Bipolar Disorders PDF

Psychiatric health nursing Clinical (seminar) Bipolar disorder prepared by : -Ahmed Aldarabe’e -Abdullah Alhunifat prepared for : DR Yazan Almrayat Learning Objectives ✔ Define bipolar disorder ✔ Describe what is Mania & Depression ✔ Explain typ...

Psychiatric health nursing Clinical (seminar) Bipolar disorder prepared by : -Ahmed Aldarabe’e -Abdullah Alhunifat prepared for : DR Yazan Almrayat Learning Objectives ✔ Define bipolar disorder ✔ Describe what is Mania & Depression ✔ Explain types of bipolar disorder ✔ Identify sings and symptoms ✔ Identify nursing assessment ✔ Describe nursing intervention ✔ Summary Bipolar Disorder: Understanding the Spectrum of Mood Disorders ▪ Bipolar disorder is a complex mental health condition characterized by extreme mood swings that can significantly impact daily life. This presentation will explore the nuances of this disorder, including its causes, diagnosis, and effective management strategies to help individuals and their loved ones navigate this challenge with greater understanding and support.  What is Bipolar Disorder? Definition Types Prevalence ▪ Bipolar disorder is a mental health ▪ There are several types of bipolar ▪ Bipolar disorder affects approximately condition marked by periods of extreme disorder, including Bipolar I, Bipolar II, approximately 4.4% of adults in the extreme mood changes, ranging from II, Cyclothymic Disorder, and substance - United States, making it a relatively from manic highs to depressive lows. substance-induced bipolar disorder, common mental health condition, and lows. disorder, each with distinct symptoms and 82.9% of cases are severe. symptoms and characteristics. ▪ Average age at onset is age 25 years. years. Types of Bipolar Disorder ▪ Bipolar I Disorder Diagnosis requires that the patient: ‒ Is experiencing a manic episode or has a history of one or more manic episodes ‒ May have also experienced episodes of depression Diagnosis is further specified by the current or most recent behavioral episode. Types of Bipolar Disorder (continued_1) ▪ Bipolar II disorder Diagnosis requires that the patient: ‒ Presents with symptoms (or history) of depression or hypomania ‒ Has never met criteria for full manic episode ‒ Has never had symptoms severe enough to cause impairment in social or occupational functioning or to necessitate hospitalization. Types of Bipolar Disorder (continued_2) ▪ Cyclothymic disorder Diagnosis requires that the patient: ‒ Has a chronic mood disturbance, lasting at least 2 years. ‒ Has numerous periods of elevated mood that do not meet the criteria for a hypomanic episode; or ‒ Has numerous periods of depressed mood of insufficient severity or duration to meet criteria for a major depressive episode; and ‒ Is never without the symptoms for more than 2 months Types of Bipolar Disorder (continued_3) ▪ Substance-induced bipolar disorder Diagnosis requires that the patient: ‒ Has a mood disturbance as the direct result of physiological effects of a substance ‒ Has a mood disturbance that involves elevated, expansive, or irritable moods with inflated self-esteem, decreased need for sleep and distractibility Types of Bipolar Disorder (continued_4) ▪ Bipolar disorder associated with another medical condition. Diagnosis requires that the patient: ‒ Has an abnormally and persistently elevated, expansive, or irritable mood and excessive activity or energy as the direct physiological consequence of another medical condition ‒ Has a mood disturbance causing clinically significant distress or impairment in social, occupational, or other areas of functioning. Nursing Care for Bipolar Manic Episodes Caring for individuals experiencing bipolar disorder manic episodes requires a multifaceted approach. This part will cover key nursing interventions to ensure patient safety, manage medications, promote coping strategies, and collaborate with the interdisciplinary team. Understanding Bipolar Disorder: Manic Phases 1 Heightened Energy 2 Impaired Judgement Patients experience an Patients may engage in abnormal increase in risky or impulsive energy, activity, and behaviors, such as restlessness during manic excessive spending or episodes. substance abuse. 3 Decreased Need for Sleep Patients may experience a reduced need for sleep, often staying awake for extended periods. Assessing and Monitoring Manic Symptoms Vital Signs Mental Status Exam Behavior Monitoring Closely monitor the patient's heart rate, Assess the patient's mood, thought Observe the patient's activity levels, sleep blood pressure, and temperature, as they processes, and level of orientation to sleep patterns, and social interactions to may be affected during manic episodes. evaluate the severity of the manic episode. to identify any changes or escalating episode. symptoms. Assessing Mental Status 1 Appearance Evaluate grooming, dress, and motor activity. 2 Behavior Observe for impulsivity, aggression, or disorganization. 