Nursing Care Plans for Bipolar Disorder Plus Interventions and Rationale – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Bipolar Disorder plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings, including emotional and lows.

When one becomes depressed, he/she may feel sad or hopeless and lose interest or pleasure in most activities. When mood shifts to mania or hypomania (less extreme than mania), one may feel euphoric, full of energy, or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior, and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, one can manage his/her mood swings and other symptoms by following a treatment plan. Bipolar disorder is treated with medications and psychological counseling (psychotherapy) in most cases.

Nursing Care Plans for Bipolar Disorder – Symptoms of Bipolar Disorder

According to the International Bipolar Association, symptoms vary between individuals. For some people, an episode can last for several months or years. Others may experience “highs” and “lows” at the same time or in quick succession.

In “rapid cycling” bipolar disorder, the person will have four or more episodes within a year.

Mania or hypomania

Hypomania and mania are elevated moods. Mania is more intense than hypomania.

Symptoms can include:

• Impaired judgment
• Feeling wired
• Sleeping little but not feeling tired
• A sense of distraction or boredom
• Missing work or school
• Underperforming at work or school
• Feeling able to do anything
• Being sociable and forthcoming, sometimes aggressively so
• Engaging in risky behavior
• Increased libido
• Feeling exhilarated or euphoric
• Having high levels of self-confidence, self-esteem, and self-importance
• Talking a lot and rapidly
• Jumping from one topic to another in conversation
• Having “racing” thoughts that come and go quickly and bizarre ideas that the person may act upon
• Denying or not realizing that anything is wrong

Depressive symptoms

During an episode of bipolar depression, a person may experience:

• A feeling of gloom, despair, and hopelessness
• Extreme sadness
• Insomnia and sleeping problems
• Anxiety about minor issues
• Pain or physical problems that do not respond to treatment
• A sense of guilt, which may be misplaced
• Eating more or eating less
• Weight loss or weight gain
• Extreme tiredness, fatigue, and listlessness
• An inability to enjoy activities or interests that usually give pleasure
• Difficulty focusing and remembering
• Irritability
• Sensitivity to noises, smells, and other things that others may not notice
• An inability to face going to work or school, possibly leading to underperformance

In severe cases, the individual may think about ending their life, and they may act on those thoughts.

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis, or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be challenging to identify in children and teens. It’s often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic, or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

Nursing Care Plans for Bipolar Disorder – Types of Bipolar Disorder

1. Bipolar I disorder is the diagnosis given to an individual who is experiencing, or has experienced, a full syndrome of manic or mixed symptoms; the client may also have experienced periods of depression.
2. Bipolar II disorder. Bipolar II disorder is characterized by recurrent bouts of major depression with the episodic occurrence of hypomania; this individual has never experienced a full syndrome of manic or mixed symptoms.
3. Cyclothymic disorder. The essential feature is a chronic mood disturbance of at least 2 years, involving numerous periods of depression and hypomania, but not of sufficient severity and duration to meet the criteria for bipolar I or bipolar II disorder.
4. Bipolar disorder due to general medical condition. This disorder is characterized by a prominent and persistent disturbance in mood (bipolar symptomatology) that is judged to be the direct result of the physiological effects of a general medical condition (APA, 2000).
5. Substance-induced bipolar disorder. The bipolar symptoms associated with this disorder are considered to be the direct result of the physiological effects of a substance (e.g., use or abuse of a drug or medication or toxin exposure).

Nursing Care Plans for Bipolar Disorder – Pathophysiology of Bipolar Disorder

The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been determined, and no objective biologic markers correspond definitively with the disease state.

The genetics component of the bipolar disorder appears to be complex; the condition is likely to be caused by multiple different common disease alleles, each of which contributes a relatively low degree risk on its own.

Many loci are now known to be associated with the development of the bipolar disorder.

These loci are grouped as major affective disorder (MAFD) loci and numbered in the order of their discovery.

Nursing Care Plans for Bipolar Disorder – Causes of Bipolar Disorder

The exact cause of the bipolar disorder is unknown, but several factors may be involved, such as:

• Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
• Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Nursing Care Plans for Bipolar Disorder – Risk factors of Bipolar Disorder

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

• Having a first-degree relative, such as a parent or sibling, with bipolar disorder
• Periods of high stress, such as the death of a loved one or other traumatic event
• Drug or alcohol abuse

Nursing Care Plans for Bipolar Disorder – Complications of Bipolar Disorder

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

• Problems related to drug and alcohol use
• Suicide or suicide attempts
• Legal or financial problems
• Damaged relationships
• Poor work or school performance
• Co-occurring conditions

Nursing Care Plans for Bipolar Disorder – Prevention of Bipolar Disorder

There’s no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you’ve been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.

Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.

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Nursing Care Plans for Bipolar Disorder Based on Diagnosis

Nursing Care Plans for Bipolar Disorder: Nursing Care Plan 1 – Diagnosis: Risk for Violence – Self-Directed or Other-Directed

Related to the patient’s manic state secondary to imbalances in the patient’s biochemical/neurological processes

Evidenced by aggressive speech and actions and threats of hurting people thrown to others and to self.

Desired Outcome

The patient will be able to control emotions and impulses and will not be a threat to himself/herself and others around him/her.

Nursing Interventions	Rationale
Regularly monitor for the patient’s manic episodes manifested through hyperactivity and increased agitation.	Prompt management (i.e., the patient is a threat to others and to self can be avoided)  can be given as early as possible if the patient’s manic episodes are detected early.
Be calm and firm when dealing with the patient.	The patient is out of control – calmness and firmness help in properly managing him/her.
Give explanations or statements that are clear and direct to the point.	Patients in the manic state have a short attention span and must be given only small pieces of information.
Be consistent and do not give a hint of judgment when dealing with the patient.	The patient can use inconsistencies and judgment against the clinician and may point at it as his/her reason for arguing with the clinician and the worsening of his/her mania.
Redirection of violent tendencies to other outlets that may pose no harm to others and to the self, such as punching bags.	The patient may be relieved of his/her bottled-up feelings of anger. His/her muscles may also be relaxed.
Help the patient avoid stressors by providing a suitable environment for him/her.	Anxiety and manic symptoms may be prevented from being worsened by reducing environmental stimuli.
Alert the staff for the possibility of providing other management schemes should the patient be totally out of control, such as by using physical limitations, tranquilizers, and separating the patient from others.	If the patient is still uncontrollable despite the provision of other nursing interventions mentioned above, then seclusion may be considered.
Take note of the behaviors that signal the escalation of the patient’s manic episodes and what helps manage these behaviors.	Recognizing patterns that lead to the escalation of manic episodes helps in a more systematized and faster response before the patient becomes a threat to others and to themselves.

Nursing Care Plans for Bipolar Disorder: Nursing Care Plan 2 – Diagnosis: Impaired Social Interaction

Related to the patient’s manic state secondary to imbalances in the patient’s biochemical/neurological processes

This is evidenced by poor interactions with others, inability to form meaningful relationships, and poor attention span.

Desired Outcome

The patient will be able to verbalize thoughts when they become uncontrollable and will be doing activities without manifesting inappropriate behaviors.

Nursing Interventions	Rationale
The patient may be encouraged to involve themselves in activities that require social interaction when less manic.	When less manic, exposing patients to social situations helps develop his/her social skills. However, this should be done non-competitively as competition stimulates aggressive behavior and may trigger manic episodes.
Provide the patient with a calming environment with fewer stimuli, such as an environment with dim light and soft music.	Fewer stimuli mean lesser distractibility and lesser trigger for manic episodes.
Solitary activities must also be encouraged, such as writing, taking photos, painting, or walking.	Solitary activities help release stress and minimize triggers for manic episodes and distractibility.

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Nursing Care Plans for Bipolar Disorder: Nursing Care Plan 3 – Diagnosis: Ineffective Individual Coping

Related to the patient’s inability to control oneself secondary to imbalances in the patient’s biochemical/neurological processes.

Evidenced by the inability to make sound judgments and impaired problem-solving skills.

Desired Outcome

The patient will show healthy coping mechanisms such as seeking medical and legal assistance when entering financial and legal obligations and making major life decisions.

Nursing Interventions	Rationale
Assess and recognize behaviors that may hint that the patient is being manipulative such as making comparisons and trying to pit staff against each other, pointing out a staff’s mistakes, and being overly demanding. Limits between patient and staff should be established.	Setting limits between patient and staff helps in intervening against a patient’s manipulative behaviors.
Observe for behaviors that may indicate an onset of a manic episode, such as self- and other-destructive behavior.	Extreme or acute mania may be manifested through provocative behavior and aggressiveness. Early detection leads to faster and prompt management of the patient’s manic episode before the patient becomes a threat against himself/herself and his/her environment.
Approach the patient with neutrality. Avoid getting caught up in an argument, power struggle, and joking around with the patient.	A manic episode may be triggered by such behaviors by the staff towards the patient. Should the manic episode become totally uncontrollable, seclusion may be necessary, and this may provide trauma for the patient and the staff.
Place the patient’s money, credit cards, and valuables in a safe space until his/her discharge.	The patient may involve himself/herself in risky behavior associated with spending money and valuables without legal or medical assistance during mania due to impaired judgment and reality testing.
Legal service and assistance should be provided for the patient when he/she is signing legal documents, especially during the manic state.	Major life decisions should be made by the patient under the advice of professionals, especially during the manic state when their judgment and reality testing are impaired.
Administer pharmacologic management judiciously, taking into consideration the drug’s efficacy, safety, and adverse effects.	The patient’s biochemical/neurological imbalances must be corrected to enable a better outcome in the nursing and psychosocial interventions being carried out.

