Introduction OF Disease:

Bipolar disorder was formerly called manic depression. It is a form of major affective disorder, or mood
disorder, defined by manic or hypomanic episodes changes from one's normal mood accompanied by high
energy states.
Mania is often involved sleeplessness, sometimes for days, along with hallucinations, psychosis, grandiose
delusions, or paranoid rage. In addition, depressive episodes can be more devastating and harder to treat than
in people who never have manias or hypomanias.
Psychosis can happen at different stages of bipolar disorder. However, it is not always present, and not
everyone with bipolar disorder will experience it. It can be a frightening experience for the person and
those around them, but a psychiatric provider can offer treatment to control and relieve the symptoms.
Psychosis happens when a person's thinking becomes detached from the reality around them. It can
occur with biolar disorder, schizophrenia, some types of dementia, and other conditions. The person's
thinking becomes disconnected, or dissociated with reality. A psychotic episode can involve
hallucinations, delusions, confusion and disturbed thoughts, a lack of insight and self-awareness

When psychosis happens during a low mood, a person with bipolar disorder may experience fear and
paranoia.
A person may experience the following:
1. Visual and other hallucinations: The person sees, hears, and maybe smells things that are not
there.
2. Delusions: The person may be certain that something is true when it is not. They may believe
that they are important, have contacts in high places, or have a lot of money, or are related to
royalty, when in fact they are not. Some people become afraid that someone is seeking to hurt
them or that others are working against them, such as the government.
3. Paranoia and fear: The individual may believe that they have done something terrible or that
someone wants to cause them harm.
4. Unusual or racing thought patterns: This can lead to rapid, constant, or confused or disjointed
speech with rapid changes of topic. The person may forget what they were talking about.
5. Lack of insight: The person is unable to recognize unusual behavior in themselves, though they
may recognize it when they see it in others, whether it actually exists or not.
These symptoms can occur during episodes of mania, depression, or during a mixed episode, when a
person with bipolar disorder shows signs of both a low and high mood. They can cause the person to
behave in unusual ways, and this can impact their relationships with others, whether in their personal
life, at work, or in other situations. If the person believes they are very important, they may behave in
ways that are outside the law. In some cases, this can lead to aggression, for example, if someone
confronts the person. An individual who believes that they have committed a crime or that someone is
coming after them may become defensive or talk about suicide. If a person has bipolar disorder and
they shows signs of psychosis, they should see a doctor, if possible, as there is a risk of unwanted
consequences.
Patient Profile:

Patient MA is a 20 years old female, single, right handed, Filipino, Roman Catholic. Patient is a
highschool graduate and lives in San Mateo Rizal. She is now a college student from PUP

Chief Complaint/ Admitting Diagnosis:

Admitting Diagnosis: Bipolar 1 disorder mre manic with psychotic features substance involved
psychosis
Chief Complaint: Physical Agitation

Present Health History:

Patient MA is known case of Bipolar 1 disorder. 1 week prior to admission, patient started
getting stressed about her feasibility study. Patient’s mother claims that the patient frequently
ranted to her about the groupmates who are not participating and that she would end up doing
all the work herself. She also recalls several days when she would cry out of frustration.
Past Health History:
The patient was diagnosed with bipolar 1 disorder last 2017.
Family Health History:
The patient mentioned that there is a familial history of hypertension, diabetes, CVD, stroke
and asthma on paternal side and hypertension on maternal side. She has 1 sibling. MA is the
eldest of 2.
Genogram:
Paternal Maternal
 Psychosocial History:

The patient denied of using cigarettes but she enjoyed drinking alcoholic beverage with friends
when she was stressed.

GORDONS FUNCTIONAL HEALTH PATTERN

GFP BEFORE DURING NURSING

HOSPITALIZATION HOSPITALIZATION DIAGNOSIS
1. HEALTH S: “last year ko lang na- S: “Hindi na ako Ineffective self health
PERCEPTION experience nakakapag isip isip ng management
maghallucinate per kung ano-ano ngayon,
wala akong iniinom na marami rin akong
gamut at hindi pa iniinom na gamut para
naming naisipang gumaling ako agad.”
magpacheck up agad.
Kapag nagkakasakit O: Patient is alert,
katulad ng ubo awake, well-dressed
umiinom ako ng and talkative.
oregano.” Vital Signs at 4:00pm:
BP: 120/80 mmHg
HR: 80 bpm
RR: 17 bpm
T: 36.1

