388: Week 6 - Mood Disorders

Question 1

Describe the 13 Nursing Interventions associated with care of pt w/ depression

Answer 1

• Safety… assessment needs to be ongoing
• Assess the impact of depression on ind life and their external relationships
• Assess factors contributing to depression
• Establish therapeutic relationship/trust (sometimes difficult to do w/ psychotic and schizophrenia pts)
• Pharmacology
• Medication teaching
• Somatic treatments
• Encourage pt to discuss events/history that may have contributed to depression
• Address coping methods
• Explore support systems (family, friends, and HCP combined)
• Involve family when possible
• Connect pt with comm resources
• Discharge planning

Question 2

Describe the 12 domains of Nursing Interventions associated with care of pt’s w/ Bi-polar disorders

Answer 2

1. Safety
2. Pharmacology
3. Physical Care
4. Setting Limits
5. Establishing Therapeutic Relationship
6. Addressing issues/stressors in ind’s life (when mania is decreased)
7. Address feelings of shame/guilt
8. Help identify/develop coping strategies
9. Education on bipolar disorder and medications
10. Family meetings to address outstanding issues
11. Assess and connect with support systems
12. Ensure referral to resources

Question 3

Nursing Interventions for bi-polar pt regarding the domain of Safety should focus on…

Answer 3

Finances, sexual exploitation (either being exploited or engaging in risky sex), family relationships, reckless behavior (driving, running into traffic), safety from others and from oneself

Question 4

Nursing Interventions for bi-polar pt regarding the domain of Pharmacology should focus on…

Answer 4

-education regardingadministration and compliance of mood stabilizers

Question 5

Nursing Interventions for bi-polar pt regarding the domain of Physical Care should focus on…

Answer 5

• nutrition
• rest
• adequate hydration
• Re-establishment of physical well-being
• Sleep hygiene and sleep itself (may not be realistic to tackle this until meds take effect)
• Personal hygiene (may be neglected in manic and hypermanic states because ind mind occupied by so many other things)

Question 6

Nursing Interventions for bi-polar pt regarding the domain of Setting Limits should focus on…

Answer 6

• limiting intrusive behavior

- informing pt what is appropriate and what is inappropriate

Question 7

What is lithium? What is it classified as? What is the concern regarding use of lithium in treating depression?

Answer 7

• Classified as a mood stabilizing med
• salt
• excreted by kidneys
• may impact thyroid function (6-18 months into treatment)
• the most popularly recognized of the mood stabilizers
• the therapeutic and toxic ranges are very close with lithium -> multiple assessments need to be cleared before ind can begin lithium treatment; lithium levels need to be drawn regularly to ensure toxic level is not being approached

Question 8

What side effects are associated with Lithium?

Answer 8

• polydypsia (excessive thirst)
• polyuria (excessive urination)
• metallic taste
• fine tremor
• drowsiness
• mild diarrhea
• weight gain
• nausea
• skin breakouts (acne)

Question 9

What are the side effects associated w/ lithium toxicity?

Answer 9

If 1.5-2.5 mEg/L:

• severe diarrhea
• muscle irritability or twitching
• dry mouth
• asymmetric deep tendon reflexes
• nausea and vomiting
• increased muscle tone
• ataxia (mild to moderate) -> lack of voluntary muscle coordiation
• dizziness
• slurred speech
• tinnitus
• blurred vision

If >2.5 mEq/L:

• cardiac arrhythmias
• blackouts
• nystagmus death
• coarse tremors
• fasciculations (involuntary muscle contractions)
• confusion
• seizures
• coma, death
• visual or tactile hallucinations
• oliguria/hypouresis (not enough urine) -> renal failure
• peripheral vascular collapse

Question 10

What are the 2 desired treatment outcomes for all interventions implemented for Bi-polar disorders?

Answer 10

1. Stabilization of mood

2. Enhanced QOL