Bipolar Disorder Nursing Diagnosis and Nursing Care Plan

Nursing Books

Bipolar Disorder Nursing Care Plans Diagnosis and Interventions

Bipolar Disorder NCLEX Review and Nursing Care Plans

Bipolar disorder is an affective and mood disorder characterized by its chronicity and complexity. Patients with this disorder manifest with two “poles” of mood states, the manic and depressed states. A lesser degree of these mood states such as hypomania and mixed states may also be observed in these patients.

Signs and Symptoms of  Bipolar Disorder

Patients with bipolar disorder present with a depressive or manic state although some may also present with a feature from both.

Manic StateDepressive State
Disregard of social etiquettes (e.g., excessive friendliness, disregard of boundaries, aggressiveness, irritability)

Elevated or euphoric mood

Extreme lability (i.e., hyperactivity and severe mobility)

Pressured speech

Delusions (e.g., the delusion of grandeur)

Easy distractibility

Lack of concentration

Illogical condensation

Flight of ideas

Manic delirium: impaired orientation

Impaired judgment

Limited insight
Sad or elegiac mood with sad affect

Slow or soft speech

Delusions (e.g., the delusion of guilt)

Negative thoughts and ruminations

Impaired cognition and memory

Overemphasis of symptoms

Causes and Risk Factors of Bipolar Disorder

Bipolar disorder may be associated and may be caused by different factors such as the following:

  1. Biological Factors

  • genetic factors – chromosomes 18q and 22q are highly associated with bipolar disorder.
  • neuroanatomy – the areas that may be affected in bipolar disorder include the prefrontal cortex, anterior cingulate cortex, hippocampus, and amygdala.
  • structural and functional imaging – neurodegeneration is observed in subcortical regions such as the thalamus, basal ganglia, and the periventricular area in patients with bipolar disorder.
  • biogenic amines – neurotransmitters said to be involved in the pathophysiology of bipolar disorder include dopamine, serotonin, and norepinephrine.
  • second messengers – second messengers such as cyclic adenosine monophosphate (camp) and cyclic guanosine monophosphate (cgmp) are affected by mood stabilizers through alteration in g proteins or guanine binding nucleoproteins that interact with the receptors that produce these second messengers.
  • hormone regulation imbalance – increased csf somatostatin levels in mania are observed which is to be expected because somatostatin inhibits dopamine and norepinephrine release.

  1. Psychosocial Factors

  • Stressors – a patient’s experience of significant life stressors may facilitate a cascade of events leading to neuronal changes observed in bipolar disorder.
  • Traits – Other personality traits such as obsessive-compulsive or borderline personality traits are associated with depressive states in bipolar disorder.

Types of Bipolar Disorder

Types of bipolar and related disorders vary depending on the manifestation and duration of the depressed and manic state of the patient.

  • Bipolar I disorder – At least one manic episode is experienced with precedent or subsequent hypomanic or major depressive episodes.
  • Bipolar II disorder – At least one major depressive episode and at least one hypomanic episode.
  • Cyclothymic disorder – Less severe depressive symptoms and hypomania that may have occurred once during childhood and once during adolescence.

Diagnosis of Bipolar Disorder

The diagnosis of bipolar disorder is through a general psychiatric assessment that depends on meeting the criteria set by the DSM-V. Specificities regarding the disorder must also be mentioned, such as the following:

  • Rapid cycling
  • With psychotic features
  • With mixed features
  • With atypical features
  • With anxious distress
  • Has peripartum onset
  • The seasonal pattern

Treatment for Bipolar Disorder

Treatment of bipolar disorder depends on the patient’s mood state and thus involves establishing the diagnosis of mania or hypomania and defining the patient’s current mood state.

Mood stabilizers and antipsychotics are the mainstays of pharmacotherapy for acute manifestations, with combination treatment showing better results than a single drug class alone.

Prevention of relapses is the goal for long-term management while electroconvulsive therapy is considered in treatment-resistant episodes.

