Perioperative Care of the Patient with Bipolar Disorder ... - AORN

SPECIAL NEEDS POPULATIONS 

Perioperative Care of the Patient 

with Bipolar Disorder 1.4 

JANA SAUNDERS, PhD, RN, CNS 

Bipolar disorder, also known as manicdepressive 

illness, is a chronic, recurrent 

illness characterized by changes in a person’s 

mood, energy, and ability to function. Mood 

episodes may alternate between mania, hypomania, 

depression, or a combination of depression 

and mania. The person may have periods of normal 

functioning that alternates with periods of 

illness. According to the American Psychiatric 

Association, bipolar disorder is a mood disorder 

that consists of “one or more manic or hypomanic 

episodes (elevated, expansive, or irritable mood) 

and usually one or more depressive episodes.” 1(p168) 

For perioperative nurses who care for the patient 

with bipolar disorder, it is important to be aware 

of medications that the patient may be taking, be 

prepared for escalation of the patient’s mood 

and/or behavior, and understand techniques that 

can be used to help de-escalate situations that 

involve the patient. 

EPIDEMIOLOGY 

Bipolar disorder affects approximately 5.7 million 

US adults, or about 2.6% of US adults ages 18 

and older, in a given year. 2 Bipolar disorder occurs 

between the ages of 18 and 30 years, with at 

least half of all cases starting before age 25 years. 

The first episode occurs earlier for individuals 

with a family history of the disease. An individ- 

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ual who experiences a manic episode at age 40 

years or older is more likely to have mania secondary 

to a medical condition or substance abuse. 

The first episode in men is more often manic, 

whereas the first episode in women is usually depression. 

As the illness progresses, the episodes 

increase in number and severity. 3 

COMORBIDITY 

Even though substance abuse disorders are very 

common in individuals with bipolar disorder, the 

reasons remain unclear. Individuals may be trying 

to treat their symptoms with alcohol or drugs, or 

the behavior control problems associated with 

mania may cause individuals to drink too much. 4 

Attention deficit hyperactivity disorder and anxiety 

disorders, such as post-traumatic stress disorder 

and social phobia, are common in individuals 

with bipolar disorder. These individuals also may 

be at a higher risk for thyroid disease, migraine 

headaches, heart disease, diabetes, obesity, and 

other physical illnesses because these illnesses 

may cause symptoms of mania or depression. 5 

ETIOLOGY 

Results of research indicate that there is no one 

single cause of bipolar disorder; instead, many 

factors act together to produce the illness or 

increase the risk. 6 Because bipolar disorder tends 

indicates that continuing education contact hours are available for this activity. Earn the contact hours by 

reading this article, reviewing the purpose/goal and objectives, and completing the online Examination and 

Learner Evaluation at http://www.aorn.org/CE. The contact hours for this article expire August 31, 2013. 

doi: 10.1016/j.aorn.2010.04.014 

© AORN, Inc, 2010 August 2010 Vol 92 No 2 ● AORN Journal 211

August 2010 Vol 92 No 2 SAUNDERS 

Online Resources* 

Depression and Bipolar Support Alliance 

http://www.dbsalliance.org 

National Alliance on Mental Illness 

http://www.nami.org 

National Institute of Mental Health 

http://www.nimh.nih.gov/health/topics/ 

bipolar-disorder/index.shtml 

Mental Health America 

http://www.mentalhealthamerica.net/go/ 

information/get-info/bipolar-disorder 

*Access verified April 29, 2010 

to run in families, there is a strong genetic component; 

therefore, scientists continue to study this 

disorder to locate the genes that cause bipolar 

disorder. Significantly high or low levels of neurotransmitters, 

specifically epinephrine, norepinephrine, 

dopamine, and serotonin, have been 

associated with both mania and depression. It is 

likely that many different genes combined with a 

person’s environmental and neurobiological factors 

may interact to cause the disorder. 

