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N353: Practice of Nursing II > Module 5 - Mood Disorders - Bipolar/Depression > Flashcards

Module 5 - Mood Disorders - Bipolar/Depression Flashcards

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1
Q

Depressive Disorders

A

Disturbance in psychological, physiological and social functioning

Has a wide range of symptoms with disturbances in daily patterns

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2
Q

Depressive Disorder Symptoms

A

Sleep, Appetite, ADL problems, weight, attention, memory, libido

Impulse control, suicidal ideation, social withdraw

physical symptoms like H/A, stomachache, muscle tension

Symptoms present differently between patients

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3
Q

Physical Symptoms are common in depression and are often called ___ symptoms

A

somatic

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4
Q

Levels of Depression

A

Transient Depression

Depressive Disorder

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5
Q

Transient Depression Level

A

A normal reaction to loss

everyone experiences this at some point

sadness directly attributable to a situation or disappointment - “reactive or secondary depression!”

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6
Q

Depressive Disorder Level

A

sad mood can be related to external events or not

symptoms range from dissatisfaction with life to sudden and abrupt changes in function that suppress or take away the will to live

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7
Q

The most common illness of any medical or psychiatric illness is?

A

Major Depression / Major Depressive Disorder

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8
Q

Depression affects who?

A

all ages and backgrounds

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9
Q

Depression is the current leading cause of __ in the US in ages 15-44, and is predicted to be the 2nd leading cause in all ages by 2020

A

disability

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10
Q

Average Age of Depression disorder

A

32 yo

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11
Q

How much of the Us population has major depression?

A

14.8 million people aged 18 yo or older

that is 6.7% of the population

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12
Q

15% of those with depressive disorder will….

A

die via suicide

very prevalent in older people

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13
Q

Comorbidities that frequently accompany other psychiatric disorders like depression?

A

Schizophrenia

Substance Abuse

Eating Disorders

Anxiety Disorders

Personality disorders

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14
Q

Risk Factors for Depression

A

Higher in women than men

Past episodes of depression

Family history

Stressful life event

Current substance use

Medical illness

Limited social supports

know the persons PMH and the whole picture

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15
Q

Etiology for Depression

A

Exact cause is Unknown!! but.. there is a combination of Interactions Between:

-Genetics (increased risk if first degree relative has it, NT deficiency in Dopamine, NEP and Serotonin)

-Environment

-Individual life history

-Development

-Neurobiological

-Irregularities in the thyroid as especially important in relation to major depressive disorder

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16
Q

Regions of the Brain affected by depression

A

Thalamus

Cingulate Gyrus

Amygdala

Prefrontal Cortex

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17
Q

Thalamus

A

Assoc with changes in emotion and stimulates the amygdala

In depression there is INCREASED levels of activity

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18
Q

Amygdala

A

responsible for negative feelings

In depression there is INCREASED levels of activity / overactivity

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19
Q

Cingulate Gryus

A

Helps associate smells and sights with pleasant memories of past emotions and takes part in emotional reaction to pain and regulation of aggression

In depression there is INCREASED activity

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20
Q

Prefrontal Cortex

A

helps regulate emotions

In depression there is DECREASED activity

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21
Q

Primary Depressive Disorders

A

Major Depressive Disorder

Persistent Depressive Disorder (Dysthymia)

Post Partum Depression

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22
Q

Major Depressive Disorder

A

Potential for pain and suffering in all aspects of life

Affects kids, teens, adults, elderly, everyone

it is a depressed mood or inability to feel pleasure from previously enjoyed activity - this is the key thing!

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23
Q

What is needed for diagnosis of Major Depressive Disorder

A
  1. 4 out of 7 Symptoms (Suicidal Ideation, Sleep disruptions, Appetite disruptions/weight issues, disruption in concentration, disruption in energy level, psychomotor agitation/retardation, or excessive guilt/feelings of worthlessness)
  2. Must occur over a MINIMUM OF 2 WEEKS
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24
Q

What features may major depressive disorder symptoms include?

A

Psychotic Features

Catatonic Features

Melancholic Features

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25
Q

Dysthymia

A

Persistent Depressive Disorder

It is a chronic depressed mood with symptoms of poor appetite or over eating, insomnia or excessive sleep, low energy, fatigue, low self esteem, poor concentration, difficulties making decisions and feelings of hopelessness

Less severe than MDD but presents as a LIFE LONG struggle against depression, chronic negativity and irritability

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26
Q

How long must Dysthymia occur for diagnosis?

