UNIVERSITY OF SOUTHERN MINDANAO

BIPOLAR DISORDER
Prepared by: Ricarte B. Sangines, RN
 Topic Outline

I. Overview
II. Classification
III. Assessment
IV. Nursing diagnosis
V. Planning/outcome identification
VI. Implementation
VII. Evaluation
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 Intended Learning Outcomes

• Discuss etiology, theories and

principles of bipolar disorder
•Apply nursing process to the care of
clients and family with bipolar
disorder
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 Introduction

Bipolar disorder is a brain disorder that causes

changes in a person’s mood, energy, and inability
to function.
• People with bipolar disorder experience intense
emotional states that typically occur during distinct
periods of days to weeks called mood episodes.
• These mood episodes are categorized as
manic/hypomanic and depressive symptoms.
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 Causes of bipolar disorder
Specific causes within the brain are unclear; an imbalance of
brain chemicals is believed to lead to disregulation brain
activity.
• Commonly runs in families: 80 to 90 percent of individuals
with bipolar disorder or depression.
• Environmental factors such as stress and sleep disruption
• Drugs and alcohol may trigger mood disorder in vulnerable
people.
• The average age of onset is 25 years old.
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 Biological components of Bipolar disorder
Neurotransmitter imbalance of dopamine and serotonin
Dopamine = experience mania/hypomania

Dopamine= experience tiredness and sad

Serotonin= unknown what role of serotonin in manic episodes.

Serotonin= lead to depressive symptoms

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 Bipolar disorder Category

1. Bipolar I- manic episodes at least one depressive

episodes.
2. Bipolar II-recurrent depressive episodes with at
least one hypomanic episodes.
3. Bipolar Mixed-cycle alternate between periods of
mania, normal mode, depression, normal mode,
mania and so forth.

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Graphic depiction of mood cycle

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Bipolar Disorder NCM 117 RLE
 Patterns of Mood Disturbances

• Mania with Delirium: Persecutory delusion,

grandiose delusions, hallucinations
• Acute Mania: Flight of ideas, impulsive
behavior. Bizarre dress and behavior,
distractibility.
• Hypomania: Decreased sleep, inflated self-
esteem, increase activity, irritability.

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 Patterns of Mood Disturbances

• Mild depression: Sadness, irritability, sleep

disorders, social withdrawal, crying and tearful,
low energy
• Moderate depression: Recurring thoughts of
suicide, hopelessness, helplessness.
• Severe depression: delusions, hallucinations,
psychomotor retardation and stupor,
agitation(in depression with melancholia)
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 Bipolar I disorder

Bipolar I is diagnosed when a person experiences a

manic episode. During a manic episode, people with
bipolar I disorder experience extreme increase in
energy and may feel on top of the world or
uncomfortably irritable in mood. Some people with
bipolar I disorder also experience depressive or
hypomanic episodes, and most people with bipolar I
disorder also have periods of neutral mood.

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 Bipolar II disorder

Bipolar II is similar to Bipolar I disorder, with moods

cycling between high and low over time. However, in
bipolar II, the “up” moods never reach full-blown
mania. The less-intense elevated moods in bipolar II
disorder are called hypomanic episodes, or
hypomania. A person affected by bipolar II disorder
has had at least one hypomanic episode in their life,
more often from episodes of depression. This is
where the term “manic depression” comes from.
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 Application of Nursing Process
ASSESSMENT
• History
• General appearance and motor behavior
• Mood and affect
• Thought process and content
• Sensorium and intellectual processes
• Judgment and insight
• Self -concept
• Role and relationship
• Physiologic and self-care consideration
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 Symptoms of Bipolar Disorder (manic episode)

• Hyperactivity to the point of physical exhaustion.

• Flamboyant dress/makeup
• Sexual acting out
• Impulsive behaviors
• Flight of ideas: inability to finish one thought before jumping to another
• Loud, domineering, manipulative behavior
• Distractibility
• Dehydration, nutritional deficits
• Delusions of grandeur
• Hostility, aggression
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 Symptoms of Bipolar Disorder (depressive episode)

• Possible short-term depression (risk of suicide)

• Loss of pleasure
• Low energy and activity
• Feeling of guilt or worthlessness
• Lack of motivation
• Difficult concentration

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 Nursing Diagnosis

The nurse analyzes assessment data to determine priorities and to establish a plan of
care. Nursing diagnosis commonly established for clients in the manic phase are as
follows:
• Risk for other-directed violence
• Risk for injury
• Imbalance nutrition: less than body requirements
• Ineffective coping
• Noncompliance
• Ineffective role performance
• Self-care deficit
• Chronic low self-esteem
• Disturbed sleep pattern

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 Outcome identification

• The client will not injure self or others.