SYMPTOMS 

Unlike the normal ups and downs that everybody 

experiences in life, the symptoms of bipolar disorder 

are severe and can be described as unusually 

intense emotional states, called “mood episodes.” 

6 An overly joyful or overexcited mood 

that seems out of proportion or inappropriate to 

the circumstance is called a manic episode. Mania 

may present as anger, belligerence, and irritability 

instead of elation and euphoria in some individuals. 

The characteristic symptoms of a manic episode 

are 

� lability (eg, changing quickly from happiness 

to anger or depression); 

� inappropriate demanding of other’s attention; 

� manipulative, profane, or sexually explicit language 

or behavior; 

� grossly inappropriate or loud, rapid speech; 

212 AORN Journal 

� stringing words together that rhyme (ie, clang 

associations); 

� thoughts that race from topic to topic (ie, 

flight of ideas); 

� disorganized thoughts; 

� grandiosity (eg, believing oneself to be a 

prominent businessman or religious figure); 

� restlessness; 

� disorganized or aggressive behavior; 

� poor concentration and distractibility; 

� poor judgment; 

� psychomotor agitation; and 

� disorientation, incoherence, delusions, and 

hallucinations. 3 

An extremely sad or hopeless mood is called a 

depressive episode. Sometimes, a mood episode 

includes symptoms of both mania and depression; 

this is called a mixed episode. Extreme changes 

in activity, behavior, energy, and sleep accompany 

these changes in mood. An individual may 

be diagnosed with bipolar disorder if he or she 

has a number of manic or depressive symptoms 

for most of the day, nearly every day, for at least 

one to two weeks. 1 Sometimes symptoms are so 

severe that the individual cannot function normally 

at work, school, or home. 

TREATMENT: MOOD STABILIZERS 

Individuals with bipolar disorder often need several 

medications. Anti-anxiety, antidepressant, and 

atypical antipsychotic medications may be used in 

addition to mood stabilizers, which are considered 

lifetime maintenance therapy for individuals with 

bipolar disorder. 7 Most often, lithium carbonate is 

the first choice of mood stabilizer for the acute 

treatment of mania and the prevention of recurrent 

manic episodes. To avoid toxicity, lithium 

maintenance blood levels should range between 

0.4 mEq/L and 1.3 mEq/L, and not exceed 1.5 

mEq/L. 3 Lithium is usually contraindicated in 

individuals with cardiovascular, renal, or thyroid 

disease, or myasthenia gravis; those who are 

pregnant or breastfeeding; and children younger 

than 12 years.

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Approximately 20% to 40% of individuals with 

bipolar disorder may not respond to lithium, so 

the next choice of medications prescribed are 

antiepileptics, such as carbamazepine, divalproex, 

lamotrigine, gabapentin, and topiramate. 3 Because 

these medications may have major adverse 

effects, patients who are taking them should be 

monitored carefully: 

� Carbamazepine 

can cause agranulocytoses, 

aplastic 

anemia, sedation, 

diplopia, and 

incoordination. 

� Divalproex can 

cause fever, 

chills, right upper 

quadrant pain, 

Because bipolar disorder is a chronic and 

episodic disorder, continual maintenance 

treatment consists of medications, 

psychoeducational classes, support groups, 

and psychotherapy for both the individual 

and family members. 

dark-colored urine, jaundice, malaise, tremors, 

gastrointestinal upset, and weight gain. Nurses 

who have patients who are taking this medication 

also should monitor their liver function 

tests. 

� Lamotrigine can cause rash, dizziness, diplopia, 

headache, ataxia, and sedation. 

� Gabapentin can cause breathing difficulty, 

swelling of lips, rash, slurred speech, fatigue, 

sedation, dizziness, ataxia diplopia, and 

hypertension. 

� Topiramate can cause cognitive adverse effects, 

fatigue, dizziness, and paresthesia. 

