Bipolar Flashcards
Mania Major Depression `2.5% us pop mostly males Mood swings Extreme Mania to extreme depression Impulsive; promiscuity, gambling, risky behavior Strong hereditary link Might not sleep or eat for days in mania
Bipolar I
*Hypomania (milder form of mania)
*Major Depression
drinking
More common in Females
`mis/underdiagnosed commom
Bipolar disorder, type 2
rapid cycling, rapid alternating moods @ exact same time. Quick minutewise
Bipolar disorder, mixed
Sad one month, happy the next; up & down
Cyclothymic diorder
A suicidal client, with a history of manic behavior, is admitted to the ED. The client’s diagnosis is documented as bipolar I disorder: depressive state. What is the rationale for this diagnosis versus a diagnosis of major depression?
The client has experienced a manic episode in the past.
Diagnosis difficult; use Find:
- Frequency: symptoms occur most days in a week.
- Intensity: symptoms are severe enough to cause extreme disturbance
- Number: symptoms occur 3 to 4 times a day
- Duration: symptoms occur 4 or more hours a day
Diagnosis of Bipolar
Euphoric mood Irritable mood; rage over trivial things Grandiosity; better than anyone else Decreased need for sleep Pressure speech Racing thoughts Distractibility Psychomotor agitation Risky behavior Psychosis Suicidal thoughts
Childhood and adolescence bipolar symptoms
age starts as early as 4, 5, 6; show symptoms but looks like ADHD
Risk for injury; grandiose thinking (I can fly)
Risk for violence
Imbalance nutrition; for manic ; no stop going; give finger foods
Impaired social interactions; manipulative and irritable
Disturbed thought process; delusions
Disturbed sensory perception; hallucinations
Insomnia; no sleeping *mania
Nursing diagnosis for bipolar
In the initial stages of caring for a client experiencing acute manic episode, what should the nurse consider to be the priority nursing diagnosis?
Risk for injury related to excessive hyperactivity
Mood stabilizing
- Antimanic
- Anticonvulsants
- Antipsychotics
***No antidepressants given to Bipolar I
Meds for mania
Mood stabilizing:
Antidepressants
Meds for depressive state
Action of Lithium
Salt
Hydration: 6 to 8 glasses of H2O a day
fluids 2500 to 3000 ml/day
Antimanic: Lithium
Therapeutic Ranges:
1.0 to 1.5 mEq/L (acute mania)
0.6 to 1.2 mEq/L (maintenance); stable to baseline
Toxicity, taxia nausea/vomiting 3.5 mEq/L seizures, coma, death
Therapeutic ranges for Lithium
dry mouth, thrist,
GI upset, nausea/vomiting, call dr immediately
Fine hand tremors, polyuria, hypotension, arhythmias, pulse irregularity
Side Effects of Lithium
Action of anticonvulsants: not fully understood; does afftect GABA
such as:
Valproate (Depakote; needs labs for) good for any kind of bipolar; liver; hepatotoxicity
Lamotrigine (Lamictal)
Carbamazepine (Tegretol)
Anticonvulsants
prolonged bleeding time (Depakote) CBC levels
Risk for severe rash (Lamictal) Steven Johnson Syndrome
Risk of suicide
drowsiness; dizziness
Side effects of anticonvulsants
Action of antipsychotics: Not fully understand (anger pill)
such as:Olanzapine (Zyprexa)
Risperidone (Risperdal)
Side effects; drowsiness, dizziness, dry mouth, constipation, increased appetite, weight gain, ECG changes, EPS
`Hyperglycemia, diabetes
Antipsychotics
A client, who is prescribed lithium carbonate, is being discharged from inpatient care. Which medication information should the nurse teach this client?
Do not skimp on dietary sodium intake.
- Induction of a grand mal seizure using electrical current to the brain
- Electrodes are placed on bilateral frontal temporal region
- Dose based on threshold, variable
- Duration-at least 20 seconds
- Administered every other day x 6-12 tx
Memory loss around event temporary
Contraindicate in pts with increased intracranial pressure or past 3 months of MI or stroke
Electroconvulsive therapy
electroconvulsive therapy
induction of grand mal seizures’; application of electrical currency through the brain
`effective in treatment of severe depression, esp exp. suicidal with psychotic symptoms
-disturbances in sleep, appetite and energy
`Side effects; confusion, and temporary memory loss
Meds used: atropine sulfate or glycopyrrolate (Robinul)
administer 30 mins before treatment; decrease secretions (prevent aspiration) and counteract the effect of vagal stimulation (bradycardia) decrease saliva and increase heart rate
ECT
has a pervasive and sustained emotion that may have a major influence on a persons perception of the world
ie depressed, joy, elation, anger and anxiety
Mood
describes as the emotional reaction assoc with an experience
affect
mood disorders as they are manifested by cycles of mania and depression
bipolar
an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking. Mania can occur as a bilogical (organic) or psychological disorder, or as a response to substance use or a general med. condition.
Mania
milder degree of mania; not severe enough to cause marked impairment in social or occupational functioning; or to require hospitalization; no psychotic features
hypomania
symptoms of mania and depression
mixed bipolar
manic episodes
hx of 1 or more manic episodes with episodes of depression.
