Bipolar Disorder Nursing Care Plan: 2 Sample Plans and Interventions

Bipolar disorder causes mood swings between mania and depression. During mania, the client may not sleep, eat, or notice danger, and can become exhausted or hurt. Your priorities are safety, basic physical needs, and safe mood stabilizer use.

A · AssessmentD · DiagnosisP · PlanningI · InterventionE · Evaluation

Each care plan below follows the nursing process (ADPIE).

CARE PLAN 1 · NURSING DIAGNOSIS

Risk for Injury

Risk factors

Hyperactivity and poor judgment during mania
Impulsive, risky behavior
Exhaustion from lack of sleep and food
Possible lithium toxicity

PLANNING · EXPECTED OUTCOMES

Short-term goals

Client stays free of injury during the hospital stay
Client accepts limits on unsafe behavior within 24 to 48 hours

Long-term goals

Client recognizes early signs of mania and seeks help before behavior becomes unsafe

ASSESSMENT

Activity level, speech, and behavior every shift
Signs of escalating agitation
Sleep hours
Lithium level and signs of toxicity such as vomiting, diarrhea, tremor, and confusion

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Provide a calm, low-stimulation environment	Noise and activity feed the client's racing thoughts and agitation.
Set clear, firm, consistent limits in a calm voice	Consistent limits give structure and reduce unsafe behavior and staff splitting.
Redirect energy into solo physical activities like walking	Safe outlets burn off energy without competitive group activities that can escalate.
Give mood stabilizers as ordered and check lithium levels	Lithium has a narrow therapeutic range, so levels guide safe dosing.
Teach steady salt and fluid intake, about 2 to 3 L per day, while on lithium	Low sodium or dehydration makes the body hold onto lithium and raises toxicity risk.

EVALUATION

Client remains free of injury
Client follows unit limits with fewer reminders
Client names signs of lithium toxicity to report

CARE PLAN 2 · NURSING DIAGNOSIS

Imbalanced Nutrition: Less Than Body Requirements

Related to

Hyperactivity and high energy use
Too distracted to sit and eat

As evidenced by

Weight loss
Eats less than half of meals
Constant movement and pacing

PLANNING · EXPECTED OUTCOMES

Short-term goals

Client eats at least 50% of each meal and snack within 48 hours
Client drinks the ordered amount of fluid daily

Long-term goals

Client returns to and keeps a healthy weight

ASSESSMENT

Daily weight
Meal and fluid intake
Skin turgor and signs of dehydration

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Offer high-calorie finger foods and drinks the client can take while moving	Portable foods let the client eat without having to sit still.
Offer frequent small snacks	Small, frequent intake is easier to finish than full meals.
Track intake and daily weight	Records show whether nutrition goals are being met.

EVALUATION

Client eats at least half of meals and snacks
Weight is stable or increasing

Practice this in Pharmacy

Practice safe dosing and toxicity checks for mood stabilizers like lithium.

Play Pharmacy

Quick answers

A client on lithium has vomiting, diarrhea, and a coarse tremor. What should the nurse do first?

Hold the next dose and notify the provider. These are signs of lithium toxicity, and a level should be drawn.

Which activity is best for a client with acute mania?

A solo, non-competitive activity like walking or drawing. Group and competitive games add stimulation and can lead to conflict.

For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.