Bipolar Disorder Flashcards
Mania Symptoms
· Inflated self esteem or grandiosity
· Decreased need for sleep
· More talkative than usual or pressure to keep talking
· Flight of ideas, or racing thoughts
· Distractibility i.e. the person’s attention is too easily drawn to unimportant or irrelevant external stimuli
· Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation
· Excessive involvement in activities that have a high potential for painful consequences
Assessment
- Mood
- Behaviour
- Thought Processes & Speech Patterns
- Cognitive Function
Nursing Diagnosis
- Risk for self-directed / or other-directed violence
- Ineffective coping
- Ineffective impulse control
- Impaired verbal communication
- Impaired social interaction
- Deficient fluid volume
- Imbalanced nutrition: less than body requirements
- Disturbed sleep pattern
- Self-care deficit
Interventions: Safety
- Safety first! Always ensure safety
- Protect patient against giving away money & possessions. Hold valuables until judgment returns
- Maintain low level of stimuli in patient’s environment (away from bright lights, loud noise and people)
- Suggest solitary activities
- Redirect violent behaviour
- PRN medications for agitated behavior
- Seclusion or restraints may be warranted based on assessment. Note that seclusion or restraints are used only if the patient presents a clear danger to self or others.
Interventions: Communication
- Firm, calm approach
Rationale: structure and control are provided for client who is out of control i.e. “John, come with me. Eat this sandwich”
- Short concise explanations
Rationale: short attention span limits comprehension to small bits of information.
- Be consistent in approach & expectations
Rationale: consistent limits and expectations minimize potential for client’s manipulation of staff
Example of setting limits:
“John, do not yell at or hit Peter. If you cannot control yourself, we will help you.”
“The seclusion room will help you feel less out of control and prevent harm to yourself and others.”
Interventions: Nutrition and Elimination
- Monitor intake and output
- Offer frequent, high calorie, protein drinks and finger food
- Remind patient to eat
- Monitor BMs
- Offer fluids and foods high in fiber
- Evaluate need for laxative
Interventions: Self Care
- Encourage frequent rest periods
- Provide low stimulation
- Encourage relaxation measures i.e. listening to soft music, drawing, writing, etc
- Avoid giving patient caffeine, particularly at night
- Supervise choice of clothes
- Give reminders to bath, shave
Health Teaching
- Role of family - education about the disorder and preventing relapse
- Relapse can be caused by alcohol, recreational drugs, over-the-counter-drugs - requires substance abuse treatment
- Provide psychosocial strategies to lower stress
- Encourage group & individual psychotherapy
- Support groups
- Ami Quebec-Quebec Alliance for the Mentally Ill - (514) 486-1448
- Internet site: www.mooddisorderscanada.ca
Short Term Outcomes
- After 5 hours, patient started taking 8 oz of water per hour with much reminding and encouragement.
- Patient still having insomnia, awake for most of night, slept for 2 hours from 4 to 6 a.m.
- Demonstrated relaxation techniques taught
Long Term Outcomes
- Adherence to the medication regimen
- Resumption of functioning in the community
- Achievement of stability in family, work, and social relationships and in mood
- Improved coping skills for reducing stress
