Mood Disorders
before ECT
-psychiatric assessment, medical exam, blood test, ECG -informed conscent -discuss all options
What is the priority reason for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder?
. Depression is a symptom of several medical conditions. Medical conditions such as hormone disturbances, electrolyte disturbances, and nutritional deficiencies may produce symptoms of depression. T
A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess?
. The client has endured periods of elation and dysphoria lasting for more than 2 years.
sesonal effective disorder
. To be diagnosed with SAD, an individual must meet criteria for major depression coinciding with specific seasons for at least two years. The individual must experience seasonal depressions much more frequently than any non-seasonal depressions.
lithium level
1.0 to 1.5 mEq/L for acute mania and 0.6 to 1.2 mEq/L for maintenance therapy.
Lithium toxicity range
1.0-1.5 (acute mania) .6-1.2 (maintenance)
ECT admin
2-3 times a week for 6-12 treatments given general anesthesia, m relaxant , and electrode attach to scalp brain stimulated with a brief controlled series of electrical pulses patient asleep during procedure and awakens after 5-10 min
A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, I heard about something called a monoamine oxidase inhibitor (MAOI). Cant my doctor add that to my medications? Which is an appropriate nursing reply?
A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis.
A client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this clients plan of care?
A simple, structured daily schedule with limited choices of activities
A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention?
A structured program of activities in which the client can participate
A client is admitted with a diagnosis of persistent depressive disorder. Which client statement would describe a symptom consistent with this diagnosis?
A. I am sad most of the time and Ive felt this way for the last several years.
patient has been started on MAOI which can p not eat
Aged cheese Caviar Wine; beer Raisins Chocolate; colas Pickled herring Coffee; tea Yeast products Sour cream; yogurt Broad beans Smoked and processed meats Soy sauce Beef or chicken liver Cold remedies Canned figs Diet pills
A highly agitated client paces the unit and states, I could buy and sell this place. The clients mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this clients behavior?
Agitated and pacing. Exhibiting grandiosity. Mood labile.
A client diagnosed with bipolar I disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this clients priority nursing diagnosis?
Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
Verapamil
Although more generally used for the treatment of cardiovascular disorders, Calcium channel blockers (CCBs) have been shown to be effective in a number of psychiatric disorders. Verapamil, the most widely studied of the CCBs, has been found to be superior to placebo and equivalent to lithium in the treatment of mania
A client diagnosed with bipolar disorder states, I hate oatmeal. Lets get everybody together to do exercises. Im thirsty and Im burning up. Get out of my way; I have to see that guy. What should be the priority nursing action?
Assess the clients vital signs. could be symp of infection or dehydration
A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level?
B. 1.7 mEq/L
A client admitted to the psychiatric unit following a suicide attempt is diagnosed with major depressive disorder. Which behavioral symptoms should the nurse expect to assess?
B. Lack of attention to grooming and hygiene
An adult client diagnosed with bipolar I disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which is a true statement about this medication order?
C. This dosage is more than twice the recommended dosage range.
Bipolar disorder diagnosed
Cannot be diagnosed by blood test or brain scans diagnose on symptoms , illness, and family history rule out other conditions like brain tumor, stroke or neuropsychiatric illness may also cause mood disturbance according to DSM5 four basic types
A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client?
Carefully and unobtrusively observe on the basis of assessed data, at varied intervals around the clock.
Major depressive disorder
Characterized by depressed mood Loss of interest or pleasure in usual activities Symptoms have been present for at least 2 weeks No history of manic behavior Cannot be attributed to use of substances or another medical condition
post procedure
Client monitored in the recovery room (oxygen, suction, and other emergency equipment is available Vital signs are monitored Client may need reassurance if they wake confused, provide frequent orientation Client returned to the unit when oxygen saturation, vital signs, and mental status are stable Ensure client can swallow before starting fluids, food, or oral medications Note: Although memory loss is usually temporary some clients have memory loss lasting six months or more.
Pre procedure
Complete patient education Sign informed consent NPO after midnight or for 4-6 hours Baseline vital signs Client is asked to void, hairpins, jewelry, contact lens, and dentures removed Administer pre-procedure medications as Rx
A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis?
D. The client has maxed-out charge cards and exhibits promiscuous behaviors. bc this is manic symptoms
What is Disruptive Mood Dysregulation Disorder?
