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nursing 233 > Bipolar disorder > Flashcards

Bipolar disorder Flashcards

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1
Q

what is a manic episode?

A

euphria, state of elation experienced as heightened sense of well being

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2
Q

whats an expansive mood?

A

lack of restraint in expressive feelings and overvalues own existence

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3
Q

what lability of mood?

A

when you alternate between euphoria and irritability

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4
Q

what are flight of ideas?

A

loss of logical connection between thoughts

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5
Q

how might someone with bipolar disorder present in a manic episode? (lots here.)

A

inflated self-esteem, dec need for sleep, talkative, flight of ideas, distractibility, dec in goal-dreited activity or psychomotor agitation,e excessive involvement in pleasurable activities that have high risk of painful consequences, lots of energy, lack of need for sleep, hyper productivity, uncontrolled talking

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6
Q

what do you need to rule out that has similar symptoms as bipolar disorder?

A

borderline personality disorder and substance abuse

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7
Q

what is a hypomanic episode?

A

same symptoms but shorter period of symptoms and no marked impairment of social and occupational functioning

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8
Q

what is mixed features?

A

shows fluctuation between anxiety, agitation, irritability with depressive symptoms during an acute episode

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9
Q

what is secondary mania?

A

caused by underlying metabolic disorders, neurological disorders, CNS tumors, meds, medical tx, steroid tx, substance abuse, elderly esp susceptible, those who have no hx of mania

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10
Q

what is the mean age onset of bipolar?

A

21-30

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11
Q

what does the onset look like for bipolar

A

mild retarded depression or excessive sleeping for weeks prior to mania or overly psychotic epi or several depressive episodes

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12
Q

how do children first exhibit bipolar

A

first exhibit rage, irritability or euphoria (usually reflects developmental stage of child)
often have ADHD or other condition as well.

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13
Q

when are children usually diagnosed with bipolar?

A

5-10 years after onset. when behaviour becomes disruptive.

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14
Q

how does mania manifest in geri pop?

A

confusion and disorientation

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15
Q

usually, why does late onset occur?

A

secondary mania

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16
Q

what are two common comorbities?

A

anxiety disorders and substance abuse

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17
Q

what is the sensitization and kindling theory? (Et)

A 
sensitization = inc in response to drug w same dosage
kingdling= sub threshold stimulation of neutron generates action potential.

repeated episodes lower threshold to induce future episodes- perhaps why tend to occur at inc freq with less precipitating factors

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18
Q

what is the chronologic theories (Et)

A

sleep disturbance is an important aspect of depression and mania. important Hs in circadian rhythm; changes with seasons

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19
Q

what are the different types of Et for bipolar (think: theories)

A 
chronobiologic theories
sensitization and kindling theory
genetic factors
social and psychological
brain abnormalities
20
Q

what is viewed as overcompensation for depression?

A

mania

21
Q

in the biologic domain, what might you assess?

A 
simp of mania- sleep patterns is key!!
diet, weight, fluid imbalance, labs
thyroid fx
drug screen
changes in sexual activity
22
Q

Nursing dx for biologic domain

A 
altered sleep pattern
sleep deprivation
imbalanced nutrition
hypothermia
risk for deficient fluid volume
noncompliance
those for depression
23
Q

interventions for biological domain>?

A

physical care: rest, nutrition, fluids, sleep, limit stimuli

teaching- explore what preveds episodes, sleep routine, avoid high risk times for manic episodes,

24
Q

interventions according to stage r/t mood stabilizers?

think of phases

A

o Acute phase: goal is symptom reduction + stabilization; mood stabilizers may be combined with antipsychotics + benzos; gradual inc in dose to therapeutic effect
o Continuation phase: goal is to prevent relapse or movement into opposite pole; ~2-9 months after acute symptoms resolve; continue with mood stabilizers + watch for relapse
o Maintenance phase: goal is to sustain remission; long-term or lifetime prophylaxis recommended
o Discontinuation of med use: like depressive disorders course is usually recurrent + progressive (so same issues around whether to discontinue tx)

25
Q

when is ECT used?

A

when unresponsive to antimony drugs or at high risk of suicide

26
Q

what is lithiums classification?

A

mood stabilizer.

27
Q

what is lithiums MOA?

A

unknown but says alters Na transport in nerve and muscle cell; inc norE uptake and serotonin receptor sensitivity

28
Q

what are side effects of lithium?

A

edema, weight gain, hand tremors, GI symptoms, muscle weakness, polyuria

29
Q

why should you be careful with doses for lithium?

A

very narrow range between therapeutic and toxic doses

30
Q

whats a physiological aspect of lithium you should be concerned about? (think of food..)

A

lithium is salt.

electrolyte and water balance issues; changes in dietary sodium can inc side effects
less salt intake- inc lithium serum concentration

teaching: dec in salt intake will cause further retention of lithium salts- which can lead to toxicity

31
Q

what class is dicalproex sodium?

A

antimanic agent

also an anticonvulsant

32
Q

what are signs of toxicity in lithium?

A

discomfort, tremor, confusion, sezuires, possible death.

early signs= diarrhea, weakness, vomitting, lack of coordination

33
Q

what is the most serious adverse effect of taking lithium?

A

cardiac dysrhtymia

34
Q

what other side effects occur from taking lithium?

A

drowsiness, seizures, ataxia, slurred speech, HoTN, hypothyroidism

35
Q

what are some drug interactions with lithium?

A

ACE inhibitots, thiazides, Ca channel blockers, NSAIDS

36
Q

what is the therapeutic onset of lithium? peak? duration?

A

10-21 days onset
peak 1-3 hr
duration 24 hr

37
Q

what is the receptor affinity of divalproex sodium?

A

thought to inc level of inhibitory GABA to brain neurons

38
Q

what are some side effects of divalproex sodium?

A

sedation, GI symp, anorexia, weight loss, liver failure

39
Q

can you give divalproex sodium in large doses?

A

yes to slow manic episodes and dec need for antipsychotics

40
Q

when should you not give divalproex sodium?

A

liver disease or pregnant

41
Q

what assessments would you do in regards to the psychological domain?

A

mood, cognition, psychosis, stress and coping, and risk

42
Q

what are some nursing diagnosis for psychological domain?

A 
disturbed sensory perception
disturbed thought process
defensive coping
risk for suicide
risk for other directed or self-directed violence
ineffective coping
43
Q

interventions for psychological domain?

A

pharmacotherapy
risk factors for recurrence (obesity, divorce, non adherence to meds, marital conflict, unemplyment)
psychotherapy
psychoeducation (usually focuses on med adherence (help pt recognize warning signs to cope with residual symptoms, weight adherence plans)

44
Q

what are some nursing diagnosis for the social domain?

A 
ineffective role performance
interrupted family processes
impaired social interaction
compromised family coping
delayed growth and development (for children)
45
Q

what are some interventions for the social domain?

A

consider roommates in room
support groups
marital and family interventions
family focus

46
Q

what is bipolar I?

A

characterized by one or more manic episodes

generally includes major depressive occurrence,

47
Q

what is bipolar II?

A

periods of major depression

at least one instance of hypomania

nursing 233 (4 decks)

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