Care of Clients with Bipolar Disorders na kanang mangisog niya mukalit lang hilak or katawa

out of nowhere without context or warning.

But in this presentation, the colloquial term bipolar is

Let us put ourselves in the holy presense of God, as we actually different from bipolar disorder, that which our
adore His holy name. report is being centered over.
Let us pray, th Bipolar disorder, formerly known as manic-depression
Most gracious and Heavenly father, or manic depressive illness, is a mental health illness
that is classified as a mood disorder, or a disturbance to
We honor and acknowledge your presence with us how a person feels, that is manifested in patients by
today. We thank you for this new day that you have cycles or episodes of mania and depression ; causing
given to us and we thank you for all the blessings that marked shifts, mood, enery, and ability to function
you have showered upon us and for waking us up early
this morning to another new day of learning. Lord, we At some points of our life, we experience periods of
are sorry for all the sins that we have committed and for high and lows in. And that is normal, especially as
all the bad words and misdeeds that we have said and normal response to certain stimulus in the environment
committed against other people and to people we love. and they don’t usually persist or cause significant
As we begin our class with our classmates and teacher impairments to our normal day to day functioning. we
in NCM 56 this morning, may you guide our teacher and feel happy in response to achievements or
reporters who will be sharing their topics for today and accomplishments, and sad or down in response to
may you bless our classmates the knowledge and depressing situations. However, for people with bipolar
strength that they will need in order to learn something disorders, they experience dramatic shifts from extreme
new today. May you protect all of our friends, families, lows and extreme highs. And in contrast to our initial
and loved ones from harm. And please bless those who belief, these shifts in mood don’t happen moment to
are in need of your warmth and mercy especially those moment. They usually happen over several days, and
who are struggling with extreme hardships in their lives weeks, sometimes with periods of euthymia (or normal
today and in the coming days to come. May all of the mood), depending of the type of bipolar disorder .
things that we are going to do and accomplish today - Bipolar disorder or BPD is a chronic and
bring honor to your mighty name and All this we ask in recurrent mood disorder, and people having
the name of Jesus, your son and our Lord and Savior this mental disorder often periods of normal
===== functioning which may alternate with periods of
feelings of highs and lows, and sometimes even
Good morning Ma’am Bustillo and Good morning fellow both; which could lead to chronic interpersonal,
classmates. My name is Shirnyl Hannah Magos, and occupational, and sometimes functional
together with my groupmates, Sushmita Oracion, and difficulties even after remission
Cheska Pileo, we will be presenting to you our topic on - During manic phases, clients often express
the Care of Patients with Bipolar Disorder. So without feelings of elation, inflated self-esteem,
any further adeieu lets begin. grandiosity, hyperactivivity, agitation, and
accelerated thinking or flight of ideas. Because
So maybe from time to time we may find ourselves
of these feelings, they are always on the go, to
hearing other people use the term bipolar in regular
the point that they would never feel tired even
conversations to describe someone who is moody or
when they do, have lowered inhibitions, and
unpredictable. Kung sa ato pa, in other cases bipolar or
would do things to the extremes like
mga “tulukaron”. Probably the first thing that comes to
overspending, over dressing, and so on; Even
mind when you hear the word bipolar kay kanang tawo
though they persistently feel high during a
manic phase, patients with bipolar disorder
 however, have very labile affect; meaning they consequences (e.g., engaging in
may quickly change to hostility or sadness unrestrained buying sprees, sexual
indiscretions, or foolish business
especially in response to attempts of forcing
investments).
them to do something that they don’t want or
when ruminating on past failuers C. The mood disturbance is sufficiently severe
- During depressive episodes or phases, patients to cause marked impairment in social or
moods, behavior, thoughts, actions, and speech occupational functioning or to necessitate
hospitalization to prevent harm to self or
are the same as those in people diagnosed with others, or there are psychotic features. 
major depression; D. The episode is not attributable to the
- so, if a persons’ first episode of bipolar illness physiological effects of a substance (e.g., a