Patient is conscious,
2. NUTRIONAL S: “Mahilig ako sa S: “Kahit anong bilhin Imbalanced
METABOLIC chicken at may ulam nila mama, kinakain ko. Nutrition: Less than
na may sabaw. Sabi Mahilig ako sa chicken. body requirements
nila pumayat daw ako. Umiinom ako ng
Pero sa tingin ko rin maraming tubig lalo na
dahil bihira akong sa umaga.”
kumain lalo na kapag
stressed.” O: Patient is at diet as
tolerated. Hair is dry,
curly and evenly
distributed. And no
clubbing of nails.
3. ELIMINATION S:”Nahihirapan ko S: “Nakakaihi na ako ng Functional urinary
A. URINE mailabas ang ihi ko, at maayos, wala naman incontinence
kahit feel ko na naiihi akong sakit na
na ako, hindi ko pa rin nararamdaman. Mga 3 Bowel incontinence
mailabas lahat.” hanggang 4 na beses
ako umiihi.”
 O: Bladder is not
distended.
B. BOWEL
S:”2 hanggang 3 beses S:” Nakakadumi na
lang ako nakakadumi ako, minsan 2 beses sa
sa isang lingo.” isang araw.”

O: Patient’s abdomen
is soft and non-tender.

4. SLEEP- REST S: “kapag may pasok sa S: “Hindi ako Disturbed Sleep

school, 12 am or 1am makatulog ng maayos pattern
na ako nakakatulog sa gabi dahil parang
dahil sa sobrang may gumagapang na
daming project.” langgam sa akin at
parang kinakagat nila
ako. Pero 10pm
nakakatulog na ako at
6am naman ako
nagigising, minsan sa
madaling araw
nagigising ako para
uminom ng tubig.”

O: Patient is awake and

sitting on her bed. She
seems active and
wanted to talked about
her stress at school.

5. ACTIVITY- S:”Magcocommute ako S: “Wala ako magawa Readiness for

EXCERCISE papuntang school, pag- ditto, bawal ang enhance self care
uwi naman ng bahay cellphone kaya naiinip
gagawa agad ng na ako.”
assignments at
projects.” O: The gait of a patient
when walking is
rhythmic &
characterized by
alternating propulsive
& retropulsive motions
of the lower
extremities.

6. COGITIVE S:”Gumagamit na ako S: “Magpapatingin ako Impaired Comfort

PERCEPTUAL ng salamin since 1st yr sa mata kung tumaas
 college ako. Near na grado ko pag alis ko Disturbed sensory
sighted ako.” ditto sa hospital, kaya perception
hindi ko na ginagamit
muna ang aking
salamin. Dahil kapag
sinuot ko yung dati
kong salamin, ako ay
nahihilo.”

O: Patient is oriented to
time and place. She was
able to differentiate
sharp and dull objects.
She can hear sounds on
both ears during hearing
test.
7. SELF-PERCEPTION S:”Nakita ko si mama S: “Parang may Ineffective impulse
sa salamin na ang langgam na control
ganda ganda nya. gumagapang sa akin,
Minsan nakikita ko rin lalo na sa gabi,
na ang sobrang kinakagat din nila ako.”
liwanag sa kwarto ko
na parang malapit ako O: Patient has
kay God.” grandiosity
hallucination, she
knows of her disease
and she is willing to be
treated. And she has a
calm tone of voice, she
wanted to answer
every questions I
asked.”
8. ROLE- S: “Kasama ko sa S: “Yung pinsan ko Readiness for
RELATIONSHIP bahay yung pinsan ang nagbabantay sa enhanced
ko, si mama at yung akin, pero minsan si relationship
isang kong lalaking mama.”
kapatid.”
O: “The patient
constantly has her
cousin for majority of
the day, but
sometimes in the
afternoon, her mom
is visiting her.”
9. SEXUALITY - S: ”nagkaroon ako ng S:”Ayoko na munang n/a
REPRODUCTIVE boyfriend noon pero isipin ang
naghiwalay din pagkakaroon ng
 kami.” boyfriend dahil gusto
ko munang
makapagtapos ng
pag-aaral dahil next
yr na ako
gagraduate.”

