General Questions
1.A suicidal client with a history of manic behavior is admitted to the emergency department. The client’s diagnosis is documented as bipolar I disorder: current episode depressed. What is the rationale for this diagnosis instead of a diagnosis of major depressive disorder?
A. The physician does not believe that the patient is suffering from major depression.
B. The patient has experienced a manic episode in the past.
C. The patient does not exhibit psychotic symptoms.
D. There is no history of major depression in the patient’s family.
What is The patient has experienced a manic episode in the past?
Correct Answer: B
§The patient’s past history of mania and current suicide attempt support the diagnosis of Bipolar I Disorder: Current Episode Depressed.
§According to the DSM-5 criteria, a manic episode rules out the diagnosis of Major Depressive Disorder.
Contemporary thinking about bipolar disorder has been shaped by the works of which theorist?
Who is Emil Kraepelin?
Emil Kraepelin first coined the term manic-depressive in 1913
This disorder is characterized by recurrent bouts of major depression with episodic occurrence of hypomania?
What is Bipolar II disorder?
Nonpharmacological interventions for Bipolar Disorder are:
What are:
Mood charting
Managing stress and sleep cycles
Maintaining healthy diet and exercise
Avoiding alcohol and drugs
This drug requires a level check every 1 to 2 months?
What is Lithium?
In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis?
A. Risk for injury related to excessive hyperactivity
B. Disturbed sleep pattern related to manic hyperactivity
C. Imbalanced nutrition, less than body requirements, related to inadequate intake
D. Situational low self-esteem related to embarrassment secondary to high-risk behaviors
What is Risk for injury related to excessive hyperactivity?
Correct Answer: A
§According to Maslow’s hierarchy of needs, maintaining client safety is always a priority.
§The impulsiveness and hyperactivity seen in clients diagnosed with acute mania puts them at risk for injury.
This disorder affects approximately 4.4% of American Adults.
What is Bipolar disorder?
This disorder is a chronic mood disturbance of at least 2 years involving numerous periods of elevated mood that do not meet the criteria for a hypomanic episode and numerous periods of depressed mood of insufficient severity or duration to meet the criteria for major depressive episode.
What is Cyclothymic disorder?
What are the treatment modalities for Bipolar Disorder?
What are:
§Individual psychotherapy
§Group therapy
§Family therapy
§Cognitive therapy
§Recovery model
§Electroconvulsive therapy (ECT)
§Bright light therapy (BLT)
When taking anticonvulsants, the patient should refrain from discontinuing the drug abruptly. Report the following symptoms to the physician immediately:
What are skin rash, unusual bleeding, spontaneous bruising, sore throat, fever, malaise, dark urine, and yellow skin or eyes?
Avoid consuming alcoholic beverages and nonprescription medications without approval from physician.
A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?
A. Do not skimp on dietary sodium intake.
B. Have serum lithium levels checked every 6 months.
C. Limit fluid intake to 1,000 mL of fluid per day.
D. Adjust the dose if you feel out of control.
What is Do not skimp on dietary sodium intake?
Correct Answer: A
§Patients taking lithium should consume a diet adequate in sodium and drink 2,500 to 3,000 mL of fluid per day.
§Lithium is a salt and competes in the body with sodium.
§If sodium is lost, the body will retain lithium with resulting toxicity.
§Maintaining normal sodium and fluid levels is critical to maintaining therapeutic levels of lithium and preventing toxicity.
Bipolar is the ___ leading cause of disability in middle age groups.
What is the 6th?
_______ are associated with intoxication from substances, such as alcohol, amphetamines, cocaine, hallucinogens, inhalants, opioids, phencyclidine, sedatives, hypnotics, and anxiolytics
What are mood disturbances?
Bright Light Therapy (BLT) may benefit which type of bipolar state?
What is bipolar depression?
When using this type of drug, patient should use sunblock lotion and wear protective clothing when spending time outdoors. Skin is more susceptible to sunburn, which can occur in as little as 30 minutes.
What are antipsychotics?
Mood is defined as:
What is a pervasive and sustained emotion that may have a major influence on a person’s perception of the world?
What are the types of Bipolar Disorder?
What are:
Bipolar I Disorder
Bipolar II disorder
Cyclothymic disorder
Substance-induced bipolar disorder
Bipolar disorder associated with another medical condition
The exact etiology of bipolar disorder___
What is has yet to be determined?
Scientific evidence supports a chemical imbalance in the brain
Electroconvulsive therapy (ECT) may benefit which type of Bipolar state?
What are episodes of acute mania?
Particularly when the patient does not tolerate or fails to respond to lithium or other drug treatment or when life is threatened by dangerous behavior or exhaustion
There are how many stages of Mania? and what are they?
What are 3?
Stage I: Hypomania
Stage II: Acute Mania
Stage III: Delirious Mania
Affect is described as:
What is the external, observable emotional reaction associated with an experience?
This disorder has a mood disturbance as the direct result of physiological effects of a substance.
What is Substance-induced bipolar disorder?
In adolescents which comorbid condition is the most prevalent to Bipolar Disorder?
What is ADHD?
______ is possible when the patient is empowered and actively engaged in a multi-faceted illness approach.
What is Recovery?
What is stage II: Acute Mania?
Describe the symptoms of Stage II: Acute mania.
Symptoms of acute mania may be a progression in intensification of those experienced in hypomania, or they may be manifested directly. Most individuals experience marked impairment in functioning and require hospitalization.
Acute mania is characterized by euphoria and elation. The person appears to be on a continuous high, but mood is always subject to frequent variation.
Cognition and perception become fragmented and often psychotic in acute mania. Accelerated thinking proceeds to racing thoughts, overconnection of ideas, and rapid, abrupt movement from one thought to another and may be manifested by a continuous flow of accelerated, pressured speech to the point where trying to converse with this individual may be extremely difficult. Attention can be diverted by even the smallest of stimuli. Hallucinations and delusions are common.
Psychomotor activity is excessive. Sexual interest is increased. There is poor impulse control, low frustration tolerance, and the individual who is normally discreet may become socially and sexually uninhibited. Energy seems inexhaustible, and the need for sleep is diminished. They may go for many days without sleep and still not feel tired. Hygiene and grooming may be neglected. Dress may be disorganized, flamboyant, or bizarre, and the use of excessive make-up or jewelry is common.