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Bipolar Disorder Nursing Guide

Content created by: Tiffany Fields, RN, BSN, MSN, DNP, CRNP

Bipolar Disorder Overview

This course is intended as a Quick Reference for Bipolar Disorder and will cover an overview as well as nursing considerations utilizing the nursing process.

Bipolar Disorder Etiology and Epidemiology

Bipolar disorder is a mental disorder that shifts the mood, energy, activity levels, and day-to-day abilities of an individual. The mood can change from manic to depressive. Manic episodes include high-energy behaviors such as grandiosity, talking a lot, decreased need for sleep, racing thoughts, and engagement in risky behaviors. Sadness, loss of interest, and suicidal ideation are associated with depressive episodes.

There are three types of bipolar disorder (National Institute of Mental Health, 2023):

  • Bipolar I: Defined as having a manic episode that lasts at least 7 days (or results in hospitalization). Episodes of major depression may also precede or follow the manic episodes. Having at least four episodes of mania or depression within a year is known as rapid cycling.
  • Bipolar II: Defined as having both major depressive episodes and hypomanic episodes. Hypomanic episodes are less severe forms of manic episodes lasting for at least 4 consecutive days.
  • Cyclothymic disorder: Defined as having a mixture of hypomanic and depressive symptoms, but they are not severe enough to meet the diagnostic criteria for Bipolar I or II.

Bipolar disorder often presents during the late stages of adolescence or early adulthood. Periodically, it can occur in children or appear in women after childbirth. The incidence of bipolar disease does not differ significantly between genders or ethnicities (Jain & Mitra, 2023).

Contributing factors to bipolar disorder are thought to be related to genetics, brain structure and functioning, and environmental factors (Soreff, 2022). Bipolar disorder is a condition that warrants lifelong treatment focusing on the symptoms to improve the quality of life.

Bipolar Disorder Diagnosis

To diagnose bipolar disorder, providers should:

  • Ask about medical history and any changes in personality or behaviors
  • Perform a physical exam and mental health evaluation
  • Test blood and urine to rule out any other medical problems, such as urinary tract infections or encephalitis

Management

Treatment of bipolar disorder focuses on the symptomatic episode, mania or depression, and its severity. Treatment may be delivered as an inpatient, partial hospitalization, or outpatient. Pharmacological agents (e.g., antipsychotics) and psychotherapy are the main treatment options to help manage symptoms.

The goals of treatment are to:

  • Improve or maintain quality of life and functioning of daily living
  • Improve cognition, mood, and behavior
  • Promote a safe environment
  • Promote social engagements

Bipolar Disorder Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with bipolar disorder are listed below.

Assessment

Signs and symptoms:

  • Altered mental status
  • Irritability
  • Social withdrawal
  • Decrease in activities of daily living
  • Intense emotion
  • Changes in sleep patterns
  • Change in behavior and decision making
  • Change in activity levels

Nursing Diagnosis/Risk For

  • Injury
  • Sleep disturbances
  • Low self-esteem
  • Disturbed thought process

Interventions

  • Collect baseline cognitive level
  • Develop a caring rapport with individual
  • Develop a daily routine
  • Assess safety daily
  • Avoid reality checks
  • Observe changes
  • Monitor sleep
  • Monitor appetite changes
  • Monitor for medication tolerance

Expected Outcomes

  • Remain safe and free from injury
  • Be comfortably able to express needs freely
  • Maintain weight
  • Remain free from irritability
  • Maintain or improve level of function
  • Sleep at least 6 hours a day

Patient/Caregiver Education

Psychoeducation for the individual and family is vital and includes:

  • Adhering to medication regimen
  • Recognizing, managing, and reporting symptoms of mania and depression
  • Improving lifestyle choices
    • Healthy diet
    • Adequate sleep
    • Exercise regularly
    • Keeping a daily schedule
    • Avoiding activities that cause behavioral changes
  • Adhering to follow-up appointments
  • Assisting with activities of daily living
  • Participating in local support groups and programs

Pharmacological Management of Bipolar Disorder

The goal of this course is to assist the healthcare team in keeping up to date with medications used in the management of BD.

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Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2029

Course Contributors

The content for this course was created by Relias staff writer Tiffany Fields, RN, BSN, MSN, DNP, CRNP. Tiffany has been a clinical nurse for over 20 years. She was educated and trained as a Licensed Practical Nurse in Alabama, where she practiced as a Gerontological Nurse at the local Nursing Homes. She earned her Associate, Bachelor’s and Master’s degrees in Nursing and a Doctorate in Nursing Practice. She also as a Certified Family Nurse Practitioner degree. Her clinical expertise is Adult-Geriatric Nursing and Medical-Surgical medical complexity. She is currently Assistant Director of Nursing at a Rural Hospital as well as a writer for Relias.

The content for this course was reviewed by Relias staff writer Sooa Devereaux, MSN, RN. Sooa Devereaux has a long history of professional development experience within the hospital setting. She has taught in pre-licensure nursing programs and has mentored many nurses, both new graduates and experienced, throughout her career as a nurse educator. Sooa is a Lead SME Writer at Relias and holds an MSN in Nursing Education.

Resources

References

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