A

> 1 year for children and adolescents

> 2 years for adults and the elderly

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27
Q

What are the must have symptoms for MDD diagnosis?

A
  1. Depressed Mood
  2. Loss of Interest
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28
Q

What is the average length of MDD?

A

4-12 months

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29
Q

What is the average length of Dysthymia?

A

averages more days than not with s/s for at least 2 years

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30
Q

Post Partum Depression

A

more serious and persistent

Lasting weeks of months after a pregnancy

can emerge any time during the 1st year after childbirth

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31
Q

What leads to a higher incidence of post partum depression

A

previous psych history

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32
Q

Untreated post partum depression…

A

can become dangerous for the family and affected individual

*if they have HCP they need to be screened and treated

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33
Q

How obvious is Post Partum depression

A

Obvious in some women where other clients may not be as ready to share their feelings - so make sure to watch non verbal’s

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34
Q

Assessment Tools for Depression

A

Beck Depression inventory

Hamilton Depression scale

Geriatric Depression scale

Zung Depression scale

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35
Q

When it comes to psych what always comes first?

A

Safety (for your and patient)

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36
Q

It is important to always assess for what with depression patients

A

suicidal risk, ideation, and intent

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37
Q

Key Symptoms of Depression seen in an Assessment

A

Depressed Mood

Anhedonia

Anxiety

Psychomotor Agitation or Retardation

Somatic Complaints

Vegetative State - Physical and Mental inactivity

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38
Q

Anhedonia

A

inability to have pleasure/feel pleasure

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39
Q

Areas to Assess in Depression patients

A

Mood

Affect

Thought Processes

Feelings

Physical Behaviors

Communication

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40
Q

Assessment of Mood in Depression

A

subjective report of clients emotional state that impacts current life situation

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41
Q

Assessment of Affect in Depression

A

emotional tone the client projects - physical appearance, posture, mood, eye contact, speech, withdrawn, blunted and flat

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42
Q

Assessment of Thought Processes in Depression

A

insight and judgment, decision making, memory and concentration and delusions

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43
Q

Assessment of Feelings in Depression

A

anxiety, hopeless, helpless, guilt, anger and listless

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44
Q

Assessment of Physical Behaviors in Depression

A

hygiene and grooming, sleep patterns, appetite, bowel habits, libido and anorexia

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45
Q

Assessment of Communication in Depression

A

maybe soft spoken, mute, cadence, rate, response time

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46
Q

Potential Depression Related Nursing Diagnoses

A

Risk for Suicide

Hopelessness

Powerlessness

Disturbed Thought Process

Ineffective Coping

Risk for Violence

Ineffective Health Maintenance

Impaired Social Interaction

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47
Q

Therapeutic Communication

A

Involves:

  1. Counseling and encouraging engagement in treatment
  2. encouraging self care activities
  3. maintain therapeutic milieu
  4. health teaching
  5. administering meds per physician/advanced practice nurse
  6. assess effects of medications and treatments
  7. educate on coping skills and medications
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48
Q

What always bubbles to the top of psychiatric (and in general) nursing in regard to treatment ?

A

Therapeutic Communication

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49
Q

Define Communication

A

conveying info through verbal and nonverbal behaviors.

sending and receiving messages

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50
Q

Define Therapeutic Communication

A

nurse demonstrates empathy, effective communication skills, and responds to clients thoughts, needs, and concerns

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51
Q

Define Nontherapeutic Communication

A

nurse responds in ways that cause defensive feelings, misunderstood, controlled, minimized, alienated, discouraged from expressing self, thoughts, and feelings

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52
Q

Examples of Therapeutic Communication Techniques

A

Giving Broad Openings

Paraphrasing

Offering General Leads

Reflecting Feelings

Voicing Doubts

Clarifying

Placing Events in time Sequence

Giving Information

Encouraging formulation of Plan

Testing Discrepancies

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53
Q

Examples of Non Therapeutic Communication Techniques

A

Social Responding

Asking Closed Ended Questions

Changing the Subject

Belittling

Making Stereotyped comments

Offering False Reassurance

Moralizing

Interpreting

Advising

Challenging

Defending

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54
Q

___ is a highly important behavior for Therapeutic communication

A

Listening (Actively)

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55
Q

Active listening involved focus on…

A

ALL behaviors that the client express, non verbal’s and verbal’s

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56
Q

What is required to actively listen

A

energy, concentration, specific skills to ask the right questions

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57
Q

What does active listening allow the client to do?

