Bipolar Disorder Nursing Care for the NCLEX

Manic Episode

• Elevated or irritable mood lasting ≥1 week
• Decreased need for sleep, pressured speech, flight of ideas
• Grandiosity, increased activity, impulsivity
• Poor judgment: excessive spending, risky behavior

Depressive Episode

• Depressed mood, loss of interest (anhedonia)
• Sleep changes, appetite changes, fatigue
• Feelings of worthlessness, difficulty concentrating
• Suicidal ideation (assess at every encounter)

Medications

• Lithium: First-line mood stabilizer. Therapeutic level 0.6-1.2 mEq/L. Monitor thyroid and renal function. Maintain adequate sodium and hydration
• Valproic acid: Monitor liver function, CBC
• Carbamazepine: Monitor CBC (risk of aplastic anemia)
• Lamotrigine: Risk of Stevens-Johnson syndrome (rash)

Nursing Interventions for Mania

• Provide a calm, structured, low-stimulus environment
• Offer high-calorie finger foods (client too active to sit for meals)
• Set firm, consistent limits on behavior
• Channel energy into constructive activities

Review our Psychiatric Medications deep dive and Psychosocial study guide.