A nurse is caring for a client who is diagnosed with bipolar disorder and is taking lithium

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Nursing Care Plans
Recommended Resources

Medically Reviewed by Dan Brennan, MD on June 09, 2021

You may take lithium as a treatment for bipolar disorder. It’s the most common form of treatment for this condition. Lithium toxicity can be caused by underlying health issues, changes to medication, or incorrect dosage.

Lithium is commonly prescribed by psychiatrists to manage recurrent bipolar illness. Lithium was approved in the 1970s by the U.S. Food and Drug Administration (FDA) as a mood stabilizer and a treatment for mania.

Lithium is a powerful medication that has antimanic properties. Though lithium has been approved as a treatment, its effects on the brain aren’t completely understood. Researchers believe lithium makes the brain less responsive to stimulation that causes manic episodes. It’s also thought to reduce the responsiveness to neurotransmitters.

Lithium can become dangerous when it’s taken in excess. When excessive amounts are taken intentionally or accidentally, it can cause acute or acute-on-chronic overdose symptoms.

To determine whether you’re experiencing lithium toxicity, you first need to know the common side effects of prescribed lithium. They include:

Headache
Nausea or vomiting
Dizziness or drowsiness
Diarrhea
Changes in appetite
Hand tremors
Dry mouth
Increased thirst
Increased urination
Thinning of hair or hair loss
Acne-like rash‌

Some signs of lithium toxicity are similar to its side effects, but more severe. Symptoms of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, and vision changes. If you experience these, you should seek immediate medical attention to check your lithium levels.

There are three types of lithium toxicity. They range from mild and uncomfortable to severe and dangerous if left untreated. ‌

Acute lithium toxicity. Symptoms commonly include feeling weak, having a worsening tremor, feeling unbalanced or uncoordinated, poor concentration, diarrhea.

Acute-on-chronic lithium toxicity. With this level of poisoning, you could experience gastrointestinal (GI) problems. You may also experience neurological problems. ‌

Chronic lithium toxicity. At this level, you will mostly experience neurological symptoms. Severity will depend on the levels of lithium in your body.‌

If you have one or more of the following symptoms, you may be experiencing early lithium toxicity:

Loss of appetite, or vomiting
Blurred vision
Excessive thirstiness
Needing to pee frequently
Uncontrollable urination and bowel movements
A lightheaded or drowsy feeling
Confusion and blackouts
Shaking, muscle weakness, twitches, jerks, or spasms affecting your face, tongue, eyes, or neck
Trouble speaking

Lithium toxicity mostly affects your kidneys and central nervous system. In acute lithium toxicity, your GI tract will be affected too. In more severe cases, you may experience neurological or cardiovascular problems. In early lithium toxicity, you may have mild confusion. As the toxicity worsens, you may feel delirious or even have seizures or go into a coma.

In very rare cases, lithium toxicity may cause diabetes insipidus. This condition leads to large amounts of urine in your body, regardless of how much fluid you drink. You’ll also experience a significant amount of thirst.

If you're experiencing any of these symptoms or side effects, you should seek immediate medical attention. Left untreated, lithium toxicity can progress and worsen. Lithium poisoning can be life-threatening and should be monitored and treated promptly.

By noticing the early signs of lithium toxicity, you can get the help you need. Contact your doctor or psychiatrist if you feel like you're experiencing any side effects from your medication. You can also have them check your lithium levels to find out if they're too high.

When caught early, lithium toxicity can be treated by keeping or reducing your lithium levels to the low to medium range. If you notice a lithium-induced tremor, you may be treated with beta-blockers. ‌

Diligent monitoring is the best way to avoid lithium toxicity. You’ll also need to make sure other medications you're on don't affect your lithium excretion. If your body excretes too much lithium, it can also create toxic levels in your body. ‌

Medications that can interfere with this include:

‌Your doctor should monitor you closely to ensure you're taking the right levels of lithium. It's also important that you tell them about any side effects. Since lithium toxicity can happen through your body's excretion, you might not know initially whether you have high levels in your body.

Bipolar disorders are mood disorders that comprise of one or more manic or hypomanic episode and usually one or more depressive episodes with periods of relatively normal functioning in between. They are said to be linked to biochemical imbalances in the brain and it is said that the disease is genetically transferred.

Nursing Care Plans

Clients with bipolar disorders are at a high risk for suicide. Although clients in the manic phase are briefly agitated, energized and elated, their underlying depression makes them likely to inflict self-injury.

Essential responsibilities of nurses are to provide a safe environment, to improve the self-esteem, to meet the physiologic needs and to guide patients toward socially appropriate behavior.

Here are six nursing care plans and nursing diagnosis for bipolar disorders:

Nursing Diagnosis

Risk factors

Affective, cognitive, and psychomotor factors.
Biochemical/neurologic imbalances.
Exhaustion and dehydration.
Extreme hyperactivity/physical agitation.
Rage reaction.

Possibly evidenced by

Abrasions, bruises, cuts from running/falling into objects.
Extreme hyperactivity.
Impaired judgment (reality-testing, risk behavior).
Lack of fluid ingestion.
Lack of control over purposeless and potentially injurious movements.

Desired Outcomes

Patient will respond to the medication within the therapeutic levels.
Patient will sustain optimum health through medication management and therapeutic regimen.
Patient will have stable cardiac status while in the hospital.
Patient will drink 8 oz of fluid every hour throughout the day while on acutely manic stage.
Patient will remain free from falls and abrasions every day while in the hospital.
Patient will be free of dangerous levels of hyperactive motor behavior with the aid of medications and nursing interventions within the first 24 hours.
Patient will spend time with the nurse in a quiet environment three to four times a day between 7 am and 11 pm with the aid of nursing guidance.
Patient will take short voluntary rest periods during the day.
Patient will be free of excessive physical agitation and purposeless motor activity within 2 weeks.
Patient will be free of injury within 2 to 3 weeks:
- Stable cardiac status.
- Skin free of abrasions and scrapes.
- Well dehydrated.

Nursing Interventions	Rationale
Provide structured solitary activities with the assistance of a nurse or aide.	Structure provides focus and security.
Provide frequent rest periods.	Prevents exhaustion.
Provide frequent high-calorie fluids (e.g., fruit shake, milk).	Prevents the risk of serious dehydration.
Maintain a low level of stimuli in client’s environment (e.g., loud noises, bright light, low-temperature ventilation).	Helps minimize escalation of anxiety.
Acute mania might warrant the use of phenothiazines and seclusions to decrease any physical harm.	Exhaustion and death result from dehydration, lack of sleep, and constant physical activity.
Observe for signs of lithium toxicity (e.g., nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears).	There is a small margin of safety between therapeutic and toxic doses.
Protect client from giving away money and possessions. Hold valuables in a hospital safe until rational judgment returns.	Client’s “generosity” is a manic defense that is consistent with irrational, grandiose thinking.
Redirect violent behavior.	Physical exercise can decrease tension and provide focus.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.