BIP

OLA DI
R SO
RD
ER
 What is Bipolar Disorder?
• Bipolar disorder (formerly
called manic-depressive
illness or manic depression)
is a mental disorder that
causes unusual shifts in
mood, energy, activity levels,
concentration, and the ability
to carry out day-to-day tasks.
• It is diagnosed when a
person’s mood cycles
between extremes of mania
and depression.
 Case Study Details
Gabriel is a 17-year-old who withdrew from college after
experiencing a manic episode during which he was brought to the
attention of the Campus Police (“I took the responsibility to pull
multiple fire alarms in my dorm to ensure that they worked, given
the life or death nature of fires”). He had changed his major from
engineering to philosophy and increasingly had reduced his sleep,
spending long hours engaging his friends in conversations about the
nature of reality. He had been convinced about the importance of his
ideas, stating frequently that he was more learned and advanced
than all his professors. He told others that he was on the verge of
revolutionizing his new field, and he grew increasingly irritable and
intolerant of any who disagreed with him.
He also increased a number of high-risk behaviors – drinking and
engaging in sexual relations in a way that was unlike his previous
history. At the present time, he has returned home and his been placed
on a mood stabilizer (after a period of time on an antipsychotic), and his
psychiatrist is requesting adjunctive psychotherapy for his bipolar
disorder.  The patient’s parents are somewhat shocked by the diagnosis,
but they acknowledge that Gabriel had early problems with anxiety
during pre-adolescence, followed by some periods of withdrawal and
depression during his adolescence.  His parents are eager to be involved
in treatment, if appropriate.
 Patient Profile
Patient Name: Gabriel
Address: Liteng, Baguio City
Age: 17
Nationality: Filipino
Religion: Roman Catholic
Sex: Male
Civil Status: Single
Diagnosis: Bipolar disorder
 13 Areas of Assessment
1. Psychosocial and Psychological Status
Gabriel is a 17-year-old who withdrew from college after experiencing a manic
episode during which he was brought to the attention of the Campus Police. He
lives with his parents and presently residing in Liteng, Baguio City. He had
changed his major from engineering to philosophy, spending long hours engaging
his friends in conversations about the nature of reality.
2. Mental and Emotional Status
He is conscious, and alert. He is responsive in verbal stimuli, noise, light, touch
and pain stimuli. He is oriented to current time and date. He’s impulsive,
uncooperative, irritable and intolerant of any who disagree with him. He gets
distracted easily and has an elevated mood.
3. Environmental Status
He is aware that he is in the hospital and he’s also aware about his condition.
There is a steady pattern activity, light, noise and color in his environment.
4. Sensory Status
• Visual Status
There is no known visual deficits like color blindness and etc.
• Auditory
No corrective auditory deficits and no auditory devices noted being used by
the patient. He can also distinguish voices.
• Olfactory
He was able to distinguish an odor from other.
• Gustatory
He was able to distinguish sweet, sour, salty, and bitter taste from each other.
• Tactile
He was able to perceive heat, cold, pain with regards to stimulus, able to
differentiate common object by touch.
5. Motor Status
He is active, his movements are not limited, and he can walk, sit, and stand by
himself. He is able to move all his joints and can grasp or grab anything he
wants.
6. Nutritional Status
He’s not following any types of diet and has decreased appetite. He eats
whenever he wants. He has no food allergies, no difficulty in swallowing her
food or medicines. He usually craves for alcohol. Patient denied any
indigestion, vomiting. He lost 10 pounds of his usual weight.
7. Elimination Status
Reported diarrhea every now and then.
8. Fluid and Electrolyte Status
He usually drinks 5-6 glasses a day. Has good skin turgor.
10. Respiratory Status
His respiratory rate is 22 bpm with no use of accessory muscles. No abnormal
breath sounds. Patient’s lips look pinkish but slightly dry.
11. Integumentary Status
During assessment, he had a good skin turgor, no history of skin allergies, no
tattoo, skin lesions, and his skin was warm to touch.
12. Temperature Status
Skin warm to touch; temperature is in normal range (36.6 °C). No signs of
perfused sweating.
13. Sleep, Rest and Comfort
Increasingly reduced his sleep. He sleeps for about 3-4 hours and doesn’t take
a nap during the day.
PROBLEM/ EXPLANATION NURSING GOAL INTERVENTION RATIONALE EVALUATION
NURSING OF THE
DIAGNOSIS PROBLEM