Diagnosis is made after age 6 and before age 18 Severe recurrent temper outbursts verbal or behavioral. Out of proportion to the situation or provocation. Temper outbursts occur 2-3 times a week. Mood is persistently irritable Symptoms present for more than 12 months (no period of more than 3 months without symptoms). Common precipitating factors: physical or emotional detachment by caregiver, parental separation or divorce, death of a loved one (person or pet), academic failure, illness.
Antipsychotics patient teaching
Do not discontinue drug abruptly. Use sunblock lotion when outdoors. Rise slowly from a sitting or lying position. Avoid alcohol and over-the-counter medications. Continue to take the medication, even if feeling well and as though it is not needed. Symptoms may return if medication is discontinued.
Verapamil
Do not discontinue the drug abruptly. Rise slowly from sitting or lying position to prevent sudden drop in blood pressure. Report the following symptoms to physician: Irregular heart beat, chest pain Shortness of breath, pronounced dizziness Swelling of hands and feet Profound mood swings Severe and persistent headache
s/e of antipsychotics
Drowsiness, dizziness Dry mouth, constipation Increased appetite, weight gain ECG changes Extrapyramidal symptoms Hyperglycemia and diabetes
another example of SNRI
Duloxetine
Electroconvulsive therapy
Episodes of mania may be treated with ECT when: Client does not tolerate medication. Client fails to respond to medication. Client's life is threatened by dangerous behavior or exhaustion.
What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder?
FIND tool
A newly admitted client is diagnosed with bipolar disorder: manic episode. Which symptom related to altered thought is the nurse most likely to assess?
Flight of ideas
SSRI examples
Fluoxetine (Prozac) Citalopram (Celexa) Sertraline (Zoloft) Paroxetine (Paxil) Escitalopram (Lexapro)
A client is diagnosed with persistent depressive (dysthymia) disorder. Which should a nurse classify as an affective symptom of this disorder?
Gloomy and pessimistic outlook on life
A client diagnosed with major depressive disorder states, Ive been feeling down for 3 months. Will I ever feel like myself again? Which reply by the nurse will best assess this clients affective symptoms?
Help me understand what you mean when you say, feeling down?
A clients spouse asks, What evidence supports the possibility of genetic transmission of bipolar disorder? Which is the best nursing reply?
Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder.
Serotonin syndromes on physical exam
Hyperthermia, Agitation, Slow, continuous, horizontal eye movements (referred to as ocular clonus), Dilated pupils, Tremor, Akathisia, Deep tendon hyperreflexia (common), Inducible or spontaneous muscle clonus (common), Muscle rigidity, Bilateral Babinski signs, Dry mucus membranes, Flushed skin and diaphoresis, Increased bowel sounds .
Which client statement would the nurse recognize as indicating that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment?
I will maintain normal salt intake.
After teaching a client about lithium carbonate (Lithane), a nurse would consider the teaching successful on the basis of which client statement?
Ill call my doctor immediately if I experience any diarrhea or ringing in my ears.
An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu?
Ill walk with you to the day room. Group is about to start.
A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom?
Im the worlds most perceptive attorney.
MAOI inhibitors:
Inhibit monoamine oxidase, an enzyme known to inactivate norepinephrine, serotonin, and dopamine
A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching?
It is going to take 2 to 3 weeks in order for me to begin to feel better.
Mania
Lithium carbonate Anticonvulsants Verapamil Antipsychotics
A client who has been diagnosed with bipolar I disorder states, God has taught me how to decode the Bible. A nurse should anticipate that which combination of medications would be ordered to address this clients symptoms?
