Bipolar disorders are mood disorders that comprise of one or more manic or hypomanic episode and usually one or more depressive episodes with periods of relatively normal functioning in between. They are said to be linked to biochemical imbalances in the brain and it is said that the disease is genetically transferred.
Nursing Care Plans
Clients with bipolar disorders are at a high risk for suicide. Although clients in the manic phase are briefly agitated, energized and elated, their underlying depression makes them likely to inflict self-injury.
Essential responsibilities of nurses are to provide a safe environment, to improve the self-esteem, to meet the physiologic needs and to guide patients toward socially appropriate behavior.
- Risk For Injury
- Risk For Violence: Self-Directed or Other Directed
- Impaired Social Interaction
- Ineffective Individual Coping
- Interrupted Family Processes
- Total Self-Care Deficit
Risk For Violence: Self-Directed or Other Directed
- Risk for self-directed violence
- Biochemical/neurologic imbalances.
- Manic excitement.
- Psychotic symptomatology.
- Rage reaction.
Possibly evidenced by
- Agitated behaviors (e.g., slamming doors, increased muscle tension, throwing things over).
- Delusional thinking.
- Loud, threatening, profane speech.
- Poor impulse control.
- Provocative behaviors (e.g., argumentative).
- Verbal threats against others.
- Verbal threats against self (suicidal threats/attempts, hitting or injuring self, banging head against the wall).
- Patient will verbalize control of feelings.
- Patient will respond to external controls (medications, seclusion, nursing interventions) when potential or actual loss of control occurs.
- Patient will refrain from provoking others to physical harm, with the aid of seclusion or nursing interventions.
- Patient will display nonviolent behavior toward others in the hospital, with the aid of medications and nursing interventions.
- Patient will seek help when experiencing aggressive impulses.
- Patient will refrain from verbal threats and loud, profane language toward others.
- Patient will be safe and free from injury.
|Frequently assess client’s behavior for signs of increased agitation and hyperactivity.||Early detection and intervention of escalating mania will prevent the possibility of harm to self or others, and decrease the need for seclusions.|
|Use a calm and firm approach.||Provides structure and control for a client who is out of control.|
|Use short, simple and brief explanations or statements.||Short attention span limits understanding to small pieces of information.|
|Remain neutral as possible; Do not argue with the client;||Client can use inconsistencies and value judgments as justification for arguing and escalating mania.|
|Maintain a consistent approach, employ consistent expectations, and provide a structured environment.||Clear and consistent limits and expectations minimize potential for client’s manipulation of staff.|
|Redirect agitation and potentially violent behaviors with physical outlets in an area of low stimulation (e.g., punching bag).||Can help to relieve pent-up hostility and relieve muscle tension.|
|Decrease environmental stimuli (e.g., by providing a calming environment or assigning a private room)||Helps decrease escalation of anxiety and manic symptoms.|
|Alert staff if a potential for seclusion appears imminent. Usual priority of interventions would be:
||If nursing interventions (quiet environment and firm limit setting) and chemical restraints (tranquilizers–e.g., haloperidol [Haldol]) have not helped dampen escalating manic behaviors, then seclusion might be warranted.|
|Chart, in nurse’s notes, behaviors; interventions; what seemed to escalate agitation; what helped to calm agitation; when as-needed (PRN) medications were given and their effect; and what proved most helpful.||Staff will begin to recognize potential signals for escalating manic behaviors and have a guideline for what might work best for the individual client.|
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Mental Health and Psychiatric Care Plans
Care plans about mental health and psychiatric nursing: