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Nursing 201 > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

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1
Q

Bipolar is characterized by…

A

mania and depression

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2
Q

Bipolar I disorder

A
  • most significant
  • at least one episode of mania with major depression
  • psychosis may accompany the manic episode.
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3
Q

Bipolar II disorder

A
  • hypomanic episode alternating with major depression
  • psychosis NOT present
  • hypomania tends to be euphoric and depression tends to place the person at risk for suicide.
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4
Q

Rapid cycling (bipolar I)

A
  • 4 or more mood episodes in a 12 month period

- severe symptoms: poor global functioning, higher recurrence risk.

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5
Q

Cyclothymic disorder (bipolar II)

A
  • hypomanic episodes alternating with minor depressive episodes (at least 2 year duration)
  • tend to have irritable hypomanic episodes
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6
Q

Etiology of Bipolar disorder

A
  • genetics play a role
  • excessive levels of norepinephrine and dopamine
  • decreased levels or serotonin
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7
Q

Bipolar neurotransmitters….

A
  • excessive levels of norepinephrine and dopamine

- decreased levels or serotonin

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8
Q

Manic episodes

A
  • hyperactivity
  • involvement in pleasurable activities (spending a lot of money, giving money away, sex)
  • push limits
  • loud, rapid speech
  • talkative
  • no time to eat or sleep
  • outlandish dress
  • poor concentration
  • poor judgement
  • some may have psychotic symptoms
  • may have altered sensory perception
  • flight of ideas
  • clang associations
  • grandiose
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9
Q

Diagnostic criteria for a manic episode

A
  • elevated, expansive, or irritable mood lasting for at least 1 week
  • AND 3 or more of the following…
  • inflated self-esteem, decreased need for sleep, more talkative, flight of ideas, distractibility, increase in goal-directed activity, and increased involvement in pleasurable activities
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10
Q

Hypomanic episode

A
  • talks and jokes- “life of the party”
  • talk is often sexual in nature
  • pressured speech
  • very social
  • enthusiastic
  • judgement may be poor
  • NO halluciantions
  • busy with grandiose plans
  • increased sexual appetite
  • may go without sleeping
  • goes on buying sprees
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11
Q

Co-morbidity of bipolar

A
  • abuse of alcohol (and other substances) is common

- attempt to self medicate - relapse rates increase, response to lithium decreases, poor treatment compliance

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12
Q

Assessment for bipolar

A
  • danger to self
  • need for control
  • need for hospitalization
  • medical status
  • medical examination
  • co-existing medical conditions
  • understanding bipolar disorder
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13
Q

Outcomes - Phase I (acute phase)

A
  • be well hydrated in 24 hours
  • maintain stable cardiac status
  • maintain tissue integrity
  • sufficient sleep and rest
  • demonstrate control with aid of staff or medication
  • make no attempt at self-harm with aid of staff or medication
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14
Q

Outcomes - Phase II (continuation of treatment)

A
  • lasts for 2 to 6 months
  • relapse prevention
  • education: knowledge of disease, early signs of relapse, medication. consequences of substance addictions for predicating further relapse, knowledge of early s/s, support groups
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15
Q

Outcomes - Phase III (maintenance treatment)

A
  • focus on relapse prevention

- limit the severity and duration of future episodes (coping skills, support groups, medication compliance)

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16
Q

Nurse/patient relationship

A

matter of fact tone, clear concise directions and comments, limit setting, do not reinforce hallucinations, provide homogenous group if possible, respond to legitimate complaints, redirect patients to a more healthy activity, provide foods to be eaten on the run, provide high calorie snacks and maybe a vitamin supplement, provide a quiet place to sleep, lookout for splitting

17
Q

Milieu therapy

A
  • control of hyperactivity usually includes anti-psychotic
  • may need seclusion if out of control
  • reduce environmental stimuli
  • protect from self, injury, others, or staff
  • prevent destruction of property
  • follow protocols and document
18
Q

Lithium

A
  • medication of choice for mania and depressive episodes
  • inhibits about 80% of acute mania and hypomanic episodes within 10-21 days
  • less effective in rapid cycling people
  • must reach therapeutic blood levels to be effective - therefore anti-psychotic and benzodiazepine is also needed initially bc anti-psychotics have more immediate action
19
Q

Lithium can help control….

