Bipolar disorder Flashcards
Etiology of Bipolar d/o
genetic, too much NE and 5-HT, transmembrane CA2+ (that’s why Ca+ blockers work for manic pregnant pt), neuroanatomical factors, medication s/e
types of bipolar d/o
bipolar 1, bipolar 2, cyclothymic d/o;
which bipolar d/o has acute mania?
bipolar 1 only
cyclothymic d/o is
a fluctuation of mood in a limited range; at least 2 yrs of episodes of hypomania and depressed mood of insufficient severity or duration to meet criteria for bipolar I or II
cyclothymic rapid cycler is
x4+ episodes per year
acute Mania is
seen in bipolar I only, euphoria and nonfunctioning; elation, frequently labile, fragmented thought, favorite color is red, often psychotic, flight of ideas, disorganized, hypersexuality d/t low impulse control and no bounderies (sex precaution); also safety issue (can assault or be assaulted); excessive pyschomotor activity, decreased need for sleep, hygiene neglect, flamboyant and bizarre, excessive make-up/jewelry (sharpied eyebrows)
hypomania is
irritable and highly productive; cheerful, expansive, underlying hostility, volatile and fluctuating; exalted self perception, easily distracted by irrelevant stimuli, difficulty with goal directed activities, increased motor activity, extroverted, sociable, increased libido
Elevated mood s/s for mania
expansive, flight of ideas, decreased sleep, grandiose ideas
Bipolar II is
depression with hypomanic episodes; better functioning than Bipolar I
Lithium will
decrease TSH, so outer eyebrow don’t grow
Bipolar with psychotic features: Mood congruent
grandiose delusions (it is plausible)
Bipolar with psychotic features: Mood INcongruent
Delusion of control, persecutory delusions, thought inertion (ppl sending pt messages)
Delirious Mania Concern
frenzied then may die from exhaustion; #1 concern is SAFETY
Delirious Mania characteristics
very labile, unrestrained ecstasy to despair, panic or anxiety, confused/disoriented, religiosity/grandeur/persecutory delusions, extremely distractable, incoherent
Nursing dx for Mania
Risk for injury, impaired social interaction d/t no bounderies, feeding self care deficit (finger foods on the go), insomnia (no sleep = more stress); risk for violence self/other directed, imbalanced nutrition: less than body requirements, disturbed thought process, disturbed sensory perception
If manic, activities should be
repetitive and simple
Risk for Injury Intervention for mania
low stimuli, private room, remove hazards, stay with agitated pt, talking down, provide physical activities, tranquilizer, Olanzapine 15mg PO qd
Risk for violence: self other directed intervention for mania
observe q15min, remove dangerous objects, be calm, talking down, sufficient staff, tranquilizer, Olanzapine 15mg PO qd, mechanical restraints
Imbalanced Nutrition: less than body requirement intervention for mania
high protein, high calorie finger foods, juice snacks on unit, I&Os, calorie count, daily wt, provide favorite food, supplement with vitamins and minerals, sit with pt during meals
3 Stages of bipolar d/o (mania)
1) hypomania, 2) acute mania, 3) delirious mania
What is your last resort for tx mania?
physical restraints
renew md order for physical restraints
q4 hrs for adults; q1-2hrs for children
always choose (x) for physical restraint
least restrictive
unconventional self tx of mood d/o
magnet, herb, accupuncture
