Bipolar Disorder NANDA help

[eloradannon]

We just started our psych rotation and I'm having trouble choosing and prioritizing my NANDAs. Would anyone be willing to put in their 2 cents?

Dx: Bipolar I Disorder, Most Recent Episode Mixed, Severe With Psychotic Features

Pt has persecutory delusions, easily agitated, extremely labile, intrusive, unpredictible, non-compliant with meds, unkempt appearance...

I am supposed to choose 3 NANDAs and prioritize them. The three I have chosen are:

-Disturbed thought processes

-Ineffective self-health maintenance

-Risk for other-directed violence

My question is the disturbed thought processes seem to be the root of all problems. If you have impaired thinking, you cannot make good judgments about taking meds, having appropriate social interactions or self care. But if a pt is capable of violence, does that automatically become the priority?

My next question is that my NANDA book no longer has the Disturbed Thought Process diagnosis included. Is this an outdated NANDA? Would there be an appropriate substitute?

Thank you for any input.

[Esme12, ASN, BSN, RN]

Psyche is NOT my forte.....here is a care plan example.Bipolar Disorders Care Plan Nursing Care Plan (NCP) - Memoir of a Schizo

Risk for other-directed Violence

NANDA-I Definition

At risk for behaviors in which an individual demonstrates that he or she can be physically, emotionally, and/or sexually harmful to others

Disturbed Sensory perception (specify: visual, auditory, kinesthetic, gustatory, tactile, olfactory

NANDA-I Definition

Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli

Defining Characteristics

Change in behavior pattern; change in problem-solving abilities; change in sensory acuity; change in usual response to stimuli; disorientation; hallucinations; impaired communication; irritability; poor concentration; restlessness; sensory distortions

Related Factors (r/t) ]Altered sensory integration; altered sensory reception; altered sensory transmission; biochemical imbalance; electrolyte imbalance; excessive environmental stimuli; insufficient environmental stimuli; psychological stress

Self Neglect

NANDA-I DefinitionA constellation of culturally framed behaviors involving one or more self-care activities necessary to maintain a socially-accepted standard of health and well-being

Defining Characteristics

Inadequate personal hygiene; inadequate environmental hygiene; nonadherence to health activities

Related Factors (r/t) Capgras syndrome; cognitive impairment (i.e., dementia); depression; learning disability; fear of institutionalization; frontal lobe dysfunction and executive processing ability; functional impairment; lifestyle/choice; maintaining control; malingering; obsessive compulsive disorder; schizotypal personality disorder; paranoid personality disorder; substance abuse; major life stressor (i.e., coping difficulty); mental retardation

Ackley: Nursing Diagnosis Handbook, 9th Edition

[TABLE]

[TR]

[TD=class: toolbarDiv][/TD]

[/TR]

[/TABLE]

[VivaLasViejas, ASN, RN]

I'm surprised not to see Ineffective Individual Coping used here. If there's anything bipolars can't do when they're in crisis, it's cope!

Granted, it's been 15 years since I used NANDA and my take on BP disorder is from the perspective of a patient, not a nurse. However, IMHO this nursing dx covers a lot of the ground others might miss. In the throes of an episode (whether manic, depressed, or mixed), most BPers have little or no insight as to how to help themselves: they don't eat or sleep well, they don't keep things clean, they don't pay their bills, they don't practice good hygiene or self-care skills. They don't even understand that they need help......IOW, they don't do much of anything that's in their best interests.

I don't know if this information will help you with your care plan, but I offer it, even though psych isn't my cup of tea either, because this particular issue is very near (if not dear) to my own heart. :)

[guest042302019, BSN, RN]

Would you mind right out your full diagnosis with r/t factors?

My question is the disturbed thought processes seem to be the root of all problems.

I'm wondering if "disturbed thought processes" is the manifestation/symptom of the problem. The problem being a neurological chemical or structural imbalance. But, after all, we don't diagnosis the medical problem, we diagnosis the response to the problem. Just saying. Anyway.

If there is a safety issue either for the patient or others around the patient, I feel like that would take priority. What indicated that the patient was risk for violence towards others? Something he said or did? I see easily agitated and unpredictable as well as has psychotic features. Is that what you are concerned about.