Subjective: Bipolar disorder STG: After 2 hrs of Diagnostic: STG: GOAL MET
“Marigaan ngay suna involved period of NI patient will be Assess past patterns of Sleep patterns are After 2 hrs of NI
nga maturog manu excitability (mania) able to identify sleep in normal unique to each patient was able to
nga rabii –en suna
alternating with individually environment: amount, individual. identify individually
haan nga makaturog” bedtime, length, appropriate
Verbalized by the periods of appropriate depth, positions, aid interventions to
mother. depression. The interventions to and interfering agents. promote sleep.
mood swings promote sleep.
Objective: between mania and Evaluate use of
Appears restless, have depression can be caffeine and alcoholic
dark circles under his very abrupt. Mania LTG: After 8 hrs of beverages. Over indulgence LTG: GOAL MET
eyes, irritable, is a signature NI patient will interferes with REM After 8 hrs of NI
frequent change of characteristic of report feeling of Determine client’s sleep. patient reported
mood. expectation of feeling of well
bipolar disorder and well rested and adequate sleep.
depending on its show improvement rested and showed
V/S: Provides opportunity improvement in
severity is how the in sleep/ rest to address sleep/ rest pattern.
PR – 110bpm
disorder is pattern. misconceptions/
RR – 22 bpm
classified. unrealistic
T – 36.6 °C
expectations.
BP – 130/80 mmHg
NDX: People commonly Therapeutic:
Disturbed sleep experience an Provide calm, Overstimulation
pattern r/t increase in energy relaxing during manic
hyperactivity. and a decreased environment. episodes may cause
need for sleep. an exacerbation of
symptoms.
 
Reduce chance of
Minimize overstimulation to
environmental minimize
stimuli (Close aggression or
blinds/ curtains, agitation.
keep door closed to  
reduce noise, limit  
visitors).  
To enhance client’s
Implement ability to sleep,
effective age- reinforce that bed is
appropriate bed a place to sleep.
time ritual
Educative:
Encourage bedtime Promote healthy
routine that may sleep hygiene and
include warm bath, encourages rest and
soothing music and relaxation which
lack of stimulation. can decrease mania
and improved
mood.
Instruct client to  
follow a consistent This promotes
daily schedule for regulation of the
retiring and arising circadian rhythm,
as possible. and reduces the
energy required for
adaptation to
changes.
Encourage  
adequate physical Enhances
activities during expenditure of
day. energy/ release of
tension so that
client feels ready
for sleep/rest.
PROBLEM/ EXPLANATION NURSING GOAL INTERVENTION RATIONALE EVALUATION
NURSING OF THE
DIAGNOSIS PROBLEM

Has an agitated Alcohol and drug STG: Diagnostic: STG: Goal Met
behavior, Loud, abuse can be a risk After 4 hours of NI Frequently assess Early detection and After 4 hours of NI
threatening, profane factor. Bipolar patient will seek client’s behavior for intervention of patient sought for
speech, patients are prone help when signs of increased escalating mania help when
argumentative to agitation that can experiencing agitation and will prevent the experiencing
when contradicted, result in impulsive aggressive hyperactivity. possibility of harm aggressive
irritable, verbal aggression during impulses. to self or others, impulses.
threats against manic and mixed and decrease the
other. episodes. However, need for seclusions.
depressed states can LTG: Goal Met
Nxd: involve intense LTG: Crisis situation can After 8 hrs. of NI
Risk for violence: dysphoria with After 8 hours of NI Note motivation for provide impetus for patient was safe
Other directed. agitation and patient will be free change. change but requires and free from
irritability. from injury. timely therapeutic injury.
intervention to
sustain effort.
 which can also Obtain history from To determine if
increase risk of client or family client’s symptoms
violent behavior. members regarding are caused by or
any current or a exacerbated by use
history of substance of drugs or alcohol.
abuse.

