Nursing Resource Blog

1. Types of Bipolar Disorder

Bipolar I

  • Criteria: At least one manic episode lasting ≥ 1 week (or requiring hospitalization), with or without depressive episodes.

  • Mania Symptoms (DIG FAST mnemonic):

    • Distractibility

    • Indiscretion (risky behavior)

    • Grandiosity

    • Flight of ideas

    • Activity increase

    • Sleep deficit (decreased need for sleep)

    • Talkativeness (pressured speech)

  • Example: A patient who has not slept for 4 days, is impulsively spending large amounts of money, and speaking rapidly with tangential thoughts.

Bipolar II

  • Criteria: At least one hypomanic episode (lasting ≥ 4 days, not severe enough for hospitalization) and one or more major depressive episodes.

  • Example: A patient who feels “invincible” for several days, with increased productivity but no severe impairment, followed by weeks of hopelessness and fatigue.

2. Nursing Assessment – Key Findings

  • Mood changes: Elevated, irritable, or expansive mood in mania/hypomania; sadness or hopelessness in depression.

  • Energy/activity: Restlessness, impulsivity, increased goal-directed activity in mania; fatigue and withdrawal in depression.

  • Sleep patterns: Markedly decreased need for sleep in mania; hypersomnia or insomnia in depression.

  • Thought process: Flight of ideas, pressured speech, racing thoughts in mania; slowed thinking in depression.

  • Safety concerns: Poor judgment during mania → high risk for injury, financial loss, legal problems.


3. Nursing Priorities (NCLEX Focus)

Priority Area Actions
Safety Prevent harm to patient or others during mania (remove hazards, limit spending access, monitor for suicidal ideation in depression)
Medication management Monitor therapeutic levels (e.g., lithium 0.6–1.2 mEq/L), assess for toxicity, reinforce adherence
Sleep & rest Encourage rest periods, low-stimulation environment
Nutrition Offer portable, high-calorie snacks during mania when patient is too distracted to eat full meals
Therapeutic communication Use calm, concise statements; avoid power struggles; redirect excessive energy


4. Pharmacologic Management

Mood Stabilizers

  • Lithium

    • Therapeutic range: 0.6–1.2 mEq/L

    • Toxicity signs: Tremor, confusion, polyuria, vomiting, diarrhea, seizures

    • Nursing points: Maintain consistent sodium and fluid intake; monitor renal and thyroid function

Anticonvulsants with mood-stabilizing effects

  • Valproic acid (Depakote) – monitor liver function, platelets

  • Carbamazepine (Tegretol) – monitor CBC for agranulocytosis, avoid grapefruit juice

  • Lamotrigine (Lamictal) – risk for Stevens-Johnson syndrome (rash)

Atypical Antipsychotics

  • Used for acute mania or adjunct therapy (e.g., olanzapine, quetiapine)


5. Non-Pharmacologic Interventions

  • Psychoeducation - teach early warning signs of mood shifts, importance of medication compliance

  • Cognitive Behavioral Therapy (CBT) – improve coping and reduce relapse risk

  • Family-focused therapy – support system involvement


6. NGN-Style Clinical Judgment Tip

The Next Gen NCLEX often frames bipolar questions as patient safety and priority decision-making scenarios. Expect to:

  • Identify most urgent nursing action (e.g., preventing harm during mania > addressing minor sleep issues)

  • Select interventions that stabilize mood and prevent relapse

  • Interpret labs and medication levels in context

Example NGN Question:
A patient on lithium reports new onset tremors and confusion. Priority action? → Hold lithium and notify provider (possible toxicity).


7. Patient Education: Testable Points

  • Take medications consistently; do not stop abruptly.

  • Avoid dehydration and maintain stable salt intake (lithium).

  • Avoid alcohol and recreational drugs.

  • Keep a mood diary to track triggers and early warning signs.

  • Engage in regular follow-ups and therapy.


Key Takeaway:

For the NGN, don’t just memorize symptoms - think safety first, medication monitoring, and prioritization of nursing actions.

Bipolar disorder questions will test your ability to connect assessment findings to urgent interventions.