Bipolar disorder is characterized by depressive and manic episodes. There are three main types: Bipolar I, Bipolar II, and Cyclothmic disorder. The causes are unknown but may involve genetic and biochemical factors. Nursing management for a manic episode focuses on assessment of increased mood, activity levels, and impulsivity. Common nursing diagnoses include risk for violence, altered thought processes such as delusions of grandeur, and impaired social interaction. Goals are to decrease hyperactivity and aggression while improving judgment and social behaviors. Interventions include environmental controls, activities, socialization, and feedback on appropriate behaviors.
Bipolar disorder is characterized by depressive and manic episodes. There are three main types: Bipolar I, Bipolar II, and Cyclothmic disorder. The causes are unknown but may involve genetic and biochemical factors. Nursing management for a manic episode focuses on assessment of increased mood, activity levels, and impulsivity. Common nursing diagnoses include risk for violence, altered thought processes such as delusions of grandeur, and impaired social interaction. Goals are to decrease hyperactivity and aggression while improving judgment and social behaviors. Interventions include environmental controls, activities, socialization, and feedback on appropriate behaviors.
Bipolar disorder is characterized by depressive and manic episodes. There are three main types: Bipolar I, Bipolar II, and Cyclothmic disorder. The causes are unknown but may involve genetic and biochemical factors. Nursing management for a manic episode focuses on assessment of increased mood, activity levels, and impulsivity. Common nursing diagnoses include risk for violence, altered thought processes such as delusions of grandeur, and impaired social interaction. Goals are to decrease hyperactivity and aggression while improving judgment and social behaviors. Interventions include environmental controls, activities, socialization, and feedback on appropriate behaviors.
Bipolar disorder is characterized by depressive and manic episodes. There are three main types: Bipolar I, Bipolar II, and Cyclothmic disorder. The causes are unknown but may involve genetic and biochemical factors. Nursing management for a manic episode focuses on assessment of increased mood, activity levels, and impulsivity. Common nursing diagnoses include risk for violence, altered thought processes such as delusions of grandeur, and impaired social interaction. Goals are to decrease hyperactivity and aggression while improving judgment and social behaviors. Interventions include environmental controls, activities, socialization, and feedback on appropriate behaviors.
Classification of Bipolar disorder: 1.Bipolar I. 2.Bipolar II. 3.Cycloththymic disorder. Etiology of bipolar disorder (manic) Nursing Management Assessment)1( Common Nursing diagnosis)2( Introduction
Bipolar disorder
The bipolar disorders include the occurrence of depressive
mood episodes and one or more elated mood episodes, They can result in damaged relationships, poor job or school performance, and even suicide Classification of Bipolar disorder: The bipolar disorders include: (1) Bipolar I. (2) Bipolar II. (3) Cycloththymic disorder. 1) Bipolar I disorder
1-Bipolar I disorder is characterized by:
one or more manic episodes, usually
alternating with major depressive episode manic and depressive episodes with; periods of relatively normal functioning in between 2) Bipolar II disorder
Bipolar II disorder is characterized by having
major depressive episode (current or past) and at least one hypo manic episode. Most hypo manic episodes in bipolar 2 disorder occur immediately before or after a major depressive episode. 3) Cyclothymic disorder:
The Episodes of hypomania alternating with
minor depressive episode , usually not severe enough to warrant hospitalization, Hospitalization is rarely necessary unless the person thought to be suicidal. Etiological theories
It'sun known, but there are many theories
attempt to explain the cause of mania. 1. Biological Theories
A) Genetic Theories Family studies First-degree relatives of patients with bipolar disorder have a 7–10 times greater risk of developing a mood disorder, compared with unrelated individuals. Twins studies monozygotic twins is 78% - 90%. dizygotic twins is 5% - 25%. & B) Biochemical factors The belief was that high levels of serotonin dopamine and nor epinephrine at the synaptic receptor sites in the brain cause mania . 2. Psychoanalytic Theory
Freud psychoanalytical theory postulates
that mood disorder is a maladaptive response to loss of loved objects. In mania as a trial to avoid inner pain the person makes him self busy by frenetic running behaviors e.g. constant exhausting activities, running thoughts or speech, & exaggerated elevated mood. The person also uses some defense mechanisms which are) : Denial-Projection - Regression and Reaction formation( Nursing Management
:Assessment )1 The key symptoms in Mania are Elated mood )1( .Increasing activity )2( .Reduced sleep )3( Not all people in the manic state .experience euphoria Some people become extremely irritable especially when limits are sit on their behavior & 1) Mood, affect, and feelings Euphoria : the euphoric mood is unstable. Irritable may be short lived or may become the prominent feature of the person, especially when mania has been present for some time. They also have a low tolerance, which may lead to feelings of anger and hostility. Inflated self esteem, intolerance of criticism, and optimistic Manic patients may be Emotionally labile, switching from laughter to irritability to depression in minutes or hours. &
) Behaviour: At work Manic person constantly moves from one activity to another, one place to another, one project to another, but few, if any completed. Hyperactivity ranges from mild to severe. Inactivity is impossible, even for the shortest period of time. He is too busy to eat, sleep or engage in sexual activity, which may lead to Physical exhaustion, even death caused by non stop physical activity and lack of sleep and food. - Spending large sums of money in different items. Clients with mania often dress bizarre, colourful & inappropriate clothes, jewellery, or makeup. Impulsive marriage & divorces take place. Assessing thought processِ Flight of ideas, speech is rapid, Pressure of speech (one can hear the force, energy behind the rapid words). The continuous talking often includes joking, playing on words. The content of speech is often sexually explicit, ranges from grossly inappropriate to vulgar. Themes in the communication of the manic may revolve around his extraordinary sexual powers, business ability. &
Clang associations is also common, is the stringing
together of wards because of their rythming sounds without regard to their meaning. Grandiosity is apparent in either the client ideas expressed or the person’s behavior Delusions occur in 75% of all manic patients, (Grandeur, persecution, reference and religious delusion are common) Hallucinations may occur. :Nursing diagnosis for mania
(1)Risk for violence: directed to other
Related to. .Exhaustion 2-Poor judgment and impulse control-1 Evidenced by 1. Extreme hyperactivity & restlessness. 2 .Threatened or actual aggression toward self or others 3 .Delusion of grandeur & making attempts to harm others. 4. Agitation. Goals/Objectives
• Short term goals.
