Care Plan for Bipolar Disorder - Group B PDF

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Care Plan for Bipolar Disorder - Group B Nursing Problem: Potential for Violence Upon Self Nursing Diagnosis (NANDA statement): Risk for Suicide Related to (risk factors and etiologies): psychiatric disorder, poor support system, grieving, impulsivity, hopelessness, hallucinations, delusions As evidenced by (s/sx, diagnostic test results): patient’s verbal threats of self-harm, mood swings with manic episodes alternating with episodes of depression, impaired judgement, irritability, grand or self-confident mood Three short-term goals:(Please use S.M.A.R.T. goals (specific, measurable, applicable, realistic and time-referenced)  STG - Pt will follow verbal contract for avoiding self-harm by the end of the first day of admission.  STG - Pt will discover alternative ways for dealing with emotional problems and stress by the second day of discharge.  STG - Pt will adhere to prescribed medication therapy by the second day of discharge. One long-term goal:  

LTG - Pt will maintain self-control without supervision before discharge. LTG - Pt will express decreased anxiety and control of impulses with activities to deal with stress and emotional problems before discharge Five Interventions:

Rationales/Reason for doing Interventions:

Person Responsible - RN, LVN, MD 

Establish a therapeutic relationship while maintaining consistent nursing staff.

Establishing a therapeutic relationship will encourage the patient to trust the staff and be open about his diagnosis. Remaining kind, but firm while addressing the patient will provide structure and control for the patient who is having a manic episode, unable to stay focused, and not in control.

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Monitor prescribed drug therapy.

If the patient is prescribed lithium, monitor the lithium levels (we want to monitor for lithium toxicity). In charting, note the presence or absence of adverse effects of medication because patients are more likely to not adhere to therapy if the adverse effects are not tolerable. If

antidepressants are prescribed, remind the patient that the medication will take about 2 to 4 weeks to produce any effects. 

The nursing staff will provide a structured environment with decreased stimuli by assigning a private room.

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Encourage communication.

Encouraging communication allows the patient to ventilate negative feelings and develop healthy coping mechanisms for dealing with them. Keeping instructions specific and simple because of short attention spans which limits the patient’s ability to understand too much information given at once.

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Provide a safe environment for the patient with pills, weapons, and other harmful objects removed from the patient’s access.

Removing objects that are potentially harmful such as scissors or utensils will prevent the patient from acting on sudden or self-destructive impulses.

A calm, quiet, and structured environment will help with reducing the exacerbation of the patient’s anxiety and manic symptoms.

Outcome/Goals Evaluation: (Are the goals met, not met or progressing? If not met, what will you change in order for the patient to meet the goals? What data were used to evaluate if goals were met?) STG #1 was met, patient avoided and did not have any urge to self-harm. STG #2 was met, the patient communicated with staff about negative thoughts as a coping mechanism. STG #3 was met, the patient took medication on time and without resistance. LTG #1 was partially met, the patient took a knife from another lunch tray but gained control over themself and returned it to a nurse. LTG #2 was met, the patient reacted positively to having a private room and communicated with staff that they experienced less anxiety.

Skit for bipolar patient

Background: A patient is brought to the ER by her mother who found her 17 year old daughter Lisa, in the tub with her wrists bleeding. Mother was experiencing emotional distress, because she had no idea what was going on. Lisa was admitted as a suicidal ideation and put on a hold for a 72-hour observation. Patient is being seen by the psychiatrist for a full evaluation, patient briefly explains she has been feeling depressed, and having suicidal thoughts because she feels the only solution to her problem would be that she hurts herself to take away the pain she is experiencing from school. She explains how she is being bullied from a group of girls from school. She feels she can’t tell anyone about it, because she doesn’t want people to think she is weak and can’t handle hurtful comments. Patient starts to cry and show hopelessness in her voice as she continues explaining how she wants to end her life. Psychiatrist then explains, she will receive the care she needs to reduce anxiety levels and depression. Psychiatrist updates her file with medications to reduce stress levels, and assigns a sitter at bedside, and hold for further observations. Nurse will carry out interventions to provide a safe environment, prevent self harm and negative thoughts. 72- hours later, patient is evaluated by psych. and had met their goals in the end and saw progress in her behavior according to sitter’s observations and nurses notes. The nurse gave the patient resources as provided by the psychiatrist, if she feels she is experiencing emotional distress, she is welcome to reach out to any. 8/25/20, 1500 *Nurse takes vital signs Nurse: So, Lisa I got a report from the ER doctor about what happened, but I’d like to hear it directly from you in your own words. What happened tonight that brought you to the ER? Patient: well I've been feeling very depressed lately and i’ve been having suicidal thoughts Nurse: when did it all start? Are you having any AH or VH ? Do you feel like hurting yourself or hurting others ?How are you feeling sad happy ? on scale 1-10 pain how are feeling ? Patient: I keep getting bullied at school. Ive been sad and started feeling worse a few days ago, but tonight it got really bad to a point where I just wanted to end it all. I grabbed a knife from the kitchen and I decided to try to end it all. I have a 5 pain. Nurse: I’m sorry you feel that way, I’m here to help if you need to talk about it more. We want to make sure you’re safe from harming yourself. According to the doctor's order you were prescribed medication to help with anxiety, so I will go ahead and grab that for you, so you can get some rest. I know it’s been a long day for you. You call me if you need something. A sitter will be required to be in the room with you for your safety and since you are consider on suicidal ideation. She is here to make sure you are safe and feel safe and comfortable at all times, so you let her know if you need anything as well. *Nurse walks out Sitter: Don’t hesitate to let me know if you need anything, and of course if mom needs anything, you’re welcome to stay however long you need. *Mother is at bedside Mother: Why haven't you mentioned this problem to me before? how are you feeling ? I’m here to listen, you can always talk to me. I'm always here for you, I love you. I just want you to be safe. Patient: I didn't want you to think I was weak and couldn't handle this. I feel so helpless. I couldn't relax. I tried to sleep, but I couldn't. I haven't been able to sleep for days. I just haven't been feeling like myself lately. I feel so alone. *starts crying* Mother: You need to let me know what is happening, so we can get you help or do something to help cope with your anxiety and thoughts. You get some rest, I don't want you thinking about this anymore for right now. *Patient sleeps while sitter and mother is at bedside...