Nurses who have patients who are taking this 

medication should perform a complete physical 

assessment before surgery to check the 

patient’s white blood cell, red blood cell, and 

platelet counts; liver, renal, and thyroid function 

tests; urinalysis results; weight; blood 

pressure; and blood glucose. 

Individuals with bipolar disease may not disclose 

their disease. Therefore, when the nurse 

sees these medications listed on the patient’s chart 

or if the patient displays an overjoyous, elated 

mood, or an irritable, belligerent mood that does 

not match the circumstances, or changes moods 

quickly, then bipolar disorder is a potential 

diagnosis. 

LENGTH OF TREATMENT 

Because bipolar disorder is a chronic and episodic 

disorder, continual maintenance treatment that 

consists of medications,psychoeduca- 

tional classes, support 

groups, and 

psychotherapy for 

both the individual 

and family members 

is needed. Problems 

that result from angry, 

impulsive, hyperactive, 

hostile, or 

demanding behavior that occurs during a manic 

episode often leads to interpersonal problems 

that affect the patient’s friends, family members, 

and classmates or colleagues. The focus 

of care for the individual living in the community 

is maintaining compliance with the medications, 

preventing relapse, and limiting the 

severity and duration of episodes. 

Relapses occur most often when individuals 

stop taking their mood-stabilizing medication because 

they feel better or only take the medication 

occasionally because they forget or do not think 

that taking the medication regularly is important. 

It is essential for individuals with bipolar disorder 

to take their medication on a regular basis and for 

as long as their physicians recommend, which 

will result in fewer and less-severe mood episodes. 

It is important to note that no moodstabilizing 

medication should be discontinued 

without a discusssion with the physician who prescribed 

it, and the medication always should be 

tapered off under a physician’s supervision rather 

than being stopped all at once. Bipolar disorder 

tends to worsen if it is not treated. 8 Proper diagnosis 

and treatment help individuals with bipolar 

AORN Journal 213


disorder lead healthy and productive lives, and, in 

most cases, treatment can help reduce the frequency 

and severity of episodes. 

NURSING IMPLICATIONS 

Individuals with bipolar disorder may have frequent 

crises in their lives as a result of their problems 

with interpersonal relationships, stress, ineffective 

coping and problem-solving skills, 

fluctuating employment status and social support 

systems, substance-related problems, and possible 

legal problems. 3 What may seem like a small 

stressor to the nurse (eg, a minor surgical procedure) 

may be interpreted as a major stressor by 

the patient. Perioperative nursing implications for 

nurses who care for patients with bipolar disorder 

are provided in Table 1. The nurse should perform 

an accurate and early mood assessment because 

a prevailing mood of increased anxiety or 

quick shifts of mood must be identified before the 

mood escalates to excessive overactivity, impulsivity, 

distractibility, inability to control behavior, 

anger, and/or aggression. A family member may 

be able to provide insight into the patient’s psychiatric 

history. 

To decrease the patient’s anxiety and possible 

paranoia, the nurse should not wear a surgical hat 

and mask when first meeting the patient. To make 

the patient feel safe, the nurse should provide 

structure and control by 

� using a firm and calm approach; 

� giving short and concise explanations; 

� remaining neutral and avoiding power 

struggles; 

� staying consistent in approach and 

expectations; 

� setting limits in a firm, nonthreatening and 

neutral manner; and 

� redirecting the patient’s energy into more appropriate 

and constructive avenues. 

If the patient becomes overwhelmed with feelings 

of insecurity and anxiety, he or she may be 


prone to self-harm or violence toward others. 

Therefore, crisis intervention by the nurse has two 

basic initial goals: ensuring the patient’s safety 

and reducing the patient’s anxiety to prevent 

further escalation of mania to help provide safe 

boundaries for the patient and others. 

