Background of the Study

Bipolar disorder Formerly known as manic depressive illness Diagnosed when a persons mood cycles between extremes of mania and depression Mania Distinct period during which mood is abnormally and persistently elevated, expansive or irritable This period lasts about 1 week At least episodes of the following symptoms accompany the manic episode! inflated self esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased involvement in goal"directed activity or psychomotor agitation and excessive involvement in pleasure seeking activities with a high potential for painful conse#uences$ %xhibit delusions and hallucinations Hypomania &eriod of abnormally and persistently elevated, expansive or irritable mood lasting ' days and including three or four of the additional symptoms described earlier$ Do not impair the persons ability to function and there are no psychotic features$ A mixed episode is diagnosed when the person experiences both mania and depression nearly every day for at least 1 week which is often called rapid cycling$ Bipolar disorders are described as follows: (ipolar ) disorder * one or more manic or mixed episodes usually accompanied by ma+or depressive episodes (ipolar )) disorder * one or more ma+or depressive episodes accompanied by at least one hypomanic episode

Biographic Data
I. General Data ame, -. !ge, /0 years old ationality, Filipino $ccupation, none !ddress, 2ambales Birth %lace, 3ingdom of 1audi Arabia &ducation, ($1$ 4omputer 1cience %hysician, Dra$ Agustin "i#il Status, 1ingle

II. History of %resent Illness 5n year /667, The client 8r$ -. starts to have his attacked of depression until now$ According to him the fre#uent reason for him to have a depression was that 9 wala akong ginagawa gusto ko kasing may ginagawa 9 then asked him, things like: 9 %ncoding, kasi dati akong encoder at may lugar akong gustong puntahan, ;$3$< where his mother and father is located$ (ased on the client these past few years, the depression occur almost every hour and with different durations$ =e +ust take his medication and then sleep to relieve depression$ III. "hief "omplaint 8umbling to self, paranoid ideas and euthymic with appropriate affect$ I'. %!S( HIS($)* -. had childhood diseases such as chickenpox and fever$ =e has no allergies$ According to him, he was completely immuni>ed$ =e had a car accident with his father when he was / years old but he said that he only got bruises$ =e went to hospital many times before with different

reasons, such as, periauricular cyst, hernia, and check ups but could not remember the dates$ =e does not have any foreign and local travels$ &revious confinement at ;1T hospital under the care of Dr$ ?eorge 4onde in /66@ and then in 8ariveles, (ataan 8ental =ospital under Dr$ ?o where he stayed for a month$ =ence, this is his rd admission in psychiatric facility as he was brought by his auntie on 5ctober /1, /611$ =e added that hes maintained on rivotril, 1ero#uel and Akineton$ =e said that he had auditory hallucinatory experiences when he was still in college$ =e said that the voice was saying Abilisan mo$A =e also admitted feelings of depression attributed to 9ma+or problem hindi makapasok sa trabaho, problem sa pag aabroad and study$< Bhen asked about such, he confided that his parents could not financially support him when he go to ;3 as the standard of living there is high$ )ndulgence to intoxicating and addictive substances like red horse and gin was admitted$ =e also claimed 9 &arang pinag"uusapan ako ng ibang tao, parang nakarating na ako sa lugar na iyon pero hindi naman nangyayari sa tunay na buhay$<

'. +!MI,* HIS($)* =is grandparents in the father side were already deceased due to cardiac arrest$ 5n his mother side, his grandfather died after having a sudden unexpected death syndrome while sleeping or 9bangungot<$ =is grandmother is still alive and has hypertension$ -.s mother has hypertension while his father has diabetes$ According to -., he does not have any family members who have been in any home care$

'I. %!S( %&)S$ !, HIS($)* !. %renatal data -. does not know about the pre natal check ups of his 8other$

B. +irst *ear of ,ife =e was born in a hospital in 1audi in the year 1C@'$ According to him, he was born prematurely, but does not know the month he was delivered$ =e was breastfed until / years of age$ =is mother used to stay with him until he has fallen asleep$ =e also experienced having

tantrums$ Bhen he was years old, he can say words but not that clear$ =e can walk by the age of and can stand alone when turning ' years old$ =is mother was the one who took care of him since they do not have relatives in the 1audi$ ". (oilet training =e was years old when he had his toilet training$ =is mother is strict when in comes to cleanliness$ =e did not experience having diarrhea when he was a child$ D. Secondary Sociali-ation 1ince they do not have relative in the 1audi, he does not have any playmate there$ =is parents have separate room with him$ =e is the only child and he finds it boring$ &. School History =e started schooling at the age of 7 years old$ =e was so shy especially the first time he went to school$ (ut he was able to adapt the environment and people around him$ =e cant recall some of his friends before when he started schooling$ =e is the type of an average student but is really striving hard to get high grades$ =e is a computer engineering graduate in Dational ;niversity$ +. Home &n#ironment 1ince he cannot recall how the environment of their home in 1audi was, he +ust described their home in 2ambales$ Bhen he was C years old, his parents decided to go back to &hilippines to for the reason of living with the relatives of his mother$ Then on /667, both of his parents went to ;nited 3ingdom to work$ =e was left with his two aunties and one uncle$ They have a two"storey house, well ventilated and well lightened$ According to him they have rooms and all of them are air conditioned and have ade#uate lights$ Their house is not located beside the highway and public utility vehicles seldom pass there$ Their neighbors are also their relatives$ =is grandmother has a store in the market which is the cause of some of the misunderstanding of their family members$ )t is also the reason why they are not a close with some of their relatives$ (ut -. can talk and play with his cousins sometimes$ =is father and uncles are smoking and drinking alcohol especially when they are having get together or parties$ As verbali>ed, he said that he never noticed favoritism in his family$ They do not have 9pamahiin<$

