12 The Bulletin

August, September, October 2017

independent study
Bipolar Disorder: Implications for Nursing Practice
the first published description of “la folie circulaire” Types and Symptoms of Bipolar Disorder
DIRECTIONS (circular insanity) was by Jean-Pierre Falret in 1851 with According to the Diagnostic and Statistical Manual
1. Please read carefully the enclosed article melancholia (depression) and mania as the key features of Mental Disorders (DSM-5), bipolar disorder is a
“Bipolar Disorder: Implications for Nursing (Krans, B. & Cherney, K., 2016). Known for years as a brain disorder with mood changes (APA, 2013). This
Practice.” mental or mood disorder, BD is recognized as a brain independent study focuses on Bipolar I Disorder (BID)
2. Complete the post-test, evaluation form and disorder (American Psychiatric Association, 2015; and Bipolar II Disorder (BIID).
the registration form. NIMH, 2016). The recognition and acknowledgment
3. When you have completed all of the of the brain-body-mind relationship underscores the Bipolar I Disorder (BID)
information, return the following to the Ohio interconnectedness of cause, treatment and response. Bipolar I Disorder is characterized by mood swings
Nurses Association, 4000 East Main Street, and patients experience one or more episodes of full
Columbus, OH 43213. Scope mania. Mania is intense and may last for at least a
A. The post-test; The age of diagnosis ranges from 18-60+ years. week. Episodes of depression are also present and
B. The completed registration form; and The average age of onset is 25 years. Unlike incidence may last for up to two weeks. Most patients have both
C. The evaluation form. which measures new case, lifetime prevalence describes episodes of mania and depression. It is rare that BID
the proportion or percentage of the population who has patients only experience mania.
The post-test will be reviewed. If a score of ever had a diagnosis of bipolar disorder. For the age Depression typically prompts people to seek
70 percent or better is achieved, a certificate demographic, the lifetime prevalence is as follows: 5.9% treatment. With unipolar depression such as when
will be sent to you. If a score of 70 percent is (18-29 years); 4.5% (30-44 years); 3.5% (45-59 years) a person feels ‘sad’ or ‘down’ because of a situation
not achieved, a letter of notification of the final
score and a second post-test will be sent to you. and 1% (60+ years). The 12-month prevalence accounts or series of stressors, depression in bipolar disorder
We recommend that this independent study be for about 2.6% of the adult population; of these nearly significantly impacts a person’s ability to function.
reviewed prior to taking the second post-test. If 83% of cases in the adult US population are considered Emotionally, patients may be despondent and display
a score of 70 percent is achieved on the second “severe” (nimh.nih.gov). Data by sex and race are not a lack interest in family, friends, school, and/or work.
post-test, a certificate will be issued. reported. Some data suggest that females are at greater Previous enjoyments hold no interest or enthusiasm.
If you have any questions, please feel free to risk for depression and rapid mood shift while males Feelings of anxiety or an inability to concentrate,
Sandy Swearingen, [email protected]. have a greater risk for mania. Debate continues about agitation, irritability and guilt are common. Further,
614-448-1030, Ohio Nurses Association at (614) diagnostic criteria for children; prevalence data for they may express feelings of worthlessness and wonder
237-5414. children are not available. For statistical information if things will ever improve. Recurrent thoughts of death
This independent study was developed by: about bipolar disorder in adults and children check out may prompt suicide contemplation or attempts. If
