36. Rehabilitation or treatment of patients with bipolar disorders should be directed toward several goals: First, safety must be guaranteed. Second, a complete diagnostic evaluation of the patient is necessary. Third, a treatment plan that addresses not only the immediate symptoms but also the patient’s perspective well-being should be initiated.
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48. NURSING CARE PLANS Risk for Suicide Anxiety Noncompliance Powerlessness Interrupted Family Processes Impaired Sexual Patterns Ineffective Coping Disturbed Thought Process Chronic Low Self Esteem Impaired Social Interaction
49. Risk for suicide attempt due to depression and feelings of rejection
50. The client’s depression may be rooted from the faulty family dynamics that the client experienced early on. These included her perceived loss of her father, causing her to blame herself and turn this anger inward; as well as her inability to achieve the extraordinarily high ideals her mother imposes on her. Ultimately, the client feels worthless and empty, urging her to take her own life. Her intense unstable relationships in her search for an identity which ends up in feelings of rejection from the other party threatens the client due to her fear of abandonment. Because of this, she commits suicide and other self-mutilating actions in order to avoid this feeling.
51. After 6 hours of nursing intervention, patient will: 1. Be safe from harm. 2. Verbalize her feelings and thoughts regarding her current situation and about suicide. After 6 weeks of nursing intervention, patient will: 1. Deal effectively with her thoughts and emotions that contribute to her suicidal ideations. 2. Be able to decide that suicide is not the answer to solve her problems. 3. Find alternative ways in controlling and expressing her emotions.
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56. After implementing the interventions, the client was free from any harm. She was able to recognize her difficulties by openly saying her stories. Especially her hate to her mother. Client was able to open up her emotions to her mother which reconciled them both. She was able to see clearly that suicide was not the answer to her problems and eventually forgave everyone. The client found other outlets to express he emotions such as journal writing and painting. NCPs
58. Cognitive processes include those mental processes by which knowledge is acquired. These mental processes include reality orientation, comprehension, awareness, and judgment. A disruption in these mental processes may lead to inaccurate interpretations of the environment and may result in an inability to evaluate reality accurately.
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62. O bjective: The patient was noted to have crying spells in the middle of the night
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67. Within one week, the client is able to recognize when perceptions within the environment are inaccurate. T here was also decreased verbalization of inaccurate sensory perceptions. She responded positively in correcting inaccurate perceptions and restoring reality to the situation. Within 6 weeks, the client was fairly kempt, oriented to time, place and person, with appropriate mood and affect. She had no hallucinations and suicidal ideations. She actively participated in daily therapy and activities . She was able to maintain reality through reorientation and focusing on real situations and people. NCPs
69. Powerlessness is a perception that one's own action will not significantly affect an outcome. It is the perceived lack of control over a current situation or happening. Powerlessness occurs among clients with bipolar disorders (currently on depression) and borderline personalities. The client experiences an alteration in cognition in which they have a depressed mind filled with anxiety, doom and gloom, and fear. They think that their own action will not significantly affect the outcome of things.
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74. Within the day, the patient was able to verbalize her own feelings and perceptions that contribute to her feeling of powerlessness over her own thoughts. She discussed what she did when she is feeling sexually attracted towards her sister. After a week, the patient was able to verbally express a feeling of control over her own sexual tendencies, stating that she knows that she has choice and she can choose not to act on such thoughts. She is aware that she is responsible for her own actions. She said that the next time she is in such situation; she will deal with it by putting mind over matter. NCPs
75. Interrupted family processes related to situational crises of having a broken family and a lack of support mechanisms
76. Before the client turned one year old, she was left by her parents to her grandmother, who brought her up. She grew up to the reality that her biological father was dead (even though he wasn’t) and her mother having different boyfriends every time. She had same sex preferences which led to her rejection from her church community, school and the like. Every time she would verbalize something wrong that happened to her, she would just get scolded. She never had the support she needed. All these factors contributed to the family’s altered processes which results to the prevention of the development of the family.