A

determine content and level of information disclosure

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58
Q

Active Listening involves:

A

maintaining eye contact

close proximity

projecting a relaxed environment

focus on what the client says, interpret interactions and respond objectively

remember to use non verbal’s when communicating with a client

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59
Q

What is the skill of “Confronting and Setting Limits”

A

Skill of pointing out in a caring way discrepancies between what the client does and says

It can describe behavior that is inconsistent or confusion

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60
Q

When confronting and setting limits what should you do?

A

Give at least two possible interpretations of the behavior (choices)

ask for feedback

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61
Q

How does Self Disclosure play into Therapeutic Communication?

A

It is a technique that should not be used - you should not be disclosing sensitive topics about yourself that are heavy and you have not fully mastered them

Personal information can however help a client open up, not meet your needs, so it can be used if you have total control and keep it brief

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62
Q

Use self disclosure to … not…

A

to help the client open up not meet your needs

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63
Q

Rules for Self Disclosure

A

keep it brief

do not imply your situation is the same as the client

only disclose situations you have mastered

do not use to discuss painful situations

curb your talk about yourself

needs to be appropriate and comfortable

nonverbals should be monitored during it to check if the client is receptive

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64
Q

Treatments for Depression

A

Safety Always comes first!!!!!!!!!!!!!

Psychotherapy and Meds

Group therapy and counseling

family therapy and family involvement

Electroconvulsive therapy

social skills training and milieu therapy

cognitive behavioral therapy

65
Q

What is the most effective combination to treat depressive disorders?

A

Psychotherapy and Medications

66
Q

ECT is used as a treatment when…

A

other treatments and meds don’t work

67
Q

It is important to do what during depression treatment other than just treat symptomatically?

A

get to the root cause

68
Q

SSRIs

A

Selective Serotonin Reuptake Inhibitors (Prozac, Zoloft, etc)

1st Generation serotonergic agents which are considered FIRST LINE DRUGS for depression, unless patients medical history or condition warrants use of a different medication

69
Q

How do SSRI antidepressants compare to other antidepressants?

A

They generally have fewer side effects than others, but do cause things like nausea, headache, and loss of libido

They have minimal anticholinergic or cardiotoxic side effects

70
Q

What is a possible lethal reaction to SSRIs?

A

Serotonin Syndrome

71
Q

Serotonin Syndrome typically follows use of what kinds of drugs?

A

SSRIs

TCAs

Tryptophan

Dextromethorphan

Meperidine alone, or with MAOIs

St Johns Wart

72
Q

What are the first line antidepressants?

A

SSRIs (also SARIs and SNRIs)

73
Q

How long does it take to see a good response from most antidepressants?

A

2-6 weeks

74
Q

Serotonin Syndrome

A

Potentially lethal reaction to SSRI and other antidepressant use

75
Q

S/S of Serotonin Syndrome

A

Confusion and Disorientation

Mania and Restlessness

Rigidity

Diaphoresis

Tremors

Coma, even could rarely lead to death

76
Q

Treatment for Serotonin Syndrome

A

stop all serotonergic drugs, give anticonvulsants if ordered or possibly a serotonin antagonist

77
Q

Atypical Antidepressants

A

Second line antidepressants

considered safer than TCAs or MAOIs

ex: Remeron or Trazodone

78
Q

Tricyclic Antidepressants (TCA)

A

These are an older kind of antidepressant (first gen) used before SSRIs and Atypical Antidepressants

They used to be the first line drugs against depression (ex: Elavil)

79
Q

Why are TCAs not used anymore?

A
  1. Cardiotoxic Effects
  2. Narrow Therapeutic Window
80
Q

What kind of patients never get TCAs?

A

Suicidal Patients

81
Q

What are some current uses for TCAs?

A
  1. Patients have been unsuccessful on SSRIs or Atypical antidepressants or have documented past success with TCAs
  2. Used for patients who also have certain GI disorders such as peptic ulcer disease
82
Q

Monoamine Oxidase Inhibitors (MAOIs)

A

Another older antidepressant, not used much anymore since the development of SSRIs

ex: Nardil

Increases tyramine levels

83
Q

When may MAOIs be used nowadays?

A

To treat atypical depression or for patients not showing responses to other antidepressants

84
Q

MAOIs and Tyramine?

A

Tyramine is a compound in the body that increases with MAOI use

Patients need to be careful about eating high tyramine food because high levels lead to hypertensive crisis!!!

85
Q

Foods high in tyramine?

A

yogurt, aged cheeses, beef or chicken liver, canned meats, fish, sausage, avocado, eggplant, alcoholic beverages, chocolate and meat tenderizer.