If the patient is becoming increasingly manic 

(eg, anxious, agitated, distractible, excitable), then 

the nurse should move the patient to a quiet place 

to maintain a low level of stimuli away from 

bright lights, loud noises, and people. The patient 

should be within view of staff members or, if the 

patient is not visible to staff members, then it is 

important that someone stay with him or her. This 

could be a staff member or a family member or 

friend, because family members and friends have 

been identified as major support systems for individuals 

with severe mental illness. 9 Frequent observation 

by the nurse, however, is still needed. 

The nurse’s presence provides support, and, if 

needed, the nurse can direct the patient’s energy 

into nonstimulating and calming solitary activities 

(eg, listening to soft music, drawing or writing, 

walking slowly in the room) to help minimize 

excitability. The structure that the nurse creates 

provides the patient with security and focus. The 

nurse can demonstrate respect for the patient’s 

personal space by keeping at least 1.5 feet to 3 

feet between himself or herself and the patient, so 

that the patient does not perceive the nurse as 

being intrusive. To maintain reduced environmental 

stimuli, it is ideal to have only one nurse interacting 

with the patient, but other staff members 

need to maintain an unobtrusive presence in case 

the patient’s mood and/or behavior escalates. 

To help calm a patient who becomes overexcited 

or angry, the nurse can use de-escalation 

techniques to help diffuse the situation. For example, 

speaking in a calm, nonthreatening, and caring 

manner can help the patient feel less anxious. 

Although it may be difficult for the nurse to remain 

calm when faced with an angry patient, it is 

important to maintain a calm demeanor because

SPECIAL NEEDS POPULATIONS www.aornjournal.org 

TABLE 1. Perioperative Implications for the Patient with Bipolar Disorder 

Preoperative care 

� Establish rapport with the patient. 

� Assess the patient’s mood, level of anxiety, and ability to cooperate. 

� Assess the patient’s mental status by observing the patient’s 

� facial expression, 

� behavior (eg, excessive or reduced body movements, abnormal movements, eye contact), 

� orientation level, 

� speech, and 

� vocal expressions (eg, disorganized thoughts, delusions, hallucinations, insight, judgment, memory). 

� Perform a psychosocial assessment, including 

� identifying the patient’s social support system (eg, friends, family members, caregivers, roommates) and whether 

someone is at the hospital with the patient; 

� asking a family member of the patient, if possible, to provide insight into the patient’s history; 

� assessing substance use and abuse (ie, alcohol, illicit drugs), as well as current use of medications such as psychotropic 

medications (eg, antipsychotic, antidepressant, antianxiety, mood stabilizer); and 

� assessing coping abilities, including what the patient does when he or she gets upset, to whom can the patient talk, and 

what usually helps the patient relieve stress. 

� Ask about previous hospitalizations and surgery experiences. 

� Document a thorough medication history. 

� Evaluate the patient’s white blood cell, red blood cell, and platelet counts; liver, renal, and thyroid function; urinalysis; weight; 

blood pressure; and blood glucose levels. Communicate to the surgeon and/or anesthesia care provider if any abnormalities 

are present. 

� Initiate seizure precautions. 

� Review the preoperative assessment and note any mental status changes. 

Intraoperative care 

� Monitor the patient’s blood pressure and blood glucose levels. 

� Monitor the patient’s mental status frequently while he or she is awake. 

� Be aware that the stress of surgery may exacerbate the patient’s symptoms of anxiety, depression, or mania. 

� Discourage local sedation if the patient’s mental status is extremely labile. 

� Be at the bedside during induction of and emergence from anesthesia. 

� Have additional personnel available as needed. 

Postoperative care 

� Monitor the patient’s intake, output, and vital signs. 

� Monitor the patient’s mental status frequently. 

� Assess for increased anxiety, agitation, rapid mood swings, or psychosis. 

