Study Guide (Bipolar Disorder) Flashcards
What are the signs and symptoms of Bipolar 1?
Manic Episode followed by at least 3 more of the following symptoms of mania
(That aren’t attributable to other medical conditions or substances):
Inflated Self-Esteem / Grandiosity,
Decreased Need for Sleep.
Excessive Talking.
Increased Pressure to Talk.
Racing Thoughts / Flight of Ideas.
Goal Directed Activity.
Buying Sprees.
A distinct period of abnormally elevated mood + Persistently increased goal-directed activity or energy:
Manic Episode
How long does a Manic Episode last?
At least one week. It should be present throughout most of the day nearly every day
How long should a pt be hospitalized for a Manic Episode?
Any duration of hospitalization is necessary
What may occur during Mania?
Psychosis
What are some symptoms of Psychosis?
Hallucinations, Delusions, & Dramatically Disturbed Thoughts
What are the signs and symptoms of Bipolar 2?
Current or past Hypomanic Episode with a past Major Depressive Episode
How is Hypomania different from Mania?
Hypomania is less severe than a Manic Episode.
Hypomania only occurs in Bipolar 2.
Hypomania typically doesn’t require hospitalization.
A pt with Bipolar 2 will alternate between Low Level Mania (Hypomania) and -
Profound Depression
Hypomania tends to be -
Euphoric + Often Increases Functioning
Like mania, Hypomania is accompanied by -
Excessive Activity + Energy for at least 4 days.
Involves at least 3 of the behaviors listed under mania:
Inflated Self-Esteem / Grandiosity.
Decreased Need for Sleep.
Excessive Talking.
Increased Pressure to Talk.
Racing Thoughts / Flight of Ideas.
Goal Directed Activity.
Buying Sprees.
Does Psychosis accompany Mania, Hypomania, or Both?
Only Mania
You have a pt who is Euphoric / Energized, Doesn’t Sleep, Doesn’t Eat, Talks Excessively, and they Feel Important + Powerful.
What are they showing symptoms of?
Mania
Exaggerated Irritability or Euphoria are both symptoms of -
Severe Mania
Mania patient’s are a-
Suicide Risk
What kind of assessment is important for pt’s with Mania?
The SAFE-T Assessment
Why is Mania an emergency?
It can lead to physical exhaustion and death if untreated (Due to a lack of sleep, Non-stop physical activity, & Lack of food intake)
If you are “Full-Blown Manic”, what are you going to be like?
You’ll constantly go from one activity, place, or project to another without finishing any tasks
What behavior can you expect from a Manic patient?
Manipulative, Profane, Fault Finding, & Adept at Exploiting Others’ Vulnerabilities.
Constantly Pushing Limits.
What do the behaviors of a Manic patient usually cause them to do?
Alienate their family, friends, employers, health care providers, and others
What are some things that can be indicative of Mania?
Modes of dress (May be outlandish, bizarre, colorful, or noticeably inappropriate).
Makeup may be garish and overdone.
Easily Distractible. Poor Concentration.
A nearly continuous flow of accelerated speech with abrupt changes from topic to topic =
Flight of Ideas
What is speech like for a manic pt?
Rapid, Verbose, & Circumstantial.
The incessant talking often includes a lot of jokes, puns, and teasing.
The content of their speech is often sexually explicit + ranges from grossly inappropriate to vulgar.
Speech is also loud, bellowing, or screaming.
How might a manic pt try to prevent/minimize the staff’s ability to set limits on and control dangerous behavior?
They may use humor, manipulation, power struggles, or demanding behavior
Some Manic pt’s will split faculty into “good guys” and “bad guys”.
What’s needed to keep everyone on the same page?
Frequent faculty meetings
What’s the main theme for treating someone with Mania?
Setting Limits
What is the main goal of treating a pt with Mania?
Prevent Exhaustion + Cardiac Collapse
What causes Bipolar?
Mainly Genetics.
It’s also possible that suffering traumatic events as a child can cause it.
If you are in a Euphoric Mood, then you are-
Manic
Unstable, intense feeling of well-being =
Euphoric Mood
People in a Euphoric Mood will-
Have boundless enthusiasm + Treat others with confidential friendless + Incorporate everyone into their plans & activities
Schemes to be rich and famous or claims of “Being one with God” are all examples of:
Euphoria
What might a patient in a Euphoric Mood act and scheme?
Scheme about to be rich and famous + Make excessive phone calls or emails to famous/influential people + Busy all throughout the day (Because of wild schemes and grandiose plans) + No boundaries exist to curtail the elaborate schemes
You have a Euphoric pt enter the hospital. They are financially ruined. Is this a normal occurrence, why?
Yes, in a manic state it is common to give away money, prized possessions, and expensive gifts + Spend money freely.
Intervention is required for manic patient’s to avoid financial ruin.
Groups of words because of the catchy way that they sound, not because of what they mean =
Clang Association
The quote “I tied the rope soap the slope nope” is an example of -
Clang Association
Quality of being impressive or imposing in appearance and style =
Grandiosity
When does Clang Association occur?
