Conditions › Mental health
Bipolar Disorder Nursing Care Plan and Interventions
In acute mania, the nurse puts safety first, lowers stimulation and offers finger foods the client can eat on the move. Lithium needs steady salt and water intake and regular levels; know the signs of lithium toxicity and teach relapse prevention.
Bipolar disorder nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Risk for injury or violence (mania) | No injury to self or others. | |
| Imbalanced nutrition: less than body requirements | Eats enough to keep weight and hydration. | |
| Risk for lithium toxicity | Lithium level in range; toxicity signs reported early. | |
| Health maintenance: needs teaching | Knows early relapse signs and keeps taking mood stabilizers. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Bipolar disorder
A chronic mood disorder with episodes of mania or hypomania and episodes of depression, often with stretches of normal mood between. 1
Suicidal thoughts and substance use are more common, so screen for both.
Bipolar I vs II
Bipolar I: at least one manic episode (7+ days or needing the hospital). Bipolar II: hypomania (milder, no psychosis) plus depression. 1
Hypomania can feel productive, but it can progress to mania or a depressive episode.
Assessment: what you will see
Mania cues
Elevated or irritable mood with high energy: little need for sleep, rapid pressured speech, racing thoughts, grandiosity, reckless spending. 1,2
Feels rested after 3 hours of sleep and jumps from topic to topic? Think mania.
Complications and red flags
Lithium toxicity
Early: nausea, vomiting, diarrhea, worse tremor. Then coarse tremor, unsteady gait, confusion, slurred speech. Late: seizures, arrhythmias. 1,3
Hold the dose, notify the provider, and get a level. Severe cases may need dialysis.
Priority: what the nurse does first
Acute mania: safety first
The priority is physical: exhaustion, dehydration and injury from reckless acts. Teaching waits until the mania starts to settle. 2
No sleep or food in days outranks discharge teaching.
Nursing interventions and treatment
Low stimulation
A quiet, structured space with less noise and fewer people. No competitive games or big groups. Planned rest periods. 2
A private room and a calm bedtime routine help sleep come back.
Finger foods
Frequent high-calorie, high-protein snacks, drinks and finger foods the client can eat on the move. Track weight, intake and fluids. 2
A sandwich and a shake in hand beat a full tray the client won't sit down for.
Talking with a client in mania
Stay calm, give short clear directions one at a time, don't argue with grandiose ideas, and set firm, consistent limits. 1,2
Grandiose claim? Acknowledge the feeling, skip the debate, and redirect.
Mood stabilizers
Lithium and valproate are first line for mania. Lamotrigine and carbamazepine are other mood stabilizers; antipsychotics are also used. 1,4
Clients entering mania may deny being ill and stop their meds. Check adherence.
Valproate and lamotrigine
Valproate: boxed warnings for liver failure, pancreatitis and birth defects. Lamotrigine: boxed warning for serious rash, including SJS. 3
Valproate: liver tests and reliable birth control. Lamotrigine: new rash? Hold and report.
Evaluation: is care working?
Lithium level
Therapeutic 0.6 to 1.2 mEq/L; toxic above 1.5. Draw a trough level about 12 hours after the last dose. 4,1
Narrow range: levels and kidney function are checked regularly.
Client teaching
Lithium: steady salt and water
Keep salt intake normal and drink 2.5 to 3 L a day. Low salt, heavy sweating, vomiting or diarrhea make the level climb. 3
NSAIDs, diuretics and ACE inhibitors raise lithium too. Ask before any new pain reliever.
Teach: prevent relapse
Regular sleep, wake and meal times; keep taking meds when well; avoid alcohol and drugs. Needing less sleep is an early warning sign. 1,2
"I feel great, so I stopped my lithium" needs follow-up today.
NCLEX traps
Depression vs bipolar
Depression: low mood or lost interest for 2+ weeks, with no history of mania. Bipolar: the same lows plus mania or hypomania. 1,4
Ask about past highs before an antidepressant: given alone, it can trigger mania in bipolar disorder.
Try 3 bipolar disorder questions
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Pharmacological and Parenteral Therapies
A patient with bipolar disorder is prescribed lithium. Which serum lithium level indicates the patient is within the therapeutic range?
Show answer and rationale
Answer: C. The therapeutic range for lithium is 0.6-1.2 mEq/L, and 0.9 mEq/L falls within this range. A level of 0.3 mEq/L is subtherapeutic and unlikely to control symptoms. Levels of 1.8 mEq/L and 2.5 mEq/L both exceed the toxic threshold of over 1.5 mEq/L and require urgent nursing intervention and provider notification.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 4.2; OpenStax Psychiatric-Mental Health Nursing, 16.4
Question 2 · Pharmacological and Parenteral Therapies
A nurse assesses a client with a history of bipolar disorder who is taking lithium. Which findings indicate lithium toxicity? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, C, F. Lithium toxicity presents with coarse tremor, ataxia, nausea, vomiting, diarrhea, confusion, and slurred speech. Constipation is not a characteristic toxicity finding for lithium. Hypertension is also not a typical sign of lithium toxicity. Recognizing these signs early allows the nurse to hold the dose and obtain a lithium level promptly.
Checked against: OpenStax Pharmacology for Nurses, 13.3; OpenStax Psychiatric-Mental Health Nursing, 16.4
Question 3 · Psychosocial Integrity
A patient in a manic episode states, "I will go, flow, blow, snow — it's cold out there." The nurse documents this speech pattern as which finding?
Show answer and rationale
Answer: D. Clang association is a rhyming, meaningless linking of words often seen in mania and psychosis, exactly as demonstrated in this example. Word salad is a jumble of unrelated words that lacks the rhyming pattern seen here. Echolalia is the repetition of another person's words or phrases. Flight of ideas involves rapid shifting between topics that retain some logical connection, rather than being based purely on rhyme.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 15.1
Keep studying bipolar disorder in NurseLingo Pro
Pro has 20 bipolar disorder questions like these, with a rationale for every answer. Everything for bipolar disorder in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free mental health practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for bipolar disorder?
Common nursing problems for bipolar disorder include risk for injury or violence (mania); imbalanced nutrition: less than body requirements; risk for lithium toxicity; health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for bipolar disorder?
The priority is physical: exhaustion, dehydration and injury from reckless acts. Teaching waits until the mania starts to settle.
What are the nursing responsibilities for a patient with bipolar disorder?
In mania, keep the client safe, lower stimulation and offer high-calorie finger foods. Give mood stabilizers as ordered, monitor lithium levels and watch for toxicity (vomiting, diarrhea, tremor, confusion). Teach steady salt and fluid intake and early relapse signs.
More mental health
Sources
- OpenStax Psychiatric-Mental Health Nursing, 16.4
- ncbi.nlm.nih.gov
- dailymed.nlm.nih.gov
- OpenStax Psychiatric-Mental Health Nursing, 4.2
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.