86
Q

Things to do during Counseling

A

Help client ID and question cognitive distortions

Encourage activities that improve self esteem

encourage exercise

encourage supportive relationships

provide referrals for spiritual interventions when needed

87
Q

Family Therapy

A

An assessment, intervention and evaluation of family functional and dysfunctional patterns of behavior

Need to examine interactions between parents and children

Goal is to help family members identify and change behaviors that maintain depression and dependence among family members

88
Q

Electroconvulsive Therapy (ECT)

A

A therapy that is used if psychopharmacy and all other tx’s are ineffective

It produces a seizure thought to modify neurotransmissions

Short acting anesthesia and muscle paralyzing agents are used

89
Q

What are some ECT side effects?

A

Few long term side effects

Can cause memory loss or confusion lasting a few weeks or months after series is complete

90
Q

Contraindications for ECT?

A

no absolute contraindications, but some conditions pose a risk:

Recent MI

CVA

Intercranial Mass

91
Q

ECT is not usually used for clients unless…

A

need is compelling and all else fails

92
Q

What is needed in addition to normal procedure to do ECT?

A

additional high risk consent

skill required

93
Q

Why may ECT be good for a pregnant woman?

A

There are no harmful risks to the fetus but antipsychotic drugs can be harmful

94
Q

Cases where ECT may be useful?

A

Major Depression and Bipolar Disorders - especially when psychotic features are present

Depression with psychomotor retardation or stupor

Rapid cycling bipolar disorder

Schizophrenia (especially catatonic)

Schizoaffective Syndromes

Pregnant psychotic patients

Parkinson’s Disease patients

95
Q

Nursing Care for ECT

A

Routine pre and post anesthesia care

May need to orient client after awakening

Provide supportive care for memory loss (may last for a few weeks; occasionally does not recover)

Inform that this is not a permanent cure

Watch for falls

96
Q

After ECT, patients are at high risk for…

A

falls

97
Q

Cognitive Behavioral Therapy

A

Therapy attempting to help clients identify and correct distorted, negative and catastrophic thinking, therefore relieving symptoms - change the way they think

It is done in a group OR individual setting

Hope is to work actively with clients to change faulty thought pattersn

98
Q

Cognitive Behavioral Therapy is a common treatment for …

A

depressive disorders

99
Q

What sort of things can Milieu Therapy do for a person?

A

supportive group activities

protection from suicide intent

assertiveness training

assistance with grooming and hygiene

brief and frequent interpersonal contacts

ensure adequate nutrition

prevent constipation

discourage daytime sleep

100
Q

How should a nurse assess themselves when working with depressed clients?

A

Know unrealistic expectations for outcomes

Understand depression is a systemic illness with a complex interaction of causes and IS treatable

Know depressed clients can cause feelings of depression, frustration, anger, and hopelessness

Nurses need to care for themselves as well as the client!

101
Q

What are some aspects of proper health teaching for depression?

A

Teach client and family that depression is a legitimate illness

Teach S/S

Review medications

Relaxation techniques

Appropriate humor can be used

102
Q

What are some good outcome criteria for depression patients?

A

Remains safe

Reports hope for future

Stabilize to prevent decompensation

Reports improved mood

Plans strategies to reduce effects of precursors of depression

103
Q

Bipolar Disorder

A

It is a recurrent mood disorder featuring at least one episode of mania or hypomania

104
Q

What is the big difference between depression and bipolar?

A

Depression is marked by mood disturbance where the person feels sad/down

Bipolar disorders are also marked with this but the main difference is these clients will experience mood swings from significant depression to extreme euphoria (manic)

105
Q

What is the Incidence and Prevalence of Bipolar Disorders like in the US

A

2.6% of the population have it

average age of first manic episode is 25

estimated 25-50% of clients with bipolar disease attempt suicide at least once in their life with 15% completing it

106
Q

Earlier onset of bipolar disorder is associated with what?

A

worse outcomes, including rapid cycling in adulthood

107
Q

Common Comorbidities with Bipolar Disorders

A

Substance Abuse

Personality Disorders

Anxiety Disorders

Psychosis

Increased risk of morbidity and mortality

108
Q

Why are rates of morbidity and mortality in bipolar depression so high and what is this associated with?

