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Bipolar Patho Phys Sheet

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NUR Patho for Bipolar Disorder
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  CURRENT MEDICAL DIAGNOSIS: Bipolar Personality Disorder DEFINITION OF CURRENT MEDICAL DIAGNOSIS: Mental disorder !arateri ed #y alternation o$ %ani and depressi&e states SOURCE:    '''' Essentials o$ Psy!iatri Mental (ealt! N)rsin* + , nd  ed- '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' PAT(OP(.SIOLOG.:Bipolar re$ers to t!e e/periene o$ #ot! poles o$ %ood: %ania and depression- People0it! Bipolar Disorder1 $or%erly alled manic-depressive disorder   1 !a&e e/periened at least one%ani episode or one %i/ed %ood episode 20it!rapid ylin* o$ depression and %ania in t!e sa%eday3- Us)ally t!ese indi&id)als !a&e alsoe/periened one or %ore %a4or depressi&eepisodes- O&erall1 %ost people0it! #ipolar disorder e/periene %ore depressi&et!an %ani episodes- A %ani episode is a distint period o$ a#nor%al and persistently ele&ated1e/pansi&e1 or irrita#le %ood1 lastin* at least 50ee6- T!e %ood dist)r#ane is s)$$iiently se&ereto a)se %ar6ed i%pair%ent in o)pational$)ntionin* or relations!ips 0it! ot!ers or toneessitate !ospitali ation to pre&ent !ar% to sel$ or ot!ers- First episode )s)ally in ,78s1 a$$etin*0o%en and %en e9)ally-  Types: Bipolar I1Bipolar II1 (ypo%ania1 Bipolar NOS- ETIOLOG.:CLINICAL MANIFESTATIONS 2Si*ns ; Sy%pto%s3:Mani: elation1 e)p!oria1 )n)s)ally *ood- Constant1indisri%inate ener*y and ent!)sias%- Alternates #et0een elation and irrita#ility- Grandiose del)sions< #elie&in* lient is $a%o)s or as)per!ero- Dereased need $or sleep- A0a6e !o)rsearlier t!an )s)al $eelin* alert and ener*eti- Rapidand press)red spee!- Disor*ani ed1 rapid t!o)*!ts- Easily distrated- Poor 4)d*%ent- May !a&e!all)inations- Indeisi&e1 e/essi&e=onstant %otor ati&ity1 poor n)trition1 lo)d1 !ostile1 ra*e reations- Manip)lati&e1an*ry1 i%p)lsi&e- Rain* t!o)*!ts1 pro&oati&e #e!a&iors- LAB=RADIOGRAP(IC FINDING USUALL.PRESENT:MEDICAL MANAGEMENT2Inl)de Treat%ents ; Mediations3:Antidepressants *i&en 0it! eit!er lit!i)% or di&alproe/ !a&e #een e$$eti&e- Moodsta#ili ers 2anti%ani a*ents31 antion&)lsants2%ood sta#ili ers31 #en os1 antipsy!otis-Psy!ot!erapy1 )s)ally d)rin* re%issions solients are onentratin* properly- Gro)pt!erapy 0!en t!e a)te p!ase o$ %ania or depression !as passed- Monitor !ydration< 6eep0ell !ydrated- Get s)$$iient sleep=rest-Sel)sion or restraints i$ patient is dan*ero)s- Meds: Lit!i)%1 Depa6ote1 Te*retol1 La%ital1 >lonopin1 Ati&an1 Sy%#ya/- ECT $or se&ere %ani #e!a&ior 2s)iidal1 no reation to lit!i)%1 rapid ylin*3- DISC(ARGE PLANNING2Client Ed)ation3:Sy%pto%s o$ i%pendin* episodes1 s)! as 5  T!e #rain ne)rotrans%itters norepinep!rine anddopa%ine are i%pliated in t!e a)se o$ %aniepisodes- T!e sa%e %onoa%ine ne)rotrans%itters0!ose dereased ati&ity is i%pliated indepression are inreased in %ania- (or%ones alsointerat 0it! ne)rotrans%itters in %ood disorders-(ypot!yroidis% is orrelated 0it! depression and0it! rapid ylin* o$ %ood #et0een depressionand %ania- Any *i&en %ani episode is li6ely to$ollo0 a stressor- Disordered sleep 2s)! ase/periened 0!en tra&elin* aross ti%e ones or 0or6in* t!e ni*!t s!i$t3 %ay #e a tri**er-  '''''''''''''''''' Mood Disorder ?)estionnaire $or sreenin*- C!arateristis o$ %an)a and depressi&e %oodso#ser&ed- Cyles o$ depression=%ania present 0it! possi#le periods o$ nor%al $)ntion in #et0een-Aordin* to DSM1 at least @ riteria %)st #e %et:!yperinso%nia1 e/essi&e tal6in*1 $li*!t o$ ideas1distrated easy1 ris6 ta6in* ati&ity in&ol&e%ente/essi&ely- !an*es in sleep pattern- Esta#lis! re*)larity insleepin*1 eatin*1 e/erise- Li$e<lon* need $or %ood sta#ili er- E/peted side e$$ets o$ %ediations &s to/i side e$$ets- Stay a0ay$ro% alo!ol1 dr)*s1 a$$eine1 so%e OTC %eds-  CLIENT DEVELOPMENTAL STATUS ,  For each of the following theorists, ientif! the e elo#$ental stage of the client accoring to age% Then note the e&#ecte e elo#$ental tas's for that stage (i%e%, )re#ro*ction an creati it!