� If the patient becomes agitated, 

� move him or her to a quiet place (ie, with a low level of environmental stimuli); 

� stay with the patient or have a staff member, friend of the patient, or one of the patient’s family members stay with the 

patient; 

� observe and reassure the patient frequently; 

� use a firm, neutral, and calm approach when speaking with the patient; 

� set patient behavioral limits to maintain safety; 

� use verbal de-escalation techniques as necessary; 

� administer anti-anxiety and/or antipsychotic medications as necessary; and 

� use restraints as a last alternative and only by the physician’s orders. 

the nurse’s anxiety can cause the patient to become 

more anxious or angry. Confrontations also 

can increase the patient’s anger or anxiety, so it is 

important to avoid verbal confrontation with the 

patient, and security personnel should remain in 

the background unless they are needed. 

AORN Journal 215


If low environmental stimuli and the verbal 

de-escalation techniques prove ineffective and the 

patient’s mood and/or behavior continues to escalate, 

then anti-anxiety medications can help reduce 

agitation or anxiety, and antipsychotic medications 

can reduce psychomotor activity and 

delusions or hallucinations. Because the patient is 

likely to be NPO, medication should be administered 

by IV. If the patient’s behavior escalates to 

psychosis (eg, the patient experiences delusions or 

hallucinations; exhibits disorganized, incoherent 

speech), then nursing interventions should focus 

on protecting the patient from self-harm or harming 

others. Restraints may need to be used; however, 

these should only be used after the previously 

identified, less-restrictive interventions have 

been tried and then only with a physician’s order. 

CONCLUSION 

Working with patients with bipolar disorder can 

be challenging, particularly if the patient becomes 

manic or the nurse has limited or no experience 

in psychiatric-mental health nursing. Because individuals 

with bipolar disorder can be very demanding 

and manipulative, the nurse may begin 

to feel frustrated by the patient’s behavior. In responding 

to the patient, it is important that the 

nurse set limits in a firm, calm manner and use 

therapeutic communication techniques as well as 

nursing interventions to maintain safety for both 

the patient and others. Being able to redirect and 

distract the patient who is manic are the nurse’s 

most effective tools. Remaining neutral and being 

consistent without tolerating dangerous or inappropriate 

behavior is a helpful way to approach 

the patient with bipolar disorder. 2 

The focus of nursing interventions for a patient 

with bipolar disorder may be varied, depending 

on the patient, but may involve crisis intervention, 


acute symptom stabilization (eg, medication), and 

safety measures. A nurse who is able to assess 

the patient’s level of mood, behavior, and thought 

processes will help the patient have a more positive 

perioperative experience. 

References 

1. Mood disorders. In: Diagnostic and Statistical Manual of 

Mental Disorders. 4th ed. rev. Washington, DC: American 

Psychiatric Publishing, Inc; 2000:167-208. 

2. Kessler RC, Chiu WT, Demler O, Merikangas KR, 

Walters EE. Prevalence, severity, and comorbidity of 

12-month DSM-IV disorders in the National Comorbidity 

Survey Replication. Arch Gen Psychiatry. 2005;62 

(6):617-627. 

3. Mood disorders: bipolar. In: Varcarolis EM, Carson VB, 

Shoemaker NC. Foundations of Psychiatric Mental Health 

Nursing: A Clinical Approach. 5th ed. St Louis, MO: 

Saunders; 2006:359-383. 

4. Bizzarri JV, Sbrana A, Rucci P, et al. The spectrum of 

substance abuse in bipolar disorder: reasons for use, sensation 

seeking and substance sensitivity. Bipolar Disord. 

2007;9(3):213-220. 

5. Krishnan KR. Psychiatric and medical comorbidities of 

bipolar disorder. Psychosom Med. 2005;67(1):1-8. 

6. Bipolar disorder. National Institute of Mental Health. 

http://www.nimh.nih.gov/health/publications/bipolardisorder/index.shtml. 

Accessed April 29, 2010. 