Schizophrenia & Bipolar
What are the 3 phases of caring for a patient with Depression?
Acute Phase
Continuation Phase
Maintenance Phase
What does the Acute Phase focus on?
Medically stabilizing the pt while maintaining safety, and the hospital is usually the safest environment to accomplish this
During the Acute Phase, nursing care is geared toward -
Managing Meds + Decreasing Physical Activity + Increasing Food & Fluid Intake + Ensuring 4-6 Hours of Sleep Every Night + Alleviating Bowel / Bladder Problems + Intervening / Ensuring Health Needs Are Met
What does the Continuation Phase focus on?
Maintaining adherence to a medication regimen + Prevention of relapse
What is important for a patient during the Continuation Phase?
Psychoeducational Teaching for the pt and their family.
The need for referrals to community programs, groups, and support for any co-occurring disorders/problems needs to be evaluated.
What does the Maintenance Phase focus on?
Planning focuses on preventing relapse + Limiting the severity & duration of future episodes
What things can a pt in the Maintenance Phase use to help maintain their family, social, and occupational lives?
Support Groups + Psychoeducational Groups + Periodic Evaluations
Establishing a therapeutic alliance with someone with Bipolar is important. Why?
Because non-adherence to the regimen of mood stabilization medication is a major cause of relapse
These are the first line treatments for a person with bipolar disorder and experiencing a depressive episode:
Lithium + Lamotrigine
Whenever you have a pt with bipolar who’s suffering a depressive disorder, the first line treatments are Lamotrigine & Lithium. But what if they are also suffering from Psychosis?
You’d still give Lamotrigine & Lithium, but you’d also give a Second-Gen Antipsychotic
Lithium is what category of drug?
Mood Stabilizer
What’s the therapeutic range for Lithium?
0.6 - 1.2
What is the first sign of toxicity when taking Lithium?
Diarrhea
What are the signs and symptoms of Lithium Toxicity?
Diarrhea + Shakiness + Lack of Coordination + No Appetite
What labs do you monitor for a pt taking Lithium?
BUN & Creatinine.
Low Sodium = Lithium Toxicity.
Lithium treats-
Periods of Mania in Bipolar Disorder
How long does it take to see the changes from being given Lithium?
7-14 Days
When should you measure levels after giving Lithium?
At Least After 5 Days
An elderly pt is about to be given Lithium, you should-
Start with low doses for elderly pts and increase the dosage slowly
What are the 2 major long-term effects of Lithium usage?
Hypothyroidism
Impairment of the kidneys to concentrate urine.
A patient taking lithium needs to have periodic follow ups for-
Renal / Thyroid Labs
What are the Contraindications for Lithium?
Cardiac Disease, Brain Damage, Renal Disease, Thyroid Disease, Myasthenia Gravis, Breast Feeding, Children Under 12 Years Old
A weakness and rapid fatigue of muscles under voluntary control.
The condition is caused by a breakdown in communication between nerves and muscles =
Myasthenia Gravis
What drug classification is Lamotrigine?
Anticonvulsant
If a rash appears while taking Lamotrigine, the healthcare provider should be contacted immediately.
This is because the rash is indicative of-
Steven Johnson Syndrome
What is Steven Johnson Syndrome?
A rare, serious disorder of the skin and mucous membranes
What lab should be monitored when taking Lamotrigine?
Monitor Liver Enzymes
Valporic Acid is also called-
Depakote
What is the Therapeutic Level of Valproic Acid?
50 - 100
What is the class of Valproic Acid?
Anticonvulsant
What is Valproic Acid used for?
Helps with Depression, Aggression, & Impulsivity.
Treats Bipolar Disorder / Severe Manic Episodes.
What labs do you need to check for a patient who’s taking Valproic Acid?
Platelets (Can Decrease) + Liver Functioning
What are the signs and symptoms of Valproic Acid Toxicity?
Coma, Confusion, Somnolence, Worsened Seizure Control, Dizziness, Hallucinations, Irritability, Head Ache
Used to subdue manic behavior, especially in pts with treatment resistant mania and pts with rapid cycling =
ECT
This treatment is effective for pts that have Rapid Cycling, for those with Paranoid-Destructive Features, & in Acutely Suicidal pts =
ECT
ECT stands for-
Electroconvulsive Therapy
What’s a sign and symptom of impending episodes of Bipolar that a pt can monitor for themselves?
Sleep patterns are especially important to monitor because they usually precede, accompany, or precipitate mania
Teaching for Bipolar Disorder should be aimed at-
Weight Reduction. Weight management is essential to keeping the pt physically and emotionally stable
Mood stabilizers may cause things like-
Weight Gain + Other Metabolic Disturbances (Altered metabolism of lipids and glucose).
These alterations increase the risk of Diabetes, High BP, Dyslipidemia, Cardiac Problems, or all of these at the same time
