Bipolar Disorder Flashcards
Types of bipolar disorders
Bipolar I Bipolar II Cyclothymia Mixed episode Rapid Cycling
Bipolar I
at least one episode of mania (lasting >1wk or hospitalized) and MDD of at least 2 wks
Bipolar II
hypomania (at least 4 days) and major depression
Cyclothymia
hypomania with minor depression
cycles at least 2 years
Rapid cycling
4 or more mood episodes (mania) in one year
Mixed episode
depression and mania at the same time
s/sx of mania
euphoria irritable little or no inhibition easily distracted flight of ideas gradiose delsusions high and unstable affect unlimited energy hypersexuality poor concentration/judgment pressured speech restlessness clang associations
nursing assessment for bipolar
assess for s/sx of mania
thought process
cognitive function
DTS/DTO
med exam to see if mania is primary or secondary
medical status: dehydration, exhaustion, vitals, skin turgor, urinary output
ask about substance abuse
communication with manic pt
firm, calm approach short, concise sentences remain neutral consistency redirect energy
nursing dx for mania
risk for injury risk for suicide self-care deficit deficient fluid volume imbalanced nutrition disturbed sleep pattern
therapies for bipolar
milieu therapy (seclusion)
interventions for acute mania
safe milieu nutrition sleep hygiene elimination
how does lithium work?
alters sodium transport in nerve and muscle cells
inhibits release of NE and D2
does NOT inhibit release of 5-HT
expected s/e of lithium at 0.5-1.5
mild nausea
mild tremor
mild polydipsia
mild polyuria
early lithium toxicity
levels above 1.5 N/V diarrhea thirst polyuria lack of coordination tinnitus dizziness slurred speech muscle weakness
lithium: therapeutic blood level
0.8–1.4 mEq/L
lithium: maintenance blood leel
0.4–1.3 mEq/L
lithium: toxic blood level
1.5–2 mEq/L
interventions for mild lithium toxicity
medication withheld
blood levels measured
dosage re-evaluated
advanced lithium toxicity
1.5--2 mEq/L coarse hand tremor persistent GI upset mental confusion muscle hyperirritability EEG changes incoordination
interventions for advanced lithium toxicity
medication withheld
blood levels measured
dosage re-evaluated
severe lithium toxicity
2--2.5 mEq/L ataxia serious EEG changes blurred vision clonic movement large output of dilute urine tinnitus seizures stupor severe hypotension coma
interventions for severe lithium toxicity
no antidote drug stopped excretion hastened (urea, mannitol, aminophylline) if alert, use emetic if not alert, gastric lavage
when do antimanic effects begin after taking lithium?
usually 5-7 days
can take up to 3 wks
