Schizoaffective with Bipolar Disorders

8/18/2019 Schizoaffective with Bipolar Disorders

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CAPSTONE PROJECTSCHIZOAFFECTIVEWITH BIPOLAR DISORDER

Naomi Masuda, NURS 3! PMH

P"o#$sso" C%a& Au'us&i(


2/14

WHAT IS SCHIZOAFFEC

• S*%i+oa$*&i-$ diso"d$" is a m$(&a. diso"d$" &%a& *o(&ai(s /o&%a(d mood dis&u"/a(*$2

• Mos& o# &%$ &im$, ma(ia o" d$0"$ssio( *o$is&s 4i&% &%$ 0s1*%os1m0&oms, /u& &%$"$ mus& /$ a& .$as& o($ 564$$7 0$"iod du"i(&%$"$ a"$ o(.1 0s1*%o&i* $0isod$s2

•

I&8s usua..1 o(s$&s .a&$ i( .i#$• U(7(o4( *aus$, /u& ma(1 /$.i$-$ &%a& *om/i(a&io( o# /io.o'i*

a(d $(-i"o(m$(&a. #a*&o"s *o(&"i/u&$2


3/14

S9MPTOMSS*%i+oa$*&i-$

4i&% ma(ia

• Ma"7$d i(*"$as$ i( so*ia., 4o"7, o" s$ua. a*&i-i&1

• Ra0id : 0"$ssu"$d s0$$*%

• I(*"$as$d "is7 /$%a-io"s, su/s&a(*$ us$, a(d im0u.si-$($ss

• I""i&a/i.i&1 : a'i&a&io(

• Poo" ;ud'm$(&

• Bi('$ s0$(di(' s0"$$s

•

F$$.i(' o# i(-u.($"a/i.i&1 : '"a(dios$ s$(s$ o# s$.#6im0o"&a(*$

• Dis&"a*&i/i.i&1

• I(a/i.i&1 &o s.$$0

• D$.usio(s

• Ha..u*i(a&io(s

• Diso"'a(i+$d &%i(7i('

• Bi+a""$ /$%a-io"s

S*%i+oa$*&i-$

D$0"$ssi-$ &10

•

• Lo

•

• Lo4 s$.#6$s&

•

• Ma1 0$"s$-$

• La*7


4/14

DSM6V= SCHIZOAFFECTIVE


5/14

CASE STUD9

> 1?o #$ma.$ 4as dia'(os$d 4i&% s*%i+oa$*&i-$ diso"d$" 4i&% &10$2 S%$ %as %$a"d -oi*$s si(*$ s%$ 4as *%i.d2 S%$ %as /$$( m%$" %us/a(d o-$" @! 1$a"s, a(d %as (o *%i.d"$(2 S%$ is a -$"1 "'o$s &o *%u"*% a(d .i7$s &o "$ad &%$ Bi/.$2

Hus/a(d *a..$d EMS a(d s$(& %$" TAMC d?& 4o"s$(i(' o# %$" 0a"

s$*o(da"1 &o 0oo" m$di*a&io( ad%$"$(*$2 A**o"di(' &o %$" %us/*o(di&io( 4as 4o"s$ &%a( %$8s $-$" s$$( i( &%$ .as& @!1$a"s2 S%$&"a(s#$""$d &o MC a(d admi&&$d d?& 0a"a(oid d$.usio( 4%i*% s%&%a& %$" %us/a(d 0oiso($d a(d &"i$d &o 7i.. %$"2 S%$ a.so /$.i$-$o.a(+a0i($ *aus$s /o($ ma""o4 su00"$ssio(, so s%$ s&o00$d &a7/$#o"$ &%is "$.a0s$2


6/14


7/14

CASE STUD9 IN RELATION

Ps1*%osis s1m0&oms

•

E0$"i$(*i(' 0a"a(oid d$.usio(s• B$.i$-$s &%a& %us/a(d 0oiso($d a(d &"i$d &o 7i.. %$"2

• B$.i$-$s &%a& o.a(+a0i($ *aus$s /o($ ma""o4 su00"$ssio( a(d s&o00$d &a7i('"$#usi(' &o &a7$ a.. &%$ m$di*a&io(s2

