Do you know about - Nursing Interventions in the diagnosis of Bipolar Disorder
Diagnosis Bipolar Disorder: "Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients touch alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal." (Lehne, 2004, p. 321)
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The following is a short synopsis agreeing to the Dsm-Iv-Tr, "Criteria for Bipolar Disorder" includes a certain duration of abnormality and persistently elevated, expansive, or irritable mood for at least:
- 4 days for hypomania
- week for mania
During the duration of mood disturbance, at least three or more of the following symptoms have persisted and have been present to a vital degree:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- inordinate involvement in pleasurable activities that have a high inherent for painful consequences." (American Psychiatric relationship [Apa], 2000).
Psychodynamics of the Disease The onset of the disease commonly occurs while late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. The mood swings that accompany this disorder are of several types. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, inordinate enthusiasm, and flight of ideas, constant wakefulness without sleep,
Impairment in general communal functioning commonly requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of general functioning that would wish hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last part connected with Bipolar disorders is the Mixed part in which, "patients touch symptoms of mania and depression simultaneously. The compound of high vigor and depression puts them at vital risk of suicide." (Lehne, 2004, p. 321)
Case Presentation
A Caucasian woman in her mid twenties presented signs and symptoms of self mutilation with a straight edge razor inflicted gash over her lower abdomen practically six inches below the umbilicus. The depth of the gash just stopped at the abdominal fascia. The outpatient was sent from the accident room to the psychiatric floor. Upon meeting the outpatient one day after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. She was retention her abdomen with one hand and appeared in some discomfort. Her black hair was short and disheveled. When the outpatient arrived at her room she sat down on her bed. She acknowledged with blunted influence that she cannot stop self mutilation, and described how she cut herself through the muscles in her abdomen practically down to the fascia. Her voice was tremulous and fast paced. This could be due to the fact that she had just been given her first dose of Clozaril. She stated that her mouth was dry and that she needed to drink some water. She then went on to say that she was getting very sleepy. The client felt comfortable with the interview.
She shared personal data in regards to being sexually abused by her bother starting at the age of seven until the age of fifteen. Her brother was two years older than her and died in an automobile accident at the age of eighteen. She went on to say that her mom never knew or acknowledged the sexual abuse and that she could not tell her because the mom idolized the son. The client was receptive to cognitive reframing; however she was very vital of herself and stated that she felt worthless and ashamed. She appeared very tired and stated that she wanted to sleep.
Table 1
Textbook characteristics of Bipolar disorder versus client characteristics observed
Textbook Characteristics:
Pure Manic Episode
Hypomanic Episode
Major Depressive Episode-
Affective Flattening
Alogia
Avolition-apathy
Anhedonia
Mixed Episode
Rapid-Cycling Bipolar Disorder- Patients touch four or Client
Characteristics Observed:
No current symptoms
Rapid breathing, rapid speech, however due to medication a client was concurrently exhibiting lethargy
Client acknowledged sadness/ worthlessness
Facial expression flat
Thoughts of dying, hard to focus
Hair/clothes unkempt
Expressed no interest in children or own
Client's Symptoms
1. Hypomania
2. Depression
a.) Affective Flattening
b.) Alogia
c.) Avolition & Apathy
d.) Anhedonia
3. Mixed Episode
4. Rapid Cycling
(Varcarolis, 2004, p. 485)
Nursing Interventions
1. explore the client every 15 minutes while suicidal, remove all dangerous, sharp objects from room.
2. Reinforce that she is worth while,
a.) help the client in evaluating the certain as well as the negative aspects of her life
b.) Encourage the appropriate expression of angry feelings.
c.) agenda quarterly 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.
3. Engage client in interpersonal therapies, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and journal episodes.
Table 2
Medical Interventions, Bipolar Disorder
Drug therapy using
Mood stabilizer
Antidepressants
Antipsychotics
Education and Psychotherapy
Ect
(Varcarolis, 2002, p. 483)
Clients curative Interventions
Drug therapy includes
Lithium 300mg every h.s.
Not taking any Clozaril
Client is receiving psychotherapy, family counseling, group therapy while in hospital, and cognitive restructuring.
None
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