Bipolar affective disorder (BPAD) is a mental health condition where a patient may present with symptoms of mania and depression (Stahl et al., 2019). This report summarizes the health condition of Bernadette, who is suffering from the condition and works as a local librarian in the community where she lives with her supportive husband. She has stopped taking her prescribed medication post her physical examination where she feels that her health has deteriorated as a consequence of the side effects of the management of the BPAD. The health condition has severely impacted her physical mental health impacts of which will be addressed in this report. This document has been segmented into two concise sections to analyze the impact of the condition of her mental and physical health with a holistic approach.
Part one of this document summarizes the mental health assessment record of Bernadette along with an explanation of the definition and symptoms that are exhibited by Bernadette. Further, it also identifies the potential risks of her health condition and devises a comprehensive care plan for the management of her health condition. The second part of this report identifies the potential and actual physical health issues associated with the health condition of Bernadette through an evidence-based approach. It also identifies the nursing interventions for the physical health assessment of Bernadette. Further, this section will also explain the metabolic syndrome and suggest health promotion strategies for the well-being and beneficence of Bernadette.
The mental health examination of an individual is done to observe the current state of mind of an individual with the considerations of appearance, mood, appearance, speech, thought process, cognition, and insight of an individual (Harrison et al., 2018). It has been described by the Mental Health Act (2014) in which Bernadette has been placed. The Mental state examination of Bernadette, who suffers from Bipolar affective disorder includes:
Appearance: The posture of Bernadette reveals that in the present scenario she is feeling anxious as she is sitting on the edge of the couch and her muscles appear to be tensed. It can also be observed that she is restless and in denial of taking the prescribed medication. On the second day, she also expresses that she has been brought and kept in the care facility without her consent.
Mood and affect: The mood of the patient can be described to be suspicious as she is constantly concerned that she might be poisoned by the doctor and the nurses and refuses to consume anything until it is tasted by her husband. She appears to be agitated and annoyed for not being aware of the side effects of the medication that was prescribed to her. She also fears that she might get poisoned and people wish to harm her.
Thought content: The though process of Bernadette can be classified as circumferential. This can be deduced to the fact that she returns on asserting that she will not consume the medications as she feels that it has deteriorated her health condition and asserts that “drug is eating away my body”.The thought content of Bernadette reveals that she has developed a phobia where she thinks that her wellbeing is threatened and people around her wish to poison her.
Cognition: The cognitive abilities of Bernadette are deluded and she possesses a concrete belief that people around her wish to harm her and poison her. She asserts that she does not trust anyone and when asked how to gain her trust she prompts a quick denial. She thinks that she might get poisoned through food and liquids that she might be asked to intake. Therefore, it can be concluded that her cognitive abilities are impaired with delusions.
Insight and judgment: Bernadette addresses that her BPAD medication has been able to allow her to work as a librarian and has helped her manage mood. However, she also thinks that it has resulted in the deterioration of her physical health and asserts that she has developed a metabolic disorder because of this medication. Therefore, even when she is aware of the repercussions of not taking BPAD medication, she feels that its consumption may pose more harm and hence has developed reluctance, she has also developed delusions that impair her judgment.
The bipolar affective disorder is defined as a mental illness where an individual may exhibit periods of depressive episodes along with abnormally elevated mood that can result in psychosis and delusion (Harrison et al., 2018). Individuals with BPAD may express a mix of symptoms that can either be depressive or demonstrate hyper mania (Stahl et al., 2019). In the case of Bernadette, the signs and symptoms of depression and mania evident. Symptoms displayed by Bernadette:
1. Anxiety: Bernadette expresses anxiety as she exclaims that she is unsure of why she has been brought to the care setting. She is also skeptical and denies medication.
2. Psychosis and delusion: Bernadette has developed a delusion that her doctor and people, in general, wish to poison her to death and might give her medication disguised in food or drinks.
3. Attention deficit hyperactivity disorder (ADHD): The patient shows signs of ADHD as she is reluctant to listen to the healthcare professional and has developed affirm opinion over her medication. She also seems to have limited attention span evident by her fidgety movements.
Bipolar affective disorder severely impacts the mental health of the patient (Duffy et al., 2016). Since Bernadette has stopped her medication her mental health condition can worsen. This can lead to the following development of the following risks affecting her mental health:
1. Extreme mood swings: Bernadette may experience extreme mood swings that can affect her sleep and activity cycles. This can also lead to the worsening of her health condition by periodic occurrence of depression and mania (Duffy et al., 2016).
2. Impairment of judgment and ability to think clearly: In severe cases like that of Bernadette, the rationality to make adequate decisions and form judgments is impaired. This can lead to a detrimental effect on Bernadette as her thinking and decision-making ability will be deluded making her take irrational choices that can further cause anxiety and restlessness (Harrison et al., 2018).
