Bipolar

Question 1

Mania

Answer 1

a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable

Question 2

Mania Includes:

Answer 2

-inflated self-esteem or grandiosity; decreased sleep; excessive and pressured speech, flight of ideas, distractibility, increased activity or psychomotor agitation and excessive involvement in pleasure seeking or risk taking activities with high potential for painful consequences

Question 3

Mania: Mood

Answer 3

• excessively cheerful, enthusiastic, and expansive, or person may be irritable, especially when he/she is told no or has rules to follow
• often denies any problems, placing the blame on others for any difficulties he/she experiences
• some exhibit delusions or hallucinations in manic episodes

Question 4

Hypomania

Answer 4

period of abnormally persistently devoted, expansive, or irritable mood and some milder symptoms of mania
-does not impair persons ability to function (may be productive) and have no psychotic features (delusions or hallucinations)

Question 5

Mixed Episode

Answer 5

is diagnosed when person experiences both mania and depression nearly everyday for at least 1 week (rapid cycling)

Question 6

Bipolar I

Answer 6

one or more manic or mixed episodes usually accompanied by major depressive episodes

Question 7

Bipolar II

Answer 7

one or more major depressive episodes accompanied by at least one hypomanic episode

Question 8

Bipolar Disorder

Answer 8

• involves extreme mood swings from episodes of mania to episodes of depression
• an alteration in mood that may be expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, and accelerated speech
• mania can occur as part of the psychiatric disorder

Question 9

Etiology

Answer 9

• excess of serotonin seen in mania

- excess of norepinephrine. this catecholamine energized the body

Question 10

Diagnostic Work Up

Answer 10

• thyroid and other metabolic function studies suggest hyperexcitability
• lithium levels are measured
• renal studies: lithium is nephrotoxic
• sodium levels; lithium is a salt and needs sodium levels at appropriate range to transport lithium ions
• sodium levels below 120 mEq are dangerous to all but especially on lithium
• normal sodium range= 135-145 mEq
• serum chloride levels 95-105

Question 11

Manic Phase

Answer 11

euphoric, grandiose, energetic, and sleepless

-poor judgment and rapid thoughts, actions, and speech

Question 12

Depressed Phases

Answer 12

mood, behavior, and thought are the same as in people diagnosed with major depression

Question 13

Onset and Clinical Course

Answer 13

• occurs in teens, 20s, 30s
• begin suddenly with rapid escalation of symptoms over a few days, and last from a few weeks to several months
• tend to be brief and end more suddenly than depressive episodes

Question 14

Psychopharmacology

Answer 14

• life-time regimen of treatments
• anti-manic agent; Lithium
• anti-convulsant as mood stabilizers
• if a client experiences psychosis as well, anti-psychotics can be used in addition to bipolar med

Question 15

Lithium

Answer 15

• salt contained in the human body
• treats bipolar mania and bipolar depression
• can stabilize bipolar disorder by reducing the degree and frequency of cycling or eliminating manic episodes
• competes for salt receptor sites, but also affects calcium, potassium, and magnesium ions as well as glucose metabolism

Question 16

Lithium Action

Answer 16

work in the synapses to hasten destruction of catecholamines (dopamine, norepinephrine), inhibit neurotransmitter release, and decrease the sensitivity of post-synaptic receptors
-crosses blood brain barrier and placenta and is distributed in sweat and breast milk; not recommended during pregnancy

Question 17

Anti-Convulsant Drugs

Answer 17

-used for clients who do not respond or have difficulty taking lithium because of side effects, problems with treatment regimen, drug interactions, or medical conditions such as renal disease that contraindicates use of lithium

Question 18

Examples of Anti-Convulsant Drugs

Answer 18

• Divalproex
• Carbamazepine
• Lamotrigine
• Gabapentin

Question 19

Anti-Convulsant: Divalproex (valproic acid)

Answer 19

used for simple absence and mixed seizures, migraine prophylaxis, and mania

• therapeutic levels are monitored
• baseline and ongoing liver function tests, including serum ammonia levels and platelet and bleeding times

Question 20

Anti-Convulsant: Divalproex Side Effectd

Answer 20

ataxia, drowsiness, weakness, fatigue, menstrual changes, dyspepsia, nausea, vomiting, weight gain, hair loss

Question 21

Anti-Convulsant: Divalproex Nursing Implications

Answer 21

• monitor gait and assist if necessary
• provide rest periods
• administer with food

Question 22

Anti-Convulsant: Carbamazepine

Answer 22

used for grand mal seizures and temporal lobe epilepsy and trigeminal neuralgia

• first anti-convulsant found to have mood stabilizing properties
• threat of agranulocytosis
• drug serum levels checked regularly to monitor for toxicity and to determine if drug reached therapeutic level
• baseline and periodic lab tests to monitor for suppression of WBCs

Question 23

Anti-Convulsant: Carbamazepine Side Effects

Answer 23

dizziness, hypotension, sedation, blurred vision, leukopenia, and rashes

Question 24

Anti-Convulsant: Carbamazepine Nursing Implications

Answer 24

• assist client to rise slowly from sitting position
• monitor gait and assist as necessary
• report rashes to physician