• The client will establish a balance of rest, and activity
• The client will establish adequate nutrition, hydration, and
elimination
• The client will participate in self-care activities
• The client will evaluate personal qualities realistically.
• The client will engage in socially appropriate, reality base
interaction.
• The client will verbalize knowledge of his or her illness and
treatment
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 Intervention

A. Medical management
1. Lithium carbonate (Eskalith, Lithobid, Lithotabs)
• Initial dosage levels: 600mg TID, to maintain a blood serum level of 1.0-1.5 meg/L;
blood serum level should be checked 12 hours after last dose, twice a week.
• Maintenance dosage level: 300 mg TID/QID, to maintain blood serum level of 0.4-
1.0 meq/L; check monthly
• Toxicity when blood levels higher that 2.0 meq/L; tremors, nausea and
vomiting, thirst, polyuria, coma, seizures, cardiac arrest.
2. Anti-psychotic may also be given for hyperactivity, agitation, psychotic behavior.
• Chlorpromazine (Thorazine) and haloperidol (Haldol) are most commonly used

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 Intervertion
B.Nursing Intervention
• Determine what client is attempting to tell you; use active
listening.
• Assist client in focusing on a topic.
• Offer finger foods, high-nutrition foods and fluids.
• Provide quite environment, decrease stimuli, promote rest
and sleep
• Stay with client, use silence.
• Remove harmful objects.
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 Nursing Intervention
• Be accepting in hostile statements.
• Do not argue with the client.
• Use distractive to divert the client from behavioral that is harmful to self or others.
• Administer medication as ordered and observe for effects/side effects.
• Teach client early sign of toxicity
• Maintain fluid and salt intake
• Avoid diuretics
• Monitor lithium blood levels.
• Assist in dressing, bathing.
• Set limits on disruptive behaviors.

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 Nursing Intervention
C. Providing for safety
• The risks that clients in the manic phase take, safety play a primary
role in care, followed by issues related to self-esteem and
socialization.
• Provide a safe environment for clients and ohers.
• Assess the clients directly for suicidal ideation and plans or thoughts
of hurting others.
• For clients who feel out of control, the nurse must establish external
controls empathetically and nonjudgmentally

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 Nursing Intervention
D. Client and Family education
• Teach about bipolar illness and ways to manage the disorder.
• Teach about medication management, including the need for
periodic blood work and manage of side effect.
• For clients taking lithium, teach about the need for adequate salt and
fluid intake.
• Teach the client and family about the signs of toxicity and the need
to seek medical attention immediately.
• Educte the client and family about risk-taking behavior and how to
avoid it.
• Teach about behavioral sign of relapse and how to seek treatment in
early stages. 22
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 Evaluation

Evaluation of the treatment o bipolar disorder includes but not limited

to the following:
• Safety issues
• Comparison of mood and affect between start of treatment and
present.
• Adherence to treatment regimen of medication and psychotherapy.
• Changes in client’s perception of quality of life.
• Achievements of specific goals of treatment including new coping
methods.

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 Points to consider when working with clients with mood disorder

• Remember that the client with mania may seem happy, but they are
suffering inside
• For clients with mania, delay client teaching until the acute manic phase is
resolving
• Schedule specific, short periods with depressed or agitated clients to
eliminate unconscious avoidance of them.
• Do not try to fix a client’s problems. Use therapeutic techniques to help
him or her find solutions.
• Use a journal to deal with frustration, anger, or personal needs.
• If a client’s care is troubling, talk with other professional about the plan of
care, how it is being carried out, and how it is working.
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Bipolar Disorder Part 1

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Bipolar Disorder Part 2

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Bipolar Disorder Part 3

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Bipolar Disorder Part 4

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 References
1. Videbeck, Shiela. Psychiatric-mental health Nursing. 5th ed., vol. 1,
Wolters Kluwer/Lippincott Wiliams & Wilkins, 2011, p. 298.
2. Howland , Molly. 
https://www.psychiatry.org/patients-families/bipolar-disorders/wha
t-are-bipolar-disorders
. 1 Jan. 2021, Accessed 19 July 2021.
3. Stein, Alice. Nclex-RN Review. 5th ediction., vol. 1, Thomson/Delmar
Learning, 2005. p. 651-655.

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