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NURS 419 > Quiz #2: Bipolar Disorders > Flashcards

Quiz #2: Bipolar Disorders Flashcards

1
Q

Bipolar Disorder Statistics

A
  • Less common than MDD
  • Associated with increased premature mortality secondary to general medical illnesses
  • As many as 60 – 70% of individuals with bipolar disorder meet diagnostic criteria for a lifetime history of substance abuse or dependence
  • Risk for alcohol or drug abuse is 6 – 7 x greater among people with bipolar disorder
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2
Q

Bipolar Disorder Etiology

A

Multiple independent factors

  1. Biological**
  2. Psychological
  3. Environmental
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3
Q

Etiology of Bipolar Disorder: Biological

A
  • Genetic – strong heredity
  • Neurobiological: Serotonin, Norepinephrine, and Dopamine
  • Neuroendocrine (rule out hyperthyroidism)
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4
Q

Etiology of Bipolar Disorder: Psychological

A

May play a role in precipitating manic episodes

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5
Q

Etiology of Bipolar Disorder: Environmental

A

More prevalent in upper socioeconomic classes; Those who achieve higher levels of education and higher occupational status; Children w/ stressful family environments and adverse life events may increase vulnerability toward bipolar

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6
Q

Describe Bipolar I Disorder

A
  • Characterized by at least one week-long manic episode
  • Manic episodes may alternate with depression or a mixed state of agitation and depression
  • Severe disorder that the person tends to have difficulty maintaining social connections and employment
  • Psychosis (hallucinations, delusions, and disturbed thoughts) may occur during manic episodes
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7
Q

Bipolar I Disorder: Mania

A
  • Extreme drive and energy
  • Inflated sense of self-importance
  • Drastically reduced sleep requirements
  • Excessive talking combined with pressured speech
  • Personal feeling of racing thoughts
  • Distraction by environmental events
  • Usually obsessed with and over-focused on goals
  • Purposeless arousal and movement
  • Dangerous activities such as indiscriminate spending, reckless sexual encounters, or risky investments
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8
Q

Describe Bipolar II Disorder

A
  • Low-level mania (hypomania) alternates with profound depression
  • Disorder is usually not severe enough to cause serious impairment in occupational or social functioning
  • Hospitalization is rare; however, depressive symptoms tend to put them at particular risk for suicide
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9
Q

Hypomania (Low Level Mania)

A
  • Tends to be euphoric and often increases functioning

- Psychosis is never present with this

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10
Q

Flight of Ideas

A
  • Nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations or plays on words
  • Example: “How are you doing, kid, no kidding around, I’m going home … home sweet home … home is where the heart is, the hart of the matter is I want out and that ain’t hay … hey, doc, … get me out of this place.”
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11
Q

Clang Associations

A
  • Stringing together of words because of rhyming sounds, without regard to their meaning
  • Example: “Cinema I and II, last row. Row, row, row your boat. Don’t be a cutthroat. Cut your throat. Get your goat. Go out and vote. And so I wrote.”
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12
Q

Grandiosity

A
  • Inflated self-regard – exaggerate their achievements or importance, state that they know famous people, or believe they have great powers.
  • Ex: God is speaking to them or that the FBI is out to stop them from saving the world
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13
Q

Bipolar Disorder: Moods Include

A
  • Euphoria
  • Joyous mood out of proportion with reality
  • Boundless enthusiasm
  • Labile
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14
Q

Bipolar Disorder: Behaviors Include

A
  • Nonstop Physical Activity
  • Starts a lot of projects
  • Excessive spending or giving away money
  • Poor Concentration
  • Highly distractible
  • Dress outlandishly
  • Sexual indiscretion
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15
Q

Bipolar Disorder: Though Process And Speech Patterns Include

A
  • Flight of ideas
  • Rapid Speech
  • Circumstantial
  • Speech can be incoherent or disorganized
  • Sexually explicit or inappropriate content
  • Loud or screaming
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16
Q

Bipolar Disorder: Assessment Guidelines

A
  • Assess whether patient is a danger to self and others
  • Assess need for protection from uninhibited behaviors. External control may be needed to protect patient from bankruptcy
  • Assess the need for hospitalization to safeguard and stabilize
  • Assess medical status – need thorough medical examination. Is mania primary or secondary to another condition.
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17
Q

Assessing whether the patient is a danger to self and others

A
  • Patients can exhaust themselves to the point of death
  • May not eat or sleep for days
  • Poor impulse control may result in harm to others or self
  • Uncontrolled spending
18
Q

Assessing medical status in patients with Bipolar Disorder

A
  • May be secondary to medical condition (hyperthyroidism, dementia, ADHD, certain anxiety disorders)
  • May be substance-induced (amphetamines)
19
Q

Outcomes during the acute phase of Bipolar Disorder

A
  • Safety

- Physiological

20
Q

Outcomes during the continuation phase of bipolar disorder

A
  • Knowledge of Disease and Medications

- Knowledge of early signs and symptoms of relapse

21
Q

Outcomes during the maintenance phase in bipolar disorder

A
  • Prevention of relapse

- Ongoing supportive therapy

22
Q

What is the nurses priority in planning care for a patient with bipolar disorder?