7. Bipolar disorders. In: Preston JD, O’Neal JH, Talaga 

MC. Handbook of Clinical Psychopharmacology for 

Therapists. 6th ed. Oakland, CA: New Harbinger Publications; 

2010:89-100. 

8. Fundamentals of treatment. In: Goodwin FK, Jamison 

KR. Manic-Depressive Illness: Bipolar Disorders and 

Recurrent Depression. 2nd ed. New York, NY: Oxford 

University Press; 2007:699-719. 

9. Saunders JC. Families living with severe mental illness: 

a literature review. Issues Ment Health Nurs. 2003;24(2): 

175-198. 

Jana Saunders, PhD, RN, CNS, is a professor 

at the Anita Thigpen Perry School of Nursing, 

Texas Tech University Health Sciences Center, 

Lubbock. Dr Saunders has no declared affiliation 

that could be perceived as posing a potential 

conflict of interest in the publication of this 

article.

EXAMINATION 

CONTINUING EDUCATION PROGRAM 

Perioperative Nursing Care of the 

Patient with Bipolar Disorder 

PURPOSE/GOAL 

To educate perioperative nurses about caring for the patient with bipolar disorder. 

OBJECTIVES 

1. Describe the characteristics of bipolar disorder. 

2. Describe the etiology of bipolar disorder. 

3. Explain how to assess a manic patient’s with mood, behavior, and thought 

processes. 

4. Discuss the pharmaceutical treatments for bipolar disorder. 

5. Discuss the perioperative nursing implications of caring for the patient with 

bipolar disorder. 

The Examination and Learner Evaluation are printed here for your convenience. 

To receive continuing education credit, you must complete the Examination 

and Learner Evaluation online at http://www.aorn.org/CE. 

QUESTIONS 

1. An individual with bipolar disorder can have mood 

episodes that alternate between mania, depression, 

or a combination of depression and mania. 

a. true 

b. false 

2. As the bipolar disorder progresses, the episodes 

a. decrease in number and severity. 

b. increase in number and severity. 

c. decrease in number and increase in severity. 

d. increase in number and decrease in severity. 

3. Evidence suggests that bipolar disorders may be 

linked to 

a. family violence. 

b. genetic factors. 

c. infections. 

d. nutritional deficiencies. 

1.4 

4. Characteristic symptoms of mania are 

1. amnesia. 

2. grandiosity. 

3. lability. 

4. manipulative behavior. 

5. restlessness. 

a. 1 and 3 

b. 1, 2, and 5 

c. 2, 3, 4, and 5 

d. 1, 2, 3, 4, and 5 


5. Symptoms of bipolar disorder may be so severe 

that the individual cannot function normally at 

work, school, or home. 


August 2010 Vol 92 No 2 CE EXAMINATION 

a. true 

b. false 

6. The first choice of mood stabilizer for the acute 

treatment of mania and the prevention of recurrent 

manic episodes is often 

a. clonazepam. 

b. lamotrigine. 

c. lithium carbonate. 

d. topiramate. 

7. The nurse can provide structure and control for 

the bipolar patient by 

1. avoiding power struggles. 

2. giving short and concise explanations. 

3. providing stimulating activities. 

4. staying consistent in approach and expectations. 

a. 1 and 2 b. 3 and 4 

c. 1, 2, and 4 d. 1, 2, 3, and 4 

8. Preoperative nursing care of a patient with bipolar 

disorder should include 

1. assessing the patient’s mood, anxiety, and ability 

to cooperate. 

2. assessing substance use and abuse. 

3. establishing rapport with the patient. 

4. performing a psychosocial assessment. 

a. 1 and 2 b. 3 and 4 

c. 1, 2, and 3 d. 1, 2, 3, and 4 

9. Nursing care of a patient with bipolar disorder 

who becomes agitated after surgery may include 

1. maintaining the patient’s safety by setting behavioral 

limits. 

2. ensuring that someone stays with the patient. 