• B$.i$-$s &%a& %os0i&a. #oods a"$ 0oiso($d /1 %us/a(d a(d *aus$ i&*%1 s7i( 4%$&%$m2

• E0$"i$(*i(' audi&o"1 a(d -isua. %a..u*i(a&io(s

• R$0o"&s &%a& s%$ %$a"d -oi*$s si(*$ s%$ 4as *%i.d2

• Ho4$-$", s%$ d$(i$s %a-i(' audi&o"1 a(d -isua. %a..u*i(a&io(s du"i(' &%$ s%i#&

• D$mo(s&"a&i(' diso"'a(i+$d s0$$*%, su*% as i(*o%$"$(*$, &a('$(&ia., a(d

Ma(i* s1m0&oms

• P"$ssu"$d s0$$*%

• F.i'%& o# id$a

• Dis&"a*&i/i.i&1


8/14

EVIDENCED BASED NUPRA

•

RE= Sa#$&1= Ris7 #o" i(;u"1 ? #a..• M$di*a&io( *o(&"i/u&$ '"$a&.1 &o "is7 amo(' the elderly people a(d #a.. is si'(i

*aus$ o# i(;u"i$s, %os0i&a.i+a&io( a(d d$a&%s i( &%$ $.d$".12 Hua(', $& a.2 5!G5

• I( addi&io( &o &%$ 0%1si*a. *%a('$s, a'i(' is a.&$"i(' &%$i" 0%a"ma*o7i($&i*s a(d0%a"ma*od1(ami*s &%us $.d$".1 0$o0.$ a"$ mo"$ "is7 o# 0o&$(&ia. d"u' &oi*i&12 Hu5!G5

• T%$ d"u's &%a& asso*ia&$ 4i&% &%$ #a.. i(*id$(&s i( &%$ $.d$".1 a"$ psychotropic dr/$(+odia+$0i($s, atypical antipsychotics, a(&id$0"$ssa(&s, antiepileptics, a(&

*%o.i($s&$"as$ i(%i/i&o"s a(d m$ma(&i($, o0ioids, antihypertensive and caredimedications, glucose control medications a(d a.*o%o.2 Hua(', $& a.2 5!G5

• RE= Dis&u"/$d &%ou'%& 0"o*$ss?= Im0ai"$d ;ud'm$(& a(d i(si'%&

• > o# 0a&i$(&s 4%o 4$"$ dia'(os$d 4i&% s*%i+o0%"$(ia chose to discontinue tantipsychotic medications o-$" GK mo(&%s2 Mo""iso(, $& a.2, 5!GG

• !6@! o# s*%i+o0%"$(ia 0a&i$(&s a"$ not medication compliant2 Hua(', $& a.2


9/14

FOUR PRIORIT9 NEEDS AND CONCERNS WITINTERVENTIONS

G2 P= Sa#$&1= Ris7 #o" i(;u"1?#a..

E= Posi&i-$ A?V %a..u*i(a&io( a(d 0a"a(oid d$.usio(s2 U(s&$ad1 'ai& a(d "$u S= Ass$ss #o" m$(&a. s&a&us a(d *o(#usio( o" a'i&a&io(2 Es&a/.is% "a00o"&, $(*&o $0"$ss #$$.i('s a& $a*% s%i#&2 Co(&"a*& #o" sa#$&1 a& &%$ /$'i((i(' o# $a*% s%iassis&a(*$ #o" ADLs as ($$d$d2 R$ass$ss as ($$d$d2

52 P= Dis&u"/$d &%ou'%& 0"o*$ss= Im0ai"$d ;ud'm$(& a(d i(si'%&

E= R$#usi(' 0"$s*"i/$d m$di*a&io( du$ &o #a.s$ /$.i$# o# o.a(+a0i($ *ausi(' /

su00"$ssio(, iso.a&io( #"om %us/a(d du$ &o &%$ /$.i$#s o# s%$ is 'oi(' &o /$ %u"&

S= Mo(i&o" a(d ass$ss #o" m$(&a. s&a&us2 Ass$ss &%$ &%ou'%&s a(d #$$.i('s2 MO"i$(& &%$ *.i$(& *o(&i(uous.1 4i&% *.$a" *o(*"$&$ s&a&$m$(&s2 Es&a/.is% "a00o"& 4i&% &%$ *.i$(&, u&i.i+$ *o'(i&i-$6/$%a-io"a. &%$"a01 &o im0"o-$ s1m0&oms a(d #u$(*ou"a'$ &o &a7$ 0"$s*"i/$d m$di*a&io(s2


