NCM 117 LEC

PSYCHIATRIC NURSING
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MIDTERMS
CONCEPT OF UNIPOLAR
● There are cases of depression and isolated cases of
mania
● If these two cases exist —> Bipolarity Disorders
BIPOLAR DISORDERS
● With 1 or more manic episodes, with or without a
major depressive episode
1. Bipolar, Depressive: Most recent or current behavior
displaying major depression
- the most recent case would be signs and
symptoms relating to depression
2. Bipolar, Manic: Most recent or current behavior
displaying overactive, agitated behavior
- main manifestation relating to exaggerated
feelings of happiness,
- Main manifestation: delusion of grandiosity
3. Bipolar, Mixed: Rapid Intermingling of depressed
and manic behavior
- Combination of two poles (depression &
mania)
4. Cyclothymia: Numerous occurrences of abnormally
depressed moods over a period of at least 2 years
Notes: (Bipolar, depressive), (Bipolar, Manic), (Bipolar, Mixed)
all can be diagnosed within 6 months. But unlike,
cyclothymania, it will be lasting for 2 years.
MANIA
● Mood that is elevated, expansive, or irritable
○ Exaggerated feelings of happiness
○ has broad affect
● Manic behavior is a defense against depression since
the individual attempts to deny feelings of
unworthiness and helplessness
○ They mask it, acting in reverse of what you
really feel
○ Reaction formation and denying that you
have a depression
● Manic Episode:
○ Neurotransmitter imbalance: deficient in
serotonin
1. Norepinephrine - elevation
2. Serotonin - elevation
BEHAVIORS COMMONLY ASSOCIATED WITH MANIA
A. Affective: Elation/euphoria, lack of shame, lack of
guilt, humorous, intolerance of criticism,
expansiveness, inflated self-esteem
B. Physiological: Dehydration, inadequate nutrition,
needs little sleep, weight loss
C. Cognitive: Ambitiousness, denial of realistic danger,
distractibility, grandiosity, flight of ideas, lack of
judgment
D. Behavioral: Aggressiveness, provocativeness,
excessive spacing, hyperactivity, poor grooming,
irritability, argumentative
L E C / PROF. ACUAR
Hallmark manifestation of a client with mania: Delusion of
Grandiosity
DIAGNOSTIC CRITERIA FOR A MANIC EPISODE
At least 3 of the following for at least 1 week:
1. Delusion of Grandeur (Hallmark Manifestation) - over
self-worth & inflated self-esteem
Rationale: A defense to mask feelings of depression
& inadequacies
2. Insomnia - inability to sleep
3. Flight of Ideas - talkative/pressured speech/pressure
to keep talking
4. Excessive involvement in pleasurable activities
without regard for negative consequences
5. Hyperactive & Distractibility
6. Easily Agitated
7. Manipulative
8. Increased Metabolism
9. Poor Impulse Control - impulsive
10. Violent/Aggressive/Hypersexual - there could be
cases of promiscuity
11. Pressure Speech - fast pacing of speech pattern
NURSING DIAGNOSIS
1. Risk/Potential for Injury directed to other/or self - #1
Priority
2. Fluid & Electrolytes Imbalances
3. Fluid Volume Deficit
NURSING INTERVENTION
1. Accept Client; reject behavior
- Present the rules and regulations of the
institutions & promote a firm way of
approaching the client
2. Provide consistent care
- Provide care upon admission and discharge
3. Set limits of behavior/external controls
- If the client did something good then give a
reward.
- If the client does wrong and does wrong to
other people inside the facility then promote
the setting of limits
- One staff to provide controls
- Do not leave alone in the room when
hyperactivity is escalating
- Restraining is the last resort because this
needs to be done according to doctors order.
WHAT NURSE CAN DO WITHOUT RELYING upon
DOCTORS ORDER:
- Decrease stimuli
- Keeping the patient away from load noises, a
group.
- Divert the attention of the client
- Explain restrictions on behavior
- Do not encourage performance/jokes
- Approach in a calm, collected,
non-argumentative manner

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 4. Distract and redirect energy: Choose physical
activities using large movements until acute
mania subsides (dancing, walking with staff)
- Meet nutritional needs: High-Calorie
FINGER FOODS and fluids to be carried
while moving.
- Prone to become fatigued so give finger
foods: potato chips, bread, raising, and
sandwiches.
- SHORTCUT: ALL HIGH CALORIC & HIGH
CARBOHYDRATE DIET OR ALL BAKERY
PRODUCTS
- Tuna sandwich & apple are appropriate food
for bipolar manic
- Food products that doest require utensils are
considered finger foods
- Ex: A husband of 36 y/o bipolar manic type
says, “ My wife hasn’t eaten or slept for
days” The RN should place a priority focus
on physical condition.
- Encourage rest: Sedation PRN & short PM
naps
- Encourage nap time in the early
part of the morning. NEVER
ENCOURAGE afternoon naps
since the patient can experience
insomnia.

5. Avoid activities that increases attention span

such as chess, bingo, and scrabble.
6. Avoid contact sports: Basketball, gym strenuous
activities & increase perspiration
- Acceptable Activities: Brisk walking,
punching bag, raking leaves, tearing
newspaper
7. Productive activities: Gardening, finger painting,
household chores
- Activity for Manic Bipolar includes raking
leaves (quiet, physical, constructive,
productive) to increase self-esteem;
competitive is not safe.
8. Less environmental stimulus: No bright lights &
do not touch the patient.
9. Encourage Oral Fluid Intake because of lithium
and increase metabolism

Note:
- Medication of Choice: Mood Stabilizing Agent
(Antimanic Agents) → lithium containing products
- While taking lithium, YOU NEVER RESTRICT FLUID
INTAKE. It’s either normal fluid intake or increased
fluid intake
- Increasing oral fluid intake in the body could dilute the
lithium → decreasing the effectivity of the medication.

NCM 117 Psychiatric Nursing Lecture (NCM 117) 2 of 2