A

Geared toward particular phase of the mania the patient is in as well as any other co-occurring issues identified in the assessment (i.e risk of suicide, risk of violence to person or property, family crisis, legal cries, substance abuse, risk-taking behaviors.)

23
Q

Planning: Acute Phase

A
  • Medically stabilize patient while maintaining safety (the hospital is usually the safest environment for accomplishing this)
  • Geared toward managing medications, decreasing physical activity, increasing food and fluid intake, ensuring adequate sleep, alleviating bowel or bladder problems and ensuring self-needs are met.
24
Q

Planning: Continuation Phase

A

-Adherence to medication regimen and prevention of relapse

25
Q

Planning: Maintenance Phase

A

Preventing relapse and limiting severity and duration of future episodes

26
Q

Bipolar Disorder: Implementation

A
  • High priority on potential for harm toward others
  • Impose controls on destructive behaviors and provide medication stabilization
  • Continuously set limits
  • Provide frequent high-calorie food and frequent rest periods
  • Provide structured solitary activities with staff (avoid group activities if possible)
27
Q

Medications for Bipolar Disorder Include

A
  • Lithium
  • Anticonvulsants
  • Antipsychotics and Benzodiazepines
28
Q

Lithium

A
  • Reduces elation, grandiosity, flight of ideas, irritability, anxiety
  • Gold standard
29
Q

Lithium Therapeutic Range

A
  • 0.8-1.4 mEq/L

- Therapeutic range can take 7 – 14 days

30
Q

Anticonvulsants

A
  • Valproate (Depakote), Carbamazepine (Tegretol), Lamotigrine (Lamictal)
  • Beneficial in controlling mania and depression
31
Q

Antipsychotics and Benzodiazepines

A
  • Can be used while lithium is reaching therapeutic levels to prevent exhaustion
  • Antipsychotics act promptly to slow speech, inhibit aggression, and decrease psychomotor activity
32
Q

How does lithium help treat bipolar disorder?

A
  • Interacts with a # of neurotransmitters and receptors, decreasing norepinephrine and increasing serotonin synthesis
  • Specific biochemical mechanism of lithium action in mania is unknown
33
Q

Lithium and its relationship with water and sodium

A
  • Regular serum level tests because lithium interferes with sodium and water levels in body
  • Risk for dehydration
  • Need to stay hydrated because if dehydration occurs, lithium levels increase (think of hypo and hypernatremia)
  • Dehydration is due to lithium inhibition of the antidiuretic hormone which normally enables the kidney to reabsorb water from urine
34
Q

Side effects of Lithium

A
  • Increased WBC
  • Polyuria and polydipsia
  • Dry mouth
  • Confusion
  • Muscle Weakness
  • ECG Changes
  • Muscle twitching
  • Vertigo
35
Q

Symptoms of Lithium Toxicity

A
  • Asthenia (weakness)

- Ataxia(dysfunction in coordination of muscle movements)

36
Q

Lithium Side Effects based on levels of lithium in the blood: Expected Side Effects (0.4-1.0)

A
  • Fine hand tremors, polyuria, and mild thirst

- N/V

37
Q

Early signs of lithium toxicity (1.5)

A
  • Thirst, polyuria
  • Slurred speech
  • Muscle weakness, fine hand tremor
38
Q

Advanced signs of lithium toxicity (1.5-2)

A
  • Coarse hand tremor
  • Mental confusion, sedation
  • Muscle hyperirritability, incoordination
39
Q

Severe symptoms of lithium toxicity (2-2.5)

A
  • Serious EEG changes, seizures
  • Blurred vision
  • Severe hypotension; large output of dilute urine
40
Q

If lithium levels are above 2.5, what symptoms may occur?

A
  • Convulsions
  • Oliguria
  • Death
41
Q

Electroconvulsive Therapy for Bipolar Disorder

A
  • Especially useful in treatment-resistant mania and patients with rapid cycling
  • Teamwork and safety
  • Support groups
  • Health teaching and health promotion
  • Psychotherapy

NURS 419 (11 decks)

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