Angie Chesser, PhD, RN, CNS, BC. Revisions and
updates and revisions were made by Jeanette K. www.nimh.nih.gov/health/statistics/biopolar-disorder. clinical depression worsens and is untreated, patients
Chambers, PhD, RN, and Amy Bok, RN, MSN, may be unable to meet basic needs unassisted. Offers
CRRN. The authors and planning committee Risk Factors to help or provide assistance may prompt irritable
members have declared no conflict of interest. Multiple risk factors are believed to contribute to the responses to the concerns of loved ones and health
Disclaimer: Information in this study is intended development of bipolar disorder. No single etiology of care providers. Other causes of depression related to
for educational purposes only. It is not intended to BD has been identified. The National Institute of Mental postpartum or a personal loss should also be considered.
provide legal and/or medical advice. Health describes bipolar disorder in adults possibly due Mania is the “high” side of bipolar 1 disorder.
to genetics, or brain variations in structure or function. A Patients experiencing full mania, or hypomania,
OUTCOME: The nurse will apply their knowledge genetic etiology is being studied as there is evidence of rarely seek out treatment on their own. In a manic or
when dealing with bipolar disorder patients in familial tendencies. hypomanic phase, people believe they are just fine and
regards to the signs and symptoms, as well as Yet, in identical twins, bipolar disorder may be often consider those trying to assist them as hostile, or
the pharmacological and psychosocial treatment present in one twin and not the other twin. Stressful misguided.
modalities available to help bipolar patients. life events may also contribute to the development During mania, the patient’s mood is elevated and
1.08 contacts hour will be awarded for of BD. The impact of childhood adverse events and expansive; irritability is common. They feel great about
successful completion of this independent study. misdiagnoses across the lifespan themselves and hold grand ideas
The Ohio Nurses Association is accredited - such as major depression, for accomplishments. They may
as a provider of continuing nursing education postpartum depression, attention Figure 1 dart from idea to idea, be easily
by the American Nurses Credentialing Center’s deficit hyperactivity disorder distracted and start multiple
Commission on Accreditation (OBN-001-91).
Risk Factors Contributing to Poor
(ADHD) and various anxieties - projects which are not completed.
Expires 6/2019. Copyright © 2010, 2012, 2017 are also potentially undiagnosed Physical Health in a Bipolar As energy levels rise in the
Ohio Nurses Association cases of bipolar disorder. Disorder Patient manic phase, sleeping, eating
and drinking are also interrupted.
Health Habits
Recognition and Diagnosis of Speech is rapid and pressured;
• Poor diet
Bipolar disorder (BD) is a complex and challenging Bipolar Disorder attempts to interrupt or redirect
• Inadequate exercise
brain disorder, in which moods range back and forth As a chronic and complex are difficult. While in the manic
• Irregular sleep patterns
between sadness to euphoria. Widely recognized as disorder with relapses and • Smoking phase, patients appear euphoric
a mental health entity, BD presents with a variety of recurrences, initial diagnoses • Chronic stress responses and happy. Judgment and insight
symptoms: physical and emotional. The symptoms vary may be inaccurate because • Substance use are impaired. Risky behaviors
in duration and depth, and often resemble physiological patients tend to seek treatment associated with excessive
possibilities. Bipolar disorder challenges patients, when depressed not manic. Health Care Access and Utilization drug use, speeding, gambling,
families and professional caregivers for many reasons, Physical health problems - such • Social factors -isolation, spending sprees and acting out