3 Mood and Affect Assess for elevated, irritable, or labile mood states. Pharmacological Interventions: Mood Stabilizers Lithium Anticonvulsants A widely used mood stabilizer that Such as valproate and lamotrigine, helps regulate mood and prevent lamotrigine, which can also be manic episodes. effective in stabilizing mood. Antipsychotics May be prescribed to manage acute manic symptoms or to augment the augment the effects of mood stabilizers. Non-Pharmacological Interventions: Psychotherapy Psychotherapy Cognitive-Behavioral Therapy Interpersonal and Social Rhythm Family-Focused Therapy (CBT) Rhythm Therapy Involves the patient's family in the Helps patients identify and modify negative Focuses on improving social functioning treatment process to improve negative thought patterns and behaviors functioning and establishing regular sleep- communication and support during manic behaviors associated with manic episodes. sleep-wake cycles to stabilize mood. manic episodes. episodes.  Ensuring Patient Safety During During Manic Episodes ▪ Restraint Minimization ▪ Environmental ▪ Close Monitoring Use de-escalation techniques to Modifications Closely observe the patient to prevent avoid the need for physical or Create a safe, calming prevent impulsive or dangerous chemical restraints. environment by limiting access to behavior and intervene promptly if access to potential hazards and if necessary. )One-to-One and providing a structured daily Observation( daily routine. ▪ Suicide Prevention Assess the patient's suicide risk and implement appropriate interventions to ensure their safety. Coping Strategies 1 Stress Management 2 Sleep Hygiene Teach relaxation techniques, Provide education on such as deep breathing, establishing a consistent meditation, or yoga, to help sleep schedule and creating manage manic symptoms. a calming bedtime routine. 3 Emotional Regulation Assist patients in developing skills to identify and express emotions in healthy ways. Managing Disruptive Behaviors De-escalation Conflict Resolution Emotional Support Use calming communication techniques Facilitate constructive discussions to Provide a compassionate and non- to defuse volatile situations. address interpersonal issues. judgmental listening ear. Promoting Rest and Sleep Sleep Hygiene 1 Establish a consistent sleep schedule and bedtime routine. Environmental Modifications 2 Adjust lighting, temperature, and noise levels to create a calming environment. Relaxation Techniques 3 Encourage the use of meditation, deep breathing, or progressive muscle relaxation. Interdisciplinary Collaboration Psychiatrist 1 Oversees medication management and treatment plan. Psychologist 2 Provides psychotherapy and behavioral interventions. Social Worker 3 Coordinates community resources and discharge planning. Nurses 4 Implements nursing interventions and monitors patient progress. Discharge and Ongoing Support Discharge Planning Outpatient Follow-up Develop a comprehensive Coordinate appointments with discharge plan to ensure a psychiatrists, therapists, and smooth transition to community- case managers to maintain based care. continuity of care. Family Education Community Resources Provide education and support Connect patients with local to family members to help them support groups, crisis hotlines, understand and cope with the and other resources to promote patient's condition. long-term stability.  Depressive episode Depression :Is an affective state characterized by feeling of sadness ,guilt and low self-esteem it may be apart of another illness Depression may be manifested by decrease physical activity or by psychomotor agitation  Symptoms of depressive episode feeling sad, hopeless most of the time lacking energy difficulty concentrating and remembering things loss of interest in everyday activities Delusion, having hallucinations and disturbed or illogical thinking suicidal though lack of appetite waking up early ,difficulty sleeping Diagnosis Depression RISK FOR SUICIDE COMOLICATED R/T depressed GRIEVING R/T disease mood AMB Pt process AMB inability to carry out activities of meeting daily living LOW SELF-ESTEEM R/T SOCIAL ISOLATION R/T disease process AMB disease process expression of AMB inability to worthlessness participate in usual activitiess RISK FOR SUICIDE R/T depressed mood AMB Pt meeting Ask client directly: “Have you thought about killing yourself?” or “Have you thought about harming yourself in any way? If so, what do you plan to do? Do you have the means to carry out this plan?” CONT… *Expected Outcome: Patient will remain safe and free from self-harm throughout the care period NURSING INTERVENTION : 1-Create a safe environment for the client Remove all potentially harmful objects from client’s access (sharp objects, straps, belts, ties, glass items, alcohol). Supervise closely during meals and medication administration. 2-Formulate a short-term verbal or written contract that the client will not harm self during a specific time period. When the contract expires, make another. Repeat this process for as long as required 3- Place in room close to nurse’s station; do not assign to private room. COMOLICATED GRIEVING R/T disease process AMB inability to carry out activities of daily living *Expected Outcome: Patient will express emotions appropriately and demonstrate improved ability to perform activities of daily living NURSING INTERVENTION : 1-Determine the stage of grief in which the client. Identify Behaviors associated with this stage. 2-Develop a trusting relationship with the client. 