started or first identified on its depressed drug of abuse, a medication, other
treatment) or to another medical condition.
phase, patients are often misdiagnosed with
MDD and the diagnosis of bipolar disorder will In the lesser or milder extremes; instead of a
be made only when a manic episode emerges. manic episode, some patients would experience
hypomanic episodes instead of the full blown
To tell if a person with BPD is experiencing a Manic mania. Just like mania
episode, the following DSM V diagnostic criteria must
Hypomanic Episode
be met.
- in some cases, during hypomanic episodes,
A. A distinct period of abnormally and
people with bPD are usually attributed with
persistently elevated, expansive, or irritable
increased and enhanced functioning,
mood and abnormally and persistently
creativity, and productivity unlike mania.
increased goal-directed activity or energy,
lasting at least 1 week and present most of - as appealing as it may seem at first glance,
the day, nearly every day (or any duration if hypomanic episodes should still be treated
hospitalization is necessary). seriously as other bipolar episodes because
hypomania can easily progress to mania or
decline to a major depressive episode,
B. During the period of mood disturbance and which further puts patients at risk of
increased energy or activity, three (or more) harm/injuries not only to themselves but
of the following symptoms (four if the mood also to others
is only irritable) are present to a significant
degree and represent a noticeable change A. A distinct period of abnormally and
from usual behavior: persistently elevated, expansive, or irritable
1. Inflated self-esteem or grandiosity. mood and abnormally and persistently
2. Decreased need for sleep (e.g., increased activity or energy, lasting at least
feels rested after only 3 hours of 4 consecutive days and present most of
sleep).  the day, nearly every day.
3. More talkative than usual or B. During the period of mood disturbance and
pressure to keep talking.  increased energy and activity, three (or
4. Flight of ideas or subjective more) of the following symptoms (four if the
experience that thoughts are racing.  mood is only irritable) have persisted,
5. Distractibility (i.e., attention too represent a noticeable change from usual
easily drawn to unimportant or behavior, and have been present to a
irrelevant external stimuli), as significant degree:
reported or observed.  1.  Inflated self-esteem or grandiosity. 
6. Increase in goal-directed activity 2. Decreased need for sleep (e.g.,
(either socially, at work or school, or feels rested after only 3 hours of
sexually) or psychomotor agitation sleep). 
(i.e., puφoseless non-goal-directed 3. More talkative than usual or
activity). pressure to keep talking. 
7. Excessive involvement in activities 4. Flight of ideas or subjective
that have a high potential for painful experience that thoughts are racing. 
 5. Distractibility (i.e., attention too 5. Psychomotor agitation or retardation
easily drawn to unimportant or nearly every day (observable by
irrelevant external stimuli), as others; not merely subjective
reported or observed.  feelings of restlessness or being
6. Increase in goal-directed activity slowed down). 
(either socially, at work or school, or 6. Fatigue or loss of energy nearly
sexually) or psychomotor agitation.  every day. 
7. Excessive involvement in activities 7. Feelings of worthlessness or
that have a high potential for painful excessive or inappropriate guilt
consequences (e.g., engaging in (which may be delusional) nearly
unrestrained buying sprees, sexual every day (not merely self-reproach
indiscretions, or foolish business or guilt about being sick). 
investments).  8. Diminished ability to think or
C. The episode is associated with an concentrate, or indecisiveness,
unequivocal change in functioning that is nearly every day (either by
uncharacteristic of the individual when not subjective account or as observed
symptomatic.  by others). 
D. The disturbance in mood and the change in 9. Recurrent thoughts of death (not just
functioning are observable by others.  fear of dying), recurrent suicidal
E. The episode is not severe enough to cause ideation without a specific plan, or a
marked impairment in social or occupational suicide attempt or a specific plan for
functioning or to necessitate hospitalization. committing suicide. 
If there are psychotic features, the episode B. The symptoms cause clinically significant
is, by definition, manic.  distress or impairment in social,
F. The episode is not attributable to the occupational, or other important areas of
physiological effects of a substance (e.g., a functioning. 
drug of abuse, a medication, other C. The episode is not attributable to the
treatment). physiological effects of a substance or
another medical condition
Major Depressive Episode

