University:
American Career College
Course:
NURS112 | Fundamentals of Nursing
Academic year:

2022
Views:

201

Pages:

1
Author:

Trevon Bernard

Nursing Interventions / Treatment Bipolar Disorders: Valerie Loureiro, Mental Health Desired Outcomes: Patient will respond to the medication within the therapeutic levels. Patient will sustain optimum health through medication management and therapeutic regimen. Patient will drink 8 oz of fluid every hour throughout the day while on acutely manic stage. Patient will be free of dangerous levels of hyperactive motor behavior with the aid of medications and nursing interventions within the first 24 hours. Patient will spend time with the nurse in a quiet environment three to four times a day between 7 am and 11 pm with the aid of nursing guidance. Patient will take short voluntary rest periods during the day. Patient will be free of excessive physical agitation and purposeless motor activity within 2 weeks. Patient will be free of injury within 2 to 3 weeks NURSING INTERVENTIONS Provide structured solitary activities with the assistance of a nurse or aide. Provide frequent rest periods. RATIONALE Structure provides focus and security. Prevents exhaustion. Provide frequent high-calorie fluids (e.g., fruit shake, milk). Prevents the risk of serious dehydration. Maintain a low level of stimuli in client’s environment (e.g., loud noises, bright light, low-temperature ventilation). Helps minimize escalation of anxiety. Acute mania might warrant the use of phenothiazines and seclusions to decrease any physical harm. Exhaustion and death result from dehydration, lack of sleep, and constant physical activity. Observe for signs of lithium toxicity (e.g., nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears). There is a small margin of safety between therapeutic and toxic doses. Protect client from giving away money and possessions. Hold valuables in a hospital safe until rational judgment returns. Client’s “generosity” is a manic defense that is consistent with irrational, grandiose thinking. Redirect violent behavior. Physical exercise can decrease tension and provide focus.