not the least of which is obtaining an accurate diagnosis. as diabetes, heart or thyroid homelessness, lack of insurance sexually may have long term
Patience is essential as pharmacological treatment(s) disease, alcohol and substance • Lack of access to preventive negative consequences resulting
are explored and refined. Psychosocial therapies offer use - may also prompt the healthcare or a “medical home” in shame and guilt.
support and strategies for coping with ongoing lifestyle patient to seek health care. • Medication side effects used for Psychosis in persons with
interruptions and annoyances. Relapse and recurrence is Nonadherence to medication treatment bipolar I disorder may develop
common. therapy results in relapses. • Feeling stigmatized as a person during episodes of severe
Bipolar disorder patients access the healthcare Office visits, community clinics, with a mental disorder depression or mania. Delusions
system in numerous ways. Consequently, nurses in any and emergency departments are (false beliefs) and hallucinations
setting are likely to encounter a patient with a diagnosis among the many locations used Health Care System (auditory or visual) are reported
of bipolar disorder, or a patient who has yet to receive to access the health care system. • Inadequate care coordination for and usually correspond to the
the diagnosis of bipolar disorder. As co­morbidities are All nurses, especially in non- psychiatric and physical health patient’s mood. When depressed,
often present in persons with bipolar disorder, it is psychiatric practice settings, are conditions delusions and hallucinations are
even more likely that a nurse’s practice will encounter important to the recognition and • Inadequate education and staff consistent with despondency.
a bipolar disorder patient with heart disease, diabetes, subsequent care of patients with development about bipolar The patient may not eat because
substance use, suicidal thoughts, or acute psychosis. bipolar disorder. disorder patient care among non- they feel worthless, imagine that
This independent study describes bipolar disorder: An accurate diagnosis of psychiatric caregivers they’ve done something evil, or
scope, risk factors and symptoms, types of bipolar bipolar disorder is essential to hear a voice that says the world
disorder, treatment options, and implications for development of an effective plan has ended. If manic, themes tend
nursing care along the lifespan. Communication and of treatment. to be more paranoid or grandiose. There may be a fear
coordination throughout the continuum of care among • Complete physical exam to eliminate other that someone will steal their belongings or money, or
the disciplines, along with an understanding and trusting diseases causing mood fluctuations. that God is speaking to them as a special messenger.
nurse-patient relationship contributes to care excellence. • A comprehensive medical history considering With psychosis, a diagnosis of schizophrenia is also
family and socially influenced behaviors that might possible.
Bipolar Disorder (BD) be contributing to changes in moods.
Previously known as manic-depression, bipolar • Screening for depression to differentiate unipolar Bipolar II Disorder (BIID)
disorder is a chronic, persistent and complex illness (clinical depression or major depressive disorder) Bipolar II Disorder is characterized by episodes of
which causes episodic changes in a person’s mood, from bipolar depression (occurring with mania or hypomania and depression. Hypomania is less intense
energy levels, behaviors and thinking. While the Greeks hypomania). than full mania. BIID patients experience at least
and Romans used the terms melancholia and mania, one depression episode and episodes of hypomania,
August, September, October 2017 The Bulletin 13