A. Five (or more) of the following symptoms

have been present during the same 2-week Now you might be wondering, why does this
period and represent a change from happen? Like how and why do people end up
previous functioning; at least one of the getting bipolar disorders?
symptoms is either (1) depressed mood or
(2) loss of interest or pleasure.  Unfortunately, just like other mental health
1. Depressed mood most of the day, disorders, the exact etiology of BPD is still
nearly every day, as indicated by unknown, however there are several theories and
either subjective report (e.g., feels predisposing factors that can help us explain the
sad, empty, or hopeless) or development of BPD.
observation made by others (e.g.,
appears tearful).  Biological Factors
2. Markedly diminished interest or
pleasure in all, or almost all, 1. Genetics
activities most of the day, nearly
every day (as indicated by either - The bipolar disorders have a strong
subjective account or observation).  heritability (i.e., the influence of genetic
3. Significant weight loss when not factors is much greater than the influence of
dieting or weight gain (e.g., a external factors).
change of more than 5% of body - Incidence is 5-10 times higher for people
weight in a month), or decrease or with a  relative with bipolar disorder than in
increase in appetite nearly every the general population
day. - Associated with the genome that encodes
4. Insomnia or hypersomnia nearly DGKH (diacylglycerol kinase eta)
every day. 
- Abnormal circadian genes (CRY2), resulting during steroid therapy have reported
in a superfast biologic clock that manifests spontaneous recurrence of manic symptoms
as insomnia years later. Amphetamines, antidepressants,
- Irregularities in chromosomes 13 and 15 and high doses of anticonvulsants and
narcotics also have the potential for
initiating a manic episode (Dubovsky,
2. Neurobiological
Davies, & Dubovsky, 2003).
Mania: ↑ norepinephrine, dopamine and - c. Substance Intoxication and Withdrawal:
serotonin Mood disturbances may be associated with
Depression: ↓ norepinephrine, dopamine intoxication from substances such as
and serotonin alcohol, amphetamines, cocaine,
hallucinogens, inhalants, opioids,
 Receptor insensitivity despite having phencyclidine, sedatives, hypnotics, and
adequate amounts of these anxiolytics. Symptoms can occur with
neurotransmitters withdrawal from substances such as alcohol,
 Dysregulation in the neurocircuits
amphetamines, cocaine, sedatives,
surrounding the medial temporal
lobe and prefrontal cortex due to hypnotics, and anxiolytics.
structural changes in these areas

3. Neuroendocrine
Psychological Factors
The hypothalamic-pituitary-thyroid-adrenal
(HPTA) axis has been closely scrutinized in  perceived stressful events (e.g. loss of a
people with mood disorders. Hypothyroidism is relationship, financial difficulties, failing an
known to be associated with depressed moods exam, being accepted to a highly desirable
and is seen in some patients experiencing rapid graduate school, etc. 
cycling. In patients with treatment-resistant
bipolar disorder, a high-dose thyroxine may be Environmental Factors (pg. 277)
considered
 Prevalent in upper socio-economic classic
Physiological Factors  Higher among creative writers, artists,
highly educated men and women, and
. Neuroanatomical: professionals than the general population,
however, the exact reason is unclear
 stressful family environments, and adverse
- Right-sided lesions in the limbic system,
life events increase vulnerability among
temporobasal areas, basal ganglia, and children
thalamus have been shown to induce
secondary mania. Magnetic resonance Types of Bipolar Disorders
imaging studies have revealed enlarged third
ventricles and subcortical white matter and 1.   Bipolar I disorder
periventricular hyperintensities in clients
with bipolar disorder (Dubovsky, Davies, & -          characterized by at least one week-long
Dubovsky, 2003). manic episode that results in excessive activity and
- b. Medication Side Effects: Certain energy
medications used to treat somatic illnesses -          manic episodes may alternate with
have been known to trigger a manic depression or a mixed state of agitation and
response. The most common of these are the depression
steroids frequently used to treat chronic
illnesses such as multiple sclerosis and
systemic lupus erythematosus. Some clients
whose first episode of mania occurred
-          patients may have symptom-free periods, Signs and Symptoms
but because it is a severe disorder, patients end to
have difficulty maintaining social connections and 1. The affect of an individual experiencing a manic
employment episode is one of elation and euphoria—a continuous
“high.” However, the affect is very labile and may
-          psychosis (hallucination, delusions, and change quickly to hostility (particularly in response to
dramatically disturbed thoughts) may occur during attempts at limit setting) or to sadness, ruminating
manic episodes about past failures.
  2. Alterations in thought processes and communication
patterns are manifested by the following:

a. Flight of Ideas. There is a continuous, rapid shift

2.   Bipolar II disorder
from one topic to another.
-          not usually severe enough to cause serious
impairments in occupational or social functioning; b. Loquaciousness. The pressure of the speech is so
hospitalization is rare forceful and strong that it is difficult to interrupt
maladaptive thought processes.
-          low-level mania or hypomania alternates
with profound depressions c. Delusions of Grandeur. The individual believes he
or she is all important, all powerful, with feelings of
-          hypomania tends to be euphoric and often greatness and magnificence.
increases functioning
d. Delusions of Persecution. The individual believes
-          accompanied by excessive activity and someone or something desires to harm or violate him
energy for at least 4 days and involves at least 3 of or her in some way.
the behaviors listed in mania
3. Motor activity is constant. The individual is literally
-          psychosis is never present; depressive side moving at all times.
of the disorder puts the patient at risk for suicide
4. Dress is often inappropriate: bright colors that do not
  match; clothing inappropriate for age or stature;
excessive makeup and jewelry.
3.   Cyclothymic disorder

