62

C. Drug Study

Olanzapine and Clozapine are Antipsychotic Dibenzapine derivative. Common

side effects are leukopenia, hyperthermia and hypotension. The patient was instructed to
avoid exposure to sunlight because this drug may weaken the ability of the body to
decrease the temperature. Due to leukopenias (decrease WBC) side effect, the patient
and significant others were instructed to report flu-like symptoms, avoid activities that
may lead to infection and were instructed for weekly check for CBC. Monitor the vital
signs especially temperature and blood pressure because this drug can cause
hypotension.

Divalproex Sodium is an Anticonvulsant Carboxylic Acid derivative. Common

side effects are agranulocytosis, blurred vision, and abdominal pain. The patients were
instructed to report flu-like symptoms, avoid activities that may lead to infection and were
instructed for weekly check for CBC. Instructed patient to avoid driving blurring of vision
occurs. The patient was also instructed to take drug with food to reduce adverse GI
effect.

AkinetonHcl is an Anticholinergic drug. Common side effects are hypotension,

constipation and dry mouth. Instructed patient to avoid sudden position changes to
prevent orthostatic hypotension and monitor BP. Advised patient to increase fluid and
fiber intake.

Digoxin is an Inotrope Cardiac Glycoside drug. Common side effects are

arrhythmia, generalized muscle weakness, nausea and vomiting. Teach patient and
family member about drug action, and dosage regimen. The patient was encouraged to
eat potassium-rich foods. The patient was monitored for digitalis toxicity.

Omeprazole is an Antiulcer Proton pump inhibitor. Abdominal pain, constipation,

and back pain. The patient was instructed that the drug must be taken one hour before
meals. Instructed the patient to swallow tablets whole and not to open, crush or chew
them. The patient was monitored for signs and symptoms of low magnesium level such
as abnormal heart rate/rhythm, muscles spasm, tremors, or seizures.

MetoclopromideHcl is an Antiemetic, Dopamine antagonist. Common side effects

are drowsiness, bradycardia, and diarrhea. The patient was advised to avoid activities
that require alertness for two hours after doses. The patient was also advised to avoid
alcohol during medication. And lastly, the patients bowel sound must be monitored.

Co-Amoxiclav is an Antibiotic, Broad spectrum penicillin. Common side effects

are rash/hives, diarrhea, and dizziness. Assess patient for any hypersensitivity to the
drug. The patient was also instructed to take medication after meal. Lastly, patient is
instructed to increase fluid intake if diarrhea occurs.

Outcome of Care

A. Over the 10 days of course, BDs health status had improved. He actively
participated to the activities that we introduced such as play therapy, recreational
therapy, music therapy, token economy and individual therapy. Upon applying
our nursing care plan, the patient managed to sleep early, to do hygienic
practices, to interact with other patients, to open his problems to his immediate
family member, to educate about his disorder and emphasized its management
 63

on the two phases and advised for strict compliance with his medication regimen.
During the socialization day, the last day of our interaction, patient verbalized:
Thank you maam sa pakikinig sa akin.

B. On the last day of our interaction, the patient had already overcome his shyness
and he actively participates on activities. Also, we observed that he enjoyed our
socialization day.

Discussion

Bipolar disorder is already a lifetime illness. The use of pharmacologic treatment

may manage the two phases experience by the patient. There is various medication
ordered like antipsychotic drugs such as olanzapine and clozapine controlled the
inactivity of neurotransmitters in the patients brain (Sylvia et. al.,; Vitiello, Correll, van
Zwieten-Boot, Zuddas, Parellada, & Arango, 2009). It also helped the patient to attain his
physical, mental, occupational and social functioning. His euthymic mood promotes a
better functioning while under medication regimen (McDougall, 2009). During his
medication, nursing management was also implemented. It assisted the patient to
improve his physical, social and mental well being (Baldessarini et. al.,; Jones & Jones,
2008; Lois, Linke, & Wessa, 2014; McDougall, 2009). The plan of care implementation
had motivated the patient to learn about his disorder, to do proper hygiene, to improve
his sleep routine during confinement, to interact with other people, to accept his role in
the family and to show how capable he is even with the presence of his disorder
(Baldessarini, Tondo, & Visioli, 2014; Mosolov, Ushkalova, Kostukova, Shafarenko,
Alfimov, Kostyukova, & Angst, 2014; Pren, Bohman, von Knorring, Olsson, von
Knorring, & Jonsson, 2014; Tyler, Jones, Black, Carter, & Barrowclough, 2015). The
collaborative management which includes different therapies such as token economy,
play therapy, individual therapy, music therapy, group therapy and humor therapy
promoted motivation in order to change the patients behavior, actively participates on
activities that requires teamwork, expression of feelings and behavior that needs to be
change, showcasing his talent as part of his outlet tension and relaxation, socializing
with other patients and other support groups and facilitation of humor to enhance more
his interaction with others (Benti, Manicavasagar, Proudfoot, & Parker, 2014; Kleine-
Budde, Touil, Moock, Bramesfeld, Kawohl, & Rssler, 2014; Lois et. al.,; McKenna,
Sutherland, Legenkaya, & Eyler, 2014: Perlick, Gonzalez, Michael, Huth, Culver,
Kaczynski, & Miklowitz, 2012; Stange, Boccia, Shapero, Molz, Flynn, Matt, & Alloy,
(2013). His confinement managed the patients ups and downs with the help of nursing
assistance. Providing safety was the priority of nursing management for him due to the
tendency of suicidal ideation (Jones et. al.,; McDougall, 2009).The use of other therapies
also helped the patient to improve his condition. The roller coaster ride like of the patient
had been managed through the application of the following therapies and nursing
management.

Conclusion

The milieu of a person can greatly affect his whole personality specifically
attitude and behavior, which may lead whether to disease or wellness. Modifying the
environment of the patients may help him in faster recovery. This case study has
demonstrated a nursing management for a patient with Bipolar disorder. The combined
therapy of pharmacologic, psychological therapy and nursing management did facilitate
a development in the health status of the patient. The use of pharmacologic treatment
 64

helped the patient to stabilize his mood while the use of psychological therapies assisted
the patient to participate more and interact more with others. Nursing management aided
the patient in physical, mental and social encounters. The implementation of the
following treatment modalities has fund to be effective to the bipolar patient.

Recommendation

As the patient was ordered for discharge, we advised him for:

Medication. Strict compliance on his medication by following the 10rs to achieve

a controlled mood and behavior. Report any adverse effects of medications.

Exercise. Encouraged to exercise once in euthymic mood to promote good

physical functioning. Advised significant other to look after the patient if signs and
symptoms occurs to avoid injury.

Treatment. If there's a therapy program implemented, we advised him to join in order to

improve his social, mental and occupational functioning.

Hygiene. Encouraged for proper hygiene such as taking a bath everyday and brush his
teeth three times a day. Advised the significant other to perform good hygiene practice to
the patient if signs and symptoms persists. Patient might not perform self care if he is in
manic or depressed phase.

OPD. Advised for follow up check up to monitor progress.

Diet. Advised significant other to offer finger foods to patient of he is in mania and
depressed state to promote proper nutrition.

Spiritual. Encouraged to continue religious practices such as praying everyday, reading

the bible and join the mass and/or spiritual activities to enhance faith and recovery.

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