independent study
but never a full manic episode. Correct diagnosis of BIID is a complex process, Antipsychotics and Atypical Antipsychotics
necessitates careful evaluation of mood states, and a patient-caregiver partnership. To Antipsychotic medications may include both older conventional drugs such
avoid misdiagnosis when a patient presents with depression symptoms, it is important as the anticonvulsants and increasingly the newer atypical antipsychotics. Their
to evaluate if there have been any past periods of hypomania or mania which can primary treatment effect is for acute mania. Anticonvulsant side effects include
suggest this is bipolar disorder. extrapyramidal symptoms such as tremors or muscle spasms and tardive dyskinesia.
Hypomania also has negative impacts on the person’s life. As the hypomanic Atypical antipsychotic medications can result in metabolic changes resulting
patient experiences an intoxicating sense of well-being, they may decide to stop in weight gain, high lipid levels, diabetes, dizziness, constipation, skin rashes,
medications or not participate in psychosocial treatments. At this point, they believe cataracts, hypotension, heart problems, seizures, cognitive problems and involuntary
that they do not have bipolar disorder and/or other physical conditions. Hypomania movements.
can also progress into either a full manic or depressive episode. Repercussions of
mania or hypomania can be as devastating as the episodes of depression for patients Antidepressants
and their significant others. Antidepressants are often prescribed in combination with a mood stabilizer or
antipsychotic medication. The general recommendation is to taper and discontinue
Other Bipolar Disorders antidepressants after remission (Jan, 2014). When given alone (unopposed) to
Frequent and recurring periods of hypomania and depression lasting over a period patients with a bipolar diagnosis, mania may result. Finally, antidepressant mediations
of two years, one year in children, characterizes cyclothymic disorder or cyclothymia. can cause gastrointestinal problems, agitation, insomnia, tremors, dry mouth,
Previously known as ‘rapid cycling bipolar disorder,’ the name change was made with headaches and sexual problems.
the DSM-5 (APA, 2013). In the other unspecified and specified disorders, patients
do not have symptoms that would meet criteria for BID, BIID, or cyclothymic disorder. Medication Management Challenges
The diagnostic category of mixed episode was changed to mixed features in the DSM- Medication management can be an ongoing struggle for patients with bipolar
5 (APA, 2013). With a mixed features category, moods shift rapidly between mania disorder, for family and friends of the patient and the professionals treating them.
and depression with variations in intensity and duration. This diagnostic category was Medication nonadherence or noncompliance is a common problem and occurs for
established to assist with the specificity of treatment and diagnosis. After an initial many reasons.
diagnosis, nurses and the treatment team are just beginning a plan of care to achieve Medication regimens are complex and often expensive. Unpleasant side effects
mood stability and effective outcomes. may be annoying and perceived as not increasing quality of life. When seriously
depressed, or hyperactive, energy levels and the inability to concentrate may result in
The variability of symptoms and manifestations of bipolar disorder challenges nonadherence to the complex medication plan.
clinicians, the patient and family members. Key points to remember include: When manic, the patient with bipolar disorder may believe they are well, or feel
• Changes in mood - often sadness or depression to some extent - accompany robbed of the positive feelings associated with mania. Energy, competence and
many chronic health problems, or the challenges of aging. Some neurological creativity may be missed. When the patient feels better, even in a manic state,
disorders, living with COPD, CHF or limitations in mobility or cognitive function the patient may believe they are cured and no longer need their medications.
also can impact mood and result in depression. Medication physical and emotional side effects are of great concern and cause much
• Endocrine disorders such as hyperthyroidism may affect moods or result in noncompliance. It is helpful for the nurse to ask the patient about their physical and
hyperactivity, with an inability to concentrate, or stay focused. Hypothyroidism emotional struggles for mood stability with prescribed medications. As medications
results in loss of interest in personal care and relationships and a tendency to may need to change, the patient’s perspective on lack of adherence may be insightful.
avoid usual enjoyments.
• Mood swings may stabilize with medications, so patients ‘feel good,’ think Psychosocial Treatment
they are well, and stop taking their meds. Other patients may not like one or Psychosocial therapies assist patients to understand, accept, monitor and manage
more of the side effects, and stop taking their meds. Adherence to prescribed their disorder. With a chronic disorder that affects physical health, emotional stability
medications is a major challenge to an effective treatment plan for patients with and social function, involvement of an entire team is needed to stabilize the patient.
bipolar disorder. All healthcare providers, nurses, advanced practice nurses, physicians and mental
• Medication prescribed for mood stabilization, treatment of depression and health professionals must communicate and coordinate for optimum results. Newly
others have side effects. Pharmacological advances have lessened the diagnosed patients need referral to mental health professionals and existing bipolar
frequency of tardive dyskinesia and extrapyramidal symptoms present in typical patients with physical health concerns need understanding and support during
antipsychotics. The atypical antipsychotics present fewer problems, but may management of physical health problems. Providers focused on physical problems
result in tremors, restlessness and muscle rigidity. need to work with the patient’s mental health team to understand and more fully
manage the patient’s unique needs.
Treatment for Bipolar Disorder
Medications and psychosocial therapies are prescribed for bipolar disorders. As Independent Study continued on page 14
with many chronic health problems, bipolar disorder patients need to take medications
and learn to make life style adjustments. Managing symptoms, finding and adhering to
prescribed medications and participating in psychosocial therapies assist the patient to
stabilize and enhance quality of life. Psychosocial therapies include Psychoeducational
Come Join Our Team
Therapy (PE), Interpersonal Social Rhythm Therapy (ISRT), Cognitive Behavioral of Professionals
Therapy (CBT), and Family-Focused Therapy (FFT). Integrated care involving case
managers in support of medication adherence and selected psychosocial therapies is
providing additional support for the patient with bipolar disorder.