+ for Fre*s Genital, post-puberty   stage-% Ne&t, note how the client is acco$#lishing these e elo#$ental tas's while in the hos#ital setting% .ow is this hos#itali/ation affecting their #s!chosocial stat*s at ho$e0 1o* o nee to incl*e Piaget entr! e en for a*lts,since cognition can 2e a ersel! affecte 2! illness, e$entia, $eications, anesthesia, e elo#$ental eficits, etc%   (The e elo#$ental tas's nee to 2e incl*e in the conce#t $a#-% Freud Genital Stage: Puberty and after - Energy is directed toward full sexual maturity and function and development of skills needed to cope with the environment Encourage separation from parents! achievement of independence! and decision making y patient is really struggling with this stage right now She may have previously met it! but now is having trouble She is unable to be completely independent and reports having trouble with everyday tasks such as grocery shopping! paying bills! and even cooking She has a lot of trouble coping and has fre#uent episodes of mania $ depression brought on by the extra stress of personal situations at home Erickson aturity: %& and over ' (ntegrity vs )espair- *cceptance of worth and uni#ueness of one+s own life *cceptance of death ,EG*(.E: Sense of loss! contempt for others She has definitely met the negative resolution of this stage She repeatedly spoke about being depressed and angry She felt a sense of loss because of her husband+s accident and current health She commented on feeling lonely and not having friends or family nearby She was overwhelmed with responsibilities and has definitely not shown signs of acceptance of her own worth Piaget Formal /peration Phase: 00 to 0& ' 1ses rational thinking 2easoning is deductive and futuristic his patient is currently not meeting this stage appropriately while in the hospital She does not think rationally! even aside from her hallucinations Shehas a diagnosis of bi-polar disorder! which most definitely affects her thinking and reasoning 3er priority is her pain and she only cares about making itgo away! not how it oes away She asked for drugs and stated it would make everything better She has high anxiety and a history of depression  BRAINSTORMING LISTS  @  O#4eti&e DataS)#4eti&e DataN)rsin* Dia*noses 2All yo) an t!in6 o$3MRI:Coaine a#)seRis6 $or In4)ryPoor inspiratory e$$ortre6ed ar a$ter %edsRis6 $or ioleneS)#se*%ental AteletasisTal6in*=seein* sel$ at !o%eDist)r#ed T!o)*! ProessC> ,@ 2(3DepressedDist)r#ed Sensory PereptionA<$i#: No P a&eTossin* ; t)rnin* all ni*!tI%paired Soial InterationFli*!t o$ ideasLi&es aloneInso%niaConstant %o&e%entNo $a%ily s)pport=!elpInterr)pted Fa%ily Proesses(/: COPDTro)#le ad4)stin*  !o%eAti&ity IntoleraneDepressionDi$$- ta6in* on ne0 responsi#ilitiesAn/ietyDDDI%paired Co%$ortea6Dist)r#ed Ener*y FieldBr)isin* on $ae=ar%s=le*sRis6 $or FallsE!y%osisI%paired Gas E/!an*eA*itated easilyC!roni PainE/essi&e tal6in*Dist)r#ed Sleep PatternSoial IsolationI%paired (o%e MaintenaneAltered Tiss)e Per$)sion
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