A

It is high because of suicide rates and also because in the manic state the body can become exhausted

This exhaustion is associated with cardiovascular, cerebrovascular, and respiratory diseases and other psychiatric illnesses and substance use disorders

109
Q

Types of Mood Episodes in Bipolarism

A

Mania

Hypomania

Depression

110
Q

Mania

A

Episode of abnormal and persistent elevated, expansive, or irritable mood

It involves extreme mood swings, sudden outburst, sleep disturbances (sometimes days or weeks), feeling full of energy, grandiosity, distracted, restlessness, exaggerated self esteem, “flight of ideas”, pressured speech, sexual promiscuity, and flamboyant dress

111
Q

Manic Episodes are severe enough to cause __ __

A

marked impairment

112
Q

People undergoing a manic episode need to be what?

A

hospitalized in order to prevent harm to self or others!

113
Q

Symptoms of Mania are…

A

NOT due to other causes like substance abuse, physical disease, etc

114
Q

Hypomania

A

A more mild mania without the marked impairment and with judgment still remaining intact

There is no need for hospitalization to prevent harm to others or self

Symptoms are still not due to other causes

There are no psychotic features

115
Q

Bipolar I Disorder

A

One or more manic episodes alternative with major depressive episodes

Depressive symptoms here are far less responsive to conventional therapies than manic symptoms

Can undergo mixed state

116
Q

Mixed State

A

State or episode where the individual has rapidly alternating moods between depression and mania

117
Q

Bipolar II Disorder

A

A major depressive episode and at least one hypomanic episode

No history of a manic episode or mixed episode can exist

It is more long term presentations of symptoms but they function better and may not need hospitalization

118
Q

Why can Bipolar II Disorder be hard to diagnose?

A

It can be hard because it looks like depression and it can be even harder if its the persons first depressive episode

119
Q

Cyclothymia

A

Bipolar disorder

Clients experience repeated periods of nonpsychotic depression and hypomania for at least 2 YEARS (1 year for kids and adolescents)

A very long term battle

120
Q

When is the only time Cyclothymia is diagnosed?

A

if a client’s symptoms have never met the criteria for a MAJOR depressive or manic episode

121
Q

Rapid Cycling

A

Bipolar Disorder

Clients have 4 or more manic episodes for at least 2 weeks in a single year

Patients do not respond to classic therapy often and may need ECT

122
Q

What are rapid cycling episodes marked by?

A

either partial or full remission for at least 2 months or a switch to an episode of the opposite type

123
Q

Rapid Cycling is associated with what?

A

High risk for recurrence and resistance to conventional drug treatments and classic therapy, may need ECT

124
Q

Rapid cycling has greater severity of…

A

illness and prominent depressive symptoms

125
Q

Early Detection of Bipolar Disorders can prevent…

A

suicide

accidents

substance abuse

marital or work problems

medical comorbidity

legal problems

financial problems

126
Q

Mood Characteristics of Mania

A

hypomanic to manic

sociality and euphoria all the way to hostility, irritability, and paranoia

127
Q

Behavior Characteristics of Mania

A

hyperactivity

bizarre and colorful dress

highly distractible

impulsive

128
Q

Thought Process Characteristics of Mania

A

flight of ideas

grandiosity

poor judgment

auditory hallucinations and delusional thinking (psychosis)

129
Q

Cognitive Function Characteristics of Mania

A

significant and persistent problems

difficulties in psychosocial areas (difficulty socializing)

130
Q

Things the nurse should be aware of with manic patients?

A

Manipulative

Cause Splitting

Aggressively Demanding (need a team approach to fix this)

131
Q

Splitting

A

Staff Splitting

Need consistency with manic patients because they can cause fighting between shifts.

132
Q

Important Staff Member Actions for Manic Patients

A

Set limits consistently

frequent staff meetings to deal with patient behavior and staff response is needed.

133
Q

What things may indicate danger to self or others in a Manic patient?

A

Assess for suicidal thoughts or plans

May exhaust themselves to the point of needing emergency medical interventions

May not eat or sleep for days at a time

Poor impulse control - is that present?

134
Q

Nursing Diagnoses for Bipolar Disorders?

A

Risk for Violence Self / Others

Ineffective Health Maintenance

Impaired social interaction

Ineffective Coping

Disturbed Thought Processes

Situational Low Self – Esteem

Ineffective Therapeutic Regimen Management

135
Q

Things to Plan for in the Acute Phase of Bipolar Disorders

A

Maintaining safety (hospitalization, self care to stay alive, medicine)

Medication stabilization

Self care

136
Q

Things to Plan in the Continuation phase of bipolar disorders

A

Maintain medication compliance (meds even when better and education is important)

Psycho education teaching

Counseling

137
Q

Things to plan in the maintenance phase of bipolar disorders

A

prevent relapse (make sure they have supports and are taking meds to prevent return to the hospital)

138
Q

What techniques need to be implemented in the Acute Phase of bipolar disorders

A

communication (therapeutic) (very important with staff and patient)

structure in a safe milieu (they need a structured task to work on)

physiological safety

self care needs

139
Q

How to properly communicate with a manic patient?