Bipolar Disorder Nursing Diagnosis

Nursing Care Plan for Bipolar Disorder 1

Risk For Violence – Self-Directed or Other-Directed

Nursing Diagnosis: Risk for Violence – self-directed or other-directed related to the patient’s manic state secondary to imbalances in the patient’s biochemical/neurological processes as evidenced by aggressive speech and actions and threats of hurting people thrown to others and to self.

Desired Outcome: The patient will be able to control emotions and impulses and will not be a threat to himself/herself and others around him/her.

Nursing Interventions for Bipolar DisorderRationale
Regularly monitor for the patient’s manic episodes manifested through hyperactivity and increased agitationPrompt management (i.e., the patient is a threat to others and to self can be avoided)  can be given as early as possible if the patient’s manic episodes are detected early.
Be calm and firm when dealing with the patient.The patient is out of control – calmness and firmness help in properly managing him/her.
Give explanations or statements that are clear and direct to the point.Patients in the manic state have a short attention span and must be given only small pieces of information.
Be consistent and do not give a hint of judgment when dealing with the patient.The patient can use inconsistencies and judgment against the clinician and may point at it as his/her reason for arguing with the clinician and the worsening of his/her mania.
Redirection of violent tendencies to other outlets that may pose no harm to others and to the self such as punching bags.The patient may be relieved of his/her bottled-up feelings of anger. His/her muscles may also be relaxed.
Help the patient avoid stressors by providing a suitable environment for him/her.Anxiety and manic symptoms may be prevented from being worsened by reducing environmental stimuli.
Alert the staff for the possibility of providing other management schemes should the patient be totally out of control, such as by using physical limitations, tranquilizers, and separating the patient from others.If the patient is still uncontrollable despite the provision of other nursing interventions mentioned above, then seclusion may be considered.
Take note of the behaviors that signal the escalation of the patient’s manic episodes and what helps manage these behaviors.Recognizing patterns that lead to the escalation of manic episodes helps in a more systematized and faster response before the patient becomes a threat to others and to themselves.

Nursing Care Plan for Bipolar Disorder 2

Impaired Social Interaction

Nursing Diagnosis: Impaired Social Interaction related to the patient’s manic state secondary to imbalances in the patient’s biochemical/neurological processes as evidenced by poor interactions with others, inability to form meaningful relationships, and poor attention span.

Desired Outcome: The patient will be able to verbalize thoughts when they become uncontrollable and will be doing activities without manifesting inappropriate behaviors.

Nursing Interventions for Bipolar Disorder Rationale
The patient may be encouraged to involve themselves in activities that require social interaction when less manic.When less manic, exposing patients to social situations helps develop his/her social skills. However, this should be done non-competitively as competition stimulates aggressive behavior and may trigger manic episodes.
Provide the patient with a calming environment with fewer stimuli, such as an environment with dim light and soft music.Fewer stimuli mean lesser distractibility and lesser trigger for manic episodes.
Solitary activities must also be encouraged such as writing, taking photos, painting, or walking.Solitary activities help release stress and minimize triggers for manic episodes and distractibility.

Nursing Care Plan for Bipolar Disorder 3

Ineffective Individual Coping

Nursing Diagnosis: Ineffective Individual Coping related to the patient’s inability to control oneself secondary to imbalances in the patient’s biochemical/neurological processes as evidenced by the inability to make sound judgments and impaired problem-solving skills.

Desired Outcome: The patient will show healthy coping mechanisms such as seeking medical and legal assistance when entering financial and legal obligations and making major life decisions.

