Nursing Interventions
Treatment
S/SX
Etiology/Patho
Lithium
100
What is the most important nursing diagnosis? 

Risk for Suicide 

100

What is 1 support group resource? 

Depression and Bipolar Support Alliance (DBSA)

National Alliance on Mental Illness (NAMI)

Mental health America 

100

What is the main difference between mania and hypomania? 

Hypomania does not experience psychosis 

100
T/F:

A family history of bipolar disorder increases the risk of development. 

TRUE!!!!!

100

What is the normal lithium therapeutic range? 

0.6-1.2

200

List 2 foods that are appropriate for a client experiencing a manic episode. 

high-calorie finger foods, protein drinks

EX: chicken fingers, french fries, ham and cheese sandwich, cookies, 

200

List 1 anticonvulsant and 1 teaching for that medication. 

Valproate (Depakote) - monitor liver function, platelets 

Carbamazepine (Equetro) - Drug interactions, monitor CBC, asian ancestry 

Lamotrigine (Lamictal) - toxic rash

200

What are the 4 states a person with bipolar disorder can be in? 

Hypomania, mania, depression, psychosis 

200

What is 1 environmental factor that can influence bipolar disorder.

emotional neglect

childhood abuse

adverse stressful life events

200

Name 2 severe signs of Lithium toxicity. 

Confusion, Incontinence of urine or feces, Coma, Cardiac arrhythmias, Confusion, Incontinence of urine or feces, Coma, Cardiac arrhythmias, Peripheral circulatory collapse, Abdominal pain, Proteinuria, Oliguria, Death, Abdominal pain, Proteinuria, Oliguria, Death

300

List 2 communication techniques. 

1. Frim & calm approach

2. Short & concise explanations 

3. Identify expectations in simple & concrete terms

4.  Hear & act on legitimate complaints

5. Firmly redirect energy into more appropriate channels

6.  Convey limits and consequences

300

List 1 second-generation antipsychotic and what is an indication to use an antipsychotic. 

­Aripiprazole (Abilify), Asenapine (Saphris), ­Cariprazine (Vraylar), ­Lurasidone (Latuda), ­Olanzapine (Zyprexa), ­Quetiapine (Seroquel), Risperidone (Risperdal), ­Ziprasidone (Geodon)

Calm them down, slow their speech, inhibit aggression, decrease psychomotor activity, prevent exhaustion, prevent coronary collapse, prevent death

300

What is the first sign of relapse? 

Disturbed sleep

300

List 3 comorbidities that can be found in bipolar patients.  

Anxiety, panic attacks, substance abuse, social phobia, specific phobia, borderline personality disorder, seasonal affective disorder, ADHD, eating disorders

300

What are 2 contraindications to lithium

Cardiovascular disease, brain damage, renal disease, thyroid disease, myasthenia gravis, pregnancy, breastfeeding mothers, children younger than 12 years

400

What are 2 things we can do to alter the milieu?

1. low level stimuli 

2. structured solitary activities or with staff

3. redirect violent behavior 

4. minimize physical harm - medication, seclusion, restraints 

5. observe for medication side effects/toxicity

6. Protect from consequences of behavior 

400

List the 3 document data that is needed for a secluded and restrained client. 

Substantial risk of harm to others or self 

Patient is unable to control actions 

Other measures have failed

400

What are 3 DSM5 diagnostic criteria needed to be diagnosed with bipolar disorder?

inflated self-esteem or grandiosity, decreased need for sleep, more talkative or pressure speech, flight of ideas, distractibility, increased goal-directed activity or psychomotor agitation, excessive involvement in pleasurable activities that have high potential for painful consequences

400

What is 2 neurotransmitter involved in bipolar disorder?

Norepinephrine

dopamine 

serotonin 

400
Name 4 patient teachings for lithium therapy. 

Effects of treatment, Monitor lithium blood levels, side effects and toxic effects, effects of dietary salt and dehydration, caffeine effects, check with physician before taking OTC meds, take with food to decrease stomach irritation

500

Which would you do first in a situation where a manic phase patient is pacing the halls screaming at patients? 


Remain calm and redirect the patient from the area to prevent escalation to violence and protect those in the area

500

List the 2 long-term risks of lithium therapy and what lab values would you assess?

Hypothyroidism - TSH, T4, T3

Kidney damage - creatinine, potassium, eGFR, BUN, UA 

500

What are 2 differences between bipolar 1 and bipolar 2?

Bipolar 1: requires presence of mania, highs last more than 1 week, may lead to hospitalization 

Bipolar 2: requires hypomania in combo with 1 or more major depressive episode, no psychosis, does not lead to hospitalization 

500

What portion of the population is at 4x greater risk of developing bipolar disorder? 

Women with severe postpartum psychosis 
500

There are two patients on lithium therapy who would you see first?

1. ataxia, blurred vision, stupor, severe hypotension

2. abdominal pain, confusion, incontinence of urine, proteinuria

GO TO 2!!!!

1 - advanced lithium toxicity (2.0-2.5 mEq/L)

2 - severe lithium toxicity (>2.5 mEq/L)

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