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@Nur 181 Exam 2 > Bipolar > Flashcards

Bipolar Flashcards

1
Q 
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
A

Bipolar I

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2
Q

*Hypomania (milder form of mania)
*Major Depression
drinking
More common in Females
`mis/underdiagnosed commom

A

Bipolar disorder, type 2

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3
Q

rapid cycling, rapid alternating moods @ exact same time. Quick minutewise

A

Bipolar disorder, mixed

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4
Q

Sad one month, happy the next; up & down

A

Cyclothymic diorder

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5
Q

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?

A

The client has experienced a manic episode in the past.

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6
Q

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
A

Diagnosis of Bipolar

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7
Q 
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
A

Childhood and adolescence bipolar symptoms

age starts as early as 4, 5, 6; show symptoms but looks like ADHD

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8
Q

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

A

Nursing diagnosis for bipolar

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9
Q

In the initial stages of caring for a client experiencing acute manic episode, what should the nurse consider to be the priority nursing diagnosis?

A

Risk for injury related to excessive hyperactivity

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10
Q

Mood stabilizing

  • Antimanic
  • Anticonvulsants
  • Antipsychotics

***No antidepressants given to Bipolar I

A

Meds for mania

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11
Q

Mood stabilizing:

Antidepressants

A

Meds for depressive state

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12
Q

Action of Lithium
Salt
Hydration: 6 to 8 glasses of H2O a day
fluids 2500 to 3000 ml/day

A

Antimanic: Lithium

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13
Q

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

A

Therapeutic ranges for Lithium

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14
Q

dry mouth, thrist,
GI upset, nausea/vomiting, call dr immediately
Fine hand tremors, polyuria, hypotension, arhythmias, pulse irregularity

A

Side Effects of Lithium

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15
Q

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)

A

Anticonvulsants

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16
Q

prolonged bleeding time (Depakote) CBC levels
Risk for severe rash (Lamictal) Steven Johnson Syndrome
Risk of suicide
drowsiness; dizziness

A

Side effects of anticonvulsants

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17
Q

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

A

Antipsychotics

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18
Q

A client, who is prescribed lithium carbonate, is being discharged from inpatient care. Which medication information should the nurse teach this client?

A

Do not skimp on dietary sodium intake.

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19
Q
  • 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

A

Electroconvulsive therapy

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20
Q

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

A

ECT

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21
Q

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

A

Mood

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22
Q

describes as the emotional reaction assoc with an experience

A

affect

23
Q

mood disorders as they are manifested by cycles of mania and depression

A

bipolar

24
Q

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.

A

Mania

25
Q

milder degree of mania; not severe enough to cause marked impairment in social or occupational functioning; or to require hospitalization; no psychotic features

A

hypomania

26
Q

symptoms of mania and depression

A

mixed bipolar

27
Q

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.

A

bipolar I

28
Q

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

A

Bipolar II Disorder

29
Q

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

A

Cyclothymic disorder

30
Q

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.

A

Substance/Medication-induced bipolar disorder

31
Q

etiology not yet determined
`possible chemical imbalance
; combo of hereditary factors and environmental triggers (stressful life event)

A

Predisposing factors

32
Q 
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
A

Med side effects that trigger mania

33
Q

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

A

Stage 1 hypomania

34
Q

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

A

Stage II acute mania

35
Q

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.

A

Stage III Delirious mania

36
Q

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

A

Nursing Diagnosis for Bipolar Mania

37
Q

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

A

Lithium Toxicity

38
Q

1.5 to 2.0 mEq/L

Blurred vision, ataxia, tinnitus, persistant nausea, and vomiting, severe diarrhea

A

serum levels @ 1.5 to 2.0 (Lithium)

39
Q

excessive output of diluted urine, increasing tremors, muscular irribility, psychomotor retardation, mental confusion, giddiness

A

serum levels @ 2.0 to 3.5 mEq/L (Lithium)

40
Q

Impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, cardiovascular collapse.

A

serum levels @ 3.5 mEq/L and above (Lithium)

41
Q

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

A

Lithium

42
Q 
nausea/vomiting
severe diarrhea
ataxia
blurred vision
tinnitus
excessive output of urine
increased tremors
mental confusion
A

Side effects of Lithium **consult Dr immediately

43
Q 
skin rash
unusual bleeding
spontaneous bruising
sore throat
fever
maliase
dark urine
yellow skin/eyes
A

side effects of anticonvulsants

44
Q 
irregular heart beat
SOB
swelling of hands/feet
pronounced dizziness
chest pain
profound mood swings
severe and persistant headache
orthostatic hypertension
A

side effects of channel blockers

45
Q 
nausea
vomiting
dizziness
gastritis
headache
tachycardia
insomnia
tremulousness
A

withdrawal symptoms of antipsychotics

46
Q 
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
A

Notify dr of these side effects

from antipsychotics

47
Q

clouding of consciousness occurs

A

delirious mania

48
Q

characterized by mood swings between hypomania and mild depression

A

cyclothymic disorder

49
Q

paranoid and grandiose delusions are common

A

manic episodes

50
Q

excessive interest in sexual activity

A

manic episodes

51
Q

accelerated, pressured speech

A

manic episodes

52
Q

frenzied motor activity, characterized by agitation, purposeless movements

A

delirious mania

53
Q

recurrent bouts of major depression with episodes of hypomania

A

bipolar II disorder

54
Q

recurrent bouts of mania with episodes of depression

A

bipolar I disorder

@Nur 181 Exam 2 (8 decks)

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