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NURS 406 > Mood Disorders ppt > Flashcards

Mood Disorders ppt Flashcards

1
Q

Epidemiology of Bipolar Disorder?

A

No gender differences

Females are at greater risk for depression

Males are at greater risk for manic episodes

Symptoms before age 25

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2
Q

Etiology of Bipolar Disorders

A

A strong association with genetics

Psychosocial stress

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3
Q

Two categories of Bipolar Disorder

A

Bipolar I

Bipolar II

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4
Q

Bipolar I

A

Bipolar I disorder is the classic manic-depressive disorder with mood swings alternating from depressed to manic.

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5
Q

Manic Episode of Bipolar Disorder- What is the pneumonic?

A

DIGFAST:

Distractability
Irritability
Grandiosity
Flight of ideas or racing thoughts
Activity (increase in goal directed activities)
Sleep deficit
Talktativeness

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6
Q

Diagnostic Criteria of a Manic Episode

A

Duration of at least 1 week of (DIG FAST): Three or more s/s (4 if only irritable) lasting 1 week

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7
Q

To be diagnosed with Bipolar I, what must occur?

A

To be diagnosed with bipolar I disorder, at least one manic episode or mixed episode and a depressive episode have to occur.

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8
Q

What does mixed episode mean?

A

The term mixed episode is used when mania and depression occur at the same time, which leads to extreme anxiety, agitation, and irritability.

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9
Q

Bipolar II

A

Depressive episode and hypomania (less severe mania)*

Hypomania - able to continue with day-to-day responsibilities

The elevated mood is not so severe that the person requires hospitalization or experiences significant disruption at home or work*

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10
Q

Hypomania:

A

Hypomania, a mild form of mania, is characteristic of bipolar II disorder.

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11
Q

Bipolar Disorders Across the Life-Span: Children and Teens

A

Depression usually occurs first in children

The hallmark of childhood bipolar disorder is intense rage.

These children often have other psychiatric disorders, such as attention-deficit hyperactivity disorder or conduct disorder

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12
Q

Nursing Process: Assessment

A

History

General appearance and motor behavior (clothes reflecting elevated mood)

Mood and affect (periods of euphoria, grandiosity)

Thought process and content (circumstantiality, tangentiality)

Sensorium and intellectual processes (disoriented to time)

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13
Q

Nursing Process: Assessment continued

A

Judgment and insight- does symptoms impact day to day and do they realize it?

Self-concept (exaggerated self-esteem)

Roles and relationships (in manic phase can rarely fulfill role responsibilities)

Physiological and self-care considerations

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14
Q

Outcome identification examples of bipolar disorder

A

No injury to self or others

Balance of rest, sleep, and activity

Socially appropriate behavior

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15
Q

What is part of nurse management for Bipolar

A

During mania, patients usually violate others’ boundaries, and they may miss the cues indicating anger and aggression from others.

Priority* protecting the patient from self-harm as well as harm from others

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16
Q

What is the first line treatment for mania/suicidal thoughts?

A

Lithium

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17
Q

Lithium

A

Mood stabilizer

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18
Q

What is medication is contraindicated with mania?

A

Antidepressants

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19
Q

When is lithium contraindicated?

A

Impaired kidneys

Impaired Thyroid

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20
Q

What should you assess before and while taking Lithium?

A

Renal function/creatinine functions

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21
Q

Normal Creatinine for men

A

0.74 to 1.35 mg/dL

65.4 to 119.3 micromoles/L

22
Q

Normal Creatinine for adult women

A

For adult women, 0.59 to 1.04 mg/dL

(52.2 to 91.9 micromoles/L)

23
Q

What does litium do to thyroid

A

Can reduce thyroid secretion which can result in hypothyroid.

24
Q

What does TSH mean?

A

Thyroid Stimulating Hormone

from the pituitary gland

25
Q

How does hypothyroidism show up in a test?

A

Elevated TSH is not making enough thyroid hormone = hypo

26
Q

Normal TSH test range for an adult

A

Normal TSH Normal test range for an adult:0.40 - 4.50 mIU/mL(milli-international units per liter of blood).

