which is
patient to avoid one of the most
activities requiring common cause of
alertness until the injury
effects of > to protect self from
medications are injury
known
> Instructed client > to prevent risk for
to request assistance injury and give
as needed prompt attention to
> Advised the side effects as
patient to report any necessary
adverse reactions or
side effects of the
medication taken
32
NCP POTENTIAL #2: RISK FOR RELAPSED EPISODE MAYBE R/T POOR MEDICAL TREATMENT REGIMEN COMPLIANCE
Assessment Explanation of the Objectives Nursing Interventions Rationales Evaluation
Problem
O > Has interest in Worked as a farmer STO > After 6-8 Dx > Assessed client’s > to determine STO > Patient was
treasure hunting with family early in hours of nursing perception of self causative factors able to
and going outside the morning to intervention patient and noted use of defense demonstrate
naked when the afternoon from is able to show mechanisms. coping mechanism
wife goes back to childhood to adult. signs coping > Assessed clients > to determine signs of as evidenced by
Iran. Completed his measures. coping relapse. relaxed posture
> Returns back education till college behaviors already > to determine and calm behavior.
to his usual self level and later got LTO > After 1-2 present. contributing factors.
when the wife is married and have hours of nursing > Reviewed > promotes sense of LTO > Patient was
back home. children. Went to Iran intervention patient laboratory and trust, allowing patient to able to understand
and worked abroad to is able to medication chart. discuss feelings openly. about his
A > Risk for help support his understand the Tx > Developed > to avoid reinforcing treatment by
relapsed episode family. Came back to importance of his therapeutic manipulative behavior. taking his
maybe r/t poor the Philippines and treatment and nurse-patient > offer emotional medications as
medical treatment continue working for verbalize his relationship. support and scheduled and
regimen his family. Wife had feelings. understanding. informing any
compliance gone back to Iran to > Maintained straight > builds trust, changes of
work, leaving the forward communication. enhancing therapeutic behaviors.
husband and son in > Listened to relationship.
Philippines. Then feelings that he
husband start acting expresses. > for positive
strange with interest > Being truthful distraction.
of treasure hunting when giving information
and going outside and dealing with patient. > encourages
naked. But returns > Invited client to do continuation of
normal when wife activities. treatment.
comes back home. > Gave positive
reinforcement for > decreases defense
33
client’s response.
efforts.
> Maintained calm, > to prevent fatigue.
matter of fact,
nonjudgmental attitude. > to help to deal with
Edx > Encouraged client stress.
to get adequate sleep.
> Instructed client > to understand that it
to take is a long term treatment.
medication as
ordered.
> Explained to client > to make adjustments
symptoms improve in the treatment.
gradually and not
immediately. > to prevent relapse.
>Advised client to
report mood changes
immediately.
> Educated client to
not stop on medication
without physician’s
order.
34
35
I. DISCHARGE PLAN
Instructed client to eat frequent small Mental health professionals try to steer Teach client to take medications
people away from sedentary activities
meals regularly
such as TV where the mind and body
Instructed to have high protein, high are not fully engaged. Cleaning, Instruct the wife that whenever she see
reorganizing, reading, or raising
carbohydrate diet for energy goldfish could all be great indoor signs and symptoms of Bipolar
activities. Disorder to refer him immediately
Creative activities like occupational Teach the client on the side effects of
therapy, drawings his medicines when not taken
36
J. CONCLUSIONS AND RECOMMENDATIONS
Interaction with the patient for more than 3 days is not enough to
cover from his childhood up to now. We should interact with the patient more
and more to know about his history and different traumas that he
encountered. Well preparation to go on duty at the area should be done
before the actual duty by conducting self awareness test. We should also be
well knowledgeable to psychiatric disorders prior to duty to enhance more
our interventions and interactions.
Since the client has Bipolar Disorder, the group concluded that this
disorder has different symptoms as compared to the other psychiatric
disorders. Therefore, in the making of this case study and understanding how
this disorder affects a person through appreciating it’s pathophysiology. This
study makes us student nurses more competent and gained more confidence
in handling patients with Bipolar Disorder.
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