(3) Chapter 17: Bipolar and Related Disorders *

A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lb by the end of the week?" 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

1. Provide client with high-calorie finger foods throughout the day. Rationale: The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 lb by the end of the week. Because of the hyperactive state, the client will have difficulty sitting still to consume large meals. Cognitive Level: Application Integrated Process: Implementation

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

1. Risk for suicide R/T hopelessness Rationale: The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness. The nurse should always prioritize client safety. This client is at risk for suicide because of his or her recent suicide attempt. Cognitive Level: Analysis Integrated Process: Diagnosis

9. What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder? 1. "Risky Activity" tool 2. "FIND" tool 3. "Consensus Committee" tool 4. "Monotherapy" tool

2. "FIND" tool Rationale: The nurse should use the "FIND" tool to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder. FIND is an acronym that stands for frequency, intensity, number, and duration and is used to assess behaviors in children. Cognitive Level: Application Integrated Process: Assessment

A client diagnosed with bipolar 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 client's priority nursing diagnosis? 1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia and anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss Rationale: The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity AEB weight loss. Because of the client's rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition and physical health. Cognitive Level: Analysis Integrated Process: Diagnosis

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

2. Valproic acid (Depakote) Rationale: The nurse should anticipate that the physician may prescribe valproic acid in order to increase this client's medication adherence. Valproic acid is an anticonvulsant medication that can be used to treat bipolar disorder. One of the side effects of this medication is weight loss. Cognitive Level: Application Integrated Process: Planning

A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1. Symptoms indicate consumption of foods high in tyramine. 2. Symptoms indicate lithium carbonate discontinuation syndrome. 3. Symptoms indicate the development of lithium carbonate tolerance. 4. Symptoms indicate lithium carbonate toxicity.

4. Symptoms indicate lithium carbonate toxicity. Rationale: The nurse should interpret that the client's symptoms indicate lithium carbonate toxicity. The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure proper dosage. Cognitive Level: Application Integrated Process: Evaluation

A somewhat milder form of mania is called ____________

A somewhat milder form of mania is called HYPOMANIA

___________is described as the emotional reaction associated with an experience.

AFFECT

Biochemical influences - Possible excess of ___________ and ______________

Biochemical influences - Possible excess of NOREPINEPHRINE and DOPAMINE

__________ can occur as a biological (organic) or psychological disorder, or as a response to substance use or a general medical condition.

MANIA

__________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.

MANIA

Nursing Diagnosis: ____________________ related to Excessive hyperactivity and agitation

Nursing Diagnosis: Insomnia related to Excessive hyperactivity and agitation

Onset of symptoms may reflect ____________ pattern

Onset of symptoms may reflect SEASONAL pattern

________________ (Mood-stabilizing agents) May modulate the effects of certain neurotransmitters, such as norepinephrine, serotonin, dopamine, glutamate, and GABA, thereby stabilizing symptoms associated with bipolar disorder.

Psychopharmacology: Mood-stabilizing agents Action - Lithium --- May modulate the effects of certain neurotransmitters, such as norepinephrine, serotonin, dopamine, glutamate, and GABA, thereby stabilizing symptoms associated with bipolar disorder.

Types of Bipolar Disorders: ________________________ Client is experiencing, or has experienced, a full syndrome of manic or mixed symptoms

Types of Bipolar Disorders: BIPOLAR I DISORDER Client is experiencing, or has experienced, a full syndrome of manic or mixed symptoms

Types of Bipolar Disorders: ___________________________ At least 2-year duration

Types of Bipolar Disorders: Cyclothymic Disorder At least 2-year duration

7. A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia

b. Tinnitus, severe diarrhea, ataxia

5. Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the ED by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of a a. delusion of grandeur. b. delusion of persecution. c. delusion of reference. d. delusion of control or influence.

b. delusion of persecution.

10. A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition. b. Medication would be given for both conditions simultaneously. c. The bipolar condition would be stabilized first before medication for the ADHD would be given. d. The ADHD would be treated before consideration of the bipolar disorder.

c. The bipolar condition would be stabilized first before medication for the ADHD would be given.

