exam ii: ch13 - bipolar and related disorders Flashcards

1
Q

what can bipolar disorder be misdx as?

A

depression

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2
Q

consequences of misdx?

A

incorrect tx, incorrect meds
can induce MANIC EPISODE

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3
Q

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

A

bipolar i

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4
Q

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

A

bipolar ii

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5
Q

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

A

bipolar mixed (cyclomythic)

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6
Q

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

A

mania

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7
Q

what is at risk with depression and manic agitations?

A

violence and/or suicide

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8
Q

what is the priority during a manic episode

A

basic physiologic needs

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9
Q

3 phases of mania

A
  1. acute
  2. continuation
  3. maintenance
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10
Q

interventions for acute phase of mania

A

hospitalization
medical stabilization
safety
seclusion/restraints
**prevent injury

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11
Q

interventions of continuation phase of mania

A

maintain med adherence
psychoeducation
referrals

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12
Q

interventions of maintenance phase of mania

A

prevent relapse

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13
Q

rapid speech pattern with an inappropriate sense of urgency

A

pressured speech

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14
Q

adding unnecessary details when communicating-eventually get to the point

A

circumstantial speech

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15
Q

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

A

tangential speech

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16
Q

disordered processing of info, thought are loosely connected

A

loose associations

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17
Q

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

A

flight of ideas

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18
Q

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

A

clang associations

19
Q

distorted and generally false thoughts

20
Q

inflated self regard and exaggerated achievements or importance

A

grandiosity or grandiose delusions

21
Q

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

A

persecutory delusions

22
Q

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

23
Q

hallucinations, delusions, dramatically disturbed thoughts

24
Q

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

A

rapid cycling

25
what are 3 neurotransmitters that can lead to manic episode?
norepinephrine, serotonin, dopamine
26
3 benefits of seclusion
1. dec overwhelming stimuli 2. protects pt from harm to self/others 3. prevents destruction of property
27
diet for manic pts
high protein, high cal
28
when to schedule activities for manic pts
in the evening
29
what to avoid for manic pts
caffeinated beverages
30
what is the first line agent for bipolar disorder
lithium carbonate
31
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
32
how often to draw lithium levels
q2-3 days
33
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
34
advanced lithium toxicity - level - s/s
- level = 2.0-2.5 - s/s: ataxia, blurred vision, dilute urine, seizures, hypotension, edema, stupor
35
severe lithium toxicity - level - s/s - intervention:
- level = >2.5 - s/s: seizures, oliguria, death, kidney failure - intervention: hospitalization, hemodialysis
36
divalproex (Depakote) - class - indication - SE: - N-INT:
- class: anticonvulsant - indication: mixed cycling - SE: tremor, weight gain, sedation - N-INT: baseline liver fxn, serum levels
37
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
38
iamotrigine (Lamictal) - class - indication - SE:
- class: anticonvulsant - indication: cycling, dec impulsive and aggression - SE: STEVENS JOHNSONS SYNDROME
39
why use clonazepam (Klonopin) and lorazepam (Ativan)
used in mania to dec agitation
40
relationship between lithium and creatinine
inc creatinine when taking lithium
41
what to rec if manic pt cannot sleep d/t having so much energy (from AQ)
encourage freq rest periods throughout the day
42
what antianxiety med is usually given to pts with acute mania
clonazepam
43