G. Interest. Hobbies. Habits -. is a 4omputer %ngineering graduate in Dational ;niversity$ =e has a dorm near the university when he is studying$ =e belongs to a circle of friend! they sometimes drink alcohol

but do not smoke$ =e was interested in sport hockey, basketball and computer games$ =e verbali>ed that he plays these sports whenever hes depressed because of failing to get a +ob$ 'II. M!)I(!, S(!(/S -. never experienced having a girlfriend nor undergone any courtship$ =e is not married either 'III. "/))& ( S$"I!, SI(/!(I$ !, ! D H$M& & 'I)$ M& ( At present, the client is staying at 8other Theresa =ome 4are for rehabilitation due to (ipolar Disorder$ For him, the home care is conducive$ =e verbali>ed also that there needs are met by the staff in the area$ =is parents pay all the expenses needed for his confinement$

!cti#ities of Daily ,i#ing 0. !D, utrition During Hospitali-ation =e often eats vegetables and usually takes more on meat and fish$ =e also eats biscuits during snack time and fruits$ Interpretation and !nalysis An individuals food preferences and habits are often a ma+or factor affecting actual food intake$ =abits about eating are influenced by developmental consideration, gender, ethnicity and culture, beliefs about food, personal preferences, religious practices, lifestyle, economics, medications and therapy, health, alcohol consumption, advertising, and psychological factors$ Kozier, B., Erb, G., Snyder, s., Berman, A. (2007). Fundamentals of ursin! "t# Edition $olume 2 %%.&2'7 %ating vegetable is essential to the body especially foods with fibers that can help him with constipation$ &ersonal habits regarding urination and defecation are affected by developmental

1. &limination

According to our client, he fre#uently urinates /" E "' times a day$ The color of his

urine is light yellow and the estimated amount is normally half a glass every urination$ And sometimes, he holds the urge to urinate and defecate, but admitted that he already experienced constipation$

factors, psychological factors, fluid and food intake and medications$

Kozier, B., Erb, G., Snyder, s., Berman, A. (2007). Fundamentals of ursin! "t# Edition $olume 2 %%.&2"" 5ne factor in experiencing constipation is due to the food intake of the client$ The client usually eats meat and often takes vegetable that has fibers that will help him in defecation$ Also, the client only drinks "' glasses per day$

2. &3ercise

%very day they usually do their exercise in the morning$ From F, 6"0,66A8$ They always perform aerobics played with a catchy song and according to him he always participates in their activities$

&erson often describe their health and fitness by their activity because the effectiveness of their body functioning depends largely on their mobility status$ Factors affecting activity level include growth and development, nutrition, personal values and attitude, and immobility$ Kozier, B., Erb, G., Snyder, s., Berman, A. (2007). Fundamentals of ursin! "t# Edition $olume 2 %%.&&0(, &&&( The client is very active when it comes with the activities$ =e always has the energy when it comes to exercise but he prefers playing chess more than physical sports like basketball$ =ygiene is a highly personal

4. Hygiene

The client takes a bath every

after breakfast and after taking his medications$

matter determined by individual values and practices$ )t involves care of the skin, hair, nails, teeth, oral and nasal cavities, eyes, ears, and perineal"genital area$ Kozier, B., Erb, G., Snyder, s., Berman, A. (2007). Although the clients takes a bath once a day, he has a good hygiene, no body odor or even mouth odor and always looks clean whenever we do the interview$ Be re#uired sleep for many reasons, to cope with daily stresses, to prevent fatigue, to conserve energy, to restore the mind and body, and to en+oy life much fully$ Kozier, B., Erb, G., Snyder, s., Berman, A. (2007). Fundamentals of ursin! "t# Edition $olume 2 %%.&&() The client wakes at Fam for morning exercises, he sometimes wakes at 1/ am or am$ =es flat affect even he didnt get enough some sleep$

5. Sleep and )est

The client says that he wakes up early everyday around F,66A8 then sometimes, he wakes up at 1/A8 or A8 with unknown reason$ 1ometimes, he takes a nap in the afternoon for about maximum of 6 minutes$

Mental Status &3amination The client is oriented to time, place and person as evidenced by his correct identification of names of the current president and the president before, he answer where country he lives, where he was, and what was the date that day$ =e knew that he was in 8other Teresa and what the purpose was why he was there$ -ecent memory is not impaired since he can remember what

he had eaten during breakfast and what activities they have done$ -emote memory is also not impaired because he knew when he had nervous breakdown$ The client doesnt show distractibility, he can spell the word world backward$ =is attention was drawn to external stimuli such when their someone is catching his attention The client was not yet assessed E examined in his capacity to read and write, visuospatial ability, and abstract thinking$ The client is a graduate of (1 computer engineering$ The clients facial expression is not appropriate to the stimuli presented$ During the nurse patient interaction, he pro+ects blank stares and appears to be serious$ =e has low range of mood$ The client exhibit auditory hallucination when he was in college, when he was asked about it he said that theres a voice whispering in his ears telling him, 9bilisan mo...< he said that its as if there is someone close to him and whispering it to him$ =e was able to answer #uestions spontaneously and directly$ =e did not use any new or created words$ =e did experience thought block when asked what hes thinking at the moment and other #uestion like testing his memory, concentration and so on$ 1uicidal ideation was not detected$ The client is oriented to time, place and person as evidenced by his correct identification of names of the current president and the president before, he answer where country he lives, where he was, and what was the date that day$ =e knew that he was in 8other Teresa and what the purpose was why he was there$ -ecent memory is not impaired since he can remember what he had eaten during breakfast and what activities they have done$ -emote memory is also not impaired because he knew when he had nervous breakdown$ The client doesnt show distractibility, he can spell the word world backward$ =is attention was drawn to external stimuli such when their someone is catching his attention The client was not yet assessed E examined in his capacity to read and write, visuospatial ability, and abstract thinking$ The client is a graduate of (1 computer engineering$ )n checking his insights and +udgment we asked #uestions like 9Ano %on! !a!a*in niyo +a%a! nali!a* o na*ala +ayo sa +a+a#uyan,< he answered 9ma!#a#ana% n! mala*a+ na lu!ar.< and when we asked, 9-ano naman %o +a%a! nasa sine#an +ayo at na!+aroon dun n! suno!, ano %o an! !a!a*in niyo,<, then he answered 9!u!ulon! ta%os %u%unta sa fire e.it.< Be also asked him if he had a nervous breakdown he said that he had it in year /66@$ Bhen #uestioned about his condition the client tells that he has schi>ophrenia however in the clients chart he has bipolar disorder and we clarify it to him, the client accepted the fact that he is ill and re#uires treatment$ =e has cooperated with doctors and nurses and is compliant with management$ The client is likely told the truth$ %hysical !ssessment Dorms ?eneral Appearance Actual Finding )nterpretation and analysis

