BIPOLAR DISORDER Flashcards
patient has high energy level, elated mood, hyperactive, loud
Mania/Manic
patient is sad, gloomy, talks slow, sometimes suicidal
Depression
Normal mood
Happy
between normal and mania, slightly higher than happy
Hypomania
Severe
Mania
Less Severe
Hypomania
Hyperactive but higher than a manic patient. (disoriented)
Delirious Mania
- lasts at least 1 week
- Has NEGATIVE effects on school, work, or relationships
- Need hospitalization & treatment
Mania
- Last for 4 days or less
- Has no effect on school, work, or relationship
- Need no hospitalization
Hypomania
3 TYPES OF BIPOLAR DISORDER
- MOST SEVERE form of bipolar disorder
Bipolar I
3 TYPES OF BIPOLAR DISORDER
Has no bipolar episode, but has hypomanic episodes
Bipolar II
3 TYPES OF BIPOLAR DISORDER
Least severe form
Cyclothymia
3 TYPES OF BIPOLAR DISORDER
MOOD: Mania to depression to hypomania to
depression to mania
Bipolar I
3 TYPES OF BIPOLAR DISORDER
MOOD: Hypomanic to depression to hypomanic then depression
Bipolar II
3 TYPES OF BIPOLAR DISORDER
MOOD: Hypomanic to sadness to hypomanic to sadness
Cyclothymia
- 2 years of cycling between hypomanic to sadness; there can be a few days/weeks of no symptoms, but the remission (no symptoms) should be less than 2 months only.
ETIOLOGY of BIPOLAR - Neurochemical
Manic episodes are caused by:
Increased Serotonin, Dopamine and Norepinephrine
ETIOLOGY of BIPOLAR - Psychodynamics
- Psychodynamics patients uses reaction
formation – All patient with bipolar disorder -
deep inside have depression.
Psychoanalytic Theory
- They will attempt to cover up this underlying
depression by having a high level of mood or energy (Manic episode), When their energy becomes low, patient will go back to their Depressed State (mag iipon ulit ng energy)
- From depressed states they will become manic again
Medications that trigger MANIA
- Steroids
- Amphetamine
- Narcotics (heroin, morphine)
- Antidepressants (ssri, maoi)
- Anticonvulsants
Chronic Illnesses related to Bipolar Disorder
Systemic Lupus Erythematosus
CLINICAL MANIFESTATIONS
- For a person to be manic, they should present these manifestations for 1 week or more.
- Hypomania - < a week / around 4 day
(GRANDIOSE)
G - Grandiosity
R - Rapid / Pressured Speech
A - Agitation
N - Not thinking of food and sleep
D - Dress is colorful
I - Impulsive / Impaired Judgement
O - Overwhelming Energy
S - Shopping Spree, Sexuality Indiscretion
E - Exaggerated Self-esteem Elation
CLINICAL MANIFESTATIONS (GRANDIOSE)
- feeling lahat ng staff in love sakanila
(Erotomania)
Grandiosity
CLINICAL MANIFESTATIONS (GRANDIOSE)
Rapid / Pressured Speech (loquaciousness)
* flight of ideas:
* looseness of association:
- flight of ideas - Shift from one topic to another
- looseness of association - Shift from one topic
to another in an unrelated manner
CLINICAL MANIFESTATIONS (GRANDIOSE)
- they are not always violent but they can be violent due to high level of energy.
Agitation
CLINICAL MANIFESTATIONS (GRANDIOSE)
Not thinking of food and sleep
- Risk for water and electrolytes imbalances and nutritional deficiencies
- Physiological aspect
CLINICAL MANIFESTATIONS (GRANDIOSE)
Due to their overwhelming energy, they can have sexual contact even with strangers
Sexuality Indiscretion
what are some NURSING DIAGNOSIS for bipolar disorder
- Risk for violence*
- Risk for injury*
- Imbalanced nutrition (less than body requirement)
- Disctrubed thought process
- Disurbed speech pattern
- Impaired Social Interaction
- Insomia
TREATMENTS for bipolar disorder
- Lithium
- Anticonvulsant
- ECT
TREATMENTS for bipolar disorder
___________ ____________ are equally effective in treating bipolar disorder.
Lithium Carbonate & Anticonvulsants
TREATMENTS for bipolar disorder
Treatment of choice/first line of treatment and why?
Lithium
- safer than anticonvulsants.
TREATMENTS for bipolar disorder
therapeutic range for blood lithium level
0.6 – 1.2 mEq/L
- High risk for toxicity due to its narrow therapeutic
range of lithium
TREATMENTS for bipolar disorder
has deadly adverse effects
Anticonvulsant
TREATMENTS for bipolar disorder
Anticonvulsant
- Adverse effect of Lamotrigine
Stevens – Johnsons Disease
TREATMENTS for bipolar disorder
Anticonvulsant
- Adverse effect of Valproic Acid
Hepatotoxicity / Liver Damage
TREATMENTS for bipolar disorder
Anticonvulsant
- Adverse effect of Carbamazepine
Blood Dyscrasias (aplastic anemia, agranulocytosis)
TREATMENTS for bipolar disorder
the use of electric shock to induce grand-mal seizure to promote behavioral change on the patient.