10/14

FOUR PRIORIT9 NEEDS AND CONCERNS WITH INTERV

32 P= Dis&u"/$d s$(so"1 0$"*$0&io(= I(*o('"u$(& 4i&% a*&ua. s&imu.i

E= Posi&i-$ audi&o"1?-isua. %a..u*i(a&io(2

S= Mo(i&o" #o" -$"/a.?(o(-$"/a. /$%a-io"s asso*ia&$d 4i&% %a..u*i(a&io(s#o" &%$ #$$.i('s2 Mai(&ai( sa#$&12 O"i$(& &%$ *.i$(& *o(&i(uous.1 4i&% *.$a" *os&a&$m$(&s2 Es&a/.is% "a00o"& a(d /ui.d &"us& 4i&% &%$ *.i$(& u&i.i+$ *o'(i&i-$im0"o-$ s1m0&oms a(d #u(*&io(i(', a(d $(*ou"a'$ &o &a7$ 0"$s*"i/$d m$d

2 P= H1'i$($

E= C.i$(& a00$a"s dis%$-$.$d 4i&% u(*om/$d %ai"

S= R$mi(d *.i$(& &o mai(&ai( '"oomi(' a(d &%$ im0o"&a(*$ o# %1'i$($, $"$.a&$d &o dia/$&$s2 C.i$(& di"$*&$d &o 0$"#o"m s$.#6*a"$ 4i&% assis&a(*$ #"om

CARE PLAN G


11/14

CARE PLAN Priority # _G__Nursing Diagnosis: Ris7 #o" i(;u"1?#a..

P= Sa#$&1= Ris7 #o" i(;u"1?#a.. E: Posi&i-$ audi&o"1 a(d -isua. %a..u*i(a&io( a(d d$.usio(2 U(s&$ad1 'ai& a(d 4a.7$

S: Ass$ss #o" m$(&a. s&a&us, *o(#usio(?a'i&a&io(2 Es&a/.is% "a00o"&, $(*ou"a'$ *.i$(*o(&"a*& #o" sa#$&1 a& $a*% s%i#&2 P"o-id$ assis&a(*$ #o" ADLs as ($$d$d2 R$ass$ss asLT goal= C.i$(& 4i.. /$ #"$$ #"om i(;u"1?#a.. du"i(' admissio(2ST goal= C.i$(& 4i.. /$ #"$$ #"om i(;u"1?#a.. /1 &%$ $(d o# &%$ s%i#&2

I(&$"-$(&io( : F"$u$(*1S*i$(&i* Ra&io(a.$I( *om0.$&$ s$(&$(*$s

R$#$"$(*$ i( APA #o"ma&, i(*.udi(' 0a'$ (um/$"

E-a.ua&io(

P"o-id$ a(d mai(&ai( a s&"u*&u"$d, sa#$$(-i"o(m$(& mi.i$u #o" &%$ *.i$(& Somm$",$& a.2, 5!G3, 02 G5G2 Lo*7 a00"o0"ia&$ doo"sa(d 4i(do4s a.. &%$ &im$2 R$mo-$ %a"m#u.o/;$*&s #"om &%$ *.i$(&8s $(-i"o(m$(&Fo"&i(as% : Ho.odda1 Wo""$&, 5!!>, 02 33K2

I& d$*"$as$s a(i$&1 a(d dis&"a*&s &%$ *.i$(&#"om *o(s&a(& d$.usio(a. &%i(7i(' a(d%a..u*i(a&io( Somm$", $& a.2, 5!G3, 02 G5G2A.. o# &%$s$ a*&io(s 0"o-id$ #o" a sa#$$(-i"o(m$(& a(d 0"$-$(& #a..s a(d i(;u"1Fo"&i(as% : Ho.oda1 Wo""$&, 5!!>, 02 33K

S&"u*&u"$d a(d sa#$ $(-i"o(m$(& 4as&a a(d (u"si(' s&ud$(&2 T%$ *.i$(&d$mo(s&"a&$ i(*"$as$d a(i$&1 o" *odu"i(' &%$ s%i#&2