1$ (ody built, height and weight in relation to age, lifestyle and health /$ &osture and gait when standing, sitting and walking

&roportionate, varies with lifestyle$ GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H -elax, erect posture! coordinated movement GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H 4lean, neat GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H Do body odor or minor odor relative to work or exercise! no breath odor GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H Do distress noted GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H =ealthy appearance GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H

(ody built, height and weight is proportionate

Dormal

The client has slouch posture

Deviation from Dormal

$ 5ver all hygiene and grooming

The clients hair is #uite messy$ =is fingernails and toenails are a long$ =e has no body odor

Deviation from Dormal

'$ (ody and breath odor

Dormal

7$ 1igns of distressEfacial expression F$ 5bvious 1igns of health or illness

The client is irritable

Deviation from Dormal

The client appears unhealthy because every time he is asked #uestions, it seems he is not interested and he is irritable, his posture was slightly slouching while sitting and when standing$

Deviation from Dormal

0$ 4lients attitude

4ooperative, able to follow instruction GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H Appropriate to the situation GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H

The client is cooperative although his responses are slow, he talks continuously The clients facial expression is not appropriate to the stimuli presented$ During the nurse patient interaction, he pro+ects blank stares and appears to be serious$ =e has low range of mood$

Dormal

@$ Affect, mood and appropriateness of clients responses

Deviation from Dormal

C$ Iuantity, #uality and organi>ation of speech

;nderstandable, moderate pace! clear tone and inflexion! exhibits thought association GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H Jogical se#uence! make sense! has sense of reality GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70/H F" 0$7K 4 GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, Figure /C"1, p$7/@H F6"166 , has e#ual time periods between beats, with moderate

;nderstandable, moderate pace! clear tone and inflexion! exhibits thought association

Dormal

16$ -elevance and organi>ation of thoughts

Jogical se#uence, makes sense!, has sense of reality

Dormal

8easurements 1$ Temperature

F$7K 4

Dormal

/$ &ulse rate

07, has e#ual time periods between

Dormal

pressure and e#ual with each beat Fundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7 @, and p$7'1H $ -espiratory rate 1/"/6 , silent and effortless, evenly spaced respiration Fundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7 @, and p$776H 1ystolic (& in mm=g is L1/6 and Diastolic (& n mm=g is L@6GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, Table /C"', p$77/H %xhibit normal weight within normal range for age and sex )DB MF7$Fkg"@6$1kg G4omputed based from ht$ and wt$H %xhibit normal weight within normal Dormal Findings .aries from light to deep brown! from ruddy pink to light pink! from yellow overtones to olive GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70CH ?enerally uniform except in the areas exposed to the sun GFundamentals of

beats, with moderate pressure and e#ual with each beat

1@ cycles per minute, silent and effortless, evenly spaced respiration

Dormal

'$ (lood pressure

1ystolic is 1/6and the Diastolic is @6

Dormal

7$ Beight

Dot performed 7 foot ,F inches

Dot performed Dormal

F$ =eight

(ody &art %xamined S6I 1kin 4olor

Actual Findings The client has light brown skin

)nterpretation Dormal

;niformity of color

=e has uniform skin color$

Dormal

Dursing, @th ed$, vol$1, 3o>ier, p$70CH %dema Do edema GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70CH Freckles, some birthmarks, some flat and raised nevi! no abrasions or other lesions$ GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70CH 8oisture in skin folds and the axillae GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70CH ;niform! within normal range GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$70CH Bhen pinched, skin springs back to previous state ! may be slower in elders GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@6H %venly distributed hair GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@/H 1ilky, resilient hair GFundamentals of Do edema Dormal

1kin lesions

&resence of moles on various parts of the body

Dormal

1kin moisture

4lient has moisture in skin folds and the axillae

Dormal

1kin temperature

1kin temperature is uniform and is within normal range

Dormal

1kin turgor Gfullness or elasticityH

?ood skin turgor

Dormal

H!I) %venness of growth, thickness

4lients hair is evenly distributed

Dormal

Texture and oiliness

=e has silky and resilient hair

Dormal

Dursing, @th ed$, vol$1, 3o>ier, p$7@/H ThicknessEthinness Thick hair GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@/H Do infection or infestation GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@/H .ariable GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@/H 4onvex curvature! angle of nail plate about 1F6 degrees GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@ H 1mooth texture GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@ H =e has thick hair Dormal

&resence or infections or infestations

=is hair has no infection or infestation

Dormal

Amount of body hair

The amount of body hair is variable

Dormal

!I,S Fingernail plate shape

=is nail has convex curvature and the angle of her nail plate is about 1F6 degrees =is fingernails and toenails have smooth curvature =is fingernail and toenail bed color is pink and highly vascular

Dormal

Fingernail and toenail texture

Dormal

Fingernail and toenail bed =ighly vascular and color pink in light"skinned clients may have brown or black pigmentation in longitudinal steaks GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@'H Tissues surrounding nails )ntact epidermis GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@'H