6. The most common comorbid condition in children with bipolar disorder is a. schizophrenia. b. substance disorder. c. oppositional defiant disorder. d. attention-deficit/hyperactivity disorder.

d. attention-deficit/hyperactivity disorder.

Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? (Select all that apply.) 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. Restrict sodium content. 5. Restrict fluids to 1,500 mL per day.

1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. Rationale: The nurse should instruct the client taking lithium to avoid excessive use of caffeine, maintain a consistent sodium intake, and consume at least 2,500 to 3,000 mL of fluid per day. The risk of developing lithium toxicity is high because of the narrow margin between therapeutic doses and toxic levels. Fluid or sodium restriction can impact lithium levels. Cognitive Level: Application Integrated Process: Implementation

17. Which of the following rationales by a nurse explain to parents why is it difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? (Select all that apply.) 1. Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. 2. Children are naturally active, energetic, and spontaneous. 3. Neurotransmitter levels vary considerably in accordance with age. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5. Genetic predisposition is not a reliable diagnostic determinant. Nursing Process: Assessment Client Need: Psychological Integrity

1. Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. 2. Children are naturally active, energetic, and spontaneous. Rationale: It is difficult to diagnose a child or adolescent with bipolar disorder, because bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms and because children are naturally active, energetic, and spontaneous. Symptoms may also be comorbid with other childhood disorders, such as conduct disorder. Cognitive Level: Application Integrated Process: Assessment

A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate? 1. Increase the dosage of fluoxetine. 2. Discontinue the fluoxetine and rethink the client's diagnosis. 3. Order benztropine (Cogentin) to address extrapyramidal symptoms. 4. Order olanzapine (Zyprexa) to address altered thoughts.

2. Discontinue the fluoxetine and rethink the client's diagnosis. Rationale: A full manic episode emerging during antidepressant treatment (medication, electroconvulsive therapy, etc.), but persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis. Cognitive Level: Analysis Integrated Process: Assessment

Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication adherence 2. Empowerment of the consumer 3. Total absence of symptoms 4. Improved psychosocial relationships

2. Empowerment of the consumer Rationale: The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care and to enable a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. Cognitive Level: Application Integrated Process: Assessment

A client began taking lithium carbonate (Lithobid) 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 response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug."

3. "Weight gain is a common, but troubling, side effect." Rationale: The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication adherence and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication. Cognitive Level: Application Integrated Process: Implementation

12. A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode? 1. During a manic episode, clients may experience an inflated self-esteem or grandiosity, and these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.

3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. Rationale: Three or more of the following symptoms may be experienced in both hypomanic and manic episodes: Inflated self-esteem or grandiosity, decreased need for sleep (e.g., feels rested after only 3 hours of sleep), more talkative than usual or pressure to keep talking, flight of ideas and racing thoughts, distractibility, increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments). If there are psychotic features, the episode is, by definition, manic. Cognitive Level: Analysis Integrated Process: Assessment

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood euthymic. Exhibiting magical thinking. Restless." 3. "Mood labile. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

4. "Agitated and pacing. Exhibiting grandiosity. Mood labile." Rationale: The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting mood swings from euphoria to irritability. Grandiosity refers to the attitude that one's abilities are better than everyone else's. Cognitive Level: Application Integrated Process: Evaluation

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? 1. "Treatment is compromised when clients can't sleep." 2. "Treatment is compromised when irritability interferes with social interactions." 3. "Treatment is compromised when clients have no insight into their problems." 4. "Treatment is compromised when clients choose not to take their medications."

