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Psychiatric Nursing > Bipolar Disorders > Flashcards

Bipolar Disorders Flashcards

1
Q

Involve extreme mood swings from episodes of mania to episodes of depression

A

Bipolar Disorders

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2
Q

severe mood elevation, expansion, or irritability that causes impairment in social or occupational function

A

Mania

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3
Q

Mania last for how long?

A

Must last at least one week

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4
Q

a milder form of mania

A

Hypomania

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5
Q

Hypomania must present for how long?

A

Must be present for at least 4 consecutive days

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6
Q

neutral mood

A

Euthymia

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7
Q

Manic Phase Symptoms

A

-Brightly colored clothing
-Flamboyant
-Sexually suggestive
-Attention:getting
-Pressured speech
-Difficulty sitting still

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8
Q

Unrelentingly rapid and often loud speech without pauses

A

Pressured speech

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9
Q

What are the types of Bipolar Disorders?

A

-Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymia

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10
Q

Depression + Mania

A

Bipolar I Disorder

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11
Q

Depression + Hypomania

A

Bipolar II Disorder

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12
Q

Chronic mood disturbance for at least 2 years

A

Cyclothymia

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13
Q

Theoretical Basis (Genetics)

A

-First-degree relatives of people with BP-1 are approximately 7 times more likely to develop BP-1 than the general population.
- Offspring of a parent with bipolar disorder have a 50% chance of having another major psychiatric disorder.
-Twin studies demonstrate a concordance of 33-90% for BP-1 in identical twins.

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14
Q

Serves as defense against the feelings of depression

A

Mania

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15
Q

May impact the onset of bipolar disorder, particularly in those patients with a family history of mood disorders

A

Large increase in springtime solar insolation

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16
Q

Management for Bipolar Disorders

A

Mood Stabilizers
-Lifetime treatment
-Can prevent acute cycles of bipolar behavior
-Regimen involves lithium, anticonvulsants, and atypical antipsychotics

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17
Q

The mechanism of action of Lithium Carbonate (Eskalith)

A

Normalizes reuptake of serotonin, NE, and Dopamine

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18
Q

The Lag Period of Lithium

A

5 to 14 days

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19
Q

Must know in Lithium

A

-Not metabolized and is excreted via urine
-Completes for salt receptor sites
-May elevate TSH levels

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20
Q

Lithium therapeutic range in acute mania

A

0.8 to 1.5 mEq/L

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21
Q

Lithium therapeutic range in maintenance

A

0.5 to 1.0 mEq/L

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22
Q

On what level toxicity occurs

A

Toxicity occurs at 1.5 mEq/L

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23
Q

Causes of Lithium Toxicity

A

-Dose is too high
- Diarrhea, vomiting
- Diaphoresis
- Dehydration

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24
Q

Range of Mild Lithium Toxicity

A

1.5 to 2.0 mEq/L

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25
Q

Range of Moderate Lithium Toxicity

A

2.0 to 3.0 mEq/L

26
Q

Range of Severe Lithium Toxicity

A

3.0 mEq/L and above

27
Q

The earliest sign of Mild Lithium Toxicity

A

Nausea/Vomiting or Diarrhea

28
Q

Classic signs of Mild Lithium Toxicity

A

Muscle weakness

29
Q

Classic signs of Moderate Lithium Toxicity

A

Muscle Rigidity

30
Q

May precipitate Diabetes Insipidus

A

Moderate Lithium Toxicity

31
Q

Classic signs of severe lithium toxicity

A

-Arrhythmias
-Shock-line manifestations
- Seizures

32
Q

Nursing responsibility for Lithium Toxicity

A

Promote adequate water intake (-2L/day) and continue with the usual amount of dietary table salt

33
Q

Nursing Responsibilities of Mild Lithium Toxicity

A

-Know when was the last dose of lithium given
- Facilitate testing of serum lithium level (12 hours after last dose)
- Doses may be suspended over a few days or reduced

34
Q

Nursing Responsibilities of Moderate Lithium Toxicity

A

-Facilitate STAT testing of serum lithium level
- Insert NGT and facilitate gastric lavage
- Administer IV fluids to replace lost electrolytes and maintain renal function

35
Q

Nursing Responsibilities of Severe Lithium Toxicity

A

-All preceding interventions
- Administer drugs that promote lithium excretion, as ordered
(Aminophylline)
(Mannitol)
-Hemodialysis
- Cardiovascular, Respiratory and Thyroid support as necessary

36
Q

What’s the anticonvulsants drugs?