Medications
Medications are prescribed to prevent acute episodes of depression or mania and
to stabilize mood variability. With a diagnosis of bipolar disorder, medication becomes
a critical part of his/her treatment regimen. Medication management is complex and
can be a frustrating process for the patient and his or her health care professionals.
Unfortunately, there is no single combination of medications which works well for
everyone. The right combination to manage a specific patient’s mood instability takes
time and can change over time.
Frustration and feelings of futility may ensue. Jann (2014) reported that more than
75% of the patients take the prescribed medications less than 75% of the time.
Polypharmacy, drug-drug interactions, lack of adherence and side effects 4011 S. MONROE MEDICAL PARK BLVD
necessitate that nurses appreciate some nuances of medications used to treat BLOOMINGTON, IN 47403
bipolar disorders. This article provides a limited overview of medication management
options. Prescription guidelines vary depending on the source and date of publication.
Research on the efficacy, quality of life and cost of medication therapy is of world-
wide interest. Baseline lab work is needed prior to medication therapy for newly
diagnosed patients. For long term use, on-going monitoring is also indicated.
Three categories of medications are used to treat bipolar disorder: mood Knowledge for Life
stabilizers, antipsychotics including atypical antipsychotics, and antidepressants.
The search for a combination of medications requires patience. For the patient, side Our programs focus on:
effects or a feeling of being cured contributes to non­adherence. A variety of blood • extensive clinical experience
tests may be indicated to identify negative consequences (Cullison & Resch, 2014). • proven student outcomes on licensure/certifications
On-going monitoring to evaluate response to medication therapy is essential. Changes • nationally recognized faculty
to the prescribed regimen are to be expected. We are currently offering the following degrees:
• Bachelor of Science in Nursing • Post MSN Certificate
Mood Stabilizers • RN Completion (RN-BSN) • Doctor of Nursing Practice
Lithium and anticonvulsants stabilize mood swings of mania/hypomania and • Master of Science in Nursing
depression. Lithium requires blood monitoring to assure a therapeutic range, and USI nursing promotes:
detect problems with deteriorating renal function or hypothyroidism. Patients taking • highly sought workplace skills • flexible course delivery
sodium valproate need monitoring of liver function. For Lithium and other mood • online education • valuable clinical experiences
stabilizers such as sodium valproate and lamotrigine, side effects may include
gastrointestinal problems, hair loss, motor problems, fatigue, cognitive impairment, For more information about these programs,
sexual issues, weight gain, skin eruptions and visual disturbances. please visit our website at http://USI.edu/health
14 The Bulletin August, September, October 2017