A

Use firm, calm approach!!

Use short and concise explanations

remain neutral: avoid power struggles

be consistent in approach and expectations

firmly redirect energy into more appropriate areas

140
Q

Common Psychotherapy Modalities to use in bipolar disorders?

A

Psychotherapy is used for bipolar disorders extensively and used in combination with meds:

psycho education

cognitive behavioral therapy

family focused treatment

interpersonal therapy

milieu therapy

intensive outpatient program

141
Q

What is the first line treatment drugs for bipolar disorders?

A

Mood Stabilizer Drugs

142
Q

What are 2 properties that define Mood Stabilizers?

A
  1. Provide relief from acute episodes of mania or depression
  2. They do not worsen depression or mania or lead to increases in cycling
143
Q

Most common and first line Mood Stabilizer for Bipolar disorder?

A

Lithium

144
Q

What does Lithium do as a mood stabilizer?

A

Prevention and treatment of mania

Affects the clock cycle to restore daily rhythms

May also be used to reduce suicidal tendencies in Bipolar clients

145
Q

Anticonvulsants (As a mood stabilizer)

A

Sometimes prescribed instead of Lithium when clients don’t experience a response from Lithium or have intolerable side effects to lithium

Examples: Depakote, Tegretl, Lamictal, Equetro

146
Q

How long does it take for Lithium to reach therapeutic levels in the blood?

A

7 to 14 days

147
Q

What is the therapeutic blood level of lithium and what is the maintenance blood level?

A

Therapeutic: 0.8 to 1.4 mEq/L

Maintenance: 0.4 to 1.3 mEq/L

148
Q

Major Long term risks of Lithium?

A

You have to monitor lithium closely cause it has substantial side effects:

  1. Hypothyroidism
  2. Impairment of kidneys ability to concentrate urine
149
Q

What are some Lithium contraindications?

A

Cardiovascular disease

Brain damage

Renal disease

Thyroid disease

Myasthenia gravis

Pregnancy

Breastfeeding mothers

Children younger than 12 years

150
Q

What may be done for initial treatment of acute mania after administering lithium?

A

As lithium can take several days to take effect in an acute situation, other treatments are used while the patient is in the acute phase

151
Q

What can antipsychotics do for initial treatment of acute mania?

A

While waiting for lithium to work:

  1. It can slow thought processes and slow down speech
  2. Inhibit aggression
  3. Decrease psychomotor activity
152
Q

What can antipsychotics or Benzodiazepine be used to prevent in initial treatment of acute bipolar disorder?

A

While waiting for lithium to work it can prevent:

  1. Exhaustion
  2. Coronary Collapse
  3. Death

ex: Klonopin and Ativan

153
Q

Things to teach the client and family about lithium therapy? (very important!)

A

Effects of treatment

Need to monitor lithium blood levels

side effects at therapeutic levels

effects of food and over the counter medications

when to call the provider

154
Q

Potential Lithium side effects at Therapeutic Levels

A

fine hand tremors

GI upset

thirst

muscle weakness

155
Q

Potential Lithium adverse effects at Toxic Levels

A

persistent GI upset

coarse hand tremors

confusion

hyperirritability of muscles

sedation

ECG changes

156
Q

Why is consistent sodium intake important with lithium?

A

decreased sodium intake can decrease excretion of lithium leading to toxic levels

157
Q

When is Electroconvulsive therapy used for a bipolar patient?

A
  1. Used if pharmacologic interventions fail or symptoms require immediate relief
  2. severe manic behavior
  3. rapid cycling
  4. paranoid, destructive features
  5. acutely suicidal behavior
158
Q

When is Milieu Therapy - Seclusion Room or Restraints used in an emergency for clients with bipolar disorder?

A
  1. Clear risk of harm to client or others
  2. Clients behavior has continued despite use of less restrictive methods to keep client and others safe

However always use the least restrictive type first

159
Q

What are some of the associated issues with Seclusion or Restraints?

A

Therapeutic behaviors (may not help much)

Ethics

State and federal laws

Hospital protocols

You need specific documentation when doing it

N353: Practice of Nursing II (14 decks)

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