Dormal

=is epidermis is intact

Dormal

(lanch test of capillary refill

&rompt return of pink or usual color GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@'H -ounded ! smooth skull contour GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@7H 1mooth, uniform consistency! absence of nodules or masses GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@7H 1ymmetric or slightly asymmetric facial features! palpebral fissures e#ual in si>e! symmetric nasolabial folds GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@7H 1ymmetric facial movements GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@7H =air evenly distributed! skin intact, eyebrows symmetrically aligned! e#ual movement GFundamentals of Dursing, @th ed$,

There is prompt return of pink or usual color after the clients nails are pressed 1kull is round and has smooth skull contour

Dormal

H&!D 1kull for si>e, shape and symmetry

Dormal

1kull for nodules or masses and depressions

1kull is smooth and there is absence of nodules or masses

Dormal

Facial features 1kull for nodules or masses and depressions

Facial features are symmetric

Dormal

1ymmetry of facial movements

Facial movements are symmetric

Dormal

&*&S %yebrows for hair distribution and alignment and skin #uality and movement

4lients eyebrows are evenly distributed$ 1kin is intact, eyebrows are symmetrically aligned and has e#ual movement

Dormal

vol$1, 3o>ier, p$7@@H %yelashes for evenness of distribution and direction of curl %#ually distributed! curled slightly outward GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@@H 1kin intact! no discharge! no discoloration Jids close symmetrically Approximately 17"/6 involuntary blinks per minute, bilateral blinking Bhen lids open, no visceral sclera above corneas, and upper and lower borders of cornea are slightly covered$ GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@@H Transparent! capillaries sometimes evident! sclera appears white GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@@H 1hiny, smooth, and pink or red GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@@H Do edema or tenderness over lacrimal gland GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@CH =is eyelashes are e#ually distributed and is slightly curled outward Dormal

%yelids for surface characteristics, position in relation to the cornea, ability to blink, and fre#uency of blinking and functions of trigeminal nerve

%yelid is skin intact, no discharge, no discoloration$ The eyelids close symmetrically, blinks bilaterally, no visceral sclera above corneas when lids open$ The upper and lower borders of cornea are slightly cover

Dormal

(ulbar con+unctiva for color, texture, and the presence of lesions

(ulbar con+unctiva is transparent$ 1clera appears yellowish

Deviation from Dormal

&alpebral con+unctiva for color, texture, and presence of lesions$

&alpebral con+unctiva is shiny, smooth and pink

Dormal

Jacrimal gland

Do edema or tenderness

Dormal

Jacrimal sac and nasolacrimal duct

Do edema or tearing GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@CH Transparent, shiny, and shiny smooth! details of the iris are visible GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7@CH (lack in color! e#ual in si>e! "0 mm diameter, round$ GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C6H )lluminated pupil constrictsGdirect responseH Doniluminated pupil constrictsGconsensual responseH GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C6H &upils constrict when looking at near ob+ects! pupils dilate when looking at far ob+ect! pupils convergence when near ob+ect is moved toward nose GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C6H Bhen looking straight ahead, can see ob+ects

4lient has no edema or tearing

Dormal

4ornea for clarity and texture

4ornea is transparent, shiny, and shiny smooth! details of the iris are visible

Dormal

&upils for color, shape and symmetry of si>e

4lients pupils are black in color! e#ual in si>e! mm diameter, round$

Dormal

&upils direct and consensual reaction to light$

Dot performed

Dot performed

&upils reaction to accommodation

Dot performed

Dot performed

.)1;AJ F)%JD1 &eripheral visual fields to determine function of

Dot performed

Dot performed

retina and neuronial visual pathways to brain and optic cranial nerve$ %NT-A54;JA8;14J%1 1ix ocular movements to determine eye alignment and functions of oculomotor, trochlear and abducens nerve

in periphery$ GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C1H

(oth eyes coordinated, move in unision, with parallel alignment! unision with parallel alignment GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C/H Able to read newsprint /6E/6 vision on snellen chart GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C/H 4olor same as facial skin$ 1ymmetrical Auricle aligned with outer canthus of eye, about 16 degrees from vertical GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7CFH 8obile, firm, and not tender! pinna recoils after it is folded GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7CFH Distal third contains hair follicles and

Dot performed

Dot performed

.)1;AJ A4;)TO Dear .ision Distance .ision

Dot performed Dot performed

&!)S 4olor, 1ymmetry of si>e, and position

4lients ears color is same as facial skin$ =e has symmetrical auricle aligned with outer canthus of eye, about 16 degrees from vertical =is ears are mobile, firm and not tender! pinna recoils after it is folded

Dormal

Texture, elasticity, and areas of tenderness

Dormal

%xternal ear canal and tympanic membrane

=is external ear canal contains hair

Dormal

glands! Dry cerumen, grayish"tan color! or sticky wet cerumen in various shades of brown$ &early gray color, semi" transparent GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7CFH =%A-)D? A4;)TO T%1T1 -esponse to normal voice tones Dormal voice tones audible GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C0H Able to hear ticking in both ears GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C0H 1ound is heard in both ears or is locali>ed at the center of the head GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C0H Air"conduction hearing is greater than bone"conduction hearing GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$7C@H 1ymmetric and 1traight! Do discharge or flaring! ;niform 4olor GFundamentals of

follicles, tympanic membrane is pearly gray in color and semi transparent

Able to hear normal voice tones

Dormal

Batch tick test

Dot performed

Dot performed

Bebers test

Dot performed

Dot performed

-innes test

Dot performed

Dot performed

$S& %xternal Dose for any deviations in shape, si>e and color and flaring, or discharge from the nares

4lients external nose is symmetric and straight! no discharge or flaring and has uniform