ELECTROCONVULSIVE THERAPY
* Electro – use of electric shock
* Convulsive – grand-mal seizure (seizure throughout
the body)
* Therapy – behavioral change
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
- Amount of voltage used should be exact.
- One the patient is seizing, doctor will remove the
electrodes
Voltage:
How long?
Sessions:
Interval per session:
- 70 – 150 volts
- 0.2 – 8 seconds
- 6 – 12 sessions
- 48 hours Interval / every other day / every 2 days
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
Placement of Electrodes
* Effective
* ↑ occurrence of side effects
TEMPORAL
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
Placement of Electrodes
* Less effective than temporal
* ↓ occurrence of side effects
UNILATERAL
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
Placement of Electrodes
* Effective
* ↓ occurrence of side effects
BIFRONTAL
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
Who is responsible in monitoring the DURATION of the seizure.
Nurse
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
In more advanced countries, they give muscle relaxant wherein patients don’t show seizures physically. Seizures activity are being monitored through EEG machine (electroencephalogram) and duration should be
30 – 150 Seconds
- Anything below 30 secs of seizure activity – ineffective (depends on the doctor if uuitin yung ECT)
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
If monitoring using EYES, seizure duration should only be
15 – 30 seconds
TREATMENTS for bipolar disorder - ELECTROCONVULSIVE THERAPY
If seizure activity is >150 seconds / 30 seconds:
STAT dose of Diazepam is given as ordered by the physician.
INDICATIONS OF ECT
D - Depression
M - Mania
C - Catatonia
INDICATIONS OF ECT (DMC)
- patient is acutely suicidal
- Non-responsive to anti-depressants
Depression
INDICATIONS OF ECT (DMC)
- Non-responsive to lithium and anti- convulsant
Mania
CONTRAINDICATIONS of ECT
- Increased ICP
Patients with stroke, brain tumor. Since ECT causes
increase in ICP, patient can die.
SIDE EFFECTS of ECT
- Memory Loss
- Headache - due to increased intracranial pressure caused by seizure
- Disorientation
- Muscle Ache - Due to tonic – clonic movemens during seizure
- Increased Intraocular Pressure
- Increased BP and Pulse rate
INDICATIONS OF ECT (DMC)
- (Catatonic Schizophrenia)
Catatonia
CONTRAINDICATIONS of ECT
- Patients with Cardiac Problems
As it increases the cardiac workload increasing the BP and heart rate
CONTRAINDICATIONS of ECT
- Fever & Infection
It increases the metabolic demands during the
seizure activity.
CONTRAINDICATIONS of ECT
- Fractures / at risk for fractures/ Recent Fracture
- Patients with osteoporosis
- Due to the violent movements during the seizure.
It may worsen or induce a fracture to the patient.
CONTRAINDICATIONS of ECT
- Retinal Detachment / Glaucoma
Due to increased IOP and may worsen patients condition
CONTRAINDICATIONS of ECT
- Pregnancy with complications
- If pregnant patients w/o complications may
undergo ECT (ECT is safer than pharmaceutical
treatments) - ECT may lead to Eclampsia on patients with PIH
(Pregnancy Induced Hypertension)
CONTRAINDICATIONS of ECT
- Loose Teeth
Patient may swallow the loose teeth and aspirate
which is dangerous for the patient
ECT needs consent done by the _____ and the ________ serves as witness
ECT needs consent done by the doctor and the nurse serves as witness
Preparation for ECT
Similar to surgical preparations
- NPO for _______ prior to ECT to prevent ____
- Void / Defecate prior to procedure to __________
- Remove Nail Polish, jewelries, any metallic objects.
- 6 – 8 hours, Aspiration
- to avoid soiling during the ECT
Preparation for ECT
- Attach a bite block / tongue guard to:
- to prevent biting their tongue or chipping of teeth
- a way to suction for airway patency.
Preparation for ECT
Administer Medications
A - Atrophine Sulfate
B - Brevital (Methohexiatal)
A - Anectine (Succinylcholine)
Preparation for ECT
Administer Medications
- Anticholinergic agent
- Decreases the oral and tracheal secretions
Atrophine Sulfate
Preparation for ECT
Administer Medications
- Anesthetic, induce coma - Decrease patients anxiety
Brevital (Methohexiatal)
Preparation for ECT
Administer Medications
- Muscle relaxant; muscle paralysis – minimizes
the risk for injury due to the seizure
Anectine (Succinylcholine)
What is the most serious complication of ECT and why
Respiratory Depression caused by anectine.
- Atropine sulfate counteracts the risks caused by anectine
NURSING RESPONSIBILITIES for ECT
During:
- Monitor vital signs and the duration of the seizure.
NURSING RESPONSIBILITIES for ECT
AFTER:
- Maintain patent airway
- Reorient the patient
- Promote Rest
- Document
NURSING RESPONSIBILITIES for ECT
AFTER:
- How will you Maintain patent airway?
Place patient in side lying or prone position as long as the head of the patient is tilted on one side
NURSING RESPONSIBILITIES for ECT
AFTER:
- How will you reorient?
Time, place, person.
in order to therapeutic range of lithium in blood, the patient must have?
adequate fluid and salt intake
how will you maintain patent airway after ECT?
place patient in side lying or prone position (as long as the bed is tilted)