Lithium carbonate (Lithobid) and risperidone (Risperdal)
de escalation tech
Maintain safety for the client, other clients, and self Maintain a large personal space Use a calm approach, and communicate with a calm, clear tone of voice (be assertive not aggressive) Determine what the client considers to be their need Avoid verbal struggles Provide the client with clear options to deal with the client's behavior Assist the client with problem-solving and decision-making regarding options
what happens during menopause
Menopause is defined as the state of an absence of menstrual periods for 12 months. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness
during procedure
Monitor BP and Pulse Oximetry Start IV Connect EEG and EKG leads Short acting anesthetic and muscle relaxant administered Oxygen administered throughout procedure Airway or bite block used to prevent injury to the tongue An electrical stimulus is administered and a brief seizure occurs
monitor anticonvulsants s/e
Nausea and vomiting Drowsiness, dizziness Blood dyscrasias Prolonged bleeding time (with valproic acid) Risk of severe rash (with lamotrigine) Decreased efficacy of oral contraceptives (with topiramate) Risk of suicide with all antiepileptic drugs (FDA warning, December 2008) Drowsiness, dizziness Hypotension, bradycardia Nausea Constipation
Hypertensive Crisis and MAOI
Orally ingested MAOIs inhibit the catabolism of dietary amines. The consumption of foods containing tyramine can lead to severe hypertensive crisis within an hour of eating. Patients using oral MAOIs must adhere to dietary restrictions to avoid precipitation of a crisis. Emergency signs of a rapid and severe rise in blood pressure (hypertensive crisis), include:
depression v BPD
PBD - major clinical depression is the presence of manic episodes depression is not enough to diagnose one manic episode is sufficient to make diagnosis
A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid?
Pepperoni pizza and red wine
. A client is diagnosed with bipolar I disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of Client will gain 2 pounds by the end of the week?
Provide client with high-calorie finger foods throughout the day.
risk for harm
RISK FOR HARM All clients with Mood Disorders (Depression or Bipolar and Related Disorders) should be assessed for homicidal and suicidal ideation. For a client at risk for self-harm, ask the client directly, "Have you thought of hurting yourself?"
intervention for mania
Remove hazardous objects from the environment (done for all clients) Provide a private room if possible Asses for fatigue, encourage sleep Limit group activities (if not tolerated by client), solitary activities may be necessary Supervise the clients choice of clothing Provide high calorie finger foods and fluids Avoid competitive games Seclusion may be considered is hyperactive behavior is dangerous due to altered sensory perceptions
A 75-year-old client with a long history of depression is currently on doxepin (Sinequan), 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority?
Risk for injury R/T orthostatic hypotension
A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client?
Risk for suicide R/T hopelessness
A newly admitted client is experiencing a manic episode of bipolar I disorder and presents as very agitated. The nurse should assign which priority nursing diagnosis to this client?
Risk for violence: directed toward others R/T agitation and hyperactivity
The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discusses bedroom dcor for clients experiencing mania. The nurse manager evaluates which suggestion as most appropriate?
Rooms should be painted with neutral colors and contain pale-colored accessories.
What is Persistent Depressive Disorder (Dysthymia)?
Sad or "down in the dumps" No evidence of mania or hypo mania Essential feature is a chronically depressed mood for: Most of the day More days than not For at least 2 years (adults) 1 year (children and adolescents) the individual has not been without symptoms for more than 2 months at a time.
Depressive episodes of bipolar disorder
Sad, anxious or empty-feeling mood Feelings of hopelessness and pessimism Feelings of guilt, worthlessness and helplessness Loss of interest or pleasure in activities once enjoyed, including sex Decreased energy, fatigue Difficulty concentrating, remembering or making decisions Restlessness and irritability Sleeplessness or sleeping too much Change in appetite, unintended weight loss or gain Bodily symptoms not caused by physical illness or injury Thoughts of death or suicide
The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement?
Setting limits on the client's behavior
anticonvulsants
Several anticonvulsant medications are recognized as mood stabilizers to treat or prevent mood episodes in bipolar disorder. Anticonvulsants work by calming hyperactivity in the brain in various ways usually prescribed for people who have rapid cycling (4 or more episodes of mania and depression in a year) : Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium), Lamictal (lamotrigine), Tegretol (carbamazepine)
A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?
Symptoms indicate lithium carbonate toxicity.
symptoms of serotonin syndrome
Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.
What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)?
The clients cognitive ability to understand information about the medication
client who is diagnosed with major depressive disorder asks the nurse what causes depression. Which of these is the most accurate response?
The exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role.
initial signs of litium toxicity
The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus.
A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred?
This disorder is more prevalent in the higher socioeconomic groups.
A nurse reviews the laboratory data of a 29-year-old client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis?