independent study
Independent Study continued from page 13 Encouraging patients with bipolar disorder and family • Encourage screenings for prevention and/or
member caregivers help them to manage their illness management of common health problems (e.g.
All nurses need to understand that while there through medication compliance and a more complete heart disease or pulmonary disease, diabetes, and
are some commonalities among patients with bipolar understanding of the disorder. stroke).
disorder, every bipolar disorder patient is unique. A • Promote education and insights about how
relationship with the patient, his/her family, significant Co-morbidities, Mortality and Bipolar Disorder substances such as alcohol, nicotine and drugs may
other, and the patient’s mental health professionals Co-morbidities are common in persons with bipolar interfere with bipolar disorder-management.
benefits all aspects of care for this complex, perplexing disorder. Alcohol and drug abuse, anxiety and panic • Encourage patients with bipolar disorder to get
and recurring disorder. Medical and nursing care attacks are not unusual. Suicide and accident rates screenings and assist them in managing any health
providers need to have the patient’s consent to remain high, but only partially issues found.
account for the premature death
communicate with their mental health providers for care
coordination and continuity. Mental health providers will rates in persons with BD. Patients Figure 2 Emotional Support
assist others to better understand effective approaches with severe mental illness often Resources for Support of Listening with compassion
with the patient, especially in crisis situations. have worse physical health than builds a trusting relationship. This
the general population. The the Bipolar Disorder Patient
may prompt a patient with bipolar
Evidence Based Psychosocial Treatments for Bipolar negative impact of severe mental and Significant Others disorder and his/her family or
Disorder illness on clinical outcomes significant others to share about
The psychosocial treatments for bipolar disorder of many other chronic health Depression and Bipolar Support living with bipolar disorder. Ask
include psychosocial education (PE), cognitive behavioral conditions such as cardiovascular Alliance www.dbsalliance.org about how they think their physical
disease, stroke, cancer, diabetes Offers information about living with bipolar
therapy (CBT), interpersonal social rhythm therapy and psychosocial treatments
and respiratory illness is disorder and finding support groups
(IPSRT), and family-focused therapy (FFT). Swartz and are working. Request consent to
Swanson (2014) reviewed the literature from 1995-2013 recognized (Collins, Tranter, & discuss their care with mental
Irvine, 2012; Jann, 2014; Welsh & Mental Health America www.nmha.org
reported the advantages of psychosocial therapies in health providers.
McEnany, 2015). In a blog about Provides fact sheets and screening tools on
combination with medications. bipolar disorder, including local resources
Family and significant others
the physical health and mortality are a critical support system and
Psychoeducation (PE) of patients with severe mental safety net for a person living with
National Alliance on Mental Illness
The effectiveness of psychoeducation for individuals illness such as bipolar disorder, bipolar disorder. These caregivers
(NAMI) www.nami.org
and groups of patients consists of a number of sessions Insel (2011) commented about may also be exhausted, feel
Provides fact sheets, updates of recent
designed to provide information about the bipolar several reports that patients with research and personal accounts of living overwhelmed, and totally alone in
disorder, discussion to enhance understanding and chronic mental illnesses such as with bipolar disorder. their efforts to provide support.
support for the emotional response to the information. schizophrenia, bipolar disorder and Nurses will meet family and
Psychoeducational approach would cover such topics as: depression lose 25 or more years National Institute of Mental Health significant others in as many ways
1) Understanding the nature of bipolar disorder and of life expectancy when compared www.nimh.nih.org as they will meet the patient: in
necessary treatments for management to help with to persons without mental illness. Up-to-date resources and the latest research crisis situations, medical health
stability. about all mental illnesses: statistics on problems, or social situations. The
2) Knowledge about signs and symptoms, recognition Implications for Nursing Care of prevalence, research about etiology, and family may contact a patient’s
of risk factors and warning signs of relapse. Patients with Bipolar Disorders current treatments. medical caregiver when the patient
3) Development of strategies to cope with stressful life and Their Significant Others is in crisis and does not have, or
events. Nursing care of a patient and has refused, on­going mental
4) Recognizing and developing protective factors in family/significant others with health assistance.
their lives which support treatment compliance. bipolar disorder begins with understanding the complexity • Listen and acknowledge expressed concerns, or any
5) How to access and utilize the health care system and recurrent nature of this brain disorder. In a qualitative concerns that may be inferred.
to manage their illness and crisis situations if they study of persons with bipolar disorder, three areas were • Refer to local mental health associations or crisis
occur. identified: individual, family and health system challenges centers, for information and additional support.
(Blixen, C., Perzynski, A.T., Bukach, A., Howland, M., & • Encourage peer support groups and/or family-to­
Interpersonal Social Rhythm Therapy (IPSRT), a short Sajatovic, M., 2016). By understanding bipolar disorder family education.