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83. Ineffective sexual patterns related to perceptions of own sexuality as evidenced by inappropriate sexual behaviours
84. Sexual Patterns, Ineffective: Expressions of concern regarding own sexuality Early in her life, patient had already developed homosexual preferences. She had been preoccupied with ideations of sexual intimacy with people of the same gender. She has 3 sisters, whom she did not grow up with. When her eldest sister showed more support and care towards her, she then grew fond of her and pt. started to develop special intimate feelings towards her sister.
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90. After three days, the client was conversant and was able to express her thoughts and feelings concerning her sexual desires. After three weeks, she employed diversionary activities that help her express sexual ideations in a healthy way. She displayed good insight and judgement as evidenced by her awareness of wrong behaviours she displayed. Her preoccupation on lustful acts was decreased. She actively participated in daily therapy and activities. NCPs
92. As the client was growing up, there were a lot of stressors that she experienced. She was rejected several times (by her eldest sister, Laureen, grandmother), high expectations of mother and did not have the attention she needed while she was growing up because of having an incomplete family. All these contributed to the client’s moderate anxiety: limited awareness of environmental stimuli, increased concentration, narrower perceptions.
101. Patient experienced constant disapproval from her mother by constantly putting her down whenever she commits a mistake. Also her mother makes all the decision for her. She was also constantly left alone by the ones whom she admired because of her homosexual feelings towards them.
102. After 6 hours of nursing intervention, patient will: 1.Verbalize understanding of negative evaluation of self and reason for the problem 2.Verbalize thoughts about self worth After 6 weeks of nursing intervention, patient will : 1.Participate in treatment program to promote change in self-evaluation 2.Demonstrate behaviour changes to promote positive self-image 3.Participate in family/group/community activities to enhance change
103. Subjectve: at age 14, patient verbalized, “walang ginawa ang nanay ko pakiramdam ko hindi niya ako mahal.” Objective: 1. transferred to public school because of the rumours that she was molested. 2. banned by the church for two times because of sexual indiscretion and attempted suicide.
104. 1. identify family dynamics- present and past- and cultural influences. 2 discuss client perceptions of self-related to what is happening; confront misconceptions and negative talk 3. emphasize need to avoid comparing self with others. Encourage client to focus on aspects of self that can be valued. 4. Have client list current/past success and strengths 1. Family may be engaged in “put-downs” or “teasing” 2. Addressing these issues openly provides opportunity for change. 3. May help client see that he or she can develop an internal locus of control by recognizing these aspects of themselves 4. Assist client to develop internal sense of self-esteem
105. 5. use positive I-messages rather than praise 6. set limits on aggressive behaviour such as suicide attempts, preoccupation and rumination. 7. give reinforcements on progress noted 8. assist client to identify goals that are personally achievable 5. Raises the client's self esteem 6. Negative behaviours diminish sense of self-concept 7. Positive words of encouragement promote continuation of efforts, supporting development of coping behaviour 8. Increase likelihood of success and commitment to change
108. Some of the characteristics of the client’s disorder are impulsivity, elevated mood and attention seeking behaviour. The patient is impulsive which means that she acts on the slightest whim. This can be difficult for others because a person who is impulsive may have urges to say or do things which are socially unacceptable. The client also exhibits attention seeking behavior which is burdensome even for her relatives since it is time and energy consuming.
109. Within 3 days, the client shall be able to: 1.Observe own behavior in social interaction 2.Express thoughts and feelings regarding social interaction 3.Verbalize awareness of change in social interaction 4.Identify specific behavior that lead to poor social interaction 5.Express desire to be involved in achieving positive changes in social behaviours and participate in behavioral therapy before discharge, the client will be able to: 1. Comply with medications and treatment regimen 2. Achieve positive changes in social behaviourand interpersonal relationships
110. Subjective: -Verbalized that she has poor impulse control and gets easily frustrated -suicidal ideation, “ naglaslas ako nung naghiwalay kami” “ Ang mga sugat ko ako nagslash niyan sa hands ko, di ko kasi makontrol sarili ko” Objective: -Manipulation of conversation -attention seeking behavior -sexually preoccupied -loner who easily gets irritated and depressed
111. 1 . Observe and describe social behaviours in objective terms, noting speech pattern and body language. 2. Encourage client to verbalize perception on changes in social interaction. 3. Encourage the client to verbalize negative self concepts 1. Helps identify the kind and extent of problems the client is exhibiting. Allows the nurse to identify which social skills need to be enhanced or learned. 2. To identify and to help the client resolve negative self concepts . 3. Enhances comfort with new behaviours
112. 4. Role play random social situations. Start with one on one role playing with the nurse then small group interactions and then proceeding to large groups 5. Provide positive reinforcement for improvement in social behaviour. . 4. Allows the client to learn how to behave in social activities. Proceeding from simple to more complex interactions enhances learning and makes it less stressful for the client to adapt, 5. Encourages continuation of desired behaviours and efforts to control self.