O: Patient seems
that she don’t want
to talk about her past
relationships..
10. COPING-STRESS S: “Umiiyak lang ako S: “Calmado na ako Impaired individual
TOLERANCE kapag may ngayon, gusto ko na resilience
problema, at rin umalis sa hospital
madalas ay at tapusin lahat ng
kinikimkim ko lang. requirements sa
marami rin akong school.”
iniisip katulad ng
school projects at O: Patient is actively
mga groupmates responding during
kong tamad.” the whole interview.
11. VALUE-BELIEF S: “Roman Catholic S: “Nagdadasal No alteration in this
kami, bihira na rin nalang sa gabi dahil pattern
kami magsimba hindi pa ako
tuwing linngo.” makakalabas sa
hospital.”

O: Patient don’t have

the rosary on the
bedside.
Drug Analysis:

DRUG MECHANISM INDICATIONS CONTRAINDICATION ADVERSE NURSING

NAME OF ACTION EFFECT RESPONSIBILITIES
Risperidone Interferes with To manage Contraindicated in Side Effects: - Assess patient if
binding of symptoms of patients who have -Sedation there’s a signs and
Classification: dopamine and psychosis. hypersensitivity, -Diziness symptoms occur.
Antipsychotic serotonin dehydration,neutropenia. -nausea -Record urine
drug
receptors. -vomiting output.
-Monitor Vital Signs
Dosage:
500 mg; 1 tab Adverse
Effect:
Frequency: -Tchycardia
BID -Orthostatic
hypotension
-seizures.

DRUG MECHANISM INDICATIONS CONTRAINDICATION ADVERSE NURSING

NAME OF ACTION EFFECT RESPONSIBILITIES
Ivabradine Decrease the To decrease heart Contraindicated in Side Effects: -Monitor Vital Signs
effect of rate and patients who have -headache -Position patient in
Classification: sympathetic myocardial severe anemia, and -blurred sitting or lying when
Antianginal nervous system contractility. cardiomyopathy. vision medication.
by blocking -weakness
Dosage:
action of -nausea
5mg ½ tab
catecholamines -vomiting
Frequency:
BID Adverse
Effect:
-
 hypotension
-tachycardia

DRUG MECHANISM INDICATIONS CONTRAINDICATION ADVERSE NURSING

NAME OF ACTION EFFECT RESPONSIBILITIES
Divalproex Alteration of To treat bipolar Contraindicated in Side Effects: - Assess patient for
Sodium ion transport affecting disorder. patients who have liver -headache suicidal ideation.
in muscle and and renal disease, -memory -Monitor Vital signs
Classification: nerve cells; hyponatremia. impairment -Evaluate patient
Antiepileptics
increase -blurred vision neurologic status
receptor -hypotension
Dosage:
500 mg; 1 tab sensitivity to
serotonin. Adverse
Frequency: Effect:
BID -proteinuria
-polyuria
-
nephrotoxicity
.
Nursing Care Plan
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
S: “Parang may Ineffective After 2 hrs of nursing Independent: At the end of
langgam na impulse control interventions, the patient nursing
gumagapang sa r/t delusion as will be able to: -Investigate causes/ -Current theory interventions, the
akin, lalo na sa manifested by individual factors suggest unbalanced patient was able to:
gabi, kinakagat din sharing details - Identify feelings that may involved neurotransmitters
nila ako .” As the inappropriately that precede in client’s situation in the brain. -Identify feelings
patient verbalized. desire to engage that precede desire
in impulsive -Encourage a client to engage in
O: Patient is rested actions. to make decision impulsive actions
on a sitting postion. change and set
She is well-dressed personally
and talkative She achievable goals.
has grandiosity
hallucination, she -Have client -Helps individual
knows of her identify negative begin to understand
disease and is consequences of problems of
willing to be behavior by impulsive behavior.
treated. And she expressing own
has a calm tone of feelings and
voice, she wanted anxieties.
to answer every
questions I asked.” -Encouraged client -Provides
to become involved opportunity to earn
in group or new social skills
community and feel better
activities. about self.

Dependent:
-Administer
medications as
prescribed.
Collaborative:
-Collaborate with
treatment of
underlying
condition.
 Process Recording

Client Initials: MA
Age: 20 yrs old
Sex: Female
Date Of Birth: April 4, 1998
Address: San Mateo, Rizal
Physical Appearance: She is in casual clothes hair is short, nails are short, and with slippers

STUDENT QUESTIONS PATIENT RESPONSE

- Hello! Magandang Hapon. Ako po si Jill, student nurse. Hello po! Ako po ay si Mia.
Kayo po ba, pwede ko pong malaman ang iyong
pangalan?