Therapeutic:
Decrease Can help to relieve
environmental pent-up hostility
stimuli. and relieve muscle
tension.

Clear consistent
Maintain a limits and
consistent expectations
approach, employ minimize potential
consistent for client’s
expectation. manipulation of
staff.
Use a calm and firm Provides structure and
approach. control for a client
who is out of control.

Educative: Can help to relieve

Encourage client to pent-up hostility and
redirect agitation and relieve muscle
potentially violent tension.
behaviors with
physical outlets in an
area.

Encourage family Client can use

members to remain inconsistencies and
neutral as possible and value judgments as
do not argue with the justification of
client. information.

Encourage client to Participation gives a

make choices and feeling of control and
participate in planning increases self-esteem.
of care and scheduled
activities.
DRUG MECHANISM OF
ACTION
Lithium (Lithobid, The lithium ion behaves in
Eskalith) the body much like the
sodium ion; but its exact
mechanism of action is
Drug Class: Bipolar
unclear. Competes with
Disorder Agents various physiologically
important cations: Na+,
K+, Ca++, Mg++;
therefore, it affects cell
membranes, body water,
and neurotransmitters. At
the synapse, it accelerates
catecholamine destruction,
inhibits the release of
neurotransmitters and
decreases sensitivity of
postsynaptic receptors.
SIDE EFFECT ADVERSE EFFECT NURSING
IMPLICATION
Confusion, poor Acne, rash; nausea, Monitor response to drug.
memory, or lack of diarrhea, vertigo, Usual lag of 1–2 wk
awareness. muscle weakness, dazed precedes response to
lithium therapy.
feeling; loss of
Fast, pounding, or concentration; tremors; Weigh patient daily; check
irregular heartbeat. hypothyroidism, edema; ankles, tibiae, and wrists
cardiac arrhythmias; for edema. Report changes
Frequent urination exophthalmos; in I&O ratio, sudden
restlessness; electrolyte weight gain, or edema.
Increased thirst disturbances.
Give drug with food or
Stiffness of the arms or Potentially Fatal: milk or after meals.
legs Severe neurotoxicity, Ensure that patient
leucopenia. maintains adequate intake
Weight gain of salt and adequate intake
of fluid .
Keep water intake in a
normal range & avoid
heavy sweating.
 Description
Bipolar disorder is a mental health condition that
causes extreme mood swings that include emotional
highs (mania or hypomania) lows (depression).

Risk Factors
Genetics Nursing Diagnosis Treatment
Physiological •Risk for injury •Mood stabilizers:
Environmental •Risk for violence: self-directed or other directed. Lithium, anticonvulsants
•Impaired social interaction •Antipsychotics:
•Total self-care deficit resperidone, olanzapine
Signs and Symptoms •Sleep deprivation •Antidepressants: SSRI;
•Heightened, grandiose, or fluoxetine
agitated mood •ECT, CBT, Family &
•Attention seeking Group therapy
Nursing Intervention
•Poor judgment •Maintain a safe environment
•Sleeplessness or •Providing therapeutic communication
restlessness •Limiting environmental stimulation
•Rapid speech •Providing rest periods
•Flight of ideas •Monitoring ADLs functioning & nutritional diet
•Easily distracted •Promoting appropriate behaviors
•Increased level of energy •Managing medications
 Evaluation
Potential Complications
•Client is able to differentiate between reality and Patient Education
•Substance abuse
unrealistic events/ situations •Medication adherences
•Suicidal ideation or
•Client is able to recognize thoughts that are not •Signs/ symptoms of
attempts
based in reality and stop their progression. medication adverse effect
•Financial problems
•Client is able to gain or maintain weight during •Follow up w/ case
•Damaged relationship
hospitalization. management
•Poor work or school
•Client will not act/ preform self-harm activities or •Encourage family/
performance.
harm others. group therapy
•Client is no longer exhibiting sings of physical •Importance of regular
agitation. ADL pattern.