term approach, helps bipolar disorder patients recognize and the potential physical and emotional impacts on
and manage how changes in sleep and eating routines, patients and those who care about them, nurses in non- Many national organizations such as the National
social stimulation and other daily routines might impact psychiatric settings can respond in helpful ways. Each Alliance on Mental Illness (NAMI) and the Depression and
symptoms associated with mood changes. The philosophy encounter offers opportunities to optimize the patient’s Bipolar Support Alliance (DBSA) have local chapters for
acknowledges the interrelationship between biological future health status. These opportunities include patient and family participation. Support from others who
and social rhythms. As evidence increases that there is a consideration of safety, future health, emotional support are trying to help a loved one cope with bipolar disorder
biological and/or genetic basis for bipolar disorder, IPSRT and the environment. Safety and emotional comfort can may help with practical suggestions, or the knowledge
promotes efforts for stability of routines and minimization influence decisions to seek or participate in care. that others understand the struggles they face.
of stress. With IPSRT, patients are helped to identify
and track the connection between stress and their mood Safety
If suicidal thoughts are expressed, or not, it is Environment
symptoms. By learning new interpersonal skills promoting Nurses working in any health care setting can work
relationships and minimizing conflicts, the patient important to ask the question about whether there
are thoughts or plans for self-harm. All health care to make the environment friendly, less intimidating and
can adjust daily routines to achieve a balance of social more welcoming to patients and family members living
stimulation with adequate rest. professionals should screen for suicide, alcohol and/or
drug use in a non-judgmental and empathetic manner. with bipolar disorder. All people with mental illness,
Suicide risk is increased when the bipolar patient is including bipolar disorder, are exposed to stigma in
Cognitive Behavioral Therapy (CBT) everyday aspects of their life. Stigma about mental health
Cognitive behavioral therapy is based on the belief anxious or agitated, using drugs or alcohol. Previous
suicide attempts and/or a family history of suicide also can make relatively simple decisions more complicated.
that problematic and chronic emotions can be impacted Applying for a job, finding housing, or making friends are
by distorted and irrational thoughts. How a patient with increase the risk.
• Ask the patient about suicidal thoughts. just a few of the day­to-day challenges encountered.
a bipolar disorder perceives and thinks about a situation • Make certain informational pamphlets, magazine
can affect feelings and behaviors. CBT therapists help • Ask if the patient has a plan, or the means to carry
and visuals in your health settings’ waiting and
patients examine how their thinking patterns impact out the plan.
public areas include mental health topics, in
feelings and behaviors related to acknowledging the • Take immediate steps for a suicidal patient’s safety
addition to the usual physical health materials.
existence of their bipolar disorder, participation in the by arranging transportation to a local emergency
• Include concerns about stigma and mental health
treatment plan to achieve adherence and decrease stress. department, as emergency hospitalization may be
topics for staff educational development.
needed.
Family-Focused Therapy (FFT) • Arrange for prompt evaluation by a mental health
Conclusion
Family-focused therapy involves psychoeducation for professional.
Working with a patient with bipolar disorder and their
the patient/family along with medications for the patient. significant others can be difficult in non-psychiatric
Emphasis is upon communication and problem-solving Physical Health
When there is problem with substance use, there is settings, but forming an alliance with them can be life-
skills (Miklowitz & Chung, 2016). saving or life-enriching. The benefit of helping the patient
greater risk for physical health problems. Treatment
non-compliance and suicide may result from a lack feel comfortable in accessing health care for physical and
of impulse control. Screening for substance use mental health screening, prevention and care may never
RNs & LPNs and encouraging the patient to accept and actively be known by the non-psychiatric nurse. Be assured that
compassionate and empathetic communication and care
participate in treatment can also be a life-saving
- FT, PT, PRN intervention. Do not be discouraged if the patient does impact positive outcomes. Nurses assist patients
denies substance use, refuses help or relapses. A non- living with bipolar disorder to manage life-threatening and
Opportunities available at all three judgmental and empathetic alliance with the patient life-sustaining health and emotional problems, as well
may help future decisions. Encourage psychoeducational providing support to their significant others.
locations. Stop in or apply online today! Communication and coordination of care in
interventions and personal journals describing mood
jobs.hcr-manorcare.com changes and behavior that may increase insights into partnership with mental health providers impacts
the negative connection between substance use and the quality and length of their lives. Nurses in any
quality life. Managing bipolar disorder and other chronic setting - especially non-psychiatric nurses - are in a
Indy South Summer Trace Prestwick
illnesses can be a difficult journey and the nurse’s unique position to enhance care for the person with
(317) 881-9164 (317) 848-2448 (317) 745-2522 bipolar disorder.
expertise and support are important to overall health.
August, September, October 2017 The Bulletin 15