- Maari po ba kayong sumagot sa mga itatanong kop o sa Sige

inyo?

- Alam niyo po ba ang dahilan kung bakit ka nandito? Opo, sabi po kasi ng doctor, may bipolar disorder daw po ako.

- Ilang araw ka nang nandito sa hospital? Mag iisang linggo na po.

- Anong pinagkakaabalahan mo bago ka ma-confine? Student po ako.

- Saan ka nag-aaral? Ano ang natapos mo? Sa PUP po ako nag-aaral at nakagraduate na ako ng high school.
Ngayon, engineering ang kinuha kong course.

- Estudyante, ka pala ng PUP, ano sa tingin mo ang dahilan Stress kasi ako. May itatanong ka pa ba?
ng pagkakaconfine mo ditto?

- Opo, Ano naman ang dahilan ng iyong stress? Sa school kasi kapag may activities, lalo na graduating ako, yung
feasibility namin ang daming pinapagawa.
- Nakakatulog ka ba ng maayos during your school days?
- Bukod sa activities nyo sa school, may iba pa bang
dahilan ng iyong stress?
- May mga pinagsasabihan ka ba ng iyong problema?
- Ano ginagawa mo kapag stress ka?
- Ito na rin ba ang simula ng iyong pag hallucinate?
- Sige. Iwan muna kita, balikan nalang kita ulit after mong
kumain.
 After 15-30 mins binalikan ko ang pasyente.
- Naalala mo ba yung mga ginagawa mo kapag ikaw ay
naghahallucinate?
- Ano daw yung mga bagay na naiisip mo nung mga araw
na naghahallucinate ka?
- Nung nandito ka na sa hospital may mga bagay ka pa rin
bang naiisip or naririnig?
Hindi, palagi nga akong puyat. Kasi gabing-gabi na ako
nakakauwi tapos pag-uwi sa bahay kailangan ko agad tapusin
mga assignments.
Yung mga kagroup ko kasi sa feasibility, hindi kami
nagkakaunawaan, ako lang gumagawa. Tapos nag-aaway away
kami. Tapos ako naman hindi ko nalang sila pinapansin kapag
nagkakainitan na kami. Tahimik nalang ako.
Wala, nagkukulong na lang ako sa kwarto.
Iiyak nalang ako sa kwarto. Tapos dumating yung araw na
sobrang napuno na lahat ng galit ko sa mga ka-group mates ko,
tapos bigla ko silang nasigawan sa school.
Yes! Ate kakain lang ako.
Sige.
Hindi, pero kinukuwento sa akin ni mama yung mga ginagawa
ko.
Nung araw bago ako dinala ditto, bigla kong nakita si mama sa
salamin na sobran ganda nya, tapos wala siyang pimples. Naiingit
ako sa beauty nya. Tapos minsan nagwawala daw ako, tumatalon
din ako sa kama, tapos biglang akong iiyak. Pagkatapos bigla ko
sisigawan yung mga pinsan ko, kahit si mama nasisigawan ko.
Nakikita ko na sobrang liwanag dun sa may isolation room,
parang malapit sa akin si Lord. Wala akong naririning. Ate may
itatanong ka pa ba?
- Nakakatulog ka na ba ng mahimbing ditto sa hospital? Hindi, kasi may mga langgam na gumagapang sa akin, minsan
kinakagat nila ako.

- Mia, siguro kapag nasstress ka lalo na sa school, makinig Sige po ate Jill. Hanggang kalian po kayo ditto?
ka ng music na makakagaan ng pakiramdam mo. Mainam
din na sabihin mo yung mga bagay na nararamdaman mo,
at yung mga sama ng loob mo. Hindi rin maganda sa
kalusugan natin yung hindi tayo nagsasabi ng mga sama
ng loob natin.

- Hanggang Friday lang po kami. Ahh. May itatanong ka pa ba?

- Wala na, Maraming Salamat sa cooperation mo.  Thank you din po ate.
 Psych ward Nursing
Process Bipolar disorder

Submitted by:
Eugena Jill V. Trajano

Submitted To:
Sir Gaudymer Lopez

December 14,2018