Nursing Care Plan for Bipolar Disorder

Also known as manic-depression is a severe disturbance in affect, manifested by episodes of extreme sadness alternating with episode euphoria. There are two common patterns of bipolar disorder;
bipolar I, in which depressive episode alternate with full manic episodes.
bipolar II, characterized by recurrent depressive episodes and occasional with manic episodes.

Assesment findings for bipolar disorder

During periods of mania;


• bizarre and eccentric appereance
• difficulty concentration, flight of idea, delusion of grandeur and impaired judgment
• decreased sleep
• motor agitation
• feeling of grandiosity
• rapid jumbled speech
• deteriorated physical appearance
• euphoria, hostility
• dry mouth, tremors, tachycardia, labored respirations
• inflated sense of self-worth
• increased social contact
• increased libido
• lack of inhibition, recklessness

During periods of depression;


• anorexia and weight loss, constipation
• altered sleep patterns
• decreased alertness, difficulty thinking logically
• confusion and indecisiveness
• guilt, helplessness, sadness and crying
• amenorrhea
• lack of motivation, low self-esteem, poor self-hygiene
• irritability, pessimism
• impotence and lack of interest in sex
• inability to experience pleasure

Treatment for bipolar disorder

• Anticonvulsant agent : carbamazepine (tegretol), divalproex sodium.
• Selective serotonin reuptake inhibitor : paroxetine
• Antimanic agent : lithium carbonate(eskalith), lithium citrate(cibalith-S)
• Individual therapy and family therapy
• Electroconvulsive therapy if drug therapy fails

Nursing diagnoses for bipolar disorder

• Disturbed thought processes
• Impaired social interaction
• Risk for injury
• Disturbed sleep pattern

Planning and goal for bipolar disorder, the client will;

• demonstrate a stable mood and practice self-care activities
• control thought processes
• demonstrate a normal sleep pattern
• interact adequately with others
• not harm himself

Nursing implementation for bipolar disorder

During manic phase;


• decrease environmental stimuli, to promote relaxation and enable to sleep
• monitor drug level, especially lithium
• ensure safe environment to protect the client
• define and explain acceptable behaviors and then set limits
• if a mood swing to depression, implement suicide precaution for client
• channel the client's energy in one direction and pace activities, to decrease client's energy expenditure, prevent overstimulation and have soothing effect

During depressive phase;


• assess the risk of suicide and formulate a safety contract with client
• assess the level and intensity if client's depression to obtain baseline information
• ensure a safe environment to client to protect from self-inflicted harm
• encourage the client to identify current problems and stressors, so that can begin with therapeutic treatment
• select activities that ensure success and accomplishment to increase self esteem
• spend time with the client, evens if he's too depressed to talk, in order to enhance therapeutic relationship
• help the client to modify negative expectations and think more positively
• promote opportunities for increased involvement in activities through a structures and daily program
• observe the client for medication compliance and adverse effect

Evaluation for bipolar disorder, the client ;

• doesn't harm himself or others
• maintains adequate on medication and nutrition
• sleeps throught the night
• expresses understanding of the illness and states how to obtain assistance or support from others
• engages in goal-directed activity and no longer exhibits disturbed thinking