exam ii: ch13 - bipolar and related disorders

Question 1

what can bipolar disorder be misdx as?

Answer 1

depression

Question 2

consequences of misdx?

Answer 2

incorrect tx, incorrect meds
can induce MANIC EPISODE

Question 3

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

Answer 3

bipolar i

Question 4

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

Answer 4

bipolar ii

Question 5

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

Answer 5

bipolar mixed (cyclomythic)

Question 6

period of intense mood disturbance with mood elevation, expansiveness, irritability, extreme goal-directed activity/energy (non-stop physical activity, lack of sleep, exhaustion

Answer 6

mania

Question 7

what is at risk with depression and manic agitations?

Answer 7

violence and/or suicide

Question 8

what is the priority during a manic episode

Answer 8

basic physiologic needs

Question 9

3 phases of mania

Answer 9

1. acute
2. continuation
3. maintenance

Question 10

interventions for acute phase of mania

Answer 10

hospitalization
medical stabilization
safety
seclusion/restraints
**prevent injury

Question 11

interventions of continuation phase of mania

Answer 11

maintain med adherence
psychoeducation
referrals

Question 12

interventions of maintenance phase of mania

Answer 12

prevent relapse

Question 13

rapid speech pattern with an inappropriate sense of urgency

Answer 13

pressured speech

Question 14

adding unnecessary details when communicating-eventually get to the point

Answer 14

circumstantial speech

Question 15

similar to circumstantial, but lost the point they want to make and never find it

Answer 15

tangential speech

Question 16

disordered processing of info, thought are loosely connected

Answer 16

loose associations

Question 17

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

Answer 17

flight of ideas

Question 18

stringing words together with rhyming sounds
- mellow, yellow, jello

Answer 18

clang associations

Question 19

distorted and generally false thoughts

Answer 19

delusions

Question 20

inflated self regard and exaggerated achievements or importance

Answer 20

grandiosity or grandiose delusions

Question 21

fixed belief that one is being singled out for harm (God punishing them)
- possible issue with color red

Answer 21

persecutory delusions

Question 22

excessive activity and energy for at least 4 days, PSYCHOSIS NEVER PRESENT

Answer 22

hypomania

Question 23

hallucinations, delusions, dramatically disturbed thoughts

Answer 23

psychosis

Question 24

at least 4 mood episodes in 12 months (bipolar I or II)

Answer 24

rapid cycling

Question 25

what are 3 neurotransmitters that can lead to manic episode?

Answer 25

norepinephrine, serotonin, dopamine

Question 26

3 benefits of seclusion

Answer 26

1. dec overwhelming stimuli
2. protects pt from harm to self/others
3. prevents destruction of property

Question 27

diet for manic pts

Answer 27

high protein, high cal

Question 28

when to schedule activities for manic pts

Answer 28

in the evening

Question 29

what to avoid for manic pts

Answer 29

caffeinated beverages

Question 30

what is the first line agent for bipolar disorder

Answer 30

lithium carbonate

Question 31

lithium carbonate
- class
- indication:
- onset
- TR (early, adv, severe)
- CI:
- expected SE:
- nursing interventions

Answer 31

• 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

Question 32

how often to draw lithium levels

Answer 32

q2-3 days

Question 33

early lithium toxicity
- level
- s/s
- intervention

Answer 33

• level: 1.5-2.0
• s/s: GI upset, coarse hand tremor, hyper-irritability, sedation, incoordination
• intervention: hold med, take serum levels

Question 34

advanced lithium toxicity
- level
- s/s

Answer 34

• level = 2.0-2.5
• s/s: ataxia, blurred vision, dilute urine, seizures, hypotension, edema, stupor

Question 35

severe lithium toxicity
- level
- s/s
- intervention:

Answer 35

• level = >2.5
• s/s: seizures, oliguria, death, kidney failure
• intervention: hospitalization, hemodialysis

Question 36

divalproex (Depakote)
- class
- indication
- SE:
- N-INT:

Answer 36

• class: anticonvulsant
• indication: mixed cycling
• SE: tremor, weight gain, sedation
• N-INT: baseline liver fxn, serum levels

Question 37

carbamazepine (Tegretol)
- class
- indication
- SE:
- N-INT:

Answer 37

• class: anticonvulsant
• indication: prevent mania in acute manic situations
• SE: anticholinergic like, sedation, RASH, bone marrow suppression
• N-INT: liver fxn, CBC, serum levels

Question 38

iamotrigine (Lamictal)
- class
- indication
- SE:

Answer 38

• class: anticonvulsant
• indication: cycling, dec impulsive and aggression
• SE: STEVENS JOHNSONS SYNDROME

Question 39

why use clonazepam (Klonopin) and lorazepam (Ativan)

Answer 39

used in mania to dec agitation

Question 40

relationship between lithium and creatinine

Answer 40

inc creatinine when taking lithium

Question 41

what to rec if manic pt cannot sleep d/t having so much energy (from AQ)

Answer 41

encourage freq rest periods throughout the day

Question 42

what antianxiety med is usually given to pts with acute mania

Answer 42

clonazepam