4. "Treatment is compromised when clients choose not to take their medications." Rationale: The nursing student is accurate when stating that the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose not to take their medications. Clients diagnosed with bipolar disorder feel most productive and creative during manic episodes. This may lead to purposeful medication nonadherence. Symptoms of bipolar disorder will reemerge if medication is stopped. Cognitive Level: Application Integrated Process: Evaluation

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the appropriate nursing response? 1. "Zyprexa in combination with Eskalith cures manic symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

4. "Zyprexa calms hyperactivity until the Eskalith takes effect." Rationale: The nurse should explain to the client's spouse that olanzapine can calm hyperactivity until the lithium carbonate takes effect. Lithium carbonate may take 1 to 3 weeks to begin to decrease hyperactivity. Monotherapy with the traditional mood stabilizers like lithium carbonate, or atypical antipsychotics like olanzapine, has been determined to be the first-line treatment for bipolar I disorder. Cognitive Level: Application Integrated Process: Implementation

16. A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode Rationale: The following are selected criteria for the diagnosis of cyclothymic disorder. For at least one year in children and adolescents there have been numerous periods with hypomanic, not manic symptoms that do not meet criteria for hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for a major depressive episode. The symptoms are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not elsewhere classified. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Cognitive Level: Application Integrated Process: Implementation

__________ disorder is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy

BIPOLAR DISORDER

3. A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? Client Outcomes: 1. Maintains nutritional status 2. Interacts appropriately with peers 3. Remains free from injury 4. Sleeps 6 to 8 hours a night A. 2, 1, 3, 4 B. 4, 1, 2, 3 C. 3, 1, 4, 2 D. 1, 4, 2, 3

C. 3, 1, 4, 2 Rationale: The nurse should order client outcomes based on priority in the following order: Remains free of injury, maintains nutritional status, sleeps 6 to 8 hours a night, and interacts appropriately with peers. The nurse should prioritize the client's safety and physical health as most important. Cognitive Level: Analysis Integrated Process: Planning

Client/Family Education: Lithium Notify physician if any of the following symptoms occur 1. 2. 3. 4.

Client/Family Education: Lithium - Notify physician if any of the following symptoms occur --- Persistent nausea and vomiting --- Severe diarrhea --- Ataxia --- Blurred vision

Client/Family Education: Lithium Notify physician if any of the following symptoms occur 5. 6. 7. 8.

Client/Family Education: Lithium - Notify physician if any of the following symptoms occur --- Tinnitus --- Excessive output of urine --- Increasing tremors --- Mental confusion

Client/Family Education: Lithium - Notify physician if ___________ or _______________ occur - Have serum lithium level checked every ______________, or as advised by physician

Client/Family Education: Lithium - Notify physician if vomiting or diarrhea occur - Have serum lithium level checked every 1 to 2 months, or as advised by physician

Client/Family Education: Lithium - Take the medication ______________ - Do not skimp on ___________________ - Drink ________________ water each day

Client/Family Education: Lithium - Take the medication regularly - Do not skimp on dietary sodium - Drink 6 to 8 glasses of water each day

__________ or _______________ may or may not be part of clinical picture

DELUSIONS or HALLUCINATIONS may or may not be part of clinical picture

Degree of Severity Stage III—_________________: a grave form of the disorder characterized by an intensification of the symptoms associated with acute mania. The condition is rare since the advent of antipsychotic medication. - Labile mood; panic anxiety - Clouding of consciousness; disorientation - Frenzied psychomotor activity - Exhaustion and possibly death without intervention

Degree of Severity Stage III—DELIRIOUS MANIA: a grave form of the disorder characterized by an intensification of the symptoms associated with acute mania. The condition is rare since the advent of antipsychotic medication. - Labile mood; panic anxiety - Clouding of consciousness; disorientation - Frenzied psychomotor activity - Exhaustion and possibly death without intervention

Degree of Severity Stage II—______________: marked impairment in functioning; usually requires hospitalization - Elation and euphoria; a continuous "high" - Flight of ideas; accelerated, pressured speech - Hallucinations and delusions - Excessive motor activity - Social and sexual inhibition - Little need for sleep

Degree of Severity Stage II—ACUTE MANIA: marked impairment in functioning; usually requires hospitalization - Elation and euphoria; a continuous "high" - Flight of ideas; accelerated, pressured speech - Hallucinations and delusions - Excessive motor activity - Social and sexual inhibition - Little need for sleep

Degree of Severity Stage I—_____________: symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization - Cheerful mood - Rapid flow of ideas; heightened perception - Increased motor activity

Degree of Severity Stage I—HYPOMANIA: symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization - Cheerful mood - Rapid flow of ideas; heightened perception - Increased motor activity

What do these symptoms represent? Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea

INITIAL SYMPTOMS OF LITHIUM TOXICITY

___________ is defined as a pervasive and sustained emotion that may have a major influence on a person's perception of the world.

