Question

Miss C has been on your unit for one week and states "these medications are not working properly;the doctor chose the wrong one". When you ask her why she believes that, she states, '' I'm not feeling any better yet, I'm still feeling sad and pathetic''.

5a) how would you respond to Miss C's concern that her medication is not working?

Miss C is treated and released five weeks from her admission date. Five months later you are taking report on your evening shift and you hear a name that sounds familiar. Miss C has been admitted to the unit for monitoring. She was brought into the emergency department with the police after creating a disturbance at a mall in the city. She was verbally and physically abusive to staff in the emergency department and her boyfriend states she has been increasingly bizarre for the past few weeks. He reports that she believes that she has found the cure for cancer and has been sleeping very little. He is worried as she is spending all of her money on advertising her cure for cancer and has been drinking alcohol and taking street drugs to keep herself awake. He stats that she has been ''irritable'' and they ''have been arguing a lot.'' Two nights ago, Miss C left their home after an argument and he has not seen her since. Miss C is diagnosed with Bipolar Disorder.

5b) Miss C's family is upset about her diagnosis. Describes how you would explain bipolar disorder to Miss C's family.

6) Discuss three patient safety concerns as they relate to acute mania in the bipolar patient. Include your rationale for each concern.

Miss C's treatment progress well, and her mood stabilizes. She is ready for discharge but there is concern from the psychiatrist that she will not comply with the treatment upon discharge. Her family also shares this concern as Miss C states that she "doesn't need to keep taking the medication" that has been prescribed for her bipolar disorder once she is back home.

7) Discuss community treatment order (CTO) as it relates to bipolar disorder. In your own words describe why a patient may be issued a CTO.

Miss C is being discharged from hospital on your shift. She is going home on a therapeutic does of lithium as well as valproic acid.

8) In your own words, describe the priority teaching points related to the lithium and valproic acid you would discuss with Miss C during her discharge teaching.

9) Discuss why it is important to therapeutically end the nurse-patient relationship prior to discharge.

Answer 1

5a

Answer: It is the role of the nurse to clarify the doubt/ When a patient told that the medications that are taking are not working, the nurse should first explain that the medications are prescribe by the doctor according to her condition, the patient condition and the relation with the medications that are using. Explain that it takes time to see the full recovery after taking the medications that is slow in the process to the result. Also explain that the recovery or improvement of the disease condition after taking the medication should be confirmed by performing laboratory investigation or diagnostic evaluation, it will be wrong to judge only by seeing what the patient feel.  

5b

Answer: The nurse should explain to the family member that bipolar disorder is a mental disorder that is characterized by episode of mood swing and ranging from depressive state to a high manic state. The cause is unknown. In this the patient will show the symptoms like manic episode of high energy, not sleeping and depressive episode includes low motivation, low energy, low interest and also can include suicidal thought. The treatment process is life long medications as well as supportive therapy should be given. Encourage the family member to involve in the treatment process.

6

- Prevention of patient from the suicidal thought or act: The patient with manic episode may leads to very low depression leads to develop suicidal thought and go for the suicidal act. So the health workers and the family member should not leave the patient alone, remove all the materials and articles that may harm from patient nearby place.

- Regularity administration of the medication: Make sure that the patient take the medications on time to maintain the manic.

- Prevent from trigger situation that may leads to provoke manic attack: The family member and the health worker should make sure that the environment should be prevent from the situation that may leads to change their mood as they are having mood sings, it will easily change their mood.

7

Answer: Community treatment order is the order given by the legislation for the mental disorder patient to treat by living in the community itself. When the patient is needed for recurrent hospitalization due to recurrent occurred of the symptoms. For the bipolar disorder patient, community treatment order can be used. They can be treated in the community setting or at home by living with the community. But the patient should take medication properly. Treatment in the community setting will help to the patient to understand how to adapt with the situations and behavior of the community. This will helps to recover the patient better as compared with keeping is hospital with restriction.

8

Answer; The first priority to be discuss with the patient before the discharge regarding lithium and valporic acid is to explain the drug dose, frequency, as per advice by the doctor. Also should explain the action of the drugs that is mood stabilizer is the action of the lithium and valproic acid to control the mood swing. Advice the patient to take on time regularly.

9

Answer: It is very important to maintain the therapeutic nurse patient relationship through out the patient treatment. It will increase the trust of the patient towards the nurse and the patient will co operate in the actions or interventions needed to provide the care for the patient by the nurse. It is also increase the respect for the nurse by the patient and respect to the patient by the nurse.