Nursing Assessment:
1. Assess mood for stability; range of affect, from elation to irritability to severe agitation; laughing, joking, and talking continuously; uninhibited familiarity with interviewer.
2. Assess behavior for constant activity, starting many projects but finishing few, mild to severe hyperactivity, spending large sums of money, increased appetite, indiscriminate sex, minimal to no sleeping, outlandish or bizarre dress, poor concentration.
3. Assess thought processes for flight of ideas; pressured speech, usually with that is sexually explicit; clang associations (sound of word, rather than its meaning, directs subsequent associations); delusions; hallucinations.

Nursing Diagnoses
1. Disturbed Thought Processes related to biological changes as demonstrated by agitation, hyperactivity, and inability to concentrate
2. Disturbed Sleep Pattern related to hyperactivity and perceived lack of need for sleep
3. Compromised Family Processes related to role changes, economic strain, and lack of knowledge about the patient's illness
4. Imbalanced Nutrition: Less Than Body Requirements related to hyperactivity

Nursing Interventions
Improving Thought Processes and Decreasing Sensory Overload
1. Assess patient's degree of distorted thinking.
2. Redirect patient when you are unable to follow thought processes.
3. Use brief explanations.
4. Remain consistent in approach and expectations.
5. Frequently orient patient to reality; speak in a clear, simple manner.
6. Provide patient with a relaxing area with decreased environmental stimulation.
7. Assist patient with a gradual and progressive integration into the social environment while observing for behavioral changes that indicate readiness for participation in further activities.

Improving Sleep Pattern
1. Establish a distraction-free environment at bedtime.
2. Help patient avoid the intake of caffeine and nicotine.
3. Administer prescribed drugs as ordered, and monitor patient's response.

Improving the Effect of Bipolar Illness on Family
1. Assess family's external support network, and encourage participation in family therapy and support groups.
2. Assess communication and boundaries within family.
3. Observe and assess interaction patterns within family, and discuss their influence on patient and family functioning.
4. Provide patient and family with information about bipolar disorder and the treatment plan, prognosis, and aftercare plan.

Ensuring Adequate Nutrition
1. Maintain accurate ation of food and fluid intake.
2. Offer small, frequent meals of high-calorie foods. Include foods that the patient likes and that can be eaten on the move.‌
3. Serve patient meals in a low-stimulus environment.
4. Monitor patient's serum electrolyte and albumin levels and weigh patient every other day.
5. Monitor patient's vital signs.

Patient Education and Health Maintenance
1. Instruct patient and family about bipolar illness, including symptoms of relapse.
2. Instruct patient and family members about psychopharmacologic treatment, including its purpose, effects, adverse effects, and management.
3. Advise patient and family members about community-based support groups or health care agencies that are relevant to his care.
4. For additional information, refer them to such organizations as the National Association of Mental Illness, http://www.nami.org.

Evaluation: Expected Outcomes
1. Improved thought processes demonstrated by clear sentences with no evidence of flight of ideas and completion of simple tasks
2. Sleeps for at least 5 hours at night
3. Family members verbalize realistic, goal-directed thinking related to the patient's abilities, recovery, and control of condition
4. No weight loss noted