MOOD

2. What is the speech pattern of a person experiencing a manic episode? More _ than usual or _ to keep _. ■ P_ _ _ _ _ _ _ _ speech: R_ _ _ _ speech that is l_ _ _, i_ _ _ _ _ _ _ _, and d_ _ _ _ _ _ _ _ to i_ _ _ _ _ _ _ _.

More TALKATIVE than usual or PRESSURE to keep TALKING. ■ Pressured speech: Rapid speech that is loud, intrusive, and difficult to interrupt.

Nursing Diagnosis: _____________________________ related to Biochemical alterations in the brain and to possible sleep deprivation, evidenced by auditory and visual hallucinations

Nursing Diagnosis: Disturbed sensory perception related to Biochemical alterations in the brain and to possible sleep deprivation, evidenced by auditory and visual hallucinations

Nursing Diagnosis: ___________________________ related to Biochemical alterations in the brain, evidenced by delusions of grandeur and persecution and inaccurate interpretation of the environment

Nursing Diagnosis: Disturbed thought processes related to Biochemical alterations in the brain, evidenced by delusions of grandeur and persecution and inaccurate interpretation of the environment

Nursing Diagnosis: ___________________________ related to Refusal or inability to sit still long enough to eat, evidenced by loss of weight, amenorrhea

Nursing Diagnosis: Imbalanced nutrition less than body requirements related to Refusal or inability to sit still long enough to eat, evidenced by loss of weight, amenorrhea

Nursing Diagnosis: _________________________ related to Egocentric and narcissistic behavior

Nursing Diagnosis: Impaired social interaction related to Egocentric and narcissistic behavior

Nursing Diagnosis: Risk for _________ related to Extreme hyperactivity, increased agitation, and lack of control over purposeless and potentially injurious movements

Nursing Diagnosis: Risk for INJURY related to Extreme hyperactivity, increased agitation, and lack of control over purposeless and potentially injurious movements

Nursing Diagnosis: Risk for __________________ related to - Manic excitement - Delusional thinking - Hallucinations - Impulsivity

Nursing Diagnosis: Risk for VIOLENCE SELF OR OTHER DIRECTED related to - Manic excitement - Delusional thinking - Hallucinations - Impulsivity

Predisposing Factors: Psychosocial theories Credibility of psychosocial theories has decreased/stabilized/increased (pick one) in recent years

Predisposing Factors: Psychosocial theories Credibility of psychosocial theories has DECLINED in recent years

Psychopharmacology: For depressive phase Why should you use antidepressants with care?

Psychopharmacology: For depressive phase Use antidepressants with care (may trigger mania)

The below are all examples of __________ lithium carbonate, clonazepam, carbamazepine, valproic acid, lamotrigine, gabapentin, topiramate, oxcarbazepine, verapamil, antipsychotics

Psychopharmacology: MOOD-STABILIZING AGENTS Examples: lithium carbonate, clonazepam, carbamazepine, valproic acid, lamotrigine, gabapentin, topiramate, oxcarbazepine, verapamil, antipsychotics

Psychopharmacology: Mood-stabilizing agents What do we use mood-stabilizing agents for?

Psychopharmacology: Mood-stabilizing agents Indications: prevention and treatment of manic episodes associated with bipolar disorder

Psychopharmacology: Side effects Lithium toxicity - Ensure that client consumes adequate ______________ &______________

Psychopharmacology: Side effects Lithium toxicity - Ensure that client consumes adequate sodium and fluid in diet

Psychopharmacology: Side effects Lithium toxicity - Therapeutic range --- 1.0 to 1.5 mEq/L (acute mania) --- 0.6 to 1.2 mEq/L (maintenance)

Psychopharmacology: Side effects Lithium toxicity - Therapeutic range --- 1.0 to 1.5 mEq/L (______________) --- 0.6 to 1.2 mEq/L (______________)