Dormal

Dursing, @th ed$, vol$1, 3o>ier, p$F66H &alpate external nose to determine any areas of tenderness, masses, and displacements of bone and cartilage$ &atency of both nasal cavities$ Dot tender! Do lesions GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F66H

color =is external nose is not tender! no lesions Dormal

Air move freely as the Air moves freely as client breathes he breathes through the nares GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F66H 8ucosa pink, clear, watery discharge, no lesions GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F66H The client has absence of redness, swelling, growths and discharge on her nasal cavity

Dormal

DA1AJ 4A.)TO 5bserve for any presence of redness, swelling, growths and discharge

Dormal

Dasal septum

Dasal septum intact in =is nasal septum is midline intact in middle GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F66H Dot tender GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F66H ;niform pink color! soft! moist! smooth texture! symmetry of contour! ability to purse lips GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6/H Dot performed

Dormal

FA4)AJ 1)D;1%1 &alpate the maxillary and frontal sinuses for tenderness M$/(H 5uter lips for symmetry of contour, color and texture

Dot performed

The clients outer lip has uniform pink color$ )t is soft and moist, has smooth texture and is symmetric$

Dormal

)nner lips and (uccal mucosa for color, moisture, texture, and the presence of lesions$

;niform pink color! soft! moist! smooth! glistening and elastic texture GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6/H / adult teeth GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6/H 1mooth$ )ntact denture GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6 H 4entral position$ &ink color GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6 H 8oves freely, no tenderness, no lesions GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6 H 8uscle e#ual in si>e! head centered GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F60H 4oordinated , smooth movement with no discomfort GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F60H %#ual strength

Dot performed

Dot performed

Teeth

Dentures

/@ adult teeth are missing on the right sideGdownH 1 on the left side is missing GdownH Do dentures

Deviation from Dormal

Dormal

1urface of tongue for position color and texture

Dot performed

Dot performed

Tongue movement

Dot performed

Dot performed

&"6 Deck muscle

=is neck muscle is e#ual in si>e! head centered

Dormal

=ead movement

=is head movement is smooth and coordinated with no discomfort

Dormal

8uscle strength

Dot performed

Dot performed

GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F60H Jymph Dodes Dot palpable GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F60H 4entral placement in midline of neck! spaces are e#ual on both sides GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6@H Dot visible on inspection gland ascends during swallowing but not visible GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6@H Jobes may not be palpated! if palpated, lobes are small, smooth, centrally located, painless, and rise freely with swallowing GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F6CH Dot performed Dot performed

Trachea

4lients trachea is in central placement in midline of neck

Dormal

Thyroid ?land

4lients thyroid gland is not visible on inspection gland and ascends during swallowing but not visible

Dormal

&alpate the thyroid ?land for smoothness and areas of enlargement, masses or nodules

Dot performed

Dot performed

(H$)!7 8%$S(&)I$) (H$)!79 1$ 1hape, symmetry, si>e and diameter of anteroposteriortho rax to transverse diameter

Anteroposterior to transverse diameter in ratio 1,/! chest symmetric GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F1'H

Dot performed

Dot performed

1$ 1pine alignment

1pine vertically aligned! 1pinal column is straight, right and left shoulders and hips are at same height GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F1'H 1kin intact, uniform temperature! chest wall intact! no tenderness! no masses GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F1'H

=is spine straight and vertically aligned! his right and left shoulders and hips are at same height

Dormal

/$ &alpate the posterior thorax! for clients who have no respiratory complaints rapidly assess the temperature and integrity of all chest skin $ &alpate the posterior chest for respiratory excursion

Dot performed

Dot performed

Full symmetric chest expansion! normally the thumbs separate "7 cmG1$7"/ in$H during deep inspiration GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F17H (ilaterally symmetry of vocal fremitus! fremitus is heard most clearly at the apex of the lungs GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F17H &ercussion notes resonate, except over scapula! lower point of resonance is at the diaphragm GFundamentals of

Dot performed

Dot performed

'$ &alpate the chest for vocal fremitus

Dot performed

Dot performed

7$ &ercuss the posterior thorax

Dot performed

Dot performed

Dursing, @th ed$, vol$1, 3o>ier, p$F17H F$ Auscultate the posterior thorax .esicular and (ronchovesicular breath sounds GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F1FH Dot performed Dot performed

! (&)I$) (H$)!7 1$ (reathing &atterns Iuiet, rhythmic and effortless respirations GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F10H /$ 4ostal angle 4ostal angle is less than C6 degrees, and the ribs insert into the spine at approximately '7 degrees GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F10H ;niform temperature, no tenderness, no masses GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F10H (ilateral chest excursion! thumbs normally separate "7 cm G1$7"/ inH GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F10H 1ame as the posterior vocal fremitus! fremitus is normally decreased over heart

=is breathing patterns are #uiet, rhythmic and effortless Dot performed

Dormal

Dot performed

$ &alpate for temperature, tenderness and masses

Dot performed

Dot performed

'$ &alpate the anterior chest for respiratory excursion

Dot performed

Dot performed

7$ &alpate the vocal fremitus

Dot performed

Dot performed

and breast tissue GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F10H F$ &ercuss the anterior thorax &ercussion notes resonate down to the sixth rib at the level of the diaphragm but are flat over the heart and the liver, and tympanic over the underlying stomach GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F10H (ronchovesicular and vesicular breath sounds GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F1@H Do masses, no pulsations, no lift or heave GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F/1H Do pulsations and no heaves or lift GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F//H &ulsation visible 76P of adults and palpable in most &8) in fifth J)41 at or medial to 84J Diameter of 1 to / cm G1E to Q in$H D5 lift or heave$ GFundamentals of Dot performed Dot performed