independent study

Bipolar Disorder: Implications for Nursing Practice

Post-Test and Evaluation Form
DIRECTIONS: Please complete the post-test and evaluation form. There is only one answer per question.
The evaluation questions must be completed and returned with the post-test to receive a certificate.

Name:_________________________________________________________________________________ Final Score:_______________________________________________

Please circle one answer.

1. Bipolar disorder is chronic, 7. For persons with Bipolar II Disorder 11. Cognitive behavioral therapy helps 15. People with bipolar disorder are at
complex, and easily managed. (BIID) a person with bipolar disorder to: increased risk for physical health
a. True a. Mood swings are intense and a. Consider how events are problems such as:
b. False frequent perceived and thought about a. Rheumatoid arthritis and
b. Depression is overwhelming b. Consider how personal osteoarthritis
2. The prevalence of bipolar disorder c. Physical health problems are relationships are impacted by b. Cardiovascular and pulmonary
is across the lifespan common bipolar disorder disorders
a. True d. Work and/or school efforts are c. Consider options to increase c. Blood disorders and anemia
b. False productive socialization d. None of the above
d. Consider opportunities for
3. Risk factors for development of 8. Medication therapy for bipolar personal reflection 16. Encouraging preventive health
bipolar disorder may include which disorder patients requires blood screening may enhance long term
of the following: monitoring for which of the 12. Family-focused therapy helps a health of the bipolar disorder
a. Genetics or family history following: person with bipolar disorder to: patient.
b. Being an identical twin a. Renal function a. Understand the short and a. True
c. Lack of social structure and b. Liver function long-term nature of bipolar b. False
friendships c. Blood glucose and lipids disorder
d. Not having a job d. All of the above b. Enhance communication for 17. Stigma about mental disorders in
problem-solving within the the healthcare environment is often
4. In persons with bipolar disorder, 9. Patients with bipolar disorder may family overlooked.
mania or hypomania accompanies stop taking prescribed medications c. Describe the impact of a. True
unipolar depression. because: medication side-effects b. False
a. True a. Side effects are bothersome d. Identify other family members
b. False b. They feel they are cured with characteristics of bipolar 18. Educational materials about mental
c. Medications are expensive disorder disorders in the public areas
5. A person with bipolar disorder d. All of the above of healthcare settings actually
often seeks treatment during a 13. Peer and family support programs promotes stigma of mental illness.
manic phase. 10. Interpersonal social rhythm offered to patients, families and a. True
a. True therapy helps a person with bipolar significant others by mental health b. False
b. False disorder by teaching them to: organizations are helpful.
a. Explore a wide variety of A. True 19. Health involves both physical and
6. The manic phase of Bipolar I personal friendships B. False mental health.
disorder (BID) is characterized by: b. Seek new adventures for a. True
a. Ability to concentrate on socialization 14. Integrated care for physical b. False
projects c. Track interaction of their and mental health issues is an
b. Lack of creative energy moods and daily activities encouraging trend to achieve positive 20. Poor health habits for diet, exercise
c. Irritability and strong self- d. Communicate with family outcomes for bipolar disorder. and sleep are common among
esteem members a. True persons with bipolar disorder.
d. Long periods of sleep b. False a. True
b. False

Evaluation Registration Form

1. Was the outcome met? Name: (Please print clearly)_________________________________________________
OUTCOME: The nurse will apply their knowledge when dealing with bipolar
disorder patients in regards to the signs and symptoms, as well as the
pharmacological and psychosocial treatment modalities available to help Address: (Street)_______________________________________________________
bipolar patients.

____ Yes ____ No (City/State/Zip)__________________________________________________________

2. What one strategy will you be able to use in your work setting?
Daytime phone number:_______________________________________________

3. Was this independent study an effective method of learning? Please email my certificate to:

____ Yes ____ No If no, please comment: Email address:_______________________________________________________

Fee:_______ ($20)
4. How long did it take you to complete the study, the post-test,
and the evaluation form?
ISNA OFFICE USE ONLY
Date Received:_______ Amount:_____ Check No._____
5. What other topics would you like to see addressed in an
independent study?
MAKE CHECK PAYABLE TO THE
INDIANA STATE NURSES ASSOCIATION (ISNA).
Enclose this form with the post-test, your check, and the evaluation and send to:
Indiana State Nurses Association | 2915 N. High School Road | Indianapolis, IN 46224
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