Bipolar Disorder

Question 1

Types of bipolar disorders

Answer 1

Bipolar I
Bipolar II
Cyclothymia
Mixed episode
Rapid Cycling

Question 2

Bipolar I

Answer 2

at least one episode of mania (lasting >1wk or hospitalized) and MDD of at least 2 wks

Question 3

Bipolar II

Answer 3

hypomania (at least 4 days) and major depression

Question 4

Cyclothymia

Answer 4

hypomania with minor depression

cycles at least 2 years

Question 5

Rapid cycling

Answer 5

4 or more mood episodes (mania) in one year

Question 6

Mixed episode

Answer 6

depression and mania at the same time

Question 7

s/sx of mania

Answer 7

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

Question 8

nursing assessment for bipolar

Answer 8

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

Question 9

communication with manic pt

Answer 9

firm, calm approach
short, concise sentences
remain neutral
consistency
redirect energy

Question 10

nursing dx for mania

Answer 10

risk for injury
risk for suicide
self-care deficit
deficient fluid volume
imbalanced nutrition
disturbed sleep pattern

Question 11

therapies for bipolar

Answer 11

milieu therapy (seclusion)

Question 12

interventions for acute mania

Answer 12

safe milieu
nutrition
sleep
hygiene
elimination

Question 13

how does lithium work?

Answer 13

alters sodium transport in nerve and muscle cells
inhibits release of NE and D2
does NOT inhibit release of 5-HT

Question 14

expected s/e of lithium at 0.5-1.5

Answer 14

mild nausea
mild tremor
mild polydipsia
mild polyuria

Question 15

early lithium toxicity

Answer 15

levels above 1.5
N/V
diarrhea
thirst
polyuria
lack of coordination
tinnitus
dizziness
slurred speech
muscle weakness

Question 16

lithium: therapeutic blood level

Answer 16

0.8–1.4 mEq/L

Question 17

lithium: maintenance blood leel

Answer 17

0.4–1.3 mEq/L

Question 18

lithium: toxic blood level

Answer 18

1.5–2 mEq/L

Question 19

interventions for mild lithium toxicity

Answer 19

medication withheld
blood levels measured
dosage re-evaluated

Question 20

advanced lithium toxicity

Answer 20

1.5--2 mEq/L
coarse hand tremor
persistent GI upset
mental confusion
muscle hyperirritability
EEG changes
incoordination

Question 21

interventions for advanced lithium toxicity

Answer 21

medication withheld
blood levels measured
dosage re-evaluated

Question 22

severe lithium toxicity

Answer 22

2--2.5 mEq/L
ataxia
serious EEG changes
blurred vision
clonic movement
large output of dilute urine
tinnitus
seizures
stupor
severe hypotension
coma

Question 23

interventions for severe lithium toxicity

Answer 23

no antidote
drug stopped
excretion hastened (urea, mannitol, aminophylline)
if alert, use emetic
if not alert, gastric lavage

Question 24

when do antimanic effects begin after taking lithium?

Answer 24

usually 5-7 days

can take up to 3 wks

Question 25

anticonvulsant mood stabilizers

Answer 25

valproic acid (Depakote)
carbamazepine (Tegretol)
lamotrigine (Lamictal)
topiramate (Topamax)
oxcarbazepine (Trileptal)

Question 26

s/e of all mood stabilizers

Answer 26

dizzy
hypotension
ataxia

Question 27

adverse effects of valproic acid (Depakote)

Answer 27

liver failure, pancreatitis, weight gain

Question 28

adverse effects of carbamazepine (Tegretol)

Answer 28

aggranulocytosis
aplastic anemia
hyponatremia

Question 29

adverse effects of lamotigine (Lamictal)

Answer 29

Stevens-Johnson syndrome

Question 30

anxiolytics used in bioplar

Answer 30

clonazepam (Klonopin)

lorazepam (Ativan)