Psychopharmacology: Side effects Side effects of _____________ - Drowsiness, dizziness, headache - Dry mouth; thirst; GI upset; nausea/vomiting - Fine hand tremors

Psychopharmacology: Side effects Monitor for side effects of lithium - Drowsiness, dizziness, headache - Dry mouth; thirst; GI upset; nausea/vomiting - Fine hand tremors

Psychopharmacology: Side effects Additional side effects of lithium - H_ _ _ _ _ _ _ _ _ _; A_ _ _ _ _ _ _ _ _ _, P _ _ _ _ _ irregularities - P_ _ _ _ _ _ _; dehydration - Weight _ _ _ _ - Potential for _ _ _ _ _ _ _ _

Psychopharmacology: Side effects Monitor for side effects of lithium - Hypotension; arrhythmias, pulse irregularities - Polyuria; dehydration - Weight gain - Potential for toxicity

Psychopharmacology: The following are used for _______________ - Lithium carbonate - Anticonvulsants - Verapamil - Antipsychotics

Psychopharmacology: The following are used for _______________ - Lithium carbonate - Anticonvulsants - Verapamil - Antipsychotics

Select the Outcome Measure that would indicate the nurse writing it needs additional teaching: - Exhibits no evidence of physical injury - Has not harmed self or others - Is no longer exhibiting signs of physical agitation - Has achieved full recovery - Eats a well-balanced diet with snacks to prevent weight loss and maintain nutritional status

Select the Outcome Measure that would indicate the nurse writing it needs additional teaching: - Exhibits no evidence of physical injury - Has not harmed self or others - Is no longer exhibiting signs of physical agitation -WRONG - Eats a well-balanced diet with snacks to prevent weight loss and maintain nutritional status

1. What is the most common medication that has been known to trigger manic episodes? Studies have shown that _ _, the most common medication used to prevent manic episodes, reduces expression of ANK3.

Studies have shown that LITHIUM CARBONATE, the most common medication used to prevent manic episodes, reduces expression of ANK3.

3. What is the difference between cyclothymic disorder and bipolar disorder? The difference lies in the i_ _ _ _ _ _ _ _: People with bipolar disorder will experience _____ depression and clinically diagnosed _____, while patients with cyclothymia will experience ___-grade depression and mild _____, also known as h_ _ _ _ _ _ _ _.

The difference lies in the intensity: People with bipolar disorder will experience MAJOR depression and clinically diagnosed MANIA, while patients with cyclothymia will experience LOW-grade depression and mild MANIA, also known as hypomania.

4. Why should a person on lithium therapy have blood levels drawn regularly? The m_ _ _ _ _ between the t_ _ _ _ _ _ _ _ _ _ and t_ _ _ _ levels of lithium carbonate is _ _. The usual ranges of therapeutic serum concentrations are as follows ■ For acute mania: ___ to ___ mEq/L ■ For maintenance: ___ to ___ mEq/L

The margin between the therapeutic and toxic levels of lithium carbonate is VERY NARROW. The usual ranges of therapeutic serum concentrations are as follows ■ For acute mania: 1.0 to 1.5 mEq/L ■ For maintenance: 0.6 to 1.2 mEq/L

The margin between the therapeutic and toxic levels of l_ _ _ _ _ _ c_ _ _ _ _ _ _ _ is very narrow. The usual ranges of therapeutic serum concentrations are as follows ■ For a_ _ _ _ m_ _ _ _: 1.0 to 1.5 ___/_ ■ For m_ _ _ _ _ _ _ _ _ _: 0.6 to 1.2 ___/_

The margin between the therapeutic and toxic levels of lithium carbonate is very narrow. The usual ranges of therapeutic serum concentrations are as follows ■ For acute mania: 1.0 to 1.5 mEq/L ■ For maintenance: 0.6 to 1.2 mEq/L

True/False This is an appropriately written outcome measure. -States that they are able to control their behavior now that the voices are no longer telling them what to do.