3-Convey an accepting attitude ,and enable the client to express feelings openly. CONT… NURSING INTERVENTION : 4- Help the client to discharge pent-up anger through participation in large motor activities (e.g., jogging, physical exercises, volleyball, p unching bag, exercise bike) 5- Reinforce communication between patient and his/her family to developmental life changes LOW SELF-ESTEEM R/T disease process AMB expression of worthlessness *Expected Outcome: Patient will verbalize increased self-worth and engage in activities that promote self-confidence NURSING INTERVENTION : 1-Be accepting of client and spend time with him or her even though pessimism and negativism may seem objectionable. Focus on strengths and accomplishments and minimize failures 2- Promote attendance in therapy groups that offer client simple methods of accomplishment. Encourage client to be as independent as possible. 3- Teach effective communication techniques, such as the use of “I” messages (e.g.*I feel hurt when you say those things*). CONT… NURSING INTERVENTION : 5- Provide praise for patient accomplishments 6- Assist patient in identifying his/her points strengths and weak SOCIALISOLATION R/T disease process AMB inability to participate in usual activities *Expected Outcome: Patient will gradually engage in social activities and initiate interactions with others NURSING INTERVENTION : 1-Assist client to identify reasons for feeling isolated and alone; aid him/h er in developing a plan of action to reduce these feelings. 2-Encourage significant others to visit 3- Encourage client to maintain telephone contact with others CONT… NURSING INTERVENTION : 4-Make objects such as clock, TV, radio, newspapers, and greeting cards accessible to client 5- Have significant others bring client's favorite objects from home and place in room Diagnosis Mania Risk for injury Risk for violence Imbalanced Impaired social nutrition interaction Risk for injury R/T extreme hyperactivity AMB Increased agitation and lack of control over purposeless & potentially injurious movements *Expected Outcome: Client will not experience injury NURSING INTERVENTION : 1.Reduce environmental stimuli. (Assign private room with simple décor, on quiet unit if possible. Keep lighting and noise level low) 2.Remove hazardous objects & substances (including smoking materials) 3.Stay with the client who is hyperactive and agitated 4.Provide physical activities. Such as? 5.Administer tranquilizing medication as ordered by physician Risk for violence (self-directed or other-directed) RT Manic excitement, delusional thinking, hallucinations *Expected Outcome: Client will not harm self or others NURSING INTERVENTION : 1.Maintain low level of stimuli in client’s environment. 2.Observe client’s behavior at least every 15 minute. 3.Ensure that all sharp objects, glass or mirrored items, belts, ties, smoking materials have been removed from client’s environment. 4.Redirect violent behavior with physical outlets. CONT… 5.Maintain & convey a calm attitude to client. Respond matter-of-factly to verbal hostility. 6. Have sufficient staff to indicate a show of strength to client if necessary. 7.Offer tranquilizing medication. (If client refuses, mechanical restraints may be necessary). 7. Observe client in restraints every 15 minutes. 8.Remove restraints gradually, one at a time. Imbalanced nutrition (less than body requirements) RT refusal or inability to sit still long enough to eat AMS Weight loss, amenorrhea *Expected Outcome: client will exhibit no signs or symptoms for malnutrition NURSING INTERVENTION : 1.Provide high-protein, high-calorie, nutritious finger foods & drinks that can be consumed “on the run”. 2.Have juice & snacks on the unit at all times. 3.Maintain accurate record of intake, output, calorie count, & weight. Monitor daily laboratory values. 4.Provide favorite foods. 5.Supplement diet with vitamins & minerals. 6.Walk or sit with client while he or she eats Impaired social interaction RT Egocentric & narcissistic behavior AMS Inability to develop satisfying relationships & manipulation of others for own desires *Expected Outcome: Client will interact appropriately with others NURSING INTERVENTION : 1.Recognize that manipulative behaviors help to reduce feelings of insecurity by increasing feelings of power & control. 2.Set limits on manipulative behaviors. Explain what is expected & the consequences if limits are violated. Terms of the limitations must be agreed on by all staff who will be working with the client. 3.Ignore attempts by client to argue, bargain, or charm his/her way out of the limit setting. CONT… NURSING INTERVENTION : 4.Give positive reinforcement for non-manipulative behaviors. 5.Discuss consequences of the client’s behavior & how attempts are made to attribute them to others. 6.Help client identify positive aspects about self, recognize accomplishments, & feel good about them. What is the best treatment for bipolar depression? Treating bipolar depression with antidepressants remains a popular option in clinical practice and published guidelines. Most clinicians choose the drug or class of drugs, usually selective serotonin reuptake inhibitors and bupropion, that is most effective and best tolerated Fluoxetine is the only antidepressant that is effective in treating bipolar depression, and only in combination with the atypical antipsychotic olanzapine Pharmacology summary  References References:>Nclex.com