Bipolar Disorders Cheat Sheet

Table of Contents: 1. Pathophysiology 2. Assessment Findings 3. Interventions 4. Treatments Bipolar Disorders y Bipolar I: Dramatic mood fluctuations cycling from depression to mania (FIGURE 1) y Bipolar II: Mood fluctuations from depression to hypomania (a less intense form of mania) y Having a first-degree relative with bipolarrisk. 2. Assessment Findings FIGURE 1: BIPOLAR DISORDER During a depressive episode: y Clients experience LOW mood and anhedonia (see DEPRESSION & SUICIDE CHEAT SHEET). During a manic episode: y Mood is HIGH (TABLE 1). y Mania is a psychiatric emergency because itrisk for violent behavior and unintended injury.
Insight is poor (clients do not recognize their behavior as problematic or comprehend the consequences).
Clients often dress provocatively and in bright colors with excessive jewelry or makeup.  Clients with mania demonstrate hyperactivity and poor insight, increasing the risk for injury, sleep deprivation, dehydration, and impulsive behaviors such as excessive spending and high-risk sexual behaviors.
TABLE 1: SYMPTOMS OF MANIA Symptom Examples mood (labile; ranging from euphoric to irritable) y “Everything is amazing!” y May become aggressive when limits are set 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 sexual behaviors 3. Interventions Interventions for depressive episodes:
#1 priority = suicide prevention. y Encourage behaviors that counteract depressive symptoms (grooming, physical activity, socialization). y See DEPRESSION & SUICIDE CHEAT SHEET for additional depression interventions. Interventions for manic episodes focus on: 1. Ensuring safety 2. Providing a calm environment 3. Encouraging adequate nutrition and rest Mental Health 1. Pathophysiology  To prevent exhaustion during mania, the nurse should promote sleep hygiene, promote frequent rest periods, and decrease environmental stimuli. © Bootcamp.com 3 1. Ensure safety:
Set limits by using simple and concise statements. y “Touching other clients is not allowed.” y “Standing on the table is not permitted.” y Redirect inappropriate behaviors with matter-of-fact, non-judgemental language to protect client’s dignity and prevent conflict. y Undressing in public: “Let’s go back to your room so you can get dressed.” y Invading others’ personal space: “Let’s go for a walk together.” y Continually assess suicide risk (suicide riskas mania subsides). TABLE 2: MOOD STABILIZING MEDICATIONS Drug Indications & Considerations Lithium Mood stabilization y Lithium has a narrow therapeutic index, and toxicity can be fatal. y Blood draws are required to monitor lithium levels.
Monitor for symptoms of lithium toxicity (GI distress, ataxia, sedation, seizures).
Teach clients to maintain consistent sodium intake and drink 2-3 L/day of water (dehydration andsodium intaketoxicity risk). y Starts working in 1-3 weeks (benzodiazepines or atypical antipsychotics may be used in the meantime to control symptoms) Anticonvulsants Mood stabilization y Valproate: Monitor for hepatotoxicity and pancreatitis. y Carbamazepine and lamotrigine: Monitor for rash, which could indicate Stevens-Johnson syndrome. 2. Provide a calm environment:
environmental stimuli by dimming lights and noise. y Limit group and competitive activities to prevent overstimulation (engage client in 1:1 activities). y Provide appropriate outlets forenergy like walking or cleaning. 3. Encourage adequate nutrition and rest:
Provide high-calorie finger foods and fluids that can be consumed “on the go,” like sandwiches and protein shakes.
Provide frequent rest periods and promote sleep hygiene to prevent exhaustion. 4. Treatments valproate carbamazepine lamotrigine  To manage inappropriate behaviors associated with mania, the nurse should use simple, concise statements and set clear limits on behavior. Mental Health 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).  Clients taking lithium should drink 2-3 L/day of water and maintain consistent sodium intake.  To ensure adequate nutrition and hydration during mania, the nurse should provide high-calorie finger foods and drinks like sandwiches and protein shakes. © Bootcamp.com 2  Clients with mania demonstrate hyperactivity and poor insight, increasing the risk for injury, dehydration, _____ deprivation, and _____ behaviors such as excessive spending and high-risk sexual behaviors.  To prevent exhaustion during mania, the nurse should promote _____ hygiene, promote frequent _____ periods, and decrease environmental _____.  What types of food should the nurse provide to a client during a manic episode?  Clients taking lithium should drink ____ L/day of water and maintain a consistent intake of _____.  To manage inappropriate behaviors associated with mania, the nurse should use simple, concise statements and set clear _____ on behavior. Mental Health Answers: 1. sleep, impulsive 2. sleep, rest, stimuli 3. limits 4. high-calorie finger foods 5. 2-3 L/day, sodium References: Burchum, J. R. & Rosenthal, L. D. (2025). Lehne’s pharmacology 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). 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. Attributions: y Bipolar Disorder: Created with BioRender.com © Bootcamp.com 3