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.
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