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Bipolar Disorder

Nursing Diagnoses

1. Total Self-Care Deficit

2. Risk for Violence: Self-Directed or Other Directed

3. Impaired Social Interaction

Interventions

Manic State: Decrease environmental stimuli, ensure safe environment, maintain medication regimen

Depressive State: Assess risk of suicide, ensure safe environment, communicate therapeutically, maintain medication regimen

Bipolar Symptoms

Educational Needs

  • Shifts between mania and depression.
  • Mania: feelings of heightened energy, creativity and euphoria. Can result in reckless behavior.
  • Depression: feelings of hopelessness or fatigue. Can result in negligence of ADLs.

Types of Bipolar Disorder

RN Help with Bipolar Relapse

  • Knowledge about manic and depressive episodes (symptoms, potential risks)
  • Knowledge about appropriate medications
  • Potential triggers of episodes
  • Bipolar I Disorder: At least one manic episode lasting 7 days or more. May or may not also experience depressive episodes.
  • Bipolar II Disorder: Alternating between hypomanic episodes and depression. Hypomania involves an increase in productivity and/or irritability, but is less debilitating than mania.
  • Cyclothymia: A milder form of bipolar disorder with hypomania and mild depression.
  • Help patient identify potential triggers for relapse.
  • Help patient identify symptoms that present before a relapse.
  • Create a daily mood chart.
  • Encourage open therapeutic communication.

References

Lexicomp Online. Retrieved from http:www.lexicomponline.com/lco/

action/home

National Alliance on Mental Illness. Retrieved from https://www.nami.org/

Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Treatment

Pine Rest. Retrieved from https://pinerest.org/resource/bipolar-disorder/

Lithium

Anticonvulsant Mood Stabilizers

  • Antimanic Agent: Stabilizes mood
  • Decreases norepinephrine release and increases serotonin synthesis
  • Possible side effects: CNS depression, heart failure, hypercalcemia, hypothyroidism, kidney damage

Ex) Depakote/Depakene (divalproex sodium, valproic acid, or valproate sodium), Lamictal (lamotrigine), Tegretol (Carbamazepine)

  • Depakote and Tegretol treat mania. Lamotrigine is not FDA approved for BPD.

Side effects: dizziness, drowsiness, fatigue, nausea, tremor, rash, weight gain

  • Some can cause problems with the liver (doctor

should monitor periodically)

Safe level: 0.6-1.2 mEq/L

Mild to Moderate Lithium Toxicity: Diarrhea, vomiting, stomach pain, fatigue, tremors, muscle weakness

Bipolar Relapse

  • Even with medication, bipolar relapse can occur.
  • Stopping or switching medications can increase the risk of relapse.

Severe Lithium Toxicity: Heightened reflexes, seizures, slurred speech, kidney failure, rapid heart beat, hyperthermia, low blood pressure, confusion, delerium, death

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