True/False This is an appropriately written outcome measure. False an appropriate outcome would be: - Accepts responsibility for own behaviors

Types of Bipolar Disorders: ________________________ May also have experienced episodes of depression

Types of Bipolar Disorders: BIPOLAR I DISORDER May also have experienced episodes of depression

Types of Bipolar Disorders: _______________________ Characterized by bouts of major depression with episodic occurrence of hypomania

Types of Bipolar Disorders: BIPOLAR II DISORDER Characterized by bouts of major depression with episodic occurrence of hypomania

Types of Bipolar Disorders: _________________________ Has never met criteria for full manic episode

Types of Bipolar Disorders: BIPOLAR II DISORDER Has never met criteria for full manic episode

Types of Bipolar Disorders: ______________________________ Characterized by an abnormally and persistently elevated, expansive, or irritable mood and excessive activity or energy that is judged to be the result of direct physiological effects of another medical condition.

Types of Bipolar Disorders: Bipolar Disorder Associated With Another Medical Condition Characterized by an abnormally and persistently elevated, expansive, or irritable mood and excessive activity or energy that is judged to be the result of direct physiological effects of another medical condition.

Types of Bipolar Disorders: _________________________ Chronic mood disturbance

Types of Bipolar Disorders: CYCLOTHYMIC DISORDER Chronic mood disturbance

Types of Bipolar Disorders: ___________________________ Numerous episodes of hypomania and depressed mood of insufficient severity to meet the criteria for either Bipolar I or II disorder

Types of Bipolar Disorders: Cyclothymic Disorder Numerous episodes of hypomania and depressed mood of insufficient severity to meet the criteria for either Bipolar I or II disorder

Types of Bipolar Disorders: ______________________________ A disturbance of mood (depression or mania) that is considered to be the direct result of the physiological effects of a substance (e.g., ingestion of or withdrawal from a drug of abuse or a medication or other treatment).

Types of Bipolar Disorders: Substance-Induced Bipolar Disorder A disturbance of mood (depression or mania) that is considered to be the direct result of the physiological effects of a substance (e.g., ingestion of or withdrawal from a drug of abuse or a medication or other treatment).

Which of the following outcome criteria is appropriate (SATA) - Does not manipulate others for gratification of own needs - Interacts appropriately with others - Verbalizes that hallucinatory activity has ceased and shows outward behavior indicating presence of hallucinations -Is able to fall asleep within 30 minutes of retiring - Is able to sleep 6 to 8 hours per night

Which of the following outcome criteria is appropriate (SATA) - Does not manipulate others for gratification of own needs - Interacts appropriately with others - WRONG -Is able to fall asleep within 30 minutes of retiring - Is able to sleep 6 to 8 hours per night

9. The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. ______ a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night ______ b. Risk for injury related to manic hyperactivity ______ c. Impaired social interaction evidenced by manipulation of others ______ d. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor

a = 3, b = 1, c = 4, d = 2 ______ b. Risk for injury related to manic hyperactivity ______ d. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor ______ a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night ______ c. Impaired social interaction evidenced by manipulation of others

3. The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is a. 1.0 to 1.5 mEq/L. b. 10 to 15 mEq/L. c. 0.5 to 1.0 mEq/L. d. 5 to 10 mEq/L.

a. 1.0 to 1.5 mEq/L.

4. Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply. a. Olanzepine (Zyprexa) b. Paroxetine (Paxil) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) e. Tranylcypromine (Parnate)

a. Olanzepine (Zyprexa) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin)

1. Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. She is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. The priority nursing diagnosis for Margaret is a. imbalanced nutrition: less than body requirements related to not eating. b. risk for injury related to hyperactivity. c. disturbed sleep pattern related to agitation. d. ineffective coping related to denial of depression.

b. risk for injury related to hyperactivity.

8. A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit she must remain in her room.

c. Quietly walk with her back to her room and help her change into something more appropriate.

2. Margaret, age 68, is diagnosed with Bipolar I Disorder, Current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to a. sit with her during meals to ensure that she eats everything on her tray. b. have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes. c. provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run." d. tell Margaret that she will be on room restriction until she starts gaining weight.

c. provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run."