3. Psychosis: The hyperactivity and depression in the patient can lead to the development of psychosis. Psychosis will result in the development of belief systems based on delusions. These can severely impact the wellbeing of her mental as well as physical health (Stahl et al., 2019).
a) Presenting history
Bernadette Cook (50-years old) librarian is suffering from bipolar affective disorder (BPAD). The patient lives in the desired community and with a husband who has been supportive of her journey. However, in her physical body examination, Bernadette found that she has high triglycerides and an unhealthy BMI. She thinks that she has developed this due to her BPAD medication. She has stopped taking her medicines and this has worsened her mental health. She has developed delusions that people are trying to poison her and is accelerating towards psychosis. She has developed a mistrust for people making her restless and anxious in the care setting.
b) Identified issues
The primary personal issue identified with Bernadette is a reclusive attitude towards medication. Bernadette has also developed delusions and mistrust resulting development of this false notion that people are trying to poison her by inducing lithium toxicity.
The clinical issues Identified with Bernadette include the development of psychosis, deteriorating physical health with excess weight on her abdomen, high BMI, and high triglyceride content.
Issue – Psychosis and reluctance towards medication
The rationale for selection: By effective management of delusion and reluctance towards medication, stability to the health condition can be provided for the beneficence of Bernadette, she will be able to improve her judgments, improve her mental health and take rational decisions for improvement her physical health maintenance and wellbeing (Wei et al., 2019).
The suitable interventions for her condition include:
1. Cognitive behavioral therapy: will assist in the management of psychosis and provide counsel to the patient (Kastan & Acar, 2017).
2. Motivational interviewing: A directive approach to bring change in behavior (Duffy et al., 2016)
3. Adherence therapy: to promote and enhance adherence towards medication (Wei et al., 2019).
4. Arts therapy: psychotherapeutic interventions along with the amalgamation of activities to promote expression and alleviate anxiety (Kastan & Acar, 2017).
5. Inclusion of family: Assistance of family members in activities to promote health and wellbeing and provide comfort to the patient (Stahl et al., 2019).
Bernadette expresses her concern about her deteriorating physical health. The health condition of Bernadette has deteriorated as evidenced by the body examination that revealed the current physical health issues. These include:
1. High BMI (Body Mass Index): The physical report of the patient reveals that Bernadette has unhealthy BMI. Being overweight can lead to the development of multiple health complications like diabetes, cardiovascular problems like arrhythmia, stroke, atherosclerosis, etc. (Skinner et al., 2016). Further, high BMI can result in the development of gallbladder disease, certain cancers like breast cancer and colon cancer as well. Individuals with high BMI have also been found to develop osteoarthritis and other comorbid health conditions (Opel et al., 2017).
2. High triglycerides: High concentration of triglycerides can result in hardening of the arteries (atherosclerosis) and this can further result in a higher chance of stroke due to atherosclerosis (Opel et al., 2017). As the arteries lose their flexibility due to triglyceride deposition, the blood flow gets restricted and there is a higher chance of clot formation that can cause stroke in the patient. Further, high triglyceride concentration in the patient can result in inflammation of the pancreas and or pancreatitis in the patient. High triglyceride concentration is also associated with increased chances of getting a heart attack and developing other cardiovascular health problems (Nunez et al., 2017).
3. Increased fat around the abdomen: increased fat deposition at the waist is a health problem that can give rise to chronic health conditions. Increased fat deposition around the midsection has been identified as a prominent risk factor associated with higher chances of stroke and is even associated with certain cancers (Nunez et al., 2017). It has also been associated with the development of diabetes mellitus and compromised lung function in individuals. Abdominal obesity has also been related to the development of chronic health conditions like asthma in individuals (Skinner et al., 2016).
Further negligence towards these health problems can lead to the development of health conditions like:
1. Cardiovascular diseases: Bernadette is at risk of developing cardiovascular problems and circulatory diseases like atherosclerosis as she possesses an unhealthy BMI and high triglyceride content (Wald & Garber, 2018). Cardiovascular diseases are strongly interlinked with obesity. The common cardiovascular health problems that are liked with unhealthy body weight and are increased risk of heart failure and coronary heart disease. Obesity impacts the heart condition of the individuals by causing atrial and ventricular enlargement. Further, increased concentration of triglycerides in Bernadette could result in restricting the blood flow, hardening the arteries and result in complex cardiovascular problems like stroke and heart failure (Wald & Garber, 2018).
2. Hypertension: High blood pressure is closely linked with unhealthy body weight, the higher concentration of triglycerides as well as BPAD (Lin & Buckley, 2019). Obese individuals require more oxygen than healthy individuals for maintaining the cellular function of the body. This results in the development of circulatory strain and impacts the heart rate and the blood pressure in obese individuals (Grundy, 2016). Hypertension has also been linked to psychological health conditions like bipolar disorders increasing the chances for Bernadette to acquire it.
3. Diabetes mellitus: Diabetes mellitus has been significantly linked with obesity and unhealthy BMI in the individual. Excess of fat tissue in the body results in an inflammatory response in the body where the frequent release of inflammatory chemicals results in desensitization of the insulin receptors of the body (Grundy, 2016). As a consequence, insulin reception in the patient is reduced and the blood glucose levels increase resulting in the development of diabetes. Large waistline or abdominal fat possessed by Bernadette are considered to be the hallmarks of diabetes mellites in the patients. Obesity also disrupts the metabolism of the body affecting the insulin responsive cells affecting the blood glucose levels of the individual (Lin & Buckley, 2019).