27
Q

When taking Lithium, what should you do?

A

Maintain salt intake.

Maintain adequate fluid intake

Assess therapeutic blood levels 0.6 to 1.2.

Blood tests 12 hours after last dose. Monitor serum plasma concentration every 4-6 days after initiation and 2-3 months for the first 6 months

28
Q

Why do you need to maintain salt intake while taking Lithium?

A

A decrease can lead to toxicity. Assess sodium levels. A normal blood sodium level isbetween 135 and 145 milliequivalents per liter(mEq/L).

29
Q

A normal blood sodium level is

A

A normal blood sodium level isbetween 135 and 145 milliequivalents per liter(mEq/L).

30
Q

What is therapeutic blood levels of Lithium

A

Assess therapeutic blood levels 0.6 to 1.2.

31
Q

What serum Lithium level is considered toxic?

A

Toxicity 1.5 and above.

32
Q

Notable Effects of Lithium Toxicity

A

Tremor, ataxia, diarrhea, vomiting and sedation. STOP Lithium immediately.

Push fluids

33
Q

What should you avoid when taking Lithium?

A

Avoid diuretics that contribute to sodium loss & can contribute to toxicity.

Avoid nonsteroidal anti-inflammatory as it can increase Lithium concentration. Avoid naproxen & ibuprofen

34
Q

What does Lithium put you at an increased for?

A

Increased risk of Major Birth Defects such as cardiac abnormalities (Ebstein’s anomaly)*

35
Q

What are the medications involved in Bipolar Disorder?

A

Lithium (gold standard)

Divalproex sodium

Carbamazepine (second line agent)

Lamotrigine

Antipsychotic drugs

36
Q

What is Divalproex sodium (Valproate)?

A

Mood stabilizer & Anticonvulsant

37
Q

Divalproex sodium (Valproate)- what is it contraindicated in?

A

Processed via the liver and contraindicated with liver impairment

38
Q

What is the difference between lithium and Divalproex sodium (Valproate)?

A

Not as effective as lithium for reducing suicidal tendencies*

More effective than lithium for depressive symptoms*

39
Q

Normal Liver function test results

A

Normal Liver function test results range between7-56 units/litre for ALT and 10-40 got AST

40
Q

Serum blood levels while taking Depakote?

A

Serum blood levelsbetween 50 and 125 g/mL.

41
Q

Notable Side Effects of Depakote

A

Thrombocytopenia platelet count below the lower limit of normal, below 150000/microliter
- If experiencing bruising discontinue

Weight gain
-Increases appetite and subsequent weight
-Hair loss

42
Q

Second Line drug for Bipolar Disorder?

A

Carbamazepine

43
Q

Carbamazepine

A

Antiepileptic

Serves as protection against recurrence of mania and depression

44
Q

Serum blood level of Carbamazepine

A

Serum plasma level: 4 to 12 mcg/mL

45
Q

Notable Side Effects of Carbamazepine

A

Transient vertigo

Headache

N & V and diarrhea

Benign leukopenia (low white blood count) A countless than 4,000 cells per microliter is below normal

46
Q

What drug is approved for maintenance treatment of Bipolar Disorder?

A

Lamotrigine

47
Q

Lamotrigine

A

Mood-stabilizing anticonvulsant

48
Q

Side Effects of Lamotrigine?

A

Steven John Syndrome: Skin:rashes, blister, peeling, rash of small purplish spots, red spots, or small bump Whole body:fever or malaise.
Be mindful that Depakote can increase Lamictal levels. Need to lower Lamictal dose.
Serious as death occurs in 10% of the cases.

49
Q

Antipsychotic drugs- how are they used?

A

Can be used in conjunction with mood stabilizers during acute mania & long term for its mood stabilization properties

50
Q

Common Atypical Antipsychotics Utilized

A

Risperidone (Risperdal)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Lurasidone (Latuda)

NURS 406 (29 decks)

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