exam ii: ch13 - bipolar and related disorders Flashcards
what can bipolar disorder be misdx as?
depression
consequences of misdx?
incorrect tx, incorrect meds
can induce MANIC EPISODE
type of bipolar disorder
- most severe and fatal
- onset: 18yrs
- dx: at least 1 manic ep alternating with depression
- comorbidity: anxiety, ADHD, substance use, migraines, metabolic syndrome
- priority: stable cardiac status
bipolar i
type of bipolar disorder
- not as severe, NEVER psychosis
- more time in a depressive state
- dx: at least hypomanic ep alternating with 1 major depressive
- comorbidity: anxiety, eating disorder, substance use
bipolar ii
type of bipolar disorder
- hypomania with s/s mild depression, irritable hypomanic eps
- onset: adolescence
- at least 2yrs (adult), 1yr (child)
- dx: hypomania alt with mild depression but NOT enough to impair social/work
- comorbidity: substance use, sleep disorder, ADHD
bipolar mixed (cyclomythic)
period of intense mood disturbance with mood elevation, expansiveness, irritability, extreme goal-directed activity/energy (non-stop physical activity, lack of sleep, exhaustion
mania
what is at risk with depression and manic agitations?
violence and/or suicide
what is the priority during a manic episode
basic physiologic needs
3 phases of mania
- acute
- continuation
- maintenance
interventions for acute phase of mania
hospitalization
medical stabilization
safety
seclusion/restraints
**prevent injury
interventions of continuation phase of mania
maintain med adherence
psychoeducation
referrals
interventions of maintenance phase of mania
prevent relapse
rapid speech pattern with an inappropriate sense of urgency
pressured speech
adding unnecessary details when communicating-eventually get to the point
circumstantial speech
similar to circumstantial, but lost the point they want to make and never find it
tangential speech
disordered processing of info, thought are loosely connected
loose associations
continuous flow of accelerated speech changing from topic to topic with some connection in words or play on words.
- “hopscotching”, uses last word of sentence to bounce into a different idea
flight of ideas
stringing words together with rhyming sounds
- mellow, yellow, jello
clang associations
distorted and generally false thoughts
delusions
inflated self regard and exaggerated achievements or importance
grandiosity or grandiose delusions
fixed belief that one is being singled out for harm (God punishing them)
- possible issue with color red
persecutory delusions
excessive activity and energy for at least 4 days, PSYCHOSIS NEVER PRESENT
hypomania
hallucinations, delusions, dramatically disturbed thoughts
psychosis
at least 4 mood episodes in 12 months (bipolar I or II)
rapid cycling
what are 3 neurotransmitters that can lead to manic episode?
norepinephrine, serotonin, dopamine
3 benefits of seclusion
- dec overwhelming stimuli
- protects pt from harm to self/others
- prevents destruction of property
diet for manic pts
high protein, high cal
when to schedule activities for manic pts
in the evening
what to avoid for manic pts
caffeinated beverages
what is the first line agent for bipolar disorder
lithium carbonate
lithium carbonate
- class
- indication:
- onset
- TR (early, adv, severe)
- CI:
- expected SE:
- nursing interventions
- class: mood stabilizer
- indication: first line agent for bipolar disorder
- onset: slow
- TR = 0.8-1.2
early tox = 1.5-2.0
adv tox = 2.0-2.5
severe tox = >2.5 - CI: kidney disease, thyroid, pregnant
- expected SE: fine hand tremors, polyuria, thirst, weight gain, goiter, hypothyroidism
- nursing interventions: check HR and levels, take with meals, avoid alcohol
how often to draw lithium levels
q2-3 days
early lithium toxicity
- level
- s/s
- intervention
- level: 1.5-2.0
- s/s: GI upset, coarse hand tremor, hyper-irritability, sedation, incoordination
- intervention: hold med, take serum levels
advanced lithium toxicity
- level
- s/s
- level = 2.0-2.5
- s/s: ataxia, blurred vision, dilute urine, seizures, hypotension, edema, stupor
severe lithium toxicity
- level
- s/s
- intervention:
- level = >2.5
- s/s: seizures, oliguria, death, kidney failure
- intervention: hospitalization, hemodialysis
divalproex (Depakote)
- class
- indication
- SE:
- N-INT:
- class: anticonvulsant
- indication: mixed cycling
- SE: tremor, weight gain, sedation
- N-INT: baseline liver fxn, serum levels
carbamazepine (Tegretol)
- class
- indication
- SE:
- N-INT:
- class: anticonvulsant
- indication: prevent mania in acute manic situations
- SE: anticholinergic like, sedation, RASH, bone marrow suppression
- N-INT: liver fxn, CBC, serum levels
iamotrigine (Lamictal)
- class
- indication
- SE:
- class: anticonvulsant
- indication: cycling, dec impulsive and aggression
- SE: STEVENS JOHNSONS SYNDROME
why use clonazepam (Klonopin) and lorazepam (Ativan)
used in mania to dec agitation
relationship between lithium and creatinine
inc creatinine when taking lithium
what to rec if manic pt cannot sleep d/t having so much energy (from AQ)
encourage freq rest periods throughout the day
what antianxiety med is usually given to pts with acute mania
clonazepam