A
  • insomnia
  • psychomotor behavior
  • hypersexuality
  • paranoia
20
Q

Therapeutic level of lithium

A

0.4-1 mEq/L

SEs: fine hand tremors, polyuria, mild thirst, mild nausea and general discomfort, weight gain

21
Q

Early signs of lithium toxicity

A

level 1-1.5

  • nausea, vomiting, diarrhea, thirst
  • medication should be withheld, blood lithium levels measured, and dosage reevaluated
  • dehydration if present should be addressed
22
Q

Advanced signs of lithium toxicity

A
  • level 1.5-2
  • coarse hand tremor
  • persistent GI upset
  • mental confusion
  • muscle hyper-irritability
  • EEG changes
  • incoordination
  • sedation
  • interventions for early signs of toxicity should be used, depending on severity of circumstances.
23
Q

Severe toxicity of lithium

A

> 2

  • ataxia
  • confusion
  • large output of dilute urine
  • serious EEG changes
  • blurred vision
  • clonic movements
  • seizures
  • stupor
  • severe hypotension
  • coma
  • Death secondary to PULMONARY complications
24
Q

Level >2.5 of lithium

A
  • convulsions
  • oliguria
  • death
  • in addition to toxic interventions, hemodialysis may be used in severe cases
  • lithium is similar to sodium- if sodium is reduced, lithium is reabsorbed by the kidneys
25
Q

Protocol for lithium

A
  • initially, blood levels are measured weekly or biweekly
  • once therapeutic levels are reached - check every month
  • After 6 months to 1 year of stability - every 3 months
  • blood drawn 8-12 hours after last dose
26
Q

Major risks of long term use of lithium

A
  • hypothyroidism
  • impairment of the kidneys ability to concentrate urine
  • need periodic follow-up to assess thyroid and renal function
27
Q

Effects of lithium on the kidneys

A
  • pre-existing kidney disease
  • can allow a dangerous buildup of lithium in a short time
  • increased fluid intake and urination are common (causing nephrogenic diabetes insipidus)
  • in some cases may cause severe dehydration
28
Q

Effects of lithium on thyroid

A
  • interferes with thyroid function and so will need a yearly TSH
  • hypothyroidism s/s: fatigue, sensitivity to cold, unexplained wt gain, hoarseness
  • elevated blood cholesterol levels
  • pain, stiffness or swelling in joints
  • slowed heart rate
  • impaired memory
  • dry, rough skin
  • depression
29
Q

Anti-convulsant drugs

A
  • taken when lithium does not work
  • valporic acid (depakote, depakene)
  • serious complications are rare
  • SEs: wt gain, GI upset, sedation, tremors are rare, hair loss is rare
30
Q

Valporic acid

A
  • monitor liver function
  • monitor platelet count
  • women may develop polycystic ovarian syndrome
  • may lead to birth defects and developmental delays in utero
31
Q

Tegretol (carbamazepine)

A
  • effective for pts who do not respond to lithium or valproates
  • anti-convulsant
  • for rapid cycling and severely paranoid pts
  • SEs: less wt gain, sedation, nausea, anorexia, vomiting, drowsiness
  • Adverse SE: leukopenia, agranulocytosis
32
Q

Lamictal

A
  • anti-convulsant drug
  • used for bipolar depression and approved for acute maintenance therapy
  • SEs: dizziness, double vision, HAs, potentially life threatening rash (d/c)
33
Q

Newer anti-convulsant drugs

A
  • topamax (topiramate) -helpful for mania and does not cause wt gain
  • trileptal (oxcarbazepine) - similar to tegretol, better tolerated
34
Q

Anti-anxiety medications

A
  • Klonopin and ativan
  • used for pts who are resistant to other treatments
  • effective with psychomotor agitation seen in mania
  • contraindicated in patients with history of substance abuse bc addictive

Nursing 201 (6 decks)

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