Table of Contents:

1. Pathophysiology 3. Interventions
2. Assessment Findings 4. Treatments

Bipolar Disorders

1. Pathophysiology

TABLE 1: SYMPTOMS OF MANIA
y Bipolar I: Dramatic mood fluctuations cycling from
depression to mania (FIGURE 1) Symptom Examples
y Bipolar II: Mood fluctuations from depression to
hypomania (a less intense form of mania) mood (labile; y “Everything is amazing!”
y Having a first-degree relative with bipolarrisk. ranging from y May become aggressive
euphoric to when limits are set
2. Assessment Findings irritable)

FIGURE 1: BIPOLAR DISORDER energy y Cannot sit still

y need for sleep
y Pressured speech

distractibility y Racing thoughts

y Difficulty focusing

self-esteem y Delusions of grandeur (“I’m a

famous model who travels
the world!”)
y Feels invincible

impulsivity y Excessive spending

y Engages in high-risk
During a depressive episode: sexual behaviors
y Clients experience LOW mood and anhedonia
(see DEPRESSION & SUICIDE CHEAT SHEET). 3. Interventions
During a manic episode: Interventions for depressive episodes:
y Mood is HIGH (TABLE 1).
#1 priority = suicide prevention.
y Mania is a psychiatric emergency because itrisk y Encourage behaviors that counteract depressive
for violent behavior and unintended injury. symptoms (grooming, physical activity, socialization).

Insight is poor (clients do not recognize their y See DEPRESSION & SUICIDE CHEAT SHEET for additional
behavior as problematic or comprehend the depression interventions.
consequences). Interventions for manic episodes focus on:

Clients often dress provocatively and in bright 1. Ensuring safety
Mental Health

colors with excessive jewelry or makeup. 2. Providing a calm environment

3. Encouraging adequate nutrition and rest

 Clients with mania demonstrate hyperactivity  To prevent exhaustion during mania, the nurse
and poor insight, increasing the risk for injury, should promote sleep hygiene, promote frequent
sleep deprivation, dehydration, and impulsive rest periods, and decrease environmental stimuli.
behaviors such as excessive spending and
high-risk sexual behaviors.

© [Link] 3
 1. Ensure safety:
TABLE 2: MOOD STABILIZING MEDICATIONS

Set limits by using simple and concise
statements.
Drug Indications & Considerations
y “Touching other clients is not allowed.”
y “Standing on the table is not permitted.” Lithium Mood stabilization
y Redirect inappropriate behaviors with y Lithium has a narrow
matter-of-fact, non-judgemental language to therapeutic index, and toxicity
protect client’s dignity and prevent conflict. can be fatal.
y Undressing in public: “Let’s go back to your y Blood draws are required to
room so you can get dressed.” monitor lithium levels.
y Invading others’ personal space: “Let’s go for
Monitor for symptoms of
a walk together.” lithium toxicity (GI distress,
y Continually assess suicide risk (suicide riskas ataxia, sedation, seizures).
mania subsides).
Teach clients to maintain
2. Provide a calm environment: consistent sodium intake

environmental stimuli by dimming lights and and drink 2-3 L/day of water
noise. (dehydration andsodium
y Limit group and competitive activities to prevent intaketoxicity risk).
overstimulation (engage client in 1:1 activities). y Starts working in 1-3 weeks
y Provide appropriate outlets forenergy like (benzodiazepines or atypical
walking or cleaning. antipsychotics may be used in the
meantime to control symptoms)
3. Encourage adequate nutrition and rest:

Provide high-calorie finger foods and fluids
Anticonvulsants Mood stabilization
that can be consumed “on the go,” like
y Valproate: Monitor for
sandwiches and protein shakes.
valproate hepatotoxicity and pancreatitis.

Provide frequent rest periods and promote
carbamazepine y Carbamazepine and
sleep hygiene to prevent exhaustion.
lamotrigine lamotrigine: Monitor for
rash, which could indicate
4. Treatments
Stevens-Johnson syndrome.
y Administer mood-stabilizing medications as
prescribed (TABLE 2).
y Antidepressants may trigger a manic episode
if used alone.
y Electroconvulsive therapy (ECT) may be considered
in treatment-resistant cases (see DEPRESSION & SUICIDE
CHEAT SHEET).

Mental Health

 To manage inappropriate behaviors associated  Clients taking lithium should drink 2-3 L/day of
with mania, the nurse should use simple, concise water and maintain consistent sodium intake.
statements and set clear limits on behavior.
 To ensure adequate nutrition and hydration during
mania, the nurse should provide high-calorie finger
foods and drinks like sandwiches and protein shakes.

© [Link] 2
  Clients with mania demonstrate hyperactivity  What types of food should the nurse provide
and poor insight, increasing the risk for injury, to a client during a manic episode?
dehydration, _____ deprivation, and _____
behaviors such as excessive spending and  Clients taking lithium should drink ____ L/day
high-risk sexual behaviors. of water and maintain a consistent intake
of _____.
 To prevent exhaustion during mania, the nurse
should promote _____ hygiene, promote frequent
_____ periods, and decrease environmental _____.

 To manage inappropriate behaviors associated

with mania, the nurse should use simple, concise
statements and set clear _____ on behavior.

Answers: 1. sleep, impulsive 2. sleep, rest, stimuli 3. limits 4. high-calorie finger foods 5. 2-3 L/day, sodium

References: Attributions:

Burchum, J. R. & Rosenthal, L. D. (2025). Lehne’s pharmacology y Bipolar Disorder: Created with [Link]
for nursing care (12th ed.). Elsevier.

Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A

concept-based approach to learning (4th ed., Vol 2).
Mental Health

Pearson.

Halter, M. J. (2022). Varcarolis’ foundations of psychiatric-mental

health nursing: A clinical approach (9th ed.). Elsevier.

Pollard, C. L. & Jakubec, S. L. (2023). Vacarolis’s Canadian

psychiatric mental health nursing: A clinical approach
(3rd ed.). Elsevier.

Videbeck, S. L. (2023). Psychiatric-mental health nursing (9th ed.).

Wolters Kluwer.
© [Link] 3