0$ Auscultate the anterior thorax

Dot performed

Dot performed

H&!)( )nspect and palpate the aortic and pulmonic areas

Dot performed

Dot performed

)nspect and palpate the tricuspid areas

Dot performed

Dot performed

)nspect and palpate the apical area

Dot performed

Dot performed

Dursing, @th ed$, vol$1, 3o>ier, p$F//H Auscultate the aortic, pulmonic, tricuspid and apical valves 11! usually heard at all sites ;sually louder at apical area,1/ usually heard at all sites usually louder at the base of the heart$ 1ystole! silent interval! slightly shorter duration than diastole at normal heart rate$Diastole silent interval! slightly longer duration than systole at normal heart rates GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F//H 1ymmetric pulse GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F//H Dot visible GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F/ H Female, rounded shape! slightly une#ual in si>e! generally symmetric 8ale breast even with the chest wall! if obese may be similar in shape to female breasts GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F/@H Dot performed Dot performed

&alpate carotid arteries

Dot performed

Dot performed

Rugular veins

Dot visible

Dormal

B)&!S( (reast si>e, symmetry and contour

Dot performed

Dot performed

!BD$M& )nspect the abdomen for skin integrity

;nblemished skin! ;niform color! 1ilver white striae or surgical scars GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F H Flat, rounded or scaphoid GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F H 1ymmetric movement cause by respiration! .isible peristalsis in very lean people! Aortic pulsation in thin person at epigastric area GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F H Do visible vascular pattern GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F 'H

Dot performed

Dot performed

)nspect the abdominal contour$

Dot performed

Dot performed

5bserve Abdominal movement associated with respiration, peristalsis, or aortic pulsation

Dot performed

Dot performed

.ascular patterns

Dot performed

Dot performed

M/S"/,$S6&,&(!, S*S(&M )nspect the muscle for si>e! compare the muscles on one side of the body to the same muscle on the other side )nspect the muscle and tendons for contractures

%#ual si>e on both sides of the body GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'6H Do contractures GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'6H Do fasciculation or

%#ual si>e on both sides of the body

Dormal

Do contractures

Dormal

)nspect the muscles for

Do fasciculation or

Dormal

fasciculation and tremor

tremors GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'6H Dormally firm GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'6H %#ual strength on each body part GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'6H %#ual strength on each body part GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'6H %#ual strength on each body part Do deformities GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'1H Do tenderness or swelling GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'1H .aries to some degree with persons genetic makeup and degree of physical activity GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'1H

tremors

&alpate muscle tonicity

Dot performed

Dot performed

Test muscle strength

Dot performed

Dot performed

1$ Test for muscle strength Gupper extremitiesH

Dot performed

Dot performed

/$ Test for muscle strength GJower extremitiesH (ones 1keleton for structure

Dot performed

Dot performed Dormal

Do observed bone deformities

&alpate the bones to locate any areas of edema or tenderness

Do edema upon palpation

Dormal

)! G& $+ M$(I$ 1$ ;pper %xtremities

-58 is not limited on upper extremities

Dormal

/$ Jower %xtremities

.aries to some degree with persons genetic makeup and degree of physical activity GFundamentals of GFundamentals of Dursing, @th ed$, vol$1, 3o>ier, p$F'1H

-58 is not limited on lower extremities

Dormal

Drug !nalysis 'itamin B "omple3 used to prevent vitamin deficiency since the patients nutrition inside the home care is not sufficient due to the limitations of foods that he eat$ ,actulose used to treat constipation since the patient is experiencing constipation$ 1ome factors that may contribute to constipation of the client are insufficient fiber and water intake, emotional disturbances such as depression, medications such as, antihistamine and antidepressants$ Biperiden Hcl is an anti parkinsonism to lessen or to prevent the patient having an %xtrapyramidal 1ymptoms which he can get from the side effects of the drugs that he is taking such as the 5lan>apine and 4hlorproma>ine$ %aracetamol was prescribed to the patient on February 1@, /61/ when he had fever$ Bhen the patient had urinalysis on February /6, /61/, the result shows that there were few bacteria present in his urine so his doctor prescribed him to take "iproflo3acin on February /1, /61/ to be taken for 0 days and it was consumed on February /0, /61/$ 4iprofloxacin is an antibacterial that acts by inhibiting bacterial DDA gyrase thus preventing replication in susceptible bacteria$ )t was prescribed so that the few bacteria will not multiply or replicate$ &ssentiale +orte was prescribed to the patient on 5ctober //, /611 to be taken 1 cap 5D but the doctor changed the fre#uency on 8arch 1/, /61/ to be taken 1 cap T)D$ %ssentiale Forte is a hepatic protector, which means it protects the liver of the patients from the different drugs his taking$ 5n 8arch F, /61/ the patient undergo Alanine Aminotransferase Test GAJTHE 1?&T a blood test that is typically used to detect liver in+ury and the result was C6 );EJ$ The normal range is only 7"'6 );EJ$ Jevels of AJT may be markedly elevated as a result of exposure to drugs or other substances that are toxic to the liver$ Thats why the doctor changed the fre#uency as T)D instead of 5D$ April 1@, /61/ the test was repeated and the result was /@ );EJ which is within the normal range$ Diphenhydramine was prescribed to the patient as ad+unct therapy for antipsychotic drugs$ )t treats the extrapyramidal symptoms caused by antipsychotic drugs$ )ts also because of

its synergy effect$ )t creates enhanced combined effects of the different drugs to become more effective the drugs to the patient$ (hora-ine and $lan-apine are antipsychotic drugs to treat the psychotic manifestations like mumbling to self and paranoid ideas$ This medication has to do to lessen psychotic manifestation that patient is experiencing$ )t blocks the receptor for the neurotransmitter dopamine$ Dopamine receptors are classified into subcategories GD1, D/, D , D' and D7H, and D/, D and D' have been associated with mental illness$ Sertraline is a 1elective 1erotonin )ntake -e"uptake typically used as antidepressants in the treatment of depression, anxiety disorders and personality disorders$ 1erotonin is a neurotransmitter known to have an impact on mood$ The class of 11-) bipolar medications is thought to exert their antidepressant effect in part by slowing down the process of serotonin reuptake$

