1. The client/caregiver can define bipolar disease or manic depression.
   1. It is a mental health disorder characterized by mood swings from overly high and irritable to sad and hopeless.
   2. The highs and lows can last from a few days to several months.
   3. It usually begins in adolescence or early adulthood.
2. The client/caregiver can list factors that increase risk.
   1. Familial tendency
   2. Affects men and women equally
   3. Usually appears before the age of 30 years
3. The client/caregiver can recognize signs and symptoms.
   1. Mania
      1. Increased energy, restlessness, and hyperactivity
      2. Irritability and distractibility
      3. Decreased need for sleep
      4. Racing thoughts and loud, rapid speech
      5. Manipulative
      6. Increased sexual drive
      7. Abuse of drugs
      8. Loss of appetite
      9. Inflated self-esteem
      10. Impractical schemes and poor judgment
      11. Denial that anything is wrong
      12. Unrealistic in financial and legal matters
      13. Anger
      14. Distractibility
      15. Hallucinations/delusions
   2. Depression
      1. Persistent sad, anxious mood
      2. Feelings of guilt and hopelessness
      3. Decreased energy and fatigue
      4. Loss of appetite
      5. Weight gain or loss
      6. Loss of interest in ordinary activities
      7. Irritability
      8. Thoughts of death or suicide
4. The client/caregiver can list measures to manage disease.
   1. Limit alcohol.
   2. Eat a well-balanced diet.
   3. Exercise daily with rest periods.
   4. Avoid competitive games.
   5. Follow measures to decrease insomnia.
      1. Decrease stimulating activity at bedtime.
      2. Avoid caffeine.
      3. Drink warm milk.
      4. Avoid noise and distractions.
   6. Keep follow-up appointments as scheduled.
   7. Take medication as instructed. There is a need for routine blood tests to evaluate medication.
5. The client/caregiver can list measures for the management of the disease.
   1. Watch closely to prevent clients from causing injury to themselves or others.
   2. Define acceptable behaviors to clients.
   3. Stress the importance of keeping appointments and taking medications to clients.
   4. Be honest and consistent.
   5. Encourage good nutrition.
      1. Offer finger foods to increase ease of eating.
      2. Offer high-calorie, nutritious foods.
      3. Offer foods frequently.
   6. Provide a quiet atmosphere for a manic stage.
   7. Ask whether there is a suicide plan when in the depressed stage.
   8. Have client hospitalized if severely depressed, suicidal, or at risk for injury.

Resource

Emergency numbers, including therapist’s number or clinic number, close to the phone.

SAMHSA’s National Mental Health Information Center
http://mentalhealth.samhsa.gov/publications/allpubs/ken98-0049/default.asp

Depression and Bipolar Support Alliance (formerly National Depressive and Manic-Depressive Association)
800-826-3632
www.dbsalliance.org

Healthy People 2010
www.healthypeople.gov/Document/HTML/Volume2/18Mental.htm

Psychological counseling

Spiritual counseling

Support groups

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Hitchcock, J. E., Schubert, P. E., & Thomas, S. A. (2003). Community health nursing: Caring in action. Clifton Park, NY: Thomson Delmar Learning.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.
Varcarolis, E. M. (2006). Manual of psychiatric nursing care plans. St. Louis: Saunders Elsevier.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com