Ch. 14 Bipolar Nuggets
Nursing 3014 with Fly at Oklahoma Christian University of Science & Arts
About this deck
By: Heather Wieprecht
Textbook:
Foundations of Psychiatric Mental Health Nursing: A Clinical Approach
Created: 2011-10-01
Size: 15 flashcards
Views: 36
Textbook:
Foundations of Psychiatric Mental Health Nursing: A Clinical ApproachCreated: 2011-10-01
Size: 15 flashcards
Views: 36
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3 classifications of bipolar, how are they different.
Bipolar I: at least one episode of mania alternates with major depression
Bipolar II: hypomanic episode(s) alternate with major depression, greater risk for suicide
Cyclothymia: hypomanic with minor depression, at least 2 yrs in duration
Diagnostic criteria for each of the classifications
4 days for hypomania, 1 week for mania
must have been present to sig. degree: inflated self-esteem or grandiosity, decr. need for sleep, more talkative than usual, racing thoughts, distractibility, increase in goal directed activity, excessive involvement in pleasurable activities
Hypomania: hosp. not idicated, disturbed mood, noticable changes
Mania: hosp. is indicated, severe changes
Popular theories relating to bipolar disorder
genetics, oversupply of norepinephrine, dopamine, and serotonin, hypothyroidism, triggered by life event
key elements of a general assessment of bipolar
mood (excessive cheerfullness that may be inappropriate to the situation, can quickly change to anger; give away money, expensive gifts), behavior (decreased need for sleep, many projects started but few get completed, spending lots of money), thought process, cog. fx
why self assess before taking care of pt with bipolar disorder
you need to remember the pt has a disorder, they say hurtful things, can't let what they say affect you. Pt may pit everyone against each other by lying and making others feel uncomfortable. communication between staff members is essentialPg. 287
dif. btwn outcome in acute, continuation and maintenance phase
acute: injury prevention (pt will be well hydrated, stable cardiac status, good sleep, self-control, no attempt at self harm)
continuation: 4-9 months, relapse prevention (knowledge to disease process, meds, s/sy, support groups, problem solving training)
maintenance: prevention of relapse and limitation of severity and duration of future episodes ( participate in learning interpersonal strategies related to work, family; participate in psychotherapy, group therapy)
specific interventions for acute phase depressive disorder
provide safety, administer meds (lithium and lamictal) not antidepressents because the pt's CNS may become overactive resulting in mania
specific interventions for acute phase manic episode
communication, be consistant, use short and concise explanations, remain neutral, redirect energy into more constructive channels, safe environment, lots of rest, observe for signs of lithium toxicity, nutritional needs
briefly review nurs. dx for bipolar disorder
pg. 289
risk for injury, risk for suicide, defensive coping, caregiver role strain, impaired verbal communication, imbalanced nutrition: less than body requirements, self-care deficit, disturbed sleep pattern
most common drugs utilized for bipolar disorder
lithium and lamictal
Lithium, how does it work, appropriate blood lvls, Adverse, maintenance therapy, contraindications
reduces elation, flight of ideas, irritability, anxiety, insomnia, paranoia
blood levels should be between 0.4meq/L and 1.3meq/L
maintenance: dose is lowered or stopped
contraindications: cardiovascular disease, brain damage, renal disease, MG, preg. women, breast feeding mothers
other helpful medications - anticonvulsants
Anticonvulsants: depakote, tegretol, lamictal
Depakote: treats lithium non-responders in acute mania, monitor liver fx and platelet cts altho comp. are rare
Tegretol: thought to work better with severely parnoid, angry pts. rather than euphoric over-friendly ones, monitor liver fx
Lamictal: first-line treatment for bipolar depression, acute and maintenance therapy, well tolerated, one rare serious life threatening rash can occur
other meds - antianxiety
Klonopin and ativan
useful in acute mania, avoided in pt with history of substance abuse, helps with psychomotor agitation
other meds - atypical antipsychotics
zyprexa, risperdal, abilify, geodon
used in early phase of treatment
blood values for lithium
< 0.4-1.0 mEq/L = therapeutic level: fine hand tremor, thirst, weight gain
<1.5 early signs of toxicity: n/v, lethargy, muscle weakness
1.5-2.0 advanced signs of toxicity: coarse hand tremor, GI upset, incoordination, mood
2.0-2.5 severe toxicity: confusion, blurred vision, seizures, coma
>2.5 convulsions, oliguria and death can occur
About this deck
By: Heather Wieprecht
Textbook: Foundations of Psychiatric Mental Health Nursing: A Clinical Approach
Created: 2011-10-01
Size: 15 flashcards
Views: 36
Textbook:
Foundations of Psychiatric Mental Health Nursing: A Clinical ApproachCreated: 2011-10-01
Size: 15 flashcards
Views: 36
About StudyBlue
STUDYBLUE makes things that make you better at school.
Things like online flashcards with photos and audio.
Things like personalized quizzes and friendly reminders about when (and what) to study next.
Think of it as a digital backpack™: access to all of your study materials online and on your phone.
STUDYBLUE exists to make studying efficient and effective for every student, for free. Join us.
“I have used this website for three exams, and I see a huge difference in my test results.”
Naj
Naj