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a? Conceptual understanding
a? Grammar and referencing
a? Assessment of nursing needs
a? Collaborative approach
a? Nursing care plan
a? Clinical reasoning
Case Study: Client with Bipolar disorder.
Sarahas husband threatened to divorce her if she did not go with him to the emergency department of the metropolitan hospital for assessment. She was 39 years old, sporadically unemployed and had been functioning poorly for a number of years. During the past week Sarah had been partying all night with some new friends of hers and shopping during the day. She was an attractive woman, fast talking, cheerful and casually flirtatious. She easily became irritable when challenged.
About five years before, Sarah had experienced some mild depressive symptoms. She was listless, had trouble getting out of bed, and experienced intermittent insomnia and loss of appetite. This lasted for two months and then Sarah became well again.
Two years later, Sarahas father died. She had been very close to her father and felt his death harshly. She believed that she had not been a good enough daughter. Sarahas husband saw a dramatic change in his wife following her fatheras death. She had three weeks of remarkable energy, hyperactivity and euphoria. She would stay awake cleaning the house every night. She had a strong sexual interest in her husband and was bright , self-confident company. This was then followed by one week where she could barely lift herself out of bed. She slept for long periods and complained of exhaustion.
When Sarah was in one of her energetic periods, she was bright, energetic and brimming with self-confidence. She had worked in a car yard for many years and had months when she was the most successful dealer among her co-workers. She would spend excessively during these energetic periods, on such things as wide screen televisions, hi-fi equipment and hundreds of shoes.
Her husband also suspected her of having impulsive sexual encounters with her so-workers. On two occasions she was fired from her job for her erratic behaviour. She was then rehired by other firms soon after. However, towards the end of her energetic periods she became irritable and caustic, and she received complaints from her customers. Following these episodes she would go to bed for weeks at a time to try to deal with the depressive symptoms. She would not shower during these periods and would eat very little.
This pattern of alternating periods of excessive energy followed by depression, with a few a?normal functioninga days repeated itself over the next few years. It occurred most often near the anniversary of her fatheras death or when she felt under pressure at work.
However, on the last occasion, she had been without work for three months. She was out at night with a new circle of friends and shopping most of the day, running up debt. Her husband suspected she was using drugs.
Sarahas husband felt very frustrated and gave her the ultimatum. Though angry at first and denying that anything was wrong, Sarah agreed to be seen by the Doctor. He prescribed her a mood stabiliser, sodium valproate, which she was reluctant to take. After many false starts and much fighting between Sarah and her husband, Sarah was finally stabilised on the medication. She got her job back at the car dealership and was moderately successful. She stated that she missed the highs of her illness very much but was relieved she didnat have to experience the lows as well.
Mental Health Nursing Care Plan for Bipolar Patient
Sarah is aged 39 years and presented to the emergency department for assessment. Episodes of significantly elevated and depressed mood have been persistent in Sarahas lifestyle for the past five years. Sarah has been sporadically unemployed in the same industry for years and when having a manic episode tends to display erratic behaviours. She has previously been fired from her job for episodes of erratic behaviour but tends to find work in the same industry at a new location. Presently Sarah is unemployed and has been displaying manic behaviour for a three month period causing great concern from her husband. This has consequently led to an ultimatum from her husband to seek treatment due to disruption of harmony within their marriage and risk of harmful behaviour. Sarah has agreed to be assessed by a medical officer and will reluctantly commence a treatment regime for the diagnosis of bipolar. An assessment for Sarahas nursing care will be gathered using a health history ascertaining her past episodes and present well being. This will enable an appropriate care plan to be devised using a collaborative approach to effectively reach a positive outcome for Sarah. Interventions and rationales will be used to a?perform thorough, accurate and ongoing assessmenta as described by Elder et al, (2009, p. 174), helping to gauge patientas strengths as well as patientas needs. (Elder et al, 2009)
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