A

-Carbamazepine
- Valproic Acid
-Clonazepam

37
Q

Mechanism of action of Carbamazepine

A

Unknown-off label use

38
Q

Side effects of Carbamazepine

A

drowsiness, sedation, dry mouth, rashes, orthostatic hypotension

39
Q

This drug may cause aplastic anemia (bone marrow does not produce sufficient blood cells

A

Carbamazepine

40
Q

Factors that cause aplastic anemia

A
  • Anemia
  • Leukopenia
  • Thrombocytopenia
41
Q

Carbamazepine has 2 causes

A

-May cause aplastic anemia
- Agranulocytosis

42
Q

Absence of granulocytes leading to dangerously low WBC count

A

Agranulocytosis

43
Q

What must be monitored in Agranulocytosis?

A

-Monitor for sore throat, fever, oral ulcerations

44
Q

The anticonvulsants drugs

A

-Valproic acid
- Clonazepam

45
Q

Side effects of Valproic Acid

A

-Drowsiness
-sedation
- dry mouth
-weight gain
- alopecia
- hand tremors

46
Q

MOA of valproic acid

A

Increases GABA levels

47
Q

This drug may cause a liver failure, pancreatitis

A

Valproic Acid

48
Q

A teratogenic drug which can cause neural tube defects

A

Valproic Acid

49
Q

A benzodiazepine anticonvulsant

A

Clonazepam

50
Q

This drug is used as adjunct to lithium and other mood stabilizers but must not be used alone in bipolar disorders

A

Clonazepam

51
Q

This drug may develop dependence

A

Clonazepam

52
Q

The antipsychotics drugs

A

-Aripiprazole
- Ziprasidone (Geodon)
- Quetiapine (Seroquel)

53
Q

A third-generation antipsychotic

A

Aripiprazole (Abilify)

54
Q

This drug is used when mood stabilizers alone are inadequate to control bipolar symptoms

A

Aripiprazole (Abilify)

55
Q

A second-generation antipsychotics

A

Ziprasidone (Geodon), Quetiapine (Seroquel)

56
Q

This drug is used in combination with mood stabilizers or antidepressants to treat bipolar disorders

A

Ziprasidone (Geodon), Quetiapine (Seroquel)

57
Q

Safety Precautions in Bipolar Disorders

A

-Directly ask patient for suicidal ideation and plans or thought of hurting others
-Monitor patient’s whereabouts and behaviors frequently
- Orient the patient that staff members will help him/her control the behavior if he/she cannot do so alone

58
Q

Limit setting in Bipolar Disorders

A

-It is important to clearly identify the unacceptable behavior and the expected, appropriate behavior
- All staff must consistently set and enforce limits for those limits to be effective

59
Q

Nutritional Management for Bipolar Disorders

A

-Offer finger foods
-Finger foods are things client can eat while moving around are the best options to improve nutrition
-High in calories and protein (sandwiches, protein bars, fortified shakes)
-Provide snacks in between meals
-Observe and supervise at mealtimes to prevent patient from taking food from others

60
Q

Communication Strategies for Bipolar Disorders

A

-Use clear and simple sentences
- Validate understanding by letting the patient repeat instructions
-Minimize distractions when engaging in conversations

61
Q

Behavior Modification Strategies for Bipolar Disorder

A

-Direct need for movement into socially acceptable, large motor activities:

-Arranging chairs for a community meeting
-Walking

Approach/Attitude: Uses a matter of fact attitude when dealing with sexually inappropriate behaviors, NEVER RIDICULE PATIENT!

Psychiatric Nursing (16 decks)

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