Faculty of Health Sciences

Department of nursing
Tripoli Campus

Psychiatric and mental health

NURS 419

Case Study

Prepared By: Razan Nasereddine

ID: 201803107
Dr’s Name: Maha Dankar

Date: 21/12/2019
Outline:

1. Disease report
2. Subjective assessment
3. Care plan

1. Disease report:

 Definition:

Bipolar I disorder and also known as manic-depressive disorder or manic depression is a

form of mental illness. A person affected by bipolar I disorder has had at least one manic
episode in his or her life. A manic episode is a period of abnormally elevated mood and
high energy, accompanied by abnormal behavior that disrupts life.

 Types:

According to the American Psychiatric Association, there are four major categories of
bipolar disorder: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar
disorder due to another medical or substance abuse disorder.

 Causes:

Bipolar disorder seems too often run in families and there appears to be a genetic part to
this mood disorder. There is also growing evidence that environment and lifestyle issues
have an effect on the disorder's severity. Stressful life events -- or alcohol or drug abuse
-- can make bipolar disorder more difficult to treat.

People who experience traumatic events are at higher risk for developing bipolar
disorder. Childhood factors such as sexual or physical abuse, neglect, the death of a
parent, or other traumatic events can increase the risk of bipolar disorder later in life. ...
Lack of sleep can also increase risk of a manic episode
 Who Is at Risk for Bipolar I Disorder?

Virtually anyone can develop bipolar I disorder. About 2.5% of the U.S. population
suffers from bipolar disorder -- almost 6 million people.

Most people are in their teens or early 20s when symptoms of bipolar disorder first
appear. Nearly everyone with bipolar I disorder develops it before age 50. People with an
immediate family member who has bipolar are at higher risk

 Abnormal behavior during manic episodes includes:

Flying suddenly from one idea to the next

Rapid, "pressured" (uninterruptable), and loud speech

Increased energy, with hyperactivity and a decreased need for sleep

Inflated self-image

Feeling hopeless, sad, or empty.

Substance abuse

 How long does a bipolar episode last?

Untreated, an episode of mania can last anywhere from a few days to several months.
Most commonly, symptoms continue for a few weeks to a few months. Depression may
follow shortly after, or not appear for weeks or months. Many people with bipolar I
disorder experience long periods without symptoms in between episodes

 Can bipolar go away?

Everyone goes through normal ups and downs, but bipolar disorder is different. The
range of mood changes can be extreme. Occasionally, bipolar symptoms can appear in
children. Although the symptoms come and go, bipolar disorder usually requires lifetime
treatment and does not go away on its own.
 How often do mood swings occur in bipolar?

This change or “mood swing” can last for hours, days, weeks, or even months. Typically,
someone with bipolar disorder experiences one or two cycles a year, with manic episodes
generally occurring in the spring or fall.

 How to diagnose a bipolar

However, most lab tests or imaging tests are not useful in diagnosing bipolar disorder. In
fact, the most important diagnostic tool may be talking openly with the doctor about your
mood swings, behaviors, and lifestyle habits.

While a physical examination can reveal a patient’s overall state of health, the doctor
must hear about the bipolar signs and symptoms from the patient in order to effectively
diagnose and treat bipolar disorder.

 Treatment:

Typically, treatment entails a combination of at least one mood-stabilizing drug and/or

atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment
of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote
or generically as divalproex).

2. Subjective assessment:

 Relating bipolar disorder to my patient:

My patient has bipolar disorder where she suffers from depression and she had a relapse
17 times till now.

She started having the bipolar disorder for the first time when she was twenty three years
old where in the risk factors of this disorder is that it starts at the age of twenties.

She also faced sexual abuse when she was eight years old.
When my patient became 14 years old ,there was a political conflict in the city and her
family faced problems where she started to feel hyperactive.

My patient also has a family history of bipolar where her aunt has it and her sister too.
During manic episodes, my patient suffer from the sign of feeling sad and hopeless and
empty.

My patient had the last relapse of bipolar for 3 months before she admitted to the hospital

My patient had mood swings where she was sad and depressed then suddenly she
became hyperactive

 Cause of admission:

Patient admitted to HPC Hospital in 18/7/2019 through the admission door with her
family under the psychologist doctors named Dr Dory Gergi

Admitting diagnosis: Bipolar type 1 and mixed mania

Medical observation on entry: depression and sadness

 Symptoms of admission:

Depression and sadness

Emotional

Isolated

Persecution

Aggressive

Hopeless

 Current condition and signs of patient:

Patient seems to be conscious and a little bit irritable and depressed and being sometimes
emotional and sad
 Medications taken before:

Rivotrile 0.5mg ½ capsule at night

Depakine 500mg 3 at night

 Current medications:

Prometal 25 mg 3/day

Valium 5mg 3/day

Manicarb 400 mg 1/day

Chlorpromazine ½ mornings ½ at lunch and 1 at night

3. Nursing diagnosis:

1. Hopelessness related to bipolar syndrome as evidenced by verbal behavior

2. Rape trauma syndrome related to child sexual abuse as evidenced by physician
report
3. Depression related to signs of bipolar disease as evidenced by patient behavior
4. Social isolation related to mood swings as evidenced by patient behavior
5. Risk for suicide related to loss of hope and chronic depression
6. Risk for self-directed violence related to sadness
7. Risk for loneliness related to sadness and depression
8. Risk for other directed violence related to problems with family
9. Risk for spiritual distress related to lack of support
10. Risk for compromised human dignity related to lack of family support and family
problems
Nursing diagnosis Outcome
1. Hopelessness related to  Patient expresses the
bipolar syndrome as will to live.
evidenced by verbal  Patient verbalizes
behavior feelings and participates
in care.
 Patient displays positive
future orientation.
Intervention
Nurse interventions:
 Encourage a positive
mental perspective,
discourage negative
thoughts, and brace
patient for negative
results.
 Provide openings for the
patient to verbalize
feelings of
hopelessness.
 Manage to have
consistency in staff
appointed to care for the
patient.
 Assist patient with
looking at options and
establishing goals that
are relevant to her.
 Encourage the patient to
recognize his or her own
strengths and abilities.
 Work with the patient to
set small, attainable
goals.
 In collaboration:
administer medications
 as prescribed
2. Rape trauma syndrome Patient displays resolution  Support the survivor’s
related to child sexual of anger, guilt, fear, expression of sentiments
abuse as evidenced by depression, low self-esteem. and need to talk about
physician report the sexual assault. Show
care attention, respect,
and attending without
judgment. Avoid
statements and
interrogations that may
be interpreted as
attacking or blaming the
survivor.
 Patient displays
resolution of anger,
guilt, fear, depression,
low self-esteem.
 Patient displays
resolution of anger,
guilt, fear, depression,
low self-esteem.
 Patient displays
resolution of anger,
guilt, fear, depression,
low self-esteem.
 In collaboration
:administer medications
as prescribed
3. Depression related to  Patient will seek help
signs of bipolar disease when experiencing self-
as evidenced by patient destructive impulses.
behavior  Patient will have a
behavioral
manifestation of absent
depression.
 Patient will have
satisfaction with social
circumstances and
achievements of life
goals
4. Social isolation related  The patient may
 Encourage clients to
express feelings (anger,
sadness, guilt) and come
up with alternative ways
to handle feelings of
anger and frustration.
 Ask the patient about
the losses that happen in
his or her life. Discuss
how the patient view
them.
 If indicated, mention
stories of how others
have dealt with the same
experience.
 Assist the patient in
recognizing early signs
of depression and
identify methods to
mitigate these signs.If
the symptoms persist or
worsen, suggest other
professional support.
 Assist the patient to
determine the problem,
recognize the need to
address the problem
differently, and
thoroughly describe all
facet of the problem
 Show the acceptance by
 to mood swings as demonstrate a desire to
evidenced by patient socialize with other
behavior people.
 The patient can follow
the group activity
without prompting.
5. Risk for suicide related  Patient will refrain from
to loss of hope and attempting suicide.
conducting frequent
contacts, but brief.
 Show a positive
reinforcement to the
patient.
 Accompany the patient
to show support for
group activities that
may be the case that
scary or difficult for the
patient.
 Honest and keep all
appointments.
 Orient the patient at the
time, people, places, as
Be careful with the
touch. Let the patient
got an extra room and
the opportunity to leave
the room if the patient
becomes so anscious
 In collaboration: Give
the drugs, according the
patient's treatment
program.
 Monitor the
effectiveness and side
effects of drugs.
 Encourage the client to
talk freely about
chronic depression  Patient will make a no- feelings and help plan
suicide contract with the alternative ways of
nurse covering the next handling
24 hours, then disappointment, anger,
renegotiate the terms at and frustration.
that time (If in hospital  Weapons and pills are
and accepted at your removed by friends,
institution). relatives, or the nurse.
 Patient will remain safe  Keep accurate and
while in the hospital, thorough records of
with the aid of nursing client’s behaviors
intervention and support (verbal and physical)
(if in the hospital). and all
nursing/physician
actions.
 Put on either suicide
precaution or suicide
observation
 In collaboration: If
anxiety is extremely
high, or client has not
slept in days, a
tranquilizer might be
prescribed. Only a 1 to 3
day supply of
medication should be
given.