Thyroid-stimulating hormone (TSH) level of 6.2 U/mL According to the DSM-5, symptoms of major depressive disorder cannot be due to the direct physiological effects of a general medical condition (e.g., hypothyroidism). The diagnosis of major depressive disorder may be ruled out if the clients laboratory results indicate a high TSH level (normal range for this age group is 0.4 to 4.2 U/mL),
. A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, You cant do this to me. Do you know who I am? Which is the priority nursing action in this situation?
To provide self and client with a safe environment
A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam?
To rule out neurocognitive disorder
MAOI examples
Tranylcypromine (Parnate), Phenelzine (Nardil)
A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients?
Treatment is compromised when clients choose not to take their medications.
A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders?
Valproic acid (Depakote)
Psychopharmacology MAOIs
Was the first class of antidepressants. now not the first or second line because their extensive side effect: severe adverse effects like hypertensive crisis and Serotonin syndrom
A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing reply?
Weight gain is a common but troubling side effect.
PPD
Women are particularly vulnerable to depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. Many new mothers experience a brief episode of mild mood changes known as the "baby blues." These symptoms usually dissipate by the 10th day. PPD lasts much longer than 10 days, and can go on for months following child birth. Acute PPD is a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience PPD often have had prior depressive episodes.
A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The clients spouse questions the Zyprexa order. Which is the appropriate nursing reply?
Zyprexa calms hyperactivity until the Eskalith takes effect.
Heterocyclics antidepressant ex
amoxapine (Asendin) trazodone hydrochloride (Desyrel)
MOST common S/E with SSRIs and SNRIs
headache-goes away within a few days Nausea-goes away in a few days sleeplessness or drowsiness happens during the first week goes away sometimes dose needs to be reduces or time of day its taken needs to be adjusted to help lessen side effects Agitation/Jittery Sex drive down
ECT work?
highly effective for relief of major depression
Mood stabilizing agents ind
prevent and treat manic episodes associated with BPD
Education on antidepressants
therapeutic effects may not be seen for as long as 4 weeks don't discontinue abruptly don't smoke or drink alcohol be aware of risks of taking antidepressants druing pregnancy BB warning : may have more suicidal ideation especially in children and adolescents
who is depression more prevalent in
woman Girls and boys are equal in adolescence
Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior?
~communicate expected behaviors to the client ~assist the client in identifying ways of setting limits on personal behaviors ~follow through with the consequenses of unacceptable behavior in a non punitive manner ~have client state the consequesnses for behaving in ways that are viewed and unacceptable
ind for ECT
-antidepressant not effective -rapid definitive response such as when client is suicidal or homicidal -client extremely agitated or catatonic -risk of other treatments out weigh risk poor med response good ect response or both prefers ect as treatment
Which of the following instructions regarding lithium therapy should be included in a nurses discharge teaching? Select all that apply.
A. Avoid excessive use of beverages containing caffeine. B. Maintain a consistent sodium intake. C. Consume at least 2,500 to 3,000 mL of fluid per day.
Which of the following explanations should a nurse include when teaching parents why is it difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply.
A. Bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms. B. Children are naturally active, energetic, and spontaneous.
A client diagnosed with major depressive disorder was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention would be most appropriate to help the client address spirituality as it relates to his illness?
A. Encourage the client to bring into awareness underlying sources of guilt.
A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to a nurse that discharge teaching about this medication has been successful? Select all that apply.
A. Ill have to let my surgeon know about this medication before I have my cholecystectomy. B. Guess I will have to give up my glass of red wine with dinner. C. Ill have to be very careful about reading food and medication labels. E. Ill be sure not to stop this medication abruptly.
A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention should be most therapeutic for this client?
A. Using a calm, unemotional approach during client interactions
A client on an inpatient unit is diagnosed with bipolar disorder: manic episode. During a discussion in the dayroom about weekend activities, the client raises his voice, becomes irritable, and insists that plans change. What should be the nurses initial intervention?
Assist the client to move to a calmer location.
A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, Im feeling a lot better, so you can stop watching me. I have taken up too much of your time already. Which is the best nursing reply?
Because we are concerned about your safety, we will continue to observe you.
initial symptoms of toxicity include
Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea Ensure that client consumes adequate sodium and fluid in diet
A newly admitted client diagnosed with major depressive disorder states, I have never considered suicide. Later the client confides to the nurse about plans to end it all by medication overdose. What is the most helpful nursing reply?