,aboratory and Diagnostic &3am )esult

Date February /6, /61/ %rocedure ;rinalysis ormal )esults Interpretation !nalysis

4olor

&ale yellow to amber

Oellow

Dormal

The yellow color of urine is caused by the presence of pigment urochrome, a product of metabolism that under normal conditions is produced at a constant rate$ .ariations in the yellow color are related to the bodys state of hydration$

/eferen0e1 A 2anual of 3aboratory 4ia!nosti0 5ests by Fis0#ba0+ %a!e &")

The urine becomes ha>y depending on the food or medicines ingested$ 1ometimes semen gets mixed with the urine, causing it to become

slightly ha>y$

Transparency

4lear to slightly ha>y

=a>y

Dormal

/eferen0e1 Fundamentals of ursin! "t# edition $ol. 2 by Kozier and Erb6s %a!e &27'

This depends largely on the hydration status$ Bhen fluid intake decreases 1? increases$ Bith high fluid intake 1? decreases$

/eferen0e1 2edi0al8Sur!i0al ursin! &2t# edition $ol. 2 by Brunner and Suddart#6s %a!e &'0)

1pecific ?ravity

1$616" 1$6/7

1$616

Dormal

Any result outside this range is noted to pose problems$ )f the p= level tends to be alkaline, it is indicative of infection in the kidneys or urinary tract, and side effect to drugs$ An acidic p= is indicative of medical conditions like diabetes mellitus, phenylketonuria, renal tuberculosis, etc$ The urine may also be acidic if the person ingests a high protein diet$

&h -eaction

Dormal p= level of urine ranges from '$F"@$6

7$6

Dormal

/eferen0e1 Fundamentals of ursin! "t# edition $ol. 2 by Kozier and Erb6s %a!e &27'

&yuria refers to abnormal numbers of leukocytes that may indicate infection in either the upper or lower urinary tract or with acute glomerulonephritis$ ;sually, the B(4Ss are granulocytes which include neutrophils and eosinophils$ )f two or more leukocytes per each high power field appear in non" contaminated urine, the specimen is probably abnormal$

/eferen0e1 2edi0al8Sur!i0al ursin! &2t# edition $ol 2 by Brunner and Suddart#6s %a!e &'0'

6 * ' E=pf

Bhite (lood 4ell

/ to 'E=pf

Dormal

Dormally, about 1 million -(4s pass into the urine daily$ =ematuria GT -(4sE=pfH can develop from an abnormality anywhere along the genitourinary tract and is more common in women than in men$

/eferen0e1 2edi0al8Sur!i0al ursin! &2t# edition $ol 2 by Brunner and Suddart#6s %a!e &'0'

?lucose in the urine indicates

high blood glucose level GT1@6mgEdlH and may be indicative of undiagnosed or uncontrolled diabetes mellitus$

/eferen0e1 Fundamentals of ursin! "t# edition $ol. 2 by Kozier and Erb6s %a!e &27'

6*

E=pf

(lood may be present in urine of clients who have urinary tract infection, kidney disease or bleeding from the urinary tract$

-ed (lood 4ell

/E=pf

Dormal

/eferen0e1 Fundamentals of ursin! "t# edition $ol. 2 by Kozier and Erb6s %a!e &27'

3etones, the end product of the breakdown of fatty acids are not normally present in the urine$ They may be present in the patients who have uncontrolled D8, who are in state of starvation or those who have ingested excessive amount of aspirin$

Degative ?lucose

/eferen0e1 Fundamentals of ursin! "t# edition $ol. 2 by Kozier and Erb6s %a!e &27'

Degative

Dormal

&rotein is one of the many

Degative

urinalysis values that can help doctors determine if there is a problem with the kidneys or the bladder$ Bhen the kidneys are damaged, many substances can leak from the kidneys into the urine$ 1ince proteins are made of very large molecules, the presence of protein the urine can indicate advancing kidney problems$ %levated protein levels can also indicate that a person has eaten a lot of meat recently or that they have a urinary tract infection$ Degative Dormal
/eferen0e1 Fundamentals of ursin! "t# edition $ol. 2 by Kozier and Erb6s %a!e &27'

(lood

%pithelial cells are present in the urine after exposure to toxic agents or viruses$

Dot present

/eferen0e1 A 2anual of 3aboratory 4ia!nosti0 5ests by Fis0#ba0+ %a!e 2&'

3etones

Dot present

Dormal ;nder the light microscope, the presence of T/6 bacteriaEhpf may indicate a ;T)$ ;ntreated bacteria can lead to serious kidney disease$

/eferen0e1 A 2anual of 3aboratory 4ia!nosti0 5ests by Fis0#ba0+ %a!e

2&'

1ome crystals normally appear in urine, but numerous calcium oxalate crystals suggest hypercalcemia or ethylene glycol ingestion$ 4ystine crystals GcystinuriaH reflect an inborn error of metabolism$ Dot present

&rotein

Dot present

Dormal

Few

%pithelial 4ells

5ccasional

Dormal

Degative (acteria

Few

De#iation from ormal

Done 4rystal 8arch 1@,/61/ 1erum ?lutamic &yruvic

Transaminase

Done 7$66 to '6$66 ;EJ C6 ;EJ

Dormal 8HIGH9 De#iation from ormal This test is the marker of hepatic in+ury more specific of liver damage$ 4auses of its increased are hepatitis, infectious mononucleosis, acute pancreatitis, acute

myocardial infarction, and heart failure$

Dote, 1erum glutamic pyruvic Transaminase G1?&TH, An en>yme that is normally present in liver and heart cells$ 1?&T is released into blood when the liver or heart is damaged$

/eferen0e1 Fundamentals of ursin! "t# edition $ol. 2 by Kozier and Erb6s %a!e "0'

%!(H$%H*SI$,$G* $+ BI%$,!) DIS$)D&)

Age =eredity

1tress

Damage brain cells Gbiogenic aminesH 1erotonin M Doerepinephrine Alter brain tissue Ginsular cortexH Function

