6 Bipolar Disorders Nursing Care Plans

By
Paul Martin, BSN, R.N.
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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.

Here are six (6) nursing care plans (NCP) and nursing diagnosis (NDx) for bipolar disorders:

  1. Risk For Injury
  2. Risk For Violence: Self-Directed or Other Directed
  3. Impaired Social Interaction
  4. Ineffective Individual Coping
  5. Interrupted Family Processes
  6. Total Self-Care Deficit
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Ineffective Individual Coping

Nursing Diagnosis

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May be related to

  • Biochemical/neurologic changes in the brain.
  • Disturbance in tension release.
  • Inadequate level of perception of control.
  • Ineffective problem-solving strategies/skills.

Possibly evidenced by

  • Changes in usual communication patterns.
  • Destructive behavior toward self or others.
  • Giving away valuables and financial savings indiscriminately, often to strangers.
  • Inability to problem-solve.
  • Inability to meet basic needs.
  • Inability to ask for help.
  • Presence of delusions (grandeur, persecution).
  • Using extremely poor judgment in business and financial negotiations.

Desired Outcomes

  • Patient will report an absence of delusions, racing thoughts, and irresponsible actions as a result of medications adherence and environmental structures.
  • Patient will return to pre-crisis level of functioning after acute/severe manic phase is past.
  • Patient will cease use of manipulation to obtain needs and control others.
  • Patient will demonstrate an absence of destructive behavior toward self or others.
  • Patient will be protected from making any major life decisions (legal, business, marital) during an acute or severe manic phase.
  • Patient will respond to limit-setting techniques with aid of medication during acute and severe manic phase.
  • Patient will respond to external controls (medication, seclusion, nursing intervention) when potential or actual loss of control occurs.
  • Patient will retain valuables or other possessions while in the hospital.
  • Patient will demonstrate a decrease in manipulative behavior.
  • Patient will demonstrate a decrease in demanding and provocative behavior.
  • Patient will seek competent medical assistance and legal protection when signing any legal documents regarding personal or financial matters during manic phase of illness.
Nursing Interventions Rationale
Assess and recognize early signs of manipulative behavior, and intervene appropriately: For example:

  1. Taunting staff by pointing out faults or oversights.
  2. Pitting one staff member against another (“You are more appreciative than Nurse Paul Martin, do you know what she said to me?”) or pitting one group against another (morning shift versus night shift).
  3. Aggressively demanding behaviors that can trigger exasperation and frustration in staff.
 Setting limits is an important step in the intervention of bipolar clients, especially when intervening in manipulative behaviors. Staff agreement on limits set and consistency is imperative if the limits are to be carried out effectively.
Observe for destructive behavior toward self or others. Intervene in the early phases of escalation of manic behavior. Hostile verbal behaviors, poor impulse control, provocative behaviors, and violent acting out against others or property are some of the symptoms of this disease and are seen in extreme and/or acute mania. Early detection and intervention can prevent harm to client or others in the environment.
Maintain a firm, calm, and neutral approach at all times. Avoid:

  1. Arguing with the client.
  2. Getting involved in power struggles.
  3. Joking or “clever” repartee in response and other clients. to client’s “cheerful and humorous” mood.
 These behaviors by the staff can escalate environmental stimulation and, consequently, manic activity. Once the manic client is out of control, seclusion might be required, which can be traumatic to the manic individual as well as the staff.
Have valuables, credit cards, and large sums of money sent home with family or put in hospital safe until the client is discharged. During manic episodes, people give away valuables and money indiscriminately to strangers, often leaving themselves broke and in debt.
Provide hospital legal service when and if the client is involved in making or signing important legal documents during an acute manic phase. Judgement and reality testing are both impaired during acute mania. Client might need legal advice and protection against making important decisions that are not in their best interest.
Administer an antimanic medication and PRN tranquilizers, as ordered, and evaluate for efficacy, and side and toxic effects. Bipolar disorder is caused by biochemical/neurologic imbalances in the brain. Appropriate antimanic medications allow psychosocial and nursing interventions to be effective.
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See Also

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3 COMMENTS

  1. This platform is useful because it avails good medical information. Thanks for your tremendous contribution.

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