Bipolar and related disorders

Which behavior would be most characteristic of a client during a manic episode of bipolar disorder? Going rapidly from one activity to another Taking frequent rest periods and naps during the day Being unwilling to leave home to see other people Watching others intently and talking little

Going rapidly from one activity to another Hyperactivity and distractibility are basic to manic episodes

Lithium Onset of action is usually within 10-21 days Because the onset of action is so slow it is usually supplemented in the early phases of tx by atypical antipsychotics, anticonvulsants or antianxiety meds. there is a small window between the therapeutic and toxic levels of lithium. Lithium must reach therapeutic blood levels to be effective. this usually takes 7-14 days or longer for some pts. Blood serum should be

0.6-1.2 lithium should not exceed 1.5

Which room placement would be best for a client experiencing a manic episode of bipolar disorder? A shared room with a client with dementia A single room near the unit activities area A single room near the nurses' station A shared room away from the unit entrance

A single room near the nurses' station The room placement that provides a nonstimulating environment is best. Nearness to the nurses' station means close supervision

Bipolar I disorder is the most severe bipolar disorder It is marked by

shifts in mood energy ability to function

Which side effects of lithium can be expected at therapeutic levels? Fine hand tremor and polyuria Nausea and thirst Coarse hand tremor and gastrointestinal upset Ataxia and hypotension

Fine hand tremor and polyuria The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? Withhold medication and notify the physician. Continue to administer medication as ordered. Advise the client to limit fluids for 12 hours. Advise the client to curtail salt intake for 24 hours.

Withhold medication and notify the physician. The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld and the physician notified

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will exhibit optimistic, energetic, playful behavior. adhere to follow-up medical appointments. take medication more than 50% of the time. use alcohol to moderate occasional mood "highs."

adhere to follow-up medical appointments. The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable.

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that is dark colored and modest. colorful and outlandish. compulsively neat and clean. ill-fitted and ragged

colorful and outlandish. Manic clients often manage to dress and apply makeup in ways that create a colorful, even bizarre, appearance

A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of bipolar II disorder. bipolar I disorder. cyclothymia. seasonal affective disorder.

cyclothymia. Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years' duration. The mood swings are not severe enough to prompt hospitalization

Thought content delusions brought out by mania grandiose delusions persecutory delusions

grandiose- highly inflated self-regard persecutory - people think that god is punishing them, that the FBI is spying on them, that they mayor is harrassing them

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying flight of ideas. distractibility. limit testing. grandiosity.

grandiosity. Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity.

An outcome for a manic client during the acute phase that would indicate that the treatment plan was successful would be that the client reports racing thoughts. is free of injury. is highly distractible. ignores food and fluid.

is free of injury. Risk for injury is a diagnosis of high priority for manic clients because of their hyperactivity. Lack of injury is a highly desirable outcome.

The first-line drug used to treat mania is lithium carbonate (Lithium). carbamazepine (Tegretol). lamotrigine (Lamictal). clonazepam (Klonopin).

lithium carbonate (Lithium). Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder

A desirable short-term goal for the nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors would be making no attempts at self-harm within 12 hours of admission. sleeping soundly for 12 of the next 24 hours. willingly taking prescribed medication as offered by staff within 24 hours of admission. demonstrating psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission.

making no attempts at self-harm within 12 hours of admission. Whenever aggressive verbal or physical behaviors are demonstrated, a desirable goal is cessation of those behaviors. Verbal and physical aggression are most apt to occur when staff are trying to structure the client's behavior for his or her own safety or the safety of others

Thought processes and speech patterns -pressured speech circumstantial speech tangential speech loos associations flight of ideas clang associations

pressured- fast, rapid circumstantial- adding unneccessary details but eventually getting to the point tangential- tangents, lose the point loose associations- thoughts are loosely connected flight of ideas: abrupt changes from topic to topic clang association: rhyming

When a client experiences four or more mood episodes in a 12-month period, the client is said to be dyssynchronous. incongruent. cyclothymic. rapid cycling.

rapid cycling. Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology

The priority nursing diagnosis for a hyperactive manic client during the acute phase is risk for injury. ineffective role performance. risk for other-directed violence. impaired verbal communication.

risk for injury. Risk for injury is high, related to the client's hyperactivity and poor judgment

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to question the client's motive. set verbal limits. initiate physical confrontation. prepare the client for seclusion.

set verbal limits. Verbal limit setting should always precede more restrictive measures

To plan care for a manic client the nurse must consider that lithium cannot be started until the physical examination and laboratory tests are analyzed. the initial doses of antipsychotic medication have brought behavior under control. seclusion has proven ineffective as a means of controlling assaultive behavior. electroconvulsive therapy can be scheduled to coincide with lithium administration.

the physical examination and laboratory tests are analyzed. Lithium should not be given to clients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally.

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that no research exists to suggest genetic transmission. much depends on the socioeconomic class of the individuals. highly creative people tend toward development of the disorder. the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

the rate of bipolar disorder is higher in relatives of people with bipolar disorder. This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.

When a client reports that lithium causes an upset stomach, the nurse suggests taking the medication: with meals with an antacid 30 minutes before meals 2 hours after meals

with meals Many clients find that taking lithium with or shortly after meals minimizes gastric distress