Nursing mamagement OF Bipolar AffectiveD.pptx

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1. NURSING MANAGEMENT BI POLAR AFFECTIVE DISORDER (MANIC DEPRESSIVE DISORDER)

2. OBJECTIVES OF NSG MGT Reduce risk of injury Develop coping ability Reduce risk behavior Not to harm self & others Demonstrate adequate cognitive function Family members to demonstrate coping ability with patient Have realistic expectations about self Patient to interact with others Maintain nutritional status

3. CONTD - OBJECTIVES Ability to verbalise positive aspect Ability to take control of life situations Develop communication with staff, other patients Sleep adequately during the night Maintain adequate personal hygiene

4. NURSING MANAGEMENT HYPERMANIA HYPOMANIA DEPRESSIVE EPISODE

5. NURSING MANAGEMENT FOR MANIA Nursing assessment – Severity of disorder Judging the effects of patient’s behavior on other people Relevant data should be collected from the patient as well as from his relatives Mood & affect, thinking, perceptual ability Sleep disturbances, changes in energy level , character of speech patterns

6. Nsg Mgt - mania OBJECTIVE SIGNS Disturbance of Speech Rapid speech Loud, pressured speech Easily distracted Over activity , weight changes Mood lability

7. Nsg Mgt - Mania SUBJECTIVE SYMPTOMS Feelings of joy Rapid mood swings Sleep disturbances Delusions and hallucinations

8. HIGH RISK FOR INJURY RELATED TO EXTREME HYPERACTIVITY & IMPULSIVE BEHAVIOR INTERVENTIONS Keep environmental stimuli to a minimum Remove hazardous objects & substances Engage patient in activities Stay with patient as hyperactivity increases Administer medication as prescribed

9. HIGH RISK FOR VIOLENCE; SELF DIRECTED OR DIRECTED AT OTHERS R/T MANIC EXCITEMENT, DELUSIONAL THINKING & HALLUCINATIONS INTRVENTIONS Maintain low level of stimuli in patients environment Observation of patient’s behavior Remove all sharp & injurious objects Redirect violent behavior with physical outlet Encourage verbal expression of feelings Calm attitude to the patient Administer tranquilizers Use of restraints & gradual removal

10. ALTERED NUTRITION, LESS THAN BODY REQUIREMENT R/T REFUSAL OR INABILITY TO SIT STILL LONG ENOUGH TO EAT EVIDENCED BY WEIGHT LOSS INTERVENTIONS High protein, high calorie diet Patient’s likes & dislikes, favouritefoods 6-8 glasses of water or fluids per day Intake-output, weight recording Supplement diet with vitamins & minerals

11. IMPAIRED SOCIAL INTERACTION R/T EGO CENTRIC BEHAVIOR EVIDENCED BY INABILITY TO DEVELOP SATISFYING RELATIONSHIPS & MANIPULATION OF OTHERS FOR OWN DESIRES INTERVENTIONS Recognise that behavior Ignore attempts by patient to argue Give positive reinforcement Discuss consequences of patient’s behaviors Help patient identify positive aspects about self

12. SELF ESTEEM DISTURBANCE R/T UNMET DEPENDENCY NEEDS, LACK OF POSITIVE FEEDBACK, UNREALISTIC SELF EXPECTATIONS INTERVENTIONS Ask how patient would like to be addressed Encourage verbalisation & identification of feelings related to issues of chronicity, lack of control over- self Encourage patient to view life after discharge and identify aspects over which control is possible

13. ALTERED FAMILY PROCESSES R/T EUPHORIC MOOD AND GRANDIOSE IDEAS, MANIPULATIVE BEHAVIOR , REFUSAL TO ACCEPT RESPONSIBILITY FOR OWN ACTIONS INTERVENTIONS Determine individual situation and feelings of individual family members like guilt, anger, powerlessness, despair, alienation Assess patterns of communication Determine patterns of behavior displayed by patient in his relationship with others Assess the role of patient in the family , like provider Provide information about behavior patterns and expected course of the illness

14. NSG MGT FOR HYPOMANIA ASSESSMENT Severity of symptoms Capacity to work Identify any life events Patient’s resources & effect on other people

15. NURSING DIAGNOSIS Risk of injury R/T inability to perceive potentially harmful situations evidenced by impulsive behavior Impaired social interaction R/T short attention span, high level of distractibility, liable mood evidenced by insufficient or excessive quantity or ineffective quality of social exchange Ineffective coping skills R/T poor impulse control evidenced by acting out behavior Disturbed thought process R/T disorientation & decreased concentration evidenced by disruption in activities