1. Complete cardiovascular health assessment: The cardiovascular health of Bernadette can be assessed by performing an electrocardiogram (ECG) (Selvakumarasamy et al., 2019). This will allow for the assessment of the blood rhythms and assist in the detection of structural or functional anomalies in the heart and the cardiovascular system. The electrodes are placed on the body to record the cardiac rhythm by assessing the electrical activity of the heart. The cardiac exam is also inclusive of the observations about the palpations and auscultations of the body (Selvakumarasamy et al., 2019). A lipid profile test should also be conducted to determine the concentration of fats and triglycerides in the body that will help in the determination of the risk of stroke and other cardiovascular complications in the patient (Nunez et al., 2017).
2. Blood glucose level (BGL) assessment through blood test: The blood glucose level assessment is crucial as it will help in the determination of the amount of blood glucose levels in the body of an individual (Opel et al., 2017). This assessment is essential as it will help in determining the incidence of diabetes in Bernadette. With increased risk factors, it is crucial to determine the blood glucose levels for the timely management of the condition. The BGL assessment reveals the amount of glucose present in the bloodstream. In a healthy individual, the blood glucose levels range between 72-99 mg/dL when fasting and 140mg/dL two hours after eating (Wald & Garber, 2018). Based on the blood glucose levels of an individual, one can be classified into non-diabetic, pre-diabetic, and diabetic. In the case of Bernadette, it is crucial to determine her BGL levels through a blood test and take proper interventions for adequate management.
3. Assessment of blood pressure and body vitals: Individuals with high BMI possess a higher chance of developing hypertension. The blood pressure of the patient must be monitored regularly using a sphygmomanometer that helps in providing the measurement of blood pressure in an individual which, in healthy individuals falls between 120/80mmHg- 140/90mmHg (Selvakumarasamy et al., 2019). The device measures the blood pressure through an inflatable rubber cuff that is wrapped around the arm. As the pressure of the cuff equals the atrial systolic pressure, the flow turbulence and audible sounds can be heard allowing for the accurate measurement of the blood pressure of the individual (Selvakumarasamy et al., 2019). For Bernadette, this assessment is critical as she has high chances of hypertension development that can lead her to critical health conditions like heart attack and stroke.
The metabolic syndrome is a health condition marked by the development of multiple risk factors that increase the chance of development of heart diseases, diabetes, and stroke. The syndrome occurs when there is the development of increased blood pressure, excess body fat around the waist, high blood sugar, and high cholesterol and triglyceride levels (Grundy, 2016).
Health promotion is an integral part of nursing duty and has been established as the core principle of ethical conduct by the nursing and the Midwifery Board of Australia (2018). In the case of Bernadette, a holistic approach is important for the development of a health promotion strategy. Therefore, it will be crucial to undertake the core principles of the Mental health act of the government of Australia. The health promotion for Bernadette must possess a holistic approach for her psychological as well as physical wellbeing.
For the promotion of her mental health, it is crucial to consider that the interventions are applied in the least restrictive manner and proper support for her treatment is provided and her rights and dignity are protected with informed consent and consideration of autonomy and beneficence (Government of Australia, 2014). Further, the health promotion strategy must also be inclusive of the physical wellbeing of an individual and promote complete care. The three health promotion strategies that will be beneficial for the better physical health of Bernadette will include (Government of Australia, 2016):
1. Goal setting: The physical health of Bernadette can be improved by setting up significant goals towards better health that are achievable, timely, and constructive. This will help in directing her towards better health and focus on the key achievements towards better physical health. These goals can include management of weight, regular exercise, and management of diet.
2. Self-monitoring: To motivate the patient self-monitoring activities like weight and blood glucose management are essential. These will help in keeping the individual motivated towards the targeted goal and help in the improvement of overall health.
3. Person-cantered care: To assist Bernadette in achieving the physical health goals, person-centered care is crucial as it will help in the development of a strong interpersonal relationship with the healthcare professional by building trust that will direct the patient towards beneficence and promote health and wellness.
This document presents a concise report on the physical as well as the psychological condition of a particular patient, Bernadette, presented in the case study. This document addresses the mental state of Bernadette in its part one where it provides a concise mental state examination to discuss the appearance, mood, and affect, thought content, cognition, and insight and judgment of the patient. This part also analyses the symptoms expressed by the individual in the BPAD. Moreover, the potential risk factors of the health condition have also been identified and a nursing care plan to address the identified problems has also been presented.
The second part of this document asserts the significance of the physical health of the patient and identifies the actual as well as the potential physical health issues of the patient. It also provides a suitable assessment intervention to develop insights into the physical health of Bernadette. The document also explains the metabolic syndrome along with the suitable health promotion strategies for beneficence and wellness of Bernadette.
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