Case study 2

Mr.Q is admitted to the hospital with the medical diagnoses- Hypertension and Bipolar disorder

Hypertension – Blood pressure is the force that is exerted by the blood the walls of the blood vessels
while passing through them. The normal blood pressure for the healthy human being is 120/80
mmHg. The high blood pressure of Hypertension is called when there is increase in the blood
pressure reading beyond this limit. This increase in the blood pressure is due to the structural
changes in the arteries particularly due to the large artery stiffness. These changes in the arteries can
be due to various factors that can be age related as well as diet and lifestyle factors. Due to the age
the blood vessels became weak and cause the blood to put more pressure on them. Also due to age
there reduction in the effective diet so poor diet intake also effects your blood pressure readings.

Types of Hypertension-

a) Primary or essential hypertension.

b) Secondary hypertension.

Bipolar disorder-

Every person faces the mood changes in his life. These changes depend on the different factors like
environment, family, and even on the person to whom we are talking. Bipolar disorder is the extreme
mood changes for indefinite times. It does not have any specific time frame. In bipolar disorder
affected person have two states of the mood. Mania and Depression.

In Mania the person feels overjoyed and euphoria. Affected patient feels the lot of energy in himself.
In some cases it has been seen that the patient is also affected with insomnia. He even talks fast and
more. If the mania continues than the patient became aggressive and irritable. Even the thoughts of
the person became delusional.

In Depression the affected person have negativism in his thoughts. One can even feel the helpless
after depressed. The sleeping pattern of the affected person is altered from insomnia to the excess
sleep. He even withdraw himself from the society. One can detached himself from the social and
personal life. Frustration is one of the prominent factor of depression. In some cases it has been seen
that due to societal detachment patient develop lack of confidence in himself. (institue, 2017)

Types of bipolar disorders-

Bipolar 1 disorder- More severe

Bipolar 2 disorder- less severe

Symptoms of hypertension observed in Mr.Q during the placements are-

a) Mr. Q complaint of the mild to severe headache when the BP is measured it shows the
elevated readings. So the headache is due to the hypertension.

b) During one day it has been observed that Mr.Q has feeling the shortness of breath when he
came from the physio-session during morning time this is due to the hypertension as when the blood
pressure increases this causes the thicken of the heart muscles due to which there is less space for
oxygen rich blood to flow from the lungs to the chambers that pumps blood for the rest of the body.
This can cause blood to backup into the lungs and causing the SOB.

Impact of the Hypertension on the resident-

a) As due to shortness of breath, Mr. Q cannot walk much of the distance. Like when he went for
the physio-session he get tired and cannot do effective work out there.

Symptoms of bipolar disorder-

a) Mr.Q complaint of the less sleep during night time. This is due to the bipolar disorder as it
causes the insomnia in the affected patient. This insomnia is because the bipolar disorder
interferes with the circadian rhythm of human body. Circadian rhythm is the natural clock in
human being that allow us to sleep, awake at particular time. It is the sleep-awake pattern in
human body.
b) Mr.Q experiences the loss of energy and even didn’t participate and experience the
pleasurable events in the faculty and family.

Impacts of bipolar disorder on Mr.Q are

a) Social withdrawal- Mr.Q withdraw himself from the social events and even from the family
functions.
b) Prolonged sadness- Mr.Q feels prolonged sadness during his days in the facility.

Social, psychological, cognitive and physical factors associated with the diagnoses are –

Hypertension-

a) Social factor- Job strain is one of the main social factor associated with the hypertension.
When there are some issues that are present at ones workplace can cause increase in blood
pressure.
b) Physical factors- Diet and lifestyle also causes the hypertension. Diet with high sodium intake
and alcohols are factors that contribute to the Hypertension.
 c) Psychological factors- Factors like anger and anxiety are some of the psychological factors
that are contributors of hypertension.
d) Cognitive factors- Stress causes the increase in the onset of the depression.

Bipolar disorder-

a) Social factors- When there are some stressful event that is happens in one’s life can trigger
the bipolar disorder. Stressful events includes disease onset or loss of some beloved one.
b) Physical factors- Some drugs and alcohol abuse person also develop bipolar disorder. Drugs
such as steroids can cause the symptoms of bipolar disorder.
c) Psychological factors- It has been seen that person who experience trauma and child abuse
have high risk of developing Bipolar disorder (depression).
d) Cognitive factor- Previous mental history causes can causes the bipolar disorder.

Nursing theory associated with the diagnosis of Mr.Q is Orem’s Self Care Deficit theory. This theory is
developed by the Dorothea Orem between the years of 1959 and 2001. According to this theory- the
person is self-reliant and he or she can care for him or herself. He is also responsible for the care for
their family members as well. Orem also identifies the activities of daily living. I relate this theory to
Mr.Q because due to hypertension he became SOB due to which whenever he is going to perform
any task he get tired easily so this affects his ADLs. Moreover as he is patient of Bipolar disorder due
to which his brain get affected. The part of the brain which get affected during Bipolar disorder is
Hippocampus which is associated with memory and involve in mood and impulse as well. So
when it get affected his memory is also get affected which ultimately affect his living. Also
during the placement I observe that he forget lot of things like brushing his teethes and even
forget to take a shower. This shows that he is self-care deficit in performing his basic ADLs.

Nursing care plans-

Nursing diagnosis Goal Intervention Rational

Risk of developing Make sure that patient Make sure that there Calm environment
anxiety due to do not develop anxiety is calm and decreases the
bipolar disorder during hospital nonthreatening development of
environment. environment around high level of
the patient anxiety.
 Provide reassurance This will help
and comfort to the reduce the anxiety.
client.
Make an establishing Therapeutic
relationship with the relationship is
client by listening to beneficial for the
them and client who is bit
communicate anxious. Strange
effectively with them. environment lead to
make patient more
anxious.
Refer the client to the These agencies will
support services like help the client to
Beyond blue. make strategies for
their wellbeing.
Shortness of breath Make sure that patient Make sure that the Sitting position
due to hypertension get proper breathing alignment of the allows the
patient is proper for maximum lungs
breathing. expansion and
maximum
inhalation of
oxygen.
Educate the patient This will relax
about the muscles and
diaphragmatic increase the
exercises. oxygen level.
Ask the patient to Clear airway will
clear his airway by increase the flow of
coughing when oxygen.
necessary.
Make sure that Extra activity can
patient do less worsen the
workout or avoid shortness of breath.
doing the work that
demands high
exercise or energy
Risk of ineffective Make sure that patient Make the clients This will allow the
health maintenance attain good health daily health care nurse to take care
related to lack of during hospital regimen of the patient on
ability to make environment. everyday bases.
effective judgement
due to bipolar
disorder.
Refer the client to the These
occupational professionals will
therapist, help the client to
physiotherapist, and perform activities
social worker. that are required to
attain good health.
Involve the family This will increase
members in the the confidence of
health care of the the client and allow
patient. bring the sense of
autonomy in the
patient.
Educate the resident By this the resident
about maintenance will became
of better health. independent about
his health care.