16. NURSING MGT- DEPRESSIVE EPISODE NURSING ASSESSMENT Presence of marked helplessness Written or verbal communication of suicidal intent or plan Early stages of depression Recovery from depression Observe for mood, affect, thinking, perceptual ability, somatic complaints, sleep disturbances & changes in energy level Any suicidal ideation Determine the amount of assistance required for personal hygiene, elimination needs

17. NURSING MANAGEMENT – DEPRESSIVE EPISODE OBJECTIVE SIGNS Alterations of activity Poor personal hygiene Apathy Altered social interactions

18. NURSING MANAGEMENT- DEPRESSIVE EPISODE SUBJECTIVE SYMPTOMS Anhedonia Worthlessness Hopelessness Helplessness Suicidal ideas Impairment of cognition Delusions & Hallucinations

19. HIGH RISK FOR SELF DIRECTED VIOLENCE R/T DEPRESSED MOOD ANGER DIRECTED INWARD INTERVENTIONS Create safe environment Place patient near the nursing station Do not leave the patient alone Encourage the patient to express his feelings Ask the patient directly “Have you thought about harming yourself in any way”

20. DYSFUNCTIONAL GRIEVING R/T REAL OR PERCEIVED LOSS EVIDENCED BY DENIAL OF LOSS INABILITY TO CARRY OUT ACTIVITIES INTERVENTIONS Assess stage of fixation in grief process Be accepting of patient and spend time with him Explore feelings of anger and help patient direct them towards the intended object or person Provide simple activities which can be easily and quickly accomplished

21. POWERLESSNESS R/T DYSFUNCTIONAL GRIEVING PROCESS , LIFE STYLE OF HELPLESSNESS EVIDENCED BY FELINGS OF LACK OF CONTROL OVER LIFE SITUATIONS, OVER DEPENDENCE ON OTHERS INTERVENTIONS Allow patient to take decisions regarding own care Ensure the goals are realistic E ncourage the patient to verbalize feelings about area that are not in his ability to control

22. SELF ESTEEM DISTURBANCE R/T LEARNED HELPNESSNESS, IMPAIRED,COGNITION, NEGATIVE VIEW OF SELF EVIDENCED BY EXPRESSION OF WORTHLESSNESS INTERVENTIONS Be accepting of patient and spend time with him Focus on strengths and accomplishments and minimise failures Provide him with simple and achievable activity Teach assertiveness and coping skills

23. ALTERED COMMUNICATION PROCESS R/T DEPRESSIVE COGNITIONS, EVIDENCED BY BEING UNABLE TO INTERACT WITH OTHERS , EXPRESSING FEAR OF FAILURE OR REJECTION INTERVENTIONS Observe for non verbal communication Use short sentences Ask questions in such a way that the patient will have to answer in more than one word Use silence appropriately without communicating anxiety or discomfort in doing so As patients improves, take him to other patients & included as part of the group

24. ALTERED SLEEP AND REST R/T DEPRESSED MOOD AND DEPRESSIVE COGNITIONS EVIDENCED BY DIFFICULTY IN FALLING ASLEEP, EARLY MORNING AWAKENING, VERBAL COMPLAINTS OF NOT FEELING WELL RESTED INTERVENTIONS Plan day time activities according to the patient’s interests Ensure a quiet and peaceful environment when the patient is preparing for sleep Provide comfort measures Do not allow the patient to sleep for long time during the day Talk to patient as and required

25. ALTERED NUTRITION LESS THAN BODY REQUIREMENTS R/T DEPRESSED MOOD, LACK OF APPETITE OR LACK OF INTEREST IN FOOD EVIDENCED BY POOR MUSCLE TONE INTERVENTIONS Closely monitor the patients food and fluid intake Recording of weight periodically Find out the likes and dislikes of the person Record the patient’s pattern of bowel elimination Encourage more fluid intake, roughage diet and green leafy vegetables

26. SELF CARE DEFICIT R/T DEPRESSED MOOD, FEELINGS OF WORTHLESSNESS, EVIDENCED BY POOR PERSONAL HYGIENE & GROOMING INTRVENTIONS Ensure that he takes bath regularly Do not ask the patient’s permission for a wash or bath When the patient has taken care of himself , express realistic appreciation

27. HEALTH EDUCATION MONTHLY FOLLOW UP/ AS PER GOOD DRUG COMPLIANCE PREVENTION OF RELAPSE NO SUBSTANCE ABUSE MONITORING OF WEIGHT GAIN REGULAR BLOOD INVESTIGATION ADEQUATE SLEEP & REST MAINTENANCE OF NUTRITIONAL STATUS

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