Question 25

Anti-Convulsant: Lamotrigine

Answer 25

used less frequently than valproic acid; Divalproex

Question 26

Anti-Convulsant: Lamotrigine Side Effects

Answer 26

dizziness, hypotension, ataxia, coordination, sedation, headache, weakness, fatigue, menstrual changes, sore-throat, flu-like symptoms, blurred or double vision, vomiting, or rashes

Question 27

Anti-Convulsant: Lamotrigine Nursing Implications

Answer 27

- assist in rising slowly from sitting position - monitor gait and assist as necessary - providing rest periods - monitor physical health - administer with food - report rashes to physician

Question 28

Anti-Convulsant: Gabapentin

Answer 28

used less frequently than valproic acid; Divalproex

Question 29

Anti-Convulsant: Gabapentin Side Effects

Answer 29

dizziness, hypotension, ataxia, coordination, sedation, headache, fatigue, nystagmus, nausea, and vomiting

Question 30

Anti-Convulsant: Gabapentin Nursing Implications

Answer 30

- provide rest periods | - administer with food

Question 31

Assessment: History

Answer 31

- difficult - may jump from subject to subject - obtain in several short sessions as well as talking to family members may be necessary

Question 32

Activity and Behavior

Answer 32

- excessive involvement in high risk activities - impulsivity - restlessness - energized behavior - clothing may look disorganized or disheveled; lots of jewelry or harsh makeup - increased psychomotor changes - decreased need for sleep - may be aggressive, intrusive, or combative - increased talkativeness, rapid, pressured speech

Question 33

Mood

Answer 33

euphorically elevated, overly happy, outgoing - irritable mood, agitation, jumpy, "weird" - inappropriately joyous

Question 34

Cognition

Answer 34

- inflated self-worth - expansive and optimistic thinking - unintelligible speech - thoughts racing- jumps from topic to topic; flight of ideas - talk nonstop about plans - privileges and wealth - difficulty with attention - appetite disturbances - suicide by accident as result often from not attending to needs

Question 35

Perception

Answer 35

- 3/4 have delusions - manic delusions reflect perceptions of power, prestige, self-worth, glory, wealth, movie star, god, or prophet - some have auditory hallucinations which are usually voices that tell them they are important

Question 36

Physiological and Self-Care Consideratios

Answer 36

- can go days without sleep or food and not even realize they are hungry or tired - ignore personal hygiene as "boring" when they have "more important" things to do - throw away possessions or destroy valued items - physically injure themselves and to ignore or be unaware of health needs that can worsen

Question 37

Nursing Interventions

Answer 37

- provide for the clients physical safety and those around - set limits on clients behavior when needed - remind client to respect distances between self and others - use short, simple sentences to communicate - clarify meaning of clients communication - provide finger foods high in calories and protein - promote rest and sleep - protect clients dignity - channel need for movement

Question 38

Symptoms of 1.5-2 mEq Lithium Toxicity

Answer 38

nausea, and vomiting, diarrhea, reduced coordination, drowsiness, muscle weakness, slurred speech

Question 39

1.5-2 mEq Lithium Toxicity Nursing Interventions

Answer 39

- withhold next dose; call physician | - serum lithium levels are ordered, and doses of lithium are usually suspended for a few days or the dose is reduced

Question 40

2-3 mEq/L Lithium Toxicity Side Effects

Answer 40

atoxia, agitation, blurred vision, tinnitus, giddiness, choreoathetoid movements, confusion, muscle fasciculation, hyperreflexia, hypertonic muscles, myoclonic twitches, pruritis, maculopapular rash, movement of limbs, slurred speech, large output of dilute urine, incontinence of bladder and bowel, and vertigo

Question 41

2-3 mEq/L Lithium Toxicity Nursing Interventions

Answer 41

- withhold future doses; call physician - stat serum lithium level - gastric lavage may be used to remove oral lithium - IV containing saline and electrolytes used to ensure fluid and electrolyte function and maintain renal function

Question 42

3.0 mEq/L Lithium Toxicity Side Effects

Answer 42

cardiac arrhythmias, hypotension, peripheral vascular collapse, focal or generalized seizures, reduced levels of consciousness from stupor or coma, myoclonic jerks of muscle groups, and spasticity of muscles

Question 43

3.0 mEq/L and above Lithium toxicity Nursing Interventions

Answer 43

- all preceding interventions plus lithium ion excretion is augmented with use of aminophylline, mannitol, or urea - hemodialysis may be used to remove lithium from the body - respiratory, circulatory, thyroid, and immune systems are monitored and assisted as needed

Question 44

Check Lab Values For...?

Answer 44

- Lithium (renal studies) | - Anti-Convulsant (liver enzymes)

Question 45

What helps promote a sense of control?

Answer 45

when dealing with a manic client, nurse should assist with personal hygiene tasks and encourage client to initiate grooming activities even when he/she does not feel like doing so or are busy doing other things

Question 46

What activities are appropriate for a manic client?

Answer 46

non-competitive physical activities that require use of large muscle groups

Question 47

Where should the manic client be places on the unit?

Answer 47

make every attempt to reduce stimuli in the environment | -place in quiet part of the unit

Question 48

What interventions should the nurse use if a manic client becomes abusive?

Answer 48

- redirect negative behavior or verbal abuse in a calm, firm, non-judgmental, non-defensive manner - suggest a walk or physical activity - set limits on intrusive behavior ("When you interrupt, I cannot explain the procedure to the others" or, "its janes turn to speak now")