3. administering anti-anxiety or antipsychotic 

medications as necessary. 

4. placing the patient in restraints as a last resort. 

5. using verbal de-escalation techniques as 

needed. 

a. 1 and 3 b. 2, 4, and 5 

c. 1, 2, 4, and 5 d. 1, 2, 3, 4, and 5 

10. If the patient is becoming increasingly manic, 

then the nurse can 

a. direct the patient’s energy into nonstimulating 

and calming solitary activities. 

b. ensure the patient’s room is brightly lit to provide 

security. 

c. move the patient to a quiet place where he or 

she can be alone and out of sight of others. 

d. observe the patient as infrequently as possible 

to remain unobtrusive. 

The behavioral objectives and examination for this program were prepared by Jana Saunders, PhD, RN, CNS, and Kimberly 

Retzlaff, editor, with consultation from Rebecca Holm, RN, MSN, CNOR, clinical editor, and Susan Bakewell, RN, MS, BC, 

director, Center for Perioperative Education. Dr Saunders, Ms Retzlaff, Ms Holm, and Ms Bakewell have no declared affiliations 

that could be perceived as posing potential conflicts of interest in the publication of this article. 

218 AORN Journal

LEARNER EVALUATION 

CONTINUING EDUCATION PROGRAM 

Perioperative Care of the Patient 

with Bipolar Disorder 

This evaluation is used to determine the extent to 

which this continuing education program met your 

learning needs. Rate the items as described below. 

OBJECTIVES 

To what extent were the following objectives of this 

continuing education program achieved? 

1. Describe the characteristics of bipolar disorder. 

Low 1. 2. 3. 4. 5. High 

2. Describe the etiology of bipolar disorder. 

Low 1. 2. 3. 4. 5. High 

3. Explain how to assess a manic patient’s mood, 

behavior, and thought processes. 

Low 1. 2. 3. 4. 5. High 

4. Discuss the pharmaceutical treatments for bipolar 

disorder. Low 1. 2. 3. 4. 5. High 

5. Discuss the perioperative nursing implications of 

caring for the patient with bipolar disorder. 

Low 1. 2. 3. 4. 5. High 

CONTENT 

6. To what extent did this article increase your 

knowledge of the subject matter? 

Low 1. 2. 3. 4. 5. High 

7. To what extent were your individual objectives 

met? Low 1. 2. 3. 4. 5. High 

8. Will you be able to use the information from this 

article in your work setting? 1. Yes 2. No 

1.4 


9. Will you change your practice as a result of 

reading this article? (If yes, answer question 

#9A. If no, answer question #9B.) 

9A. How will you change your practice? (Select all 

that apply) 

1. I will provide education to my team regarding 

why change is needed. 

2. I will work with management to change/implement 

a policy and procedure. 

3. I will plan an informational meeting with physicians 

to seek their input and acceptance of the 

need for change. 

4. I will implement change and evaluate the effect 

of the change at regular intervals until the change 

is incorporated as best practice. 

5. Other: 

9B. If you will not change your practice as a result of 

reading this article, why? (Select all that apply) 

1. The content of the article is not relevant to my 

practice. 

2. I do not have enough time to teach others 

about the purpose of the needed change. 

3. I do not have management support to make a 

change. 

4. Other: 

10. Our accrediting body requires that we verify the 

time you needed to complete the 1.4 continuing 

education contact hour (84-minute) program: 

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements. 

AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. 

AORN recognizes these activities as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentialing Center 

approves or endorses products mentioned in the activity. 

AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this 

activity for relicensure. 

Event: #10054; Session: #4018 Fee: Members $7, Nonmembers $14 

The deadline for this program is August 31, 2013. 

A score of 70% correct on the examination is required for credit. Participants receive feedback on incorrect answers. Each 

applicant who successfully completes this program can immediately print a certificate of completion.

Perioperative Care of the Patient with Bipolar Disorder ... - AORN

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