6.2 Bipolar Disorder and the Nursing Process Flashcards
STAGES OF BI-POLAR DISORDER
Stage 1 - Hypomania
- Disturbances not severe enough to cause impairment in function
- Cheerful and expansive with underlying irritability when a person’s wishes and desires go unfulfilled.
Symptoms
- Rapid flow of ideas
- Perception of environment is heightened
- Easily distracted
- Increased motor activity
- Very sociable/extroverted but lack depth of personality and warmth to formulate close friendships.
- Laugh a great deal usually very loudly and inappropriately
Stage 2 - Acute Mania
- Considerable impairment of functioning
- Euphoria and elation. Appears to be on a continuous high.
- Cognition and perception are fragmented, also they are often psychotic
- Racing thoughts, abrupt movement from one thought to another.
- Attention can be diverted from small stimuli
- Hallucinations and delusions are common
- Excessive psychomotor activity, increased sexual interest, poor impulse control, low frustration tolerance.
- Need for sleep diminished, energy is inexhaustible
- Hygiene/Grooming may be neglected
Stage 3 - Delirious Mania
- Grave form of severe clouding of consciousness and intensified symptoms.
- Despair quickly converting to ecstasy, irritable, indifferent to the environment.
- Extremely distractable and incoherent to the environment
- Frenzied psychomotor activity with purposeless movement
Nursing Diagnosis
Risk of injury related to extreme hyperactivity and lack of control over purposeless movements
Risk of violence related to delusional thinking, manic excitement, hallucinations
Imbalanced nutrition (less than body requires) due to refusal to sit down long enough to eat
Disturbed Thought Processes related to biochemical alterations in the brain
Disturbed Sensory Perception possibly due to sleep deprivation
Impaired social interaction related to egocentric and narcissistic behavior
Insomnia related to excessive hyperactivity and agitation
Outcomes
- No physical injury
- No harm to others or self
- Eats well balanced diet
- Verbalizes accurate interpretation of the environment
- Hallucinations have decreased (verbalizes)
Measurements of outcomes
- Accepts responsibility for behavior
- Does not manipulate others for gratification of own needs
- Interacts appropriately with others
Risk of Violence
- Help the client recognize signs of anxiety and agitation
- Maintain low stimuli
- Observe client behaviors
- Remove all dangerous objects from the room
- Maintain calm attitude
- Ensure sufficient staff is available if restraints are needed.
Impaired Social Interaction
- Help demonstrate interaction skills
- Limit manipulative behavior
- Do not argue, bargain or reason with the client
- Provide positive reinforcement
Education
- Nature of the illness
- Management of illness
(Lithium toxicity is important) - Support Services
(Crisis hotlines, support groups, individual psychotherapy)
Therapy
Interpersonal and Social Rhythm Therapy (ISRT)
- Specifically designed for bi-polar patients. Helps regulate social rhythm or daily activities like sleep-wake cycle.
Group Therapy
- Peer support helps provide security,
- Usually peer led
Family Therapy
- Restore family adaptive functioning
- Behavioral family treatment
Cognitive Therapy
- Taught to control though distortions.
- Goal is to obtain relief as quick as possible and to help client identify dysfunctional patterns of thinking and behaving.
Recovery Model
- Focuses on how to live a safe dignified life in the face of enduring disability.
- Individuals should identify goals that give them purpose
- Clinician and client work together on treatment plan
- Strategies are developed to manage illness
- Clinician serves as support for individual to maintain goals.
- No cure for bipolar disease but management of symptoms and successful coping is possible.
Electroconvulsive Therapy
- Typically when clients do not tolerate medications such as lithium.
- Also used when life is threatened by dangerous behavior or exhaustion.
