hospitalized due to acute bipolar episodes some time during their evolution. Moreover, there are several approaches available for the treatment of bipolar disorder, which most often includes a combination of medication and psychotherapy. The main treatment for an episode of mania or hypomania is typically antipsychotic medications while treatment for depression in people with bipolar may be psychological therapy on it is own or combined with medication. Lithium is the most common and effective type of mood stabiliser used for treating bipolar disorder and anti-psychotic medication examples, Olanzapine and Quetiapine. (Conus et al., 2015).The student nurse will focus now on the nursing process (Assessment, Planning, Implementing and Evaluation). The nurse will use the pas-add tool to assess Danielle’s health need. The Pas-add Checklist is a questionnaire of 25 items, designed to be used primarily by careers and family members. These are the people who are the first to notice any change in the behaviour of those for whom they care, so as to decide on the need for an assessment in a clinical setting. (Allen et al., 2017). In addition, The Pas-add tool helps to have a precise understanding of the need for clinical assessment and define the presence of any disorder. They have the great advantage of allowing personnel with no training in psychiatry or psychology to detect a possible psychiatric disorder, greatly extending the scope for assessment of the people with disabilities, in different contexts and at all ages and degrees of disability. (Allen et al., 2017). Furthermore, Bipolar mood disorders carry substantial risks for patients and sometimes others. (Bassett, 2010). Therefore, it is important to ensure the risk assessment is done in order to minimise the hazard. For example, mania brings particular risks of disinhibition, poor judgement, risk taking and sometimes aggression. Depression brings notable risks of suicidal behaviour, poor self-care and homicide and Both mania and depression bring risks of substance misuse and disrupted relationships. Therefore, management requires an optimal therapeutic alliance with good communication, appropriate treatment and sometimes compulsory care during crises (Bassett, 2010).Danielle is 53 years old, she has mild learning disability, mental health, Bipolar mood Disorder and psoriasis. She has also sleep problem and eating disorder. She has been diagnosed with bipolar when she was 20. She has been in the hospital several times because of her bipolar’s symptoms. She has been known to the psychiatry. She is on antipsychotic medication Olanzapine medication and lithium to monitor her Bipolar. she has period where her mood swings and it is difficult to have proper conversation with her. This is one of the symptoms of bipolar mood disorder according to McKenna & Eyler, (2012). Recently when you talk to her, she talks really quickly. So, it is very hard to understand what she is saying and with the conversation she is jumping around from one thing to another. Therefore. when you talk to her about one thing, she talks about something that happened two days before or in the future. She loses conversation very quickly. When you are talking about something important, she will talk about something different. She has resigned to her job because she is convincing that she is going to win the lottery. She started to be very rude to staff and swear as well, she does not do that usually. Recently, she has been spending her money to buy clothes that she does not really need them, and she ends up without money for her bills and food. She has problem budgeting, for that reason she has a carer coming one a week to help her with finances and bills.To assess Danielle’s Bipolar, the nurse will focus on the symptoms, with particular attention on mood but also changes in sleep, energy, thinking, speech and behaviour. It is also useful to get an in-depth family history from relatives. A family history can be very helpful in supporting a suspected diagnosis and prescribing appropriate treatments. Oftentimes, a family member, friend or carers may be more aware of a person’s unusual behaviours and be able to describe these in detail as they know the person much better because they spend a lot of time together. In Danielle case, the carer and sister stated that her mood and behaviour have changed, she started to swear and have hallucination, as she was convincing herself that she going to win the lottery. In addition, the nurse may suggest filling out a mood questionnaire or checklist to help guide the clinical interview when assessing mood symptoms. Furthermore, Danielle has difficulty to sleep, also she is not eating properly. To monitor her sleep and her food intake, the nurse may suggest a food chart and sleep monitoring chart. Also, she has pain in her joint. (symptoms of psoriasis) (Tsoi et al., 2012). For the pain and her swollen joint, the nurse may refer her to the General Practitioner or the physiotherapist for further assessment. In addition, Danielle has period where her mood swings, she is aggressive, swear to staff and it is difficult to have proper conversation with her. In this case, the PBS (Positive Behaviour Support) is useful as will help to monitor her behaviour and to understand the triggers.Furthermore, Danielle has psoriasis and she has red patches on her neck and arms and she is very anxious and embarrassed about that. According to Hayes & Koo 2010), the disease can contribute to low self-esteem, anxiety, embarrassment and depression, much like other chronic conditions but this may be overlooked by healthcare professionals. For example, over a third of people who have psoriasis report clinically significant anxiety and depression. The condition can also affect a person’s participation in social and physical activities, employment and education. (Hayes & Koo 2010). In addition, the nurse should assess the impact that psoriasis has on the physical, psychological and social wellbeing of their patients. Because Danielle does swimming and she really enjoy it; her condition could stop her participation in swimming session and this could lead to social isolation. Moreover, health professional should use a validated tool in assessments, such as the Psoriasis Epidemiological Screening Tool. To plan care with Danielle in relation to her psychological health need, the nurse suggests for her medication to be reviewed because of the side effects of it. Moreover, Danielle’s medication affects not only her weight but also her food intake and her sleep (Deng et al., 2012). Furthermore, psychological treatment such as talking therapy (CBT)(Cognitive Behaviour Support), which can help to deal