Bipolar Disorder
What is hypomania (stage 1)?
Mood
cheerful and elated, labile (shifts to irritable if desires not met)
What is mania (stage 2)?
activity and behavior
hyperactive; little to no sleep or nutrition; lack hygiene, lack impulse control, judgement and insight, dress inappropriately; can be sexually uninhibited
greatly impairs ability to function and often requires hospitalization to maintain safety
Types of Bipolar disorders:
bipolar 2 - hypomania - characterized by...
abnormal elevated or irritable mood with increased energy, last at least 4 consecutive days, present most of the day, nearly every day, causing noticeable change, but not severe enough to impair functioning or require hospitalizations
Medical management:
Medications - antimanic - lithium carbonate
lithium levels are affected by...
dietary considerations...
avoid what meds, activities, and consuming
what are early signs on toxicity?
highly influenced by sodium levels, increase sodium decreases lithium (non therapeutic), decreased sodium increases lithium (toxic)
sodium intake should be between 1500-2300 mg/day, fluid intake should be 2500-3000 mL/day
avoid excessive sweating, NSAIDs, diuretic medications, and drinks (coffee, tea, and colas)
early s/sx: vomiting and diarrhea
Nursing process:
Planning and goals
safety of patient and others, setting and enforcing limits, medications - teaching and compliance, promote reality-based thinking, enhancing socialization, improving self-care, increased nutritional intake, enhanced sleep patterns
What is hypomania (stage 1)?
cognition and perception
elated view of self and have great abilities, accelerated ideas, easily distracted, forget to eat
What is delirious mania (stage 3)?
mood
labile in all extremes, euphoria, despair, agitation, panic anxiety
Types of Bipolar disorders:
bipolar 3 - cyclothymic disorder - characterized by...
for at least 2 years with many hypomania and depressive episodes that do not meet criteria for those disorders
the abnormal moods have been present for at least half the time and not been without the moods for at least 2 months at a time, causing significant impairment in functioning
Medical management:
Medications - anticonvulsants
side effect
nursing considerations
clonazepam, topiramate, gabapentin, carbamazepine, valproic acid, lamotrigine
side effects: suicidal thoughts, drowsiness, GI symptoms, changes in CBC, liver impairment (bruising/bleeding, jaundice)
CBC and monitor liver function studies
Nursing process:
specific interventions - risk for violence: self or others
low stimulation environment, remove dangerous objects from environment, may need 1:1 observation, intervene for agitated/aggressive behaviors, remain calm but show strength, follow facility policies for restraints, administer medications for agitation
What is hypomania (stage 1)?
activity and behavior
increased motor activity, socialization and libido, act inappropriate and are loud, acquaintances but no deep relationships
What is delirious mania (stage 3)?
cognition and perception
confusion and disorientation, incoherent, significant delusions and hallucinations
Medical plan of care:
Diagnostics
H&P, mental health assessment, drug screen, chemistry profile, thyroid studies
Medical management:
Medications - calcium channel blocker
side effects
verapamil
side effects: drowsiness, hypotension, changes in ECG, GI symptoms, edema
Nursing process:
specific interventions - impaired social interactions
set limits on manipulative behavior, a matter-of-fact approach with consistency, positive reinforcement for non-manipulative behavior, help develop positive self-esteem
What is mania (stage 2)?
mood
euphoria and on a "high"; labile
What is delirious mania (stage 3)?
activity and behavior
frantic purposelessness activity, extreme safety risk - can die from exhaustion
rare in US - requires hospitalization for safety
Medical management:
Medications - antimanic - lithium carbonate
nursing considerations
works in 1-2 weeks, blood levels (acute mania: 1-1.5 mEq/L, maintenance: 0.6-1.2 mEq/L), requires careful monitoring of labs (do not start medications on patient who may not be complaint with follow up labs)
Medical management:
Medications - antipsychotics
side effects
olanzapine, quetiapine, aripiprazole, ziprasidone, risperidone
side effects: drowsiness, ECG changes, GI symptoms, dry mouth, weight gain, EPS, hyperglycemia
Nursing process:
specific interventions - imbalanced nutrition
high protein, high calorie diet finger foods, assess and provide favorite foods, have snacks available, avoid stimulants (caffeine), monitor I&O, labs, and weight
What is mania (stage 2)?
cognition and perception
flight of ideas and disorganized speech, limited attention; hallucinations and delusions
Types of Bipolar disorders:
bipolar 1 - manic episode - characterized by...
abnormal elevated or irritable mood with increased energy, lasts at least 1 week, present most of the day, nearly everyday or if hospitalization necessary, causing marked impairment in functioning.
Medical management:
Medications - antimanic - lithium carbonate
side effects, severe side effects, and consequence of long term use
side effects: fatigue, headache, drowsiness, weight gain, GI symptoms, tremors/slowed reflexes, increased urination, thirst
severe: arrhythmias, seizures, hypotension
long term use: hypothyroidism
Nursing process:
assessments
suicide/homicide, mental status, mood/affect, thought processes, communication/speech, judgement, motor activity and injury risk, nutrition/weight and sleep pattern, appearance and hygiene, impairment of occupational functioning
Nursing process:
evaluations
free of injury, able to perform self-care, behavior socially acceptable, willing to take medications, understand side effects/need for blood levels, weight and nutritional status stabilized, improved sleep patterns