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Nursing Care Plans for Bipolar Disorder: Nursing Care Plan 4 – Diagnosis: Interrupted Family Processes

Related to the patient’s uncontrollable behavior that may harm other members of the family secondary to nonadherence to pharmacologic management of the bipolar disorder.

Evidenced by the family showing signs of dysfunction, inability to cope, and the family members’ inadequate knowledge regarding the disorder and the management plan.

Desired Outcomes

The patient’s family will be more involved in managing the patient’s condition and will be better educated regarding the disorder and its management.

The patient will be capable of better coping when the patient is showing signs of manic or depressive behaviors.

Nursing Interventions	Rationale
Spend time with the family to determine and address the family’s needs. Educate the family about the disease, the pharmacologic intervention (its adherence and adverse effects), and the presence of support groups for the family.	Family members must be able to understand the manifestations of the patient, especially when he/she becomes out of control, in order to prevent the occurrence of dysfunction in family ties.

Nursing Care Plans for Bipolar Disorder: Nursing Care Plan 5 – Diagnosis: Total Self-Care Deficit

Related to the patient’s poor concentration and impaired perception and cognition secondary to the patient’s manic episode and severe anxiety.

Evidenced by the observation and reports of inability to do tasks such as self-hygiene and grooming without assistance.

Desired Outcomes

The patient will no longer need assistance with tasks related to personal hygiene and grooming and will be able to sleep properly at six to eight hours a day.

Nursing Interventions for Bipolar Disorder	Rationale
Disturbed Sleep Pattern
Ensure that the environment of the client will have minimal to no stimuli.	Calming and relaxation will be encouraged for the patient, and manic episodes will be avoided.
Encourage the patient to rest.	The risk of fatigue and death may be avoided through adequate sleep.
Encourage the patient to do calming routines such as taking warm baths and taking his/her medication before sleeping. Encourage also the patient to avoid caffeinated products such as coffee.	Relaxation and sleep will come more easily for the patient through this intervention.
Imbalanced Nutrition
Check for the patient’s intake & output and his/her vital signs.	I&O and vital signs are a good measure for the patient’s caloric and fluid intake to prevent malnutrition and dehydration.
Encourage the patient to eat and supervise him/her during meals.	Patients in a manic state are so distracted that they no longer get to keep track of their body’s needs so supervision is a must even during eating.
Encourage the intake of high-calorie protein drinks and finger foods.	High-calorie protein drinks help in the replacement of calories for the hyperactive, manic patient. Finger foods provide nourishment in patients who are always on the go.
Constipation
Give the patients food and drinks that are rich in fiber. Take note of the patient’s bowel habits. Determine if he/she may need a laxative.	Fecal impaction may be avoided.
Dressing/Grooming Self-Care Deficit
Supervise the patient when choosing his/her clothes to avoid him/her wearing outfits that may be too loud or too revealing.	The patient may call for unwanted attention when he/she dresses uniquely. This may trigger mania or depression brought by low self-esteem.
Always remind the patient to do hygienic practices. Remind and instruct them also on how to do it.	The patient may be too distracted that he/she may forget to do the tasks and how to do them.

Related FAQs

1. What is a bipolar person like?

Bipolar disorder is a mental health condition marked by intense mood changes. People with the illness switch back and forth from mania or hypomania (an emotional state of being energetic and gleeful or sometimes aggressive or delusional) to having episodes of depression.

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2. What are 5 signs of bipolar disorder?

• Abnormally upbeat, jumpy or wired.
• Increased activity, energy or agitation.
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep.
• Unusual talkativeness.
• Racing thoughts.
• Distractibility.

3. What are the 4 types of bipolar?

According to the American Psychiatric Association, there are four major categories of bipolar disorder: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder due to another medical or substance abuse disorder.

4. What triggers bipolar?

Factors such as stress, poor sleep, and even seasonal changes can play a role in triggering your bipolar symptoms. Learn how you can reduce your risk of bipolar episodes and better manage your condition. Bipolar disorder is a mental health condition that affects millions of people in the United States.

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