1. Demonstrate decreased restlessness, hyperactivity, and agitation. 2. Demonstrate decrease hostility. 3. Not harm him self or her self or others. – Long term goals: 4. Be free of restlessness, hyperactivity, and agitation. 5. Be free of threatened or actual aggression toward self or others. 6. Express feelings of anger or frustration verbally in a safe manner. 7. Patient will manage his anger appropriately Planning and implementation
1. Perform a violence assessment and determine clients' level
of risk. 2. Minimize environmental stimuli e.g. light & noise. 3. Discuss anger management with client and determine what behaviours are appropriate when angry. 4. Provide a suitable solitary activity to drain his excess energy. 5. Instruct the client to seek out staff when experiencing feelings of agitation & hostility. 6. Provide safe environment that's free from hazardous material to prevent accidental or intentional injuries. &
Provide positive feed back for acceptable behaviours.
8. Never argue unrealistic ideas of the client. 9. Remove the patient from anxiety provoking situations e.g. crowding, fight. 10. Set limits on destructive behaviours with little attention to undesired behaviours. 11. If patient is agitated or excited use physical restraint, seclusion or chemical restraint. 12. Encourage the client to verbalize feelings such as anxiety and anger. 2-Altered thought process Related to • Anxiety secondary to the manic state. Psychological stressor
• Evidenced by • 1. Inaccurate interpretation of environment • 2. [Altered attention span]--distractibility • 3. [Inability to follow] • 4. [Impaired ability to make decisions, problem solve, reason] • 5. [Delusions of grandeur] &
• Goals/Objectives Short term goals Within 1 week, client will be able to recognize and verbalize when thinking is non—reality based. • Long term goal Client will experience no delusional thinking by discharge from treatment. Planning and implementation:
1. Use a firm & calm approach to provide security &
control for a client out of control. 2- Actively listen, observe, and respond to client’s verbal and nonverbal expressions as it let client feel respected .3- Focus on the feeling & meaning of client's delusions not the content. 4-Focus on real topics to distract the patient from his delusions e.g. "the weather, the activity..." &
6. Avoid using touch with delusional patients, and don't argue
the client's delusional system 7. Be consistent in approach & expectations, use consistent limits to minimize potential for patient's manipulation of staff. 8. Maintain a calm & neutral manner; avoid getting caught in joking; as joking & laughing with a manic patient is disrespect of his needs. 9. Has frequent staff meeting to plan consistent approaches & to set agreed upon limits & when limits & its consequences are decided by staff they must be told to the patient in simple& concrete terms. 10. Firmly redirect energy into more constructive & appropriate channels e.g. "suitable activities, feeling expression". (3) Impaired social interaction Related to:
Evidenced by: 1- Aggressive social behaviours. 2-Verbal hostility. 3- Hypercritical behaviours 4- Bizarre dress. 5- Engage in sexual behaviours. 6-Interrupt conversation of other. Goals/Objectives
* Patient will be able to demonstrate social behaviours consistent with social norms. Planning and implementation:
1. Provide an environment with minimal stimuli e.g.
dim light, soft music, quietness. 2. Use solitary activities that require short attention span with mild physical exertion initially. 3. When under control "less manic" allow patient to join a group of 1 or 2 other patients in-quite non stimulating activities e.g. football or cards. 4. Involve patient in activities that provide more social contact. 5. Avoid competitive games as they can stimulate aggression & increase psychomotor agitation. 6-Offer feed back (positive & negative) toward the impact of patient's social behaviours. 7-Be a model by maintaining a non-defensive response to criticism & suggestions 8. Encourage patient to verbalize his feelings rather than acting out. 9. Use seclusion when patient is out of control.