`could be single manic episode 1st or current (most recent) episode manic, hypomanic, mixed or depressed (to describe ind. who’ve had recurrent mood episodes)
-psychotic or catatonic features may be noted.
bipolar I
recurrent bouts of MDD; major depressive disorder.
with episodes occurrence of hypomania. `Client has never exp a full manic episode.
-psychotic or catatonic maybe noted
Bipolar II Disorder
a chronic mood disturbance of at least 2 years duration, involving numerous periods of elevated mood that do not meet the criteria for a hypomanic episode, and numerous periods of depressed mood of insufficient severity or duration to meet the criteria for MD episode
Cyclothymic disorder
abnormally and persistently elevated, expansive or irritable mood and excessive activity or energy that is judged to be the result of direct physiological consequence of another med. condition.
Substance/Medication-induced bipolar disorder
etiology not yet determined
`possible chemical imbalance
; combo of hereditary factors and environmental triggers (stressful life event)
Predisposing factors
meds that treat somatic illness known to trigger manic episodes; steriods-treat chronic illness MS, SLE amphetamines antideppressants high doses of anticonvulsants narcotics poss potential trigger response
Med side effects that trigger mania
3 stages of mania:
`hypomania, acute mania, delirious mania
Stage I; hypomania; not severe enough to cause impairment
Mood; cheerful and expansive, underlying irribility; ideas of great worth and ability. rapid flow of ideas, loud, lack warmth and personality to form close relations
weightloss, spending, anorexia
Stage 1 hypomania
3 stages of mania;
`acute mania; progression in intensification of those experiencing hypomania; impairment in function and require hospitalization
Mood; Euphoria & Elation, continuous high; frequent variation, easy changed irribility, anger over even sadness & crying
pressured speech, incoherent, hallucinations & delusions; paranoid and grandiose
sexual increase; poor impulse control; socially and sexually inhibited; dress bizarre
Stage II acute mania
3 stages of mania
`Delirious mania; severe clouding of consciousness & intensified symptoms assoc with acute mania
Mood; Labile; excessive lies. quickly coverting from happiness to ecstasy then becoming irritable.
Confusion, stupor. Religiosity, delusions of grandiose of persecution
auditory or visual hallucinations; frenzied, agitated. exhaustion, injury to self or others, death could occur.
Stage III Delirious mania
Risk for Injury
Risk for violence; self-directed or other directed
Imbalance nutrition: less than body requirements
Disturbed thought processes (delusions)
Disturbed sensory perceptions (hallucinations)
Impaired social interactions
Insomnia
Nursing Diagnosis for Bipolar Mania
Lithium Toxicity:
acute mania: 1.0-1.5 mEq/L
maintenance: 0.6 to 1.2 mEq/L
monitor once a week after initial treatment until dosage stable then monthly.
`draw blood after 12 hr last dose
Lithium Toxicity
1.5 to 2.0 mEq/L
Blurred vision, ataxia, tinnitus, persistant nausea, and vomiting, severe diarrhea
serum levels @ 1.5 to 2.0 (Lithium)
excessive output of diluted urine, increasing tremors, muscular irribility, psychomotor retardation, mental confusion, giddiness
serum levels @ 2.0 to 3.5 mEq/L (Lithium)
Impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, cardiovascular collapse.
serum levels @ 3.5 mEq/L and above (Lithium)
similar in chemical structure of Na, behaving in the body in much the same manner and competing @ various sites in the body with Na.
`if Na intake is reduced or body depletes in some way, lithium is reabsorbed by the kidneys, increasing the possibility of toxicity.
-Client must consume diet adequate in Sodium as well as 2, 500 to 3, 000 ml of fluid (H2O)/day
*I & O’s and clients weight kept
6 to 8 glasses of water a day
Lithium
nausea/vomiting severe diarrhea ataxia blurred vision tinnitus excessive output of urine increased tremors mental confusion
Side effects of Lithium **consult Dr immediately
skin rash unusual bleeding spontaneous bruising sore throat fever maliase dark urine yellow skin/eyes
side effects of anticonvulsants
irregular heart beat SOB swelling of hands/feet pronounced dizziness chest pain profound mood swings severe and persistant headache orthostatic hypertension
side effects of channel blockers
nausea vomiting dizziness gastritis headache tachycardia insomnia tremulousness
withdrawal symptoms of antipsychotics
sore throat fever malaise pale stools yellow skin/eyes unusual bleeding easy bruising; skin rash persistant nausea/vomiting severe headache rapid heart rate difficulty urinating muscle twitching tremors; muscle coordination darkly colored urine excessive hunger weakness
Notify dr of these side effects
from antipsychotics
clouding of consciousness occurs
delirious mania
characterized by mood swings between hypomania and mild depression
cyclothymic disorder
paranoid and grandiose delusions are common
manic episodes
excessive interest in sexual activity
manic episodes
accelerated, pressured speech
manic episodes
frenzied motor activity, characterized by agitation, purposeless movements
delirious mania
recurrent bouts of major depression with episodes of hypomania
bipolar II disorder
recurrent bouts of mania with episodes of depression
bipolar I disorder
