care plan help

you are care planning for someone with bipolar disorder. follow the steps of the nursing process.

step 1 assessment - part of the purpose of assessment is to find abnormal data because nursing problems are based upon abnormal data. assessment consists of:

• a health history (review of systems) - this is information you can obtain from questioning the patient
  
• performing a physical exam - this you obtain from your own examination of the patient
  
• assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
  
• reviewing the pathophysiology, signs and symptoms and complications of their medical condition - you know that she has bipolar disorder and you need to learn about this disease, its signs and symptoms in order to find out if you missed seeing any of them or if you missed picking up on the patient's report of them when you interviewed her. your development of the care plan depends on this.
  
  • http://www.merck.com/mmpe/sec15/ch200/ch200c.html - bipolar disorders
    

  [*]reviewing the signs, symptoms and side effects of the medications they are taking - per your post, this was not available to you

step #2 determination of the patient's problem(s)/nursing diagnosis - make a list of the patient's abnormal symptoms. some you already listed were

• laughing inappropriately
  
• faulty judgment (how?)
  
• inability to set limits on behavior (how?)
  

these are defining characteristics (evidence) of nursing diagnoses.

• ineffective coping r/t biochemical and neurological changes in the brain secondary to bipolar disorder aeb destructive behavior toward self and use of poor judgment
  
• impaired social interaction r/t biochemical imbalances secondary to bipolar disorder aeb inappropriate laughing during conversations
  

risk for injury, related to faulty judgment, as evidence by, inablility to set limits on own behavior

this inappropriate laughing is a symptom of the manic phase she was in. no, it's not something you saw, but it is appropriate data that i think you should include. remember that she is now on medication to control her symptoms. she was manic and out of control and her mom had her hospitalized because she was a danger to herself when she was behaving like that and she needed to be in protective custody until they got some meds on board. by the time you saw her she was under control. when bipolars get manic they get goofy and do some crazy stuff. perhaps you might want to go with a teaching need of the patient. she certainly needs to be aware of her condition and when her behavior is a bipolar symptom. maybe deficient knowledge, bipolar disorder and treatment r/t lack of information would be appropriate.

when people are manic they are euphoric, extremely optimistic, have flight of ideas, speak rapidly, cannot concentrate, are reckless and use poor judgment (which is where she got into trouble with getting pg), they don't sleep, engage in overactivity, act with inflated self-esteem and when they slip into depression they can become suicidal. so, there is more to mania than just the pleasure seeking activities. when in a manic phase bipolars act grandiose, like they have inflated self-esteems, do not sleep much, talk all the time (almost non stop), are easily distracted, become agitated very easily and can become very irritable. because they become involved in pleasurable activities (such as sex) they can get into trouble quite easily.

i am looking at a chapter in my book on managing mood disorders and it has a long list of nursing diagnoses for both the depression and mania. these are all based on the symptoms of both depression and mania (which i listed in the paragraph above).

• anxiety
  
• impaired verbal communication
  
• ineffective coping
  
• anticipatory grieving
  
• dysfunctional grieving
  
• hopelessness
  
• risk for injury
  
• unilateral neglect
  
• noncompliance - i've had a few of these patients over the years
  
• imbalanced nutrition: less than body requirements
  
• imbalanced nutrition: more than body requirements
  
• post-trauma syndrome
  
• risk for post-trauma syndrome
  
• powerlessness
  
• ineffective role performance
  
• all the self-care deficits
  
• chronic low self-esteem
  
• situational low self-esteem
  
• risk for low self-esteem
  
• disturbed sensory perception
  
• sleep deprivation
  
• disturbed sleep pattern
  
• impaired social interaction
  
• social isolation
  
• disturbed thought processes
  
• risk for other-directed violenc3e
  
• risk for self-directed violence