Dopamine

Frontal

&refrontal

7"=T/A receptor =ypocampus

Amygdala

?eneral " Deglect of -esponsibities and appearance " &oor memory " )nability to concentrate " 1uicidal thoughts

&hysical " 1leep disturbance " )nsomnia or sleeping too much " Anergia " Joss of appetite or overeating M

"Difficulty making decisions " Feeling empty " Anhedonia " Joss of sexual desire " Joss of feelings for familyE friends

weight loss or weight gain " 1tomache, )ndigestion or change in bowel movement " =eadache and backache

" 1adness or irritability

" =opelessness

" ?uilt M self blame

&"$,$GI" M$D&,

!. H*%$(H&SIS

(ipolar Disorder involves extreme mood swings from episodes of depression$ )t was also known as manic"depressive illness$ During manic phases, clients are euphoric, grandiose, energetic, and sleepless$ They have poor +udgement and rapid thoughts, actions, and speech$ During depressed phases, mood, behavior, and thoughts are the same as in people diagnosed with ma+or depression, they are sad or hopeless and lose interest or pleasure in most activities$ Bhen your mood shifts in the other direction, you may feel euphoric and full of energy$ 8ood shifts may occur only a few times a year, or as often as several times a day$ )n some cases, bipolar disorder causes symptoms of depression and mania at the same time$ )n our patients condition we have perceived taht the predisposing factors which contributed to the occurance of (ipolar disorder is due to depression, stress, alcohol intake, and when he was left by his parents at the age of C$

B. %)&DIS%$SI G +!"($)S

1$ =51T /0 years old male

/$ FA4T5-1 Depression Alcohol )ntake Jeft by his parents at the age of C 1tress

". &"$,$GI" M$D&, The web model primarily talks of the multiple causation of the disease$ )t is used to show the relationship among different factors that contribute to the occurance of the disease$ The diagram below shows the possible predisposing factors that could affect the other as a whole$

D. ! !,*SIS The model shows that there are many contributing factors that causes bipolar disorder$ The most common cause of bipolar disorder is depression that is why the other term for this disorder is manic depression$ 1tressful life events can trigger bipolar disorder in someone with a genetic vulnerability$ These events tend to involve drastic or sudden changes*either good or bad*such as getting married, going away to college, losing a loved one, getting fired, or moving$ Bhile alcohol intake doesnt cause bipolar disorder, it can bring on an episode and worsen the course of the disease$ Age also a contributing factor because it usually first occurs between the ages of 17 " 6 years, with an average age of onset at /7 years$ =owever, bipolar disorder can affect people of all ages, including children$

&. "$ ",/SI$ S ! D )&"$MM& D!(I$ S (ipolar Disorder, also known as manic depressive disorder can be successfully treated, but many individuals fail to get the help they need for a variety of reasons$ )ndividuals

with symptoms of this condition are encouraged to seek professional help$ )f you are reluctant to seek treatment, confide in a friend or loved one, a health care professional, a pastor or someone else you trust$ They can help you take the first steps to successful treatment$

%roblem %rioriti-ation
"ues 1, 9 &arang pinag"uusapan ako ng ibang tao< Inferences )mpaired 1ocial )nteraction Diagnostic statement )mpaired 1ocial )nteraction related to absence of available significant others

5, he does not have any playmate his parents have separate room with him$ he is the only child and he finds it boring$ never experienced having a girlfriend nor undergone any courtship some misunderstanding to their family members they are not a close with some of their relatives he appears unhealthy because every time we ask him #uestions, it seems he is not interested and he is irritable, his posture was slightly slouching while sitting and when standing Bhen we start the conversation he cant stay to have eye contact, he diverts his eyes$ =e has a

flat affect and he response slowly$ 1, 9ma+or problem hindi makapasok sa trabaho, problem sa pag aabroad and study$< 9may lugar akong gustong puntahan, ;$3$< where his mother and father is located$ situational low self esteem 1ituational Jow 1elf"%steem related to failuresEre+ections

5, he doesnt have +ob his parents could not financially support him when he go to ;3 as the standard of living there is high$ 1, 9ma+or problem hindi makapasok sa trabaho, problem sa pag aabroad and study$< 9 wala akong ginagawa gusto ko kasing may ginagawa 9 9 %ncoding, kasi dati akong encoder< 5, he appears unhealthy because every time we ask him #uestions, it seems he is not interested and he is irritable, his posture was slightly slouching while

ineffective coping

)neffective coping related to inade#uate opportunity to prepare for stressor

sitting and when standing Bhen we start the conversation he cant stay to have eye contact, he diverts his eyes$ =e has a flat affect and he response slowly$ 1, 9 &arang pinag"uusapan ako ng ibang tao< < parang nakarating na ako sa lugar na iyon pero hindi naman nangyayari sa tunay na buhay$<

disturbed sensory perception

Disturbed sensory * auditory * perception related to psychological stress

5, he appears unhealthy because every time we ask him #uestions, it seems he is not interested and he is irritable, his posture was slightly slouching while sitting and when standing when we start the conversation he cant stay to have eye contact, he diverts his eyes$ =e has a flat affect and he response slowly$ the clients facial expression is not appropriate to the stimuli presented$ during the nurse patient interaction, he pro+ects blank stares and appears to be serious$ he has low range of mood$ he did experience thought block when asked what

hes thinking at the moment and other #uestion like testing his memory, concentration and so on hallucinations impaired communication irritability poor concentration restlessness he had auditory hallucinatory experiences when he was still in college$ =e said that the voice was saying Abilisan mo$ The client says that he wakes up early everyday around F,66A8 then sometimes, he wakes up at 1/A8 or A8 with unknown reason$ 1ometimes, he takes a nap in the afternoon for about maximum of 6 minutes$

-isk for )nsomnia

-isk for )nsomnia related to Depression