Nursing Interventions for Bipolar Disorder Rationale
Assess and recognize behaviors that may hint that the patient is being manipulative such as making comparisons and trying to pit staff against each other, pointing out a staff’s mistakes, and being overly demanding. Limits between patient and staff should be established.Setting limits between patient and staff helps in intervening against a patient’s manipulative behaviors.
Observe for behaviors that may indicate an onset of a manic episode such as self- and other-destructive behavior.Extreme or acute mania may be manifested through provocative behavior and aggressiveness. Early detection leads to faster and prompt management of the patient’s manic episode before the patient becomes a threat against himself/herself and his/her environment.
Approach the patient with neutrality. Avoid getting caught up in an argument, power struggle, and joking around with the patient.A manic episode may be triggered by such behaviors by the staff towards the patient. Should the manic episode become totally uncontrollable, seclusion may be necessary, and this may provide trauma for the patient and the staff.
Place the patient’s money, credit cards, and valuables in a safe space until his/her discharge.The patient may involve himself/herself in risky behavior associated with spending money and valuables without legal or medical assistance during mania due to impaired judgment and reality testing.
Legal service and assistance should be provided for the patient when he/she is signing legal documents, especially during the manic state.Major life decisions should be done by the patient under the advice of professionals, especially during the manic state when their judgment and reality testing are impaired.
Administer pharmacologic management judiciously, taking into consideration the drug’s efficacy, safety, and adverse effects.The patient’s biochemical/neurological imbalances must be corrected to enable a better outcome in the nursing and psychosocial interventions being carried out.

Nursing Care Plan for Bipolar Disorder 4

Interrupted Family Processes

Nursing Diagnosis: Interrupted family processes related to the patient’s uncontrollable behavior that may harm other members of the family secondary to nonadherence to pharmacologic management of the bipolar disorder as evidenced by the family showing signs of dysfunction, inability to cope, and the family members’ inadequate knowledge regarding the disorder and the management plan.

Desired Outcomes:

  • The patient’s family will be more involved in managing the patient’s condition, and will be better educated regarding the disorder and its management.
  • The patient will be capable of better coping when the patient is showing signs of manic or depressive behaviors.
Nursing Interventions for Bipolar Disorder Rationale
Spend time with the family to determine and address the family’s needs. Educate the family about the disease, the pharmacologic intervention (its adherence and adverse effects), and the presence of support groups for the family.Family members must be able to understand the manifestations of the patient especially when he/she becomes out of control in order to prevent the occurrence of dysfunction in family ties.

Nursing Care Plan for Bipolar Disorder 5

Total Self-Care Deficit

Nursing Diagnosis: Total self-care deficit related to the patient’s poor concentration and impaired perception and cognition secondary to the patient’s manic episode and severe anxiety as evidenced by the observation and reports of inability to do tasks such as self-hygiene and grooming without assistance.

Desired Outcomes: The patient will no longer need assistance with tasks related to personal hygiene and grooming and will be able to sleep properly at six to eight hours a day.

Nursing Interventions for Bipolar Disorder Rationale
Disturbed Sleep Pattern
Ensure that the environment of the client will have minimal to no stimuli.Calming and relaxation will be encouraged for the patient and manic episodes will be avoided.
Encourage the patient to rest.The risk of fatigue and death may be avoided through adequate sleep.
Encourage the patient to do calming routines such as taking warm baths and taking his/her medication before sleeping. Encourage also the patient to avoid caffeinated products such as coffee.Relaxation and sleep will come more easily for the patient through this intervention.
Imbalanced Nutrition
Check for the patient’s intake & output and his/her vital signs.I&O and vital signs are a good measure for the patient’s caloric and fluid intake to prevent malnutrition and dehydration.
Encourage the patient to eat and supervise him/her during meals.Patients in a manic state are so distracted that they no longer get to keep track of their body’s needs so supervision is a must even during eating.
Encourage the intake of high-calorie protein drinks and finger foods.High-calorie protein drinks help in the replacement of calories for the hyperactive, manic patient. Finger foods provide nourishment in patients who are always on the go.
Constipation
Give the patients food and drinks that are rich in fiber. Take note of the patient’s bowel habits. Determine if he/she may need a laxative.Fecal impaction may be avoided.
Dressing/Grooming Self-Care Deficit
Supervise the patient when choosing his/her clothes to avoid him/her wearing outfits that may be too loud or too revealing.The patient may call for unwanted attention when he/she dresses uniquely. This may trigger mania or depression brought by low self-esteem.
Always remind the patient to do hygienic practices. Remind and instruct them also on how to do it.The patient may be too distracted that he/she may forget to do the tasks and how to do them.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

Facebookredditpinterest

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.