113. Within 3 days the client was able to: -verbalize “kapag di maganda yung pakiramdam ko sa barkada hindi ko sinasamahan. Kapag din seryoso seryoso. Walang personalan pagdating sa mga trabaho.” -verbalize about the leadership seminar ” Nagsimula na akong magpa-pansin. May grandiose kasi ako nu’n. lagi akong nagtataas ng kamay kapag nagtatanong yung speaker. Lagi akong nagsasalita. Lahat ng contest noon sinalihan ko at very competitive din. Two poems na nagawa ko ay napublish. Pinagalitan ako ng mga fellow delegates noon kasi masyado daw akong mayabang. Sumama loob ko. Pagkauwi ko hindi na ako makatulog. Sobrang restless ko na. hindi ako mapakali. -Actively participate in daily therapy and activities and make several artworks which she bragged about to others. before discharge the client was able to: -show reduced symptoms of bipolar disorder and BPD - Reconcile her feelings with her mother. NCPs
115. Client does not adhere to prescribed therapeutic regimen due to stressful life events leading to client’s perception of lack of social support. Due to lack of constant monitoring and proper encouragement regarding treatment, the client avoid compliance and at certain instances, even alters it signifying protest regarding an existing conflict between her and the primary care provider, or close people in her environment.
116. After one week, patient will be able to: 1)Understand the necessity of following prescribed therapeutic regimen 2) Voluntarily follow the schedule of taking the prescribed medications After one month, the patient will be able to: 1) Strictly comply to the prescribed schedule of taking her medications as evidenced by: increased therapeutic effect, maintained appoinments and reduced, if not absent, re-admissions.
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118. 1. Resolve existing conflicts between the patient and her provider (mother, eldest sister) 2. Discuss importance of complying with prescribed therapeutic regimen in her well-being 3. Facilitate close monitoring of the client by supervision of taking of medications and having regular pill counts. 4. As compliance improves, gradually reduce the amount of professional supervision and reinforcement. 1. This will aid in removing the barrier that restricts the patient from following the treatment plan accordingly. 2. To set standards for the client to be more encouraged in taking her medications 3. This will make the client aware of the necessity of following therapeutic regimen and thus, setting the limits as to her behavior towards such. 4. This will allow the client to develop her own sense of responsibility in taking her medications. This will also foster independence on her part.
119. The client during her stay in the ward was observed to have reduction in the severity to total absence of her symptoms. Through the later days prior to being ordered to be discharged, she was openly conversant and had a very good insight regarding her condition. She was euthymic. There were no reports of hallucinations, delusions and suicidal ideations since December 31,2011. She was appropriately reminded of her therapies and medications. She was ready for discharge by January 12, 2011. NCPs
121. One-year risk of psychiatric hospitalization and associated treatment costs in bipolar disorder treated with atypical antipsychotics: a retrospective claims database analysis BMC Psychiatry 2011
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123. Borderline Personality Disorder: Brain Differences Related to Disruptions in Cooperation in Relationships Science Update August 12, 2008
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127. How Is Bipolar Borderline Personality Disorder Diagnosed? By Ben Paul
141. DSM-IV-TR Diagnostic Criteria Borderline Personality Disorder A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. frantic efforts to avoid real or imagined abandonment. Note : Do not include suicidal or self-mutilating behavior covered in Criterion 5. 2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. identity disturbance: markedly and persistently unstable self-image or sense of self. 4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note : Do not include suicidal or self-mutilating behavior covered in Criterion 5.
142. DSM-IV-TR Diagnostic Criteria Borderline Personality Disorder 5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. chronic feelings of emptiness 8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 9. transient, stress-related paranoid ideation or severe dissociative symptoms
