bipolar medication
Diagnosis of Bipolar Disorder: "Bipolar disorder is a severe biological illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed, separated by periods in which mood is relatively normal. "(Klaus-Heiner Lehne, 2004, p. 321)
The following is a brief synopsis according to DSM-IV-TR, "Criteria for Bipolar Disorder" includes a distinct period of abnormally and persistently elevated, expansive or irritable mood for at least:
– 4 days of hypomania
– The week of mania
During the mood disturbance, at least three or more of the following symptoms persist and have been present a significant degree:
– Inflated self-esteem or grandiosity
– Decreased need for sleep
– More talkative than usual or pressure to keep talking
– Excessive involvement in leisure activities that have a high potential for painful consequences. "(American Psychiatric Association [APA], 2000).
The psychodynamics of the disease the onset of illness usually occurs during late adolescence or twenty-five. However, the disease has been known to occur up in the fifth decade of life. Mood swings that accompany this disorder are of several types. These are: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,
Impairment of normal social functioning usually require hospitalization; hypomanic, as evidenced by a milder form of mania pure, without loss of normal operation requiring hospitalization; Major depressive episodes characterized by depressed mood that consists of symptoms such as anhedonia, apathy, Alogia, affective flattening and thoughts of suicide and death, the last episode associated with bipolar disorders is mixed episode in which "patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts in significant risk of suicide. "(Klaus-Heiner Lehne, 2004, p. 321)
Case Presentation
A white woman in her twenties to mid showed signs and symptoms of self mutilation with a straight edge razor inflicted wound through of the lower abdomen approximately six inches below the navel. The depth of the wound only stopped at the abdominal fascia. The patient was sent from the emergency room to the psychiatric floor. Upon meeting the patient one day after its entry into the ER, she appeared dressed in pajama pants and a shirt, shuffling down the aisle in his socks. She was holding her abdomen with one hand and appeared in some discomfort. His black hair was short and disheveled. When the patient came to his room, sat on his bed. He acknowledged with blunted affect that I can stop the mutilation, and described how she cut through the muscles of your abdomen almost to the fascia. His voice was tremulous and fast. This could be due to the fact that he had just received their first dose of Clozaril. He said his mouth was dry and had to take a little water. She then went on to say he was getting very sleepy. The client feels comfortable with the interview.
She shared the personal information about being sexually abused by his annoyance that begins at the age of seven until the age of fifteen. His brother was two years older she died in a car accident at age eighteen. She continued that her mother never knew or acknowledged the sexual abuse and could not tell because the mother idolized the son. The client was receptive to new cognitive frame, however was very critical of herself and said she felt worthless and ashamed. Seemed very tired and said she wanted to sleep.
Table 1
Features textbooks bipolar disorder versus client characteristics observed
Textbook Features:
Pure Manic Episode
Hypomanic
Major depressive episode —
Affective flattening
Alogia
Avolition
Anhedonia
Mixed Episode
Rapid cycling bipolar disorder: patients experience four or Client
Features observed:
There are no current symptoms
Rapid breathing, rapid speech, however, due to medication a client at the same time are presented lethargy
Customer acknowledges sadness / worthlessness
Flat facial expression
Thoughts of death, hard to focus
Hair / clothes unkempt
Not stated interest in children or self
Customer Symptoms
1. Hypomania
2. Depression
a.) Affective flattening
b.) Alogia
c.) The lethargy and apathy
d) Anhedonia
3. Mixed Episode
4. Rapid cycling
(Varcarolis, 2004, p. 485)
Interventions Nursing
1. Note that the client every 15 minutes while suicidal, remove all dangerous, sharp objects in the room.
2. Strengthening the worth,
a.) Assist the client in evaluating the positive and negative aspects of his life
b) Encourage the appropriate expression feelings of anger.
c) Schedule regular periods of time during the day for occupational therapy / recreation, encourage client to groom self, offer praise for completing grooming.
participation d.) Ensure the client in taking mood stabilizing medications. Monitor client to swallow the medication.
3. Involving clients in interpersonal therapy, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and episodes of the magazine.
Table 2
Medical interventions, bipolar disorder
Drug therapy using
Mood stabilizer
Antidepressants
Antipsychotics
Education and Psychotherapy
TEC
(Varcarolis, 2002, p. 483)
Customers medical interventions
Drug therapy includes
Lithium 300mg every hs
Not taking any Clozaril
Client is receiving psychotherapy, family therapy, group therapy, while in the hospital, and the cognitive restructuring.
None
References
Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders
Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. Pennsylvania: Saunders
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Bipolar Medication change Lithium to Carbamazepine/Tegretol personal experience