Bringing this up is a very positive action on your part.
The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to help the clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework?
C. Cognitive theory
A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client?
C. The client will remain safe throughout hospitalization.
A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents?
D. Fluoxetine (Prozac)
Which client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder?
D. Nothing will help me feel better.
A nurse is caring for four clients taking various medications, including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication?
D. Parnate Hypertensive crisis occurs in clients receiving a monoamine oxidase inhibitor (MAOI) who consume foods or drugs with a high tyramine content.
A confused client has recently been prescribed sertraline (Zoloft). The clients spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect, and what could be its possible cause?
D. Serotonin syndrome caused by ingestion of two different SSRIs The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil)
Premenstrual dysphoric disorder
Depressed mood Anxiety Mood swings Decreased interest in activities Symptoms begin during week prior to menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses
A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. According to learning theory, what is the cause of this clients symptoms?
Depression is a result of repeated failures.
depression
Depression is a serious condition that negatively affects how a person thinks, feels, and behaves. In contrast to normal sadness, clinical depression is persistent, often interferes with a person's ability to experience or anticipate pleasure, and significantly interferes with functioning in daily life. Untreated, symptoms can last for weeks, months, or years. If inadequately treated, depression can lead to significant impairment, other health-related issues, and suicide.
An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? Select all that apply.
Drastic temperature and barometric pressure changes Increased levels of melatonin Variations in serotonergic functioning
tyramine foods
Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread.
vascular depression
For older adults who experience depression for the first time later in life, other factors, such as changes in the brain or body, may be at play. For example, older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels become less flexible. They may harden and prevent blood from flowing normally to the body's organs, including the brain.
SNRIs
Serotonin and norepinephrine reuptake inhibitors very similar to SSRIs
manipulative behavior
Set clear, consistent, realistic, and enforceable limits, and communicate expected behaviors Be clear about consequences associated with exceeding set limits and follow through with consequences in a nonpunitive manner, if needed Discuss clients behavior in a nonjudgmental and nonthreatening manner Avoid power struggles with client (avoid arguing) Assist the client in developing a means to set limits on their own behavior
Hypertensive crisis symptoms
Severe headache Nausea and vomiting Sweating and severe anxiety Nosebleeds Fast heartbeat Chest pain Changes in vision Shortness of breath Confusion Rarely, a severe increase in blood pressure can lead to bleeding in the brain (hemorrhagic stroke).
A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder?
Social isolation R/T poor self-esteem AEB secluding self in room
Report the symptoms with antipsychotics
Sore throat, fever, malaise Unusual bleeding, easy bruising, skin rash Persistent nausea and vomiting Severe headache, rapid heart rate Difficulty urinating or excessive urination Muscle twitching, tremors Darkly colored urine, pale stools Yellow skin or eyes Excessive thirst or hunger Muscular incoordination or weakness
Dealing with inappropriate behaviors with BPD
aggressive? assist client to ID feelings Assist to id precipitating events or situation to lead to aggressive behavior describe the consequences of behavior on self and others assist in id previous coping mechanism assist in problem solving tech to cope with frustration and aggression
Antipsychotics
also known as neuroleptics or major tranquilizers, are a class of medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia and bipolar disorder.
