NANDA Nursing diagnosis
Disturbed thought processes
In the past two weeks, Catherine exhibited bizarre and excited behaviours that saw her do house activities in half, commencing one without finishing the other. When her husband, Greg, questioned about anything, she got defensive and irritable. She also spoke in a rapid way without coordinating the topics, an evidence of flight of ideas. She started knocking on the doors of her neighbours in the name of starting a keep-fit club. She applied too much makeup and was dressed in bright colored clothes and jewelry. She also has delusions of grandeur as she says that the neighbours have brought her to the hospital because they are jealous of her super powers.
Short term goals
- In the first 24 hours of admission, Catherine shall demonstrate a mood that is stable and shall practice coordinated activities that promote self-care. They include taking a bath, completing one task after the other, interacting well with the other patients among others (Barlow, 2011).
- After 48 hours, Catherine shall be able to control her processes of thoughts and demonstrate it physically by being rational and organized in the unit. She shall also cease to exhibit delusions such as the grandiosity that she feels.
Long term goal
- Catherine shall relate well with her husband and stop being irritable by regaining her normal mood status. Moreover, her daily activities shall be restored, and the disturbances to the neighbours shall cease. Furthermore, Catherine shall have an enhanced mental orientation for as long as it takes.
During the phase of mania
Identify the stimulants within Catherine’s environment and remove them to enhance sleep and promote relaxation.
Monitor the levels of lithium in Catherine’s blood.
Channel Catherine’s energy in pace activities and also in one direction.
Implement the precautions against suicide when Catherine’s mood swings to depression.
Consider the use of other mood stabilizers such as carbamazepine if clozapine and olanzapine do not work (Smith, 2016).
During the phase of depression
Formulate a contact of safety with Catherine after doing a suicide assessment.
Establish the baseline information of Catherine by assessing the intensity and level of her depression.
Select activities for Catherine which ensure that she succeeds and accomplishes them in order to boost her self-esteem.
Spend much time with Catherine by utilizing the provisions of Hildegard Peplau’s theory of interpersonal relations.
Observe Catherine on a daily basis for compliance to medications and any adverse effects (Blake, 2012).
Day 1-2: Catherine interacts with other clients although the manic characteristics are still expressed. Moreover, she took a bath, went to the toilet and spread her bed without any help. Thus, the goal was partially met.
Day3: Catherine remains destructed and fails to demonstrate an understanding of her illness. She still insists that she was wrongly brought to the hospital for treatment and mental assessment. She also remains uncooperative to Greg and her daughter after visiting, and it has sparked some emotional instability to Greg because he often tears and remains worried about his wife.
NANDA Nursing Diagnosis
Disturbed sleep pattern
Catherine has been having difficulties in sleeping and could wake up during the wee hours of the night such as 3 am and make calls to her friends. She can also wake up at midnight and knock on the doors of her neighbours to explain to them about her plans. The sleeping problems were translated to disturbances.
Catherine sleeps comfortably just like any other normal adult
Short term goals
- Catherine shall have a regular pattern of sleeping for an adult with an average of 8 hours per day. She shall also have enough time resting during the day and between activities such as family visits and group therapy. This is to be achieved on her first day in the facility.
- Catherine shall not disturb other patients and the hospital staff during the night to promote their comfortability unless if it is necessary during activities such as emergencies and physiological needs like micturition and defaecation.
Long term goal
After discharge, Catherine and her family shall report a normal sleeping rate and eliminated levels of lethargy due to disturbed sleep.
Administer a mood stabilizer and a tranquilizer during the night for a proper sleep.
Adjust the environment to favour a comfortable sleep during the night in order to prevent provocation of Catherine’s disturbed sleep (Genç et al., 2017).
Reassure Catherine that sleep is good for health and she should have enough for a comfortable day.
Offer Catherine some clean sheets and blankets and enhance her self-care by asking her to spread the bed for a comfortable look that she wishes to have.
Use a calm language or an authoritarian approach when asking Catherine to go to sleep depending on the necessity of the approach.
Put off the lights and regulate the room temperature to enhance a peaceful sleep for Catherine during the night. This is also suitable for other patients.
Monitor the effects of mood stabilizers to prevent an overdose and adverse reactions.
If necessary, administer amitriptyline 75mgs when needed as an antidepressant during the depressive phase of Catherine’s bipolar (Hazard, 2016).
Utilize Cognitive Behaviour Therapy to help Catherine moderate her moods and engage in activities that promote sleep such as meditation (Jones, 2012).
Enroll Catherine in group therapy so that she can learn some sleeping techniques from other patients with a similar problem (Munsterberg, 2014).
Administer therapeutic drugs against a headache, and other side effects of antidepressants and mood stabilizers. Side effects like sweating, acute akathisia, tardive dyskinesia among others deprive Catherine of sufficient sleep.
Day 1: Catherine exhibits some difficulties in sleeping but still manages to sleep for 5 hours for the entire night.
Day2: Catherine begins to have a normal sleeping pattern with the help of medications.
Day 3: She now sleeps well without any form of night disturbances and awakenings. She only woke up due to the urge to evacuate the bowels. The goal was fully met.