with depression, and provides advice about how to improve her social life. Also, lifestyle advice such as doing regular exercise (The nurse can encourage to attend swimming session, go to day centre or gymnastic), planning activities Danielle enjoys that give her a sense of achievement, as well as advice on improving her diet and getting more sleep. In this case, the nurse could put in place food intake and sleep monitoring chart in order to monitor her sleep and her food intake. Using a combination of different treatment methods is the best way to control bipolar disorder. According to Anderson et al., (2012), treatment is with drugs and supplemental psychotherapies; for both acute episodes and maintenance, treatment is guided by whether mania or depression predominates. Furthermore, it is important to explain to Danielle that psoriasis is a chronic disease that often waxes and decreases. It is also important to educate Danielle on how to apply topical cream in order to reduce rashes as some patients will be worried that the rash is contagious or a sign of cancer, and such myths should be dispelled (Cohen et al., 2012). Therefore, it is very important education not only for Danielle, but also for carers who supporting her in order to help her improve the quality of her social life. Nurse could also refer Danielle to Dermatologist and psychiatrist because of her psoriasis and her bipolar for further assessment.People with bipolar disorder experience an excessively high frequency of metabolic syndrome and other cardiovascular risk factors such as obesity, diabetes, hypertension, and dyslipidemia, in addition to the chronic cognitive and emotional burden of manic, hypomanic, and depressive symptoms (Sylvia et al., 2013). Physical inactivity and poor eating habits are common in this group of people and multiple the effects of poor physical and mental health (Fagiolini et al., 2008). Therefore, Nutrition and exercise, also review of medication will be the actions the nurse suggests monitoring Danielle’s symptoms. The aim is to maximize weight loss and improve nutritious eating. Eating well and keeping fit are important for everyone and especially for people with mental illness and bipolar as they are at risk of gaining weight because of the side effect of medication (Sylvia et al., 2013). Daumit et al. (2013) found that lifestyle intervention for people with mental illness significantly reduced weight by 1.7% at 6 months and 3.4% at 18 months. In addition, the goal of physical activities is to reach a healthy level of weekly exercise or exercise of moderate intensity, at 5 days per week, for 30 min each day in order to enhance mood for individuals with bipolar disorder. Furthermore, increase lifestyle activity (for example, taking the stairs, standing instead of sitting, walking than stay in door), is very important as help to reduce stress and enhance mobility. check up at least once a year to monitor the risk of developing cardiovascular disease or diabetes, this include recording Danielle’s weight, checking the blood pressure and having any appropriate blood test. (as some treatments increase the risk of developing diabetes or worsen the illness in people that already have it, so maintaining a healthy weight and exercising are an important way of limiting that risk). Exercise can also help reduce the symptoms of bipolar disorder, particularly the depressive symptoms (Daumit et al., 2013). Even though pharmacotherapy remains the principal treatment for bipolar disorder, side effects can frequently increase the risk of cardiovascular disease (Ketter, 2010). Furthermore, Ng et al. (2007) found that bipolar inpatients who participated in a walking group 5 days per week for 40 min per session reported lower depression and anxiety symptoms than those who did not. Additionally, an acute session of exercise (example, walking on a routine for 20 minutes at 70% of an individual’s maximum heart rate) significantly improved bipolar participants’ mood (Hays 2008).Danielle is on Olanzapine and Lithium medication, they belong to a class of drugs called atypical antipsychotics. (Krystal & Roth 2008). They work by helping to restore the balance of certain natural substances in the brain and to treat certain mental/mood conditions (such as schizophrenia, bipolar disorder) (Kluge et al., 2014). In line with Nice Guideline, and quality and outcome framework for long term antipsychotic prescribing, the nurse to ensure that GP give evidence of an annual heath check. This is because of the medication Danielle takes. This will include: weight and height, blood pressure, blood test, pulse, lipids levels, plasma glucose level. (Nice Guideline Bipolar disorder, assessment management, 2016). In addition, Olanzapine makes Danielle put on weight, as one of the side effects of Olanzapine medication is weight gained (Nasrallah, 2008). Therefore, weigh Danielle every two weeks or every month, as Danielle is at risk of gaining weight because of the side effect of medication (Sylvia et al., 2013). Ensure she eats regularly and healthy, provide her with easy read information about healthy food, encourage to drink a lot of fluid, especially water. In addition, the nurse to call every week to find out how Danielle is doing regarding her diet and her activities. Also, the nurse to visit her at least twice a month for a welfare visit, this to assess her and have an interview with her in order to find out if there is improvement or deterioration. If Danielle is doing well, encourage her to continue, but if she is not, looking for alternative ways.To conclude, this essay focused on Danielle’s biopsychosocial health needs and the factors that influence the psychological vulnerability and well-being of people with learning disabilities. Danielle has learning disability, psoriasis, mental illness and bipolar mood disorder. the side effect of her medications affects her mood, her sleep her eating and her weight. Therefore, to manage and monitor Danielle’s health needs and her bipolar, the nurse suggested healthy eating diet plan with easy read information, encouraged her to socialise, to exercise regularly in order to monitor her bipolar and improve her mental state. According to Ng et al. (2007), bipolar inpatients who participated in a walking group 5 days per week for 40 min per session reported lower depression and anxiety symptoms than those who did not. Also, the nurse suggested medication to be reviewed by the psychiatrist as her medications present a lot of side effects that influence her mental and physical state. Therefore, it is important for the nurse to ensure that Danielle has an annual health check regularly in order to monitor her health.