TCA examples
amitriptyline hydrochloride (Amitril, Elavil) doxepin hydrochloride (Sinequan) nortriptyline hydrochloride (Aventyl HC1, Pamelor
Bipolar 1
defined by manic episode last at least 7 days or manic symptoms severe need immediate hospitals may have depressive episodes must be a major change in persons normal behavior
bipolar 2
defined with depressive episodes shifting back and forth with hypomanic episodes but not fullblow manic or mixed episodes
Developmental implications child hood
diagnosis difficult use FIND (frequency intensity number and duration) ADHD most common comorbid condition ADHD med may exacerbate mania and administer only after bipolar symptoms have been controlled
Venlafaxine contradictions
do not take if you have uncontrolled narrow angle glaucoma don't use within 7 days before or 14 days after you have used an MAO inhibitor
patient teaching anticonvulsants
don't stop drug abruptly report symptoms: skin rash, bleeding unusual, spontaneous brusing, sore throat , fever malaise darke urine and yellow skin or eyes avoid alcohol and over the counter of med
S/E of tricyclic and heterocyclic
dry mouth constipation bladder problems. hard to empty the bladder or urine stream not strong, older men with enlarged prostate may be effected more sexual problem blurred vision-usually go away quickly drowsiness
Lithium
help reduce severity and frequency of mania, also relieve or prevent bipolar depression
mania episodes
inc energy, activity, restless, euphoric mood. Delusional self confidence extreme irritability - anger quickly pressure/clanging speech poor concentration racing thoughts and talk jumping between ideas significant dec in appetite, sleeplessness heightened sense of self importance dress and make up inappropriate no inhibition, inc sex behavior abuse drugs provocative aggressive behavior denial that anything is wrong
Serotonin syndrome
inc serotonergic activity in CNS seen with therapeutic medication , inadvertent interaction between drugs and intentional self poisoning vital abnormalities: tachycardia and hypertension, severe:hyperthermia and dramatic swings in pulse and BP
Long term use of antipsychotics is associated with s/e such as
involuntary movement disorders, gynecomastia, and metabolic syndrome. They are also associated with increased mortality in elderly people with dementia.
Lithium S/E
may modulate the effects of certain neurotransmitters like norepinephrine, serotonin, dopamine, glutamate, and GABA S?E Drowsiness, dizziness, headache Dry mouth, thirst, GI upset, nausea/vomiting Fine hand tremors Hypotension, arrhythmias, pulse irregularities Polyuria, dehydration Weight gain Potential for toxicity
Cyclothypic disorder
mild form of bipolar episodes of hypomania back and forth shift with mild depression for at least 2 years some may be diagnosed with rapid cycling bipolar disorder : 4 major episodes of major depression, mania, hypomania , or mixed symptoms within a year
how is it treated
no cure managed with psychotherapy and medications mood stabilizing medications usually first choice in medication lithium common mood stabilizer anticonvulsant medications used to treat seizure disorders and soethimes offer similar mood stabilizing effects as antipsychotic and antidepressants
Lithium advise physician if following symptoms occur
persistent n/v severe diarrhea ataxia blurred vision tinnitus excessive output of urine inc tremors mental confusion
MAOI s/e
potent hypotensive effects and 50% experience dizzy OTher s/e: dry mouth, GI upset, Urinary hesitancy, headache, myoclonic jergs. MAOI suppress REM sleep and after noon fatigue common
The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, what is the nurse's immediate priority of care?
provide safety for the client and other clients on the unit
psychotherapy in BPD
psychotherapy provides support, guidance and education to people with bipolar disorder and their families. Psychotherapeutic interventions increase mood stability, decrease hospitalizations and improve overall functioning. Common techniques include cognitive behavioral therapy, psychoeducation, and family therapy.
A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the listed client outcomes?
remains free from injury maintains nutritional status sleeps 6-8 hours a night interacts appropriatly with peers
have Serotonin syndrome?
stop medication IV monitoring
. A 20-year-old female has a diagnosis of premenstrual dysphoric disorder. Which of the following should a nurse identify as consistent with this diagnosis? Select all that apply.
symptoms are causing significant interference with work, school, and social relationships. Mood swings occur the week before onset of menses Patient reports subjective difficulty concentrating
Lithium education
take regulary don't skimp on dietary sodium drink 6-8 glass of water have serum lithium level checked 1-2 months
BP disorder controlled better when
treatment is continuous mood changes can occur even when someone is being treated and should be reported immediately to a physician ; full blown episodes may be averted by adjusting the treatment
Bipolar Disorder
typically starts late adolescent or early adult hood, can show up in older adults Causes repeated mood swings or episodes that can make someone feel very high (mania) or very low (depressed) Cyclic episodes are punctuated by normal moods
Depressive phase
use antidepressants with care may trigger mania
SSRIs
used as a first line antidepressant bc of efficacy, tolerability and general safety in OD treat anxiety
ECT
used in p with with severe major depression or bipolar disorder when they don't respond to any other treatments -brief electrical stimulation of brian while patient is under anesthesia
TCA and heterocyclics
used to relieve symptoms of major depression inhibit nerve cells ability to reuptake norepinephrine and serotonin
venlafaxine
used to treat major depressive disorder, anxiety and panic disorder