Us$ *.$a", *o(*"$&$ s&a&$m$(&s "a&%$" &%a(a/s&"a*&, '$($"a. s&a&$m$(&s Fo"&i(as% :Ho.odda1 Wo""$&, 5!G5, 02 5K32

T%$ 0a&i$(& is (o& a.4a1s a/.$ &o u(d$"s&a(d*om0.$ m$ssa'$s, a(d, as su*%, &%$ 0a&i$(&som$&im$s 4i.. d$-$.o0 mis0$"*$0&io(s o"%a..u*i(a&io(2 I(di-idua.s 4i&% s*%i+o0%"$(ia'$($"a..1 "$s0o(d /$&&$" &o *o(*"$&$m$ssa'$ du"i(' &%$ a*u&$ 0%as$ Fo"&i(as%

: Ho.oda1 Wo""$&, 5!G5, 02 5K3

S&a a(d &%$ (u"si(' s&ud$(& mai(&*o(*"$&$ s&a&$m$(&s &o *ommu(i*a& T%$ *.i$(& 4as #"$$ #"om a''"$ssi-$ /$%a-io" du"i(' &%$ s%i#&2

Ass$ss &%$ *.i$(&8s 4$a7($ss o" im0ai"$dmo/i.i&1, a(d 0"o-id$ assis&a(*$ as ($$d$d2

P%1sio.o'i*a. *%a('$s amo(' o.d$" adu.&si( *a"dio-as*u.a" "$$$s *a( "$su.& i(o"&%os&a&i* %10o&$(sio( Hua(', $& a.2, 5!G5,02352 W%$( a(&i0s1*%o&i* m$di*a&io( 4asus$d #o" mo"$ &%a( !da1s, i& 4as asso*ia&$d4i&% a( i(*"$as$d "is7 o# #a..s a(d #"a*&u"$sHua(', $& a.2, 5!G5, 02 3@

T%$ *.i$(&8s mo/i.i&1 a(d s&"$('&% 4&%$ /$'i((i(' o# &%$ s%i#& a(d 0"(2 T#$$.i(' o# di++i($ss o" 4$a7($ss, s%$s&a a(d &%$ (u"si(' s&ud$(& as ($$s%i#&2

T$a*% &%$ *.i$(& &o '$& u0 a(d?o" *%a('$0osi&io( s.o4.1 &o 0"$-$(& #a..?i(;u"12

A**o"di(' Hua(', $& a.2, a(&i0s1*%o&i*s a(da(&i%10$"&$(si-$s us$d i( &%$ $.d$".1 is o($o# &%$ *aus$s o# d"u' "$.a&$d #a..s2 T$a*%i(' &%$ *.i$(& &o "is$ s.o4.1 #"om /$ds

o" *%ai"s &o a-oid &%$ "is7 o# #a..i(' Fo"&i(as%: Ho.oda1 Wo""$&, 5!G5, 02 @>G2

T%$ *.i$(& -$"/a.i+$d u(d$"s&a(di('im0o"&a(*$ o# mo-i(' s.o4.12


12/14

N NUS!N" D!"N$S!S: DISTURBED THOU, 02 G5>

T%$ *.i$(& 4as a/a(ious #$$.i('s, a%a-i(' d$.usio(s d

T$a*% d$$0 /"$a&%i(' $$"*is$ &o "$du*$a(i$&1 "$.a&$d &o 0a"a(oid d$.usio(2

T%is %$.0 &o .$ss$( a(i$&1 a(d dis&"a*& &%$ *.i$(&#"om #o*usi(' o( &%$ a(i$&12 Fo"&i(as% : Ho.od1

Wo""$&, 5!G3, 02 G>

T%$ *.i$(& -$"/a.i0u"0os$, a(d 4as

&%$ s&ud$(& (u"s$

P= Dis&u"/$d &%ou'%& 0"o*$ss= Im0ai"$d ;ud'm$(& a(d i(si'%& E: R$#usi(' 0"$s*"i/$d m$ds d?& #a.s$ /$.i$# o# &%$ m$d *ausi(' /o($ ma""o4 su00"$ssio(, iso.a&io( #"om

