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Principles of nursing a person suffering from bipolar disorder

Nursing people suffering from bipolar disorder requires a variety of nursing skills and behaviours. These are based on the same principles of nursing that apply to the care of people suffering from depression, which have been discussed previously. However, the nurse needs to be aware of the possibility of mood change and particularly the development of a mixed state.

Manic episode

The nursing care required by a person in a manic episode will depend to a large degree on the extent and severity of the episode. Some episodes of mania, which border on hypomania, may be manifested primarily by an exaggeration of an individual’s usual personality. Other manic episodes may be characterized by marked lack of insight and irrational behaviour. One of the major challenges for hospital-based nurses is to care for an individual who is excited, euphoric and perhaps afraid. This person may be agitated and restless with marked pressure of speech and will often be unable to stop long enough to complete any task, including self-care tasks such as washing and dressing, watching television or reading.

Eating and drinking

It may be difficult to encourage a manic individual to eat and drink as they may feel that they have no time to eat and/or that they are not hungry. There is, therefore, considerable risk that they may become dehydrated and in the longer term, malnourished. Dehydration is a primary concern as it can cause the individual to become unwell and exacerbate their psychological symptoms. It is, therefore, important to check that the individual is taking adequate fluids and, if not, drinks should be offered and encouraged at regular intervals. Although nutrition is a less pressing problem than fluid intake, it is important that it is addressed. A manic person may engage in considerable psychomotor activity which increases their energy expenditure, and if they are not eating, they may lose weight quickly. Frequent snacks, such as sandwiches and biscuits, that can be eaten during activity is more likely to be accepted by a manic person than full meals. However, as mood stabilizes, providing a meal, which the individual must sit down to may be a way of making them stop and take time. It is important to note that in mania the opposite effect may also occur with the result that an individual may drink large volumes of fluid or eat large amounts of food. Again, in the short term this may not be a pressing problem, but in the longer term, weight gain may be undesirable.

Restlessness

The manic individual in hospital will probably find the environment constraining and irritating, often wishing to leave the ward. This can be very difficult for nurses to deal with as it may not be in the individual’s best interests to leave and, if restricted under the Mental Health Act, it may not be possible. It is important to engage the individual with mania in activities if they are restless. For some people it is appropriate to encourage them to carry out minor ‘jobs’ around the ward within the limits of health and safety regulations and therapeutic need; for example, allowing them to make a cup of tea for other residents or assisting with either setting up an activity or tidying up afterwards. It is important that such activities are the outcome of therapeutic decisions and not for staff convenience; inpatients should not act as unpaid help! Other activities may include residents organizing feedback forums and other similar administrative tasks. Such activities can provide a constructive outlet for individuals experiencing mania, which can make them feel useful and enhance their self esteem. It is important to supervise these activities carefully. Manic individuals may be overbearing, overenthusiastic and over-zealous in their dealings with other residents. Nurses should be ready to step in if such activities become inappropriate or no longer therapeutic from the point of view of either the individual with mania or other residents.

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