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Nursing 172 > Bipolar > Flashcards

Bipolar Flashcards

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1
Q

Mania

A

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

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2
Q

Mania Includes:

A

-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

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3
Q

Mania: Mood

A
  • 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
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4
Q

Hypomania

A

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)

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5
Q

Mixed Episode

A

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

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6
Q

Bipolar I

A

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

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7
Q

Bipolar II

A

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

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8
Q

Bipolar Disorder

A
  • 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
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9
Q

Etiology

A
  • excess of serotonin seen in mania

- excess of norepinephrine. this catecholamine energized the body

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10
Q

Diagnostic Work Up

A
  • 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
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11
Q

Manic Phase

A

euphoric, grandiose, energetic, and sleepless

-poor judgment and rapid thoughts, actions, and speech

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12
Q

Depressed Phases

A

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

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13
Q

Onset and Clinical Course

A
  • 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
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14
Q

Psychopharmacology

A
  • 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
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15
Q

Lithium

A
  • 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
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16
Q

Lithium Action

A

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

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17
Q

Anti-Convulsant Drugs

A

-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

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18
Q

Examples of Anti-Convulsant Drugs

A
  • Divalproex
  • Carbamazepine
  • Lamotrigine
  • Gabapentin
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19
Q

Anti-Convulsant: Divalproex (valproic acid)

A

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
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20
Q

Anti-Convulsant: Divalproex Side Effectd

A

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

21
Q

Anti-Convulsant: Divalproex Nursing Implications

A
  • monitor gait and assist if necessary
  • provide rest periods
  • administer with food
22
Q

Anti-Convulsant: Carbamazepine

A

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
23
Q

Anti-Convulsant: Carbamazepine Side Effects

A

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

24
Q

Anti-Convulsant: Carbamazepine Nursing Implications

A
  • assist client to rise slowly from sitting position
  • monitor gait and assist as necessary
  • report rashes to physician
25
Q

Anti-Convulsant: Lamotrigine

A

used less frequently than valproic acid; Divalproex

26
Q

Anti-Convulsant: Lamotrigine Side Effects

A

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

27
Q

Anti-Convulsant: Lamotrigine Nursing Implications

A
  • 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
28
Q

Anti-Convulsant: Gabapentin

A

used less frequently than valproic acid; Divalproex

29
Q

Anti-Convulsant: Gabapentin Side Effects

A

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

30
Q

Anti-Convulsant: Gabapentin Nursing Implications

A
  • provide rest periods

- administer with food

31
Q

Assessment: History

A
  • difficult
  • may jump from subject to subject
  • obtain in several short sessions as well as talking to family members may be necessary
32
Q

Activity and Behavior

A
  • 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
33
Q

Mood

A

euphorically elevated, overly happy, outgoing

  • irritable mood, agitation, jumpy, “weird”
  • inappropriately joyous
34
Q

Cognition

A
  • 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
35
Q

Perception

A
  • 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
36
Q

Physiological and Self-Care Consideratios

A
  • 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
37
Q

Nursing Interventions

A
  • 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
38
Q

Symptoms of 1.5-2 mEq Lithium Toxicity

A

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

39
Q

1.5-2 mEq Lithium Toxicity Nursing Interventions

A
  • 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

40
Q

2-3 mEq/L Lithium Toxicity Side Effects

A

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

41
Q

2-3 mEq/L Lithium Toxicity Nursing Interventions

A
  • 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
42
Q

3.0 mEq/L Lithium Toxicity Side Effects

A

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

43
Q

3.0 mEq/L and above Lithium toxicity Nursing Interventions

A
  • 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
44
Q

Check Lab Values For…?

A
  • Lithium (renal studies)

- Anti-Convulsant (liver enzymes)

45
Q

What helps promote a sense of control?

A

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

46
Q

What activities are appropriate for a manic client?

A

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

47
Q

Where should the manic client be places on the unit?

A

make every attempt to reduce stimuli in the environment

-place in quiet part of the unit

48
Q

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

A
  • 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”)

Nursing 172 (120 decks)

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