&%a& s%$ is 'oi(' &o /$ %u"& /1 %im2S: Mo(i&o" a(d ass$ss #o" m$(&a. s&a&us2 Ass$ss &%$ &%ou'%&s : #$$.i('s2 Mai(&ai( sa#$&12 O"i$(& &%$ *.i$(*o(*"$&$ s&a&$m$(&s2 Es&a/.is% "a00o"& : /ui.d &"us& 4 &%$ *.i$(&, u&i.i+$ *o'(i&i-$ &%$"a01 &o im0"o-$ s1$(*ou"a'$ &o &a7$ 0"$s*"i/$d m$ds2

LT goal= D$mo(s&"a&$ &%ou'%&s a(d id$as 4i&% a/s$(*$ o# d$.usio(s /1 &%$ dis*%a"'$

ST goal= R$mai( #"$$ #"om a*&ua. a(d 0o&$(&ia. %a"m /1 s$.# o" o&%$"s /1 &%$ $(d o# &%$ s%i#&


13/14

IMPLICATIONS O

L$'a.Co(d$(&ia.i&1

No& a/.$ &o "$.$as$i(#o"ma&io( &o &%$ *.i$(&8s%us/a(d si(*$ s%$ is "$#usi('2

Ri'%& &o /$ i(#o"m$d a(d "$-i$4

&%$ 0a&i$(&8s "i'%&

B$*aus$ o# &%$ *.i$(&8sdimi(is%$d m$(&a. s&a&us a(d*o'(i&i-$ #u(*&io(, -a"i$&1 o#$du*a&io(a. m$&%ods s%ou.d /$us$d &o i(#o"m %$" o# %$" "i'%&sa(d /$ "$0$a&$d as a 0a"& o# &%$&"$a&m$(&2

Mo"a.S$.#6A4a"$($ss a(d s$0a"a&i('o($s dis*"imi(a&io(s i( o"d$" &o0"o-id$ ua.i&1 o# *a"$ &o a..*.i$(&s $ua..12

E&%i*a.Au&o(om1

T%$ *.i$(& is a.. m$di*a&io

R$s0$*& &$du*a&$ am$di*a&io


14/14

REFER• Diagnostic and statistical manual of mental disorders: DSM-52 5!G32 A".i('&o(, VA= Am

Ps1*%ia&"i* Asso*ia&io(2• Fo"&i(as%, Q2 M2, : Ho.oda16Wo""$&, P2 A2 5!G32 Psychiatric mental health nursing @&% $

MO= E.s$-i$" Mos/12

• Fo"&i(as%, Q2 M2, : Ho.oda16Wo""$&, P2 A2 5!!>2 Psychiatric mental health nursing care S&2 Louis MO= E.s$-i$" Mos/12

• Hua(', A2 R2, Ma..$&, L2, Ro*%$#o"&, C2 M2, E'ua.$, T2, Bu*7$"id'$, D2 L2, : Tam/.1(, R2 5!M$di*a&io(6R$.a&$d Fa..s i( &%$ E.d$".1= Causa&i-$ Fa*&o"s a(d P"$-$(&i-$ S&"a&$'i$s2 Dr29@, 3@63> GK02 doi=G!25G@?GG@!6!!!!!!!!!6!!!!!

•Ma.as0i(a, D2, $& a.2, S*%i+oa$*&i-$ Diso"d$" i( &%$ DSM6@, S*%i+o0%"2 R$s2 5!G3, R$&%&&0=??d2doi2o"'?G!2G!G?;2s*%"$s25!G32!2!5

• Mo""iso(, A2 P2, Hu&&o(, P2, Wa"d.$, M2, S0$(*$", H2, Ba""a&&, S2, B"a//a(, A2, 222 Tu"7i('&oCo'(i&i-$ &%$"a01 #o" 0$o0.$ 4i&% a s*%i+o0%"$(ia s0$*&"um dia'(osis (o& &a7i(' a(&i0sm$di*a&io(= a( $0.o"a&o"1 &"ia.2 Psychological Medicine , 42!@, G!6G!@2G!2G!G>?S!!335G>GG!!GK

• Somm$", S2, Jo%(so(, J2 M2, Ro/$"&s, Q2 Q2, R$ddi(', S2 R2, C%u"*%i.., L2, H$("1, N2 J2, : M*(2d22 ! mental health nursing re"ie# module: $dition 9%2

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