-          difficult to distinguish from bipolar II disorder 5. The individual has a meager appetite, despite
excessive activity level. He or she is unable or unwilling
-          symptoms of hypomania alternate with to stop moving in order to eat.
symptoms of mild to moderate depression for at
least 2 years in adults and one year in children 6. Sleep patterns are disturbed. Client becomes
oblivious to feelings of fatigue, and rest and sleep are
-          neither symptoms constitutes an actual abandoned for days or weeks.
diagnosis of either disorder, yet symptoms are
disturbing enough to cause social and occupational 7. Spending sprees are common. The individual spends
impairment large amounts of money, which is not available, on
numerous items, which are not needed.
-          individuals tend to have irritable hypomanic
episodes; marked by sleep disturbances and 8. Usual inhibitions are discarded in favor of sexual and
irritability in children behavioral indiscretions.
-          some persons experience rapid cycling and 9. Manipulative behavior and limit testing are common
may have at least 4 mood disorders in a 12-month in the attempt to fulfill personal desires. Verbal or
period; rapid cycling is associated with more severe physical hostility may follow failure in these attempts.
symptoms (e.g. poorer global functioning, high
recurrence risk, and resistance to conventional
somatic treatments)
10. Projection is a major defense mechanism. The Rationale: Clients in an hyperactive
individual refuses to accept responsibility for the state have difficulty sitting still long
negative consequences of personal behavior. enough for a meal. 

11. There is an inability to concentrate because of a e. Have nutritious drinks and snacks
limited attention span. The individual is easily distracted available in the unit all the time.
by even the slightest stimulus in the environment.
Rationale: Nutritious intake is
12. Alterations in sensory perception may occur, and required on a regular basis to
compensate for increased caloric
the individual may experience hallucinations.
requirement with hyperactivity.
13. As agitation increases, symptoms intensify. Unless
f. Regularly remind patient to drink.
the client is placed in a protective environment, death Offer decaffeinated drinks only.
can occur from exhaustion or injury
Rationale: Patients concentration is
1. Risk for injury r/t dehydration and faulty poor and can easily get distracted to
judgment as evidenced by inability to the point that they might forget to
meet own physiological needs and set drink water when thirsty. Constantly
limits on own behavior reminding and encouraging the
patient to drink promotes adequate
Independent fluid intake and hydration. Avoiding
caffeine-containing drinks such as
a. Monitor vital signs frequently q2h. coffee prevents excessive
hyperactive as caffeine is a CNS
Rationale: Monitor cardiac status and other
stimulant that could worsen
related complications brought about by
symptoms of mania. :
dehydration, fatigue, electrolyte imbalances,
etc. g. Monitor intake and output.
b. Provide a safe and quiet Rationale: To help monitor and ensure adequate
environment for the patient free of fluid and nutritional intake necessary for
any hazardous items and maintaining health and preventing diseases and
environmental stimulants. If possible complications. 
provide them in a private room.
h. Encourage the patient to take short
Rationale: Environmental stimulants rest periods (e.g. 3-5 minutes every
escalates mania and distractibility. hour) throughout the day whenever
Removing hazards in the possible
environment prevents accidental
injuries since client’s rationality is Rationale: Patients are unaware of feelings of
impaired during a manic episode. . fatigue and lethargy. Providing short and frequent
rest periods throughout the day prevents sudden
c. Offer presence/ stay with the patient collapse from hyperactivity and over exhaustion.
and divert him/her from stimulating
situations. i. Employ nursing measures to
promote sleep and rest such as
` Rationale: Nurse’s presence warm milk, soft music, backrub,
provides support to the patient. Patients with warm bath,  etc.
bipolar mania have impaired interactions with
others. One-on-one interactions provides patients a Rationale: Such measures promote a
feeling of security, espeially one that is consistent.  nonstimulating and relaxing mood that can help the
patient fall asleep.
d. Offer high-calorie, high-protein,
nutritious finger foods  j. Direct the patient’s energy into
productive and calming activities
such as pacing to slow, soft music,
 drawing alone, writing in a quiet
area, etc.

Rationale: Redirecting energy to nonstimulating

activities helps control hyperactivity and minimize
exciteability.

k. Weigh the patient daily.

Rationale: To help assess and monitor patients

nutritional status

Dependent

a. Administer sedative medications as

ordered.

Rationale: To assist the patient to sleep until

normal sleep patterns are restored

b. Administer Lithium (Eskalith) as

ordered

Rationale: Lithium is a mood stabilizer used to treat

acute mania and is useful in reducing manic
symptoms such as anxiety, elation, gradiosity,
expansiveness, irritability, manipulative behaviors,
and flight of ideas.

c. Administer second-generation
antipsychotics

Rationale: Provide sendative properties

during acute phase of treatment; help
with insombia, anxiety, and agitaition
such as olanzapine or risperidone;