BIPOLAR DISORDER

SYMPTOMS

100

Total lack of motivation

Avolition

200

"If I close the window we won't get any oxygen from outside!"

Magical Thinking

300

State of restlessness and anxiety that results in repetitive and unintentional movements

Psychomotor agitation

400

Common s/sx of mania

Elevated mood, Inflated self-esteem or grandiosity, Agitation or irritability, Decreased need for sleep, Hyperexcitability, Highly distractible, Rapid thought and speech, Hyperactivity, Risk taking behavior, May experience delusions or hallucinations

500

Medically unexplained bodily sensations or basic physical dysfunctions such as appetite, digestion, or sleep dysfunction

Somatic symptoms

TREATMENT

100

Therapeutic range for Lithium

0.6-1.2 mEq/L

200

Medications for tx of depressive symptoms

Lurasidone

Olanzapine/Fluoxetine

300

What should be maintained well in the diet of a patient taking lithium?

Water and sodium

400

A bipolar specific type of therapy

IPSRT

500

First line medications for mania

Lithium

Valproic Acid

Olanzepine

Aripiprazole

Quetiapine

Risperidone

NURSING INTERVENTIONS

100

Interventions for sleep disturbance

Encourage rest periods

Monitor how much sleep client is getting

Discourage caffeine consumption

200

Interventions to decrease the risk of injury

Remove hazardous substances and objects from environment, Reduce stimuli, Stay with hyperactive and/or agitated patient, Structured activities, Physical activities

300

Interventions for impaired nutrition

Juice and high-protein, high-calorie snacks readily available, Finger foods at meal times, Walk or sit with patient while eating, Monitor I&O and weight, Assess likes and dislikes, Supplement with vitamin as needed

400

Interventions to decrease the risk of violence

Frequent observation – during other interactions, Intervene if behaviors indicate client is anxious, agitated, or exhibiting aggression, Offer alternative activities if patient is anxious or agitated, Remain calm, De-escalate >> medications >> restraints

500

Interventions for impaired sensory perception

Observe for signs of hallucinations, Avoid touching client without permission, Avoid reinforcing auditory hallucinations by using words like “the voices” instead of “they”, Acknowledge hallucination but orient to reality, Involve in activities to help with reality orientation, If auditory hallucinations persist, assist client to assert conscious control over them

PATIENT EDUCATION

100

What should a patient taking lithium monitor for?

Mental confusion, sedation, poor coordination, coarse tremors, and ongoing GI distress (first s/sx of toxicity)

200

Common triggers for relapse

High levels of stress, change in sleep pattern or lack of sleep, substance/alcohol abuse

300

How to decrease the GI side effects of lithium

Take medication with food or milk

400

What types of therapy could you recommend to the patient?

IPSRT, group therapy, cognitive therapy, family therapy, recovery model therapy

500

Health teaching that should be provided to patients

Educate about bipolar d/o, educate about different therapy options, What could lead to relapse, Signs of impending relapse, Importance of maintain regular sleep, meals, activity, Routine follow up with provider. Medication compliance

WILD

100

Types of Bipolar d/o

Bipolar Type 1, Bipolar Type 2, Cyclothymic d/o

200

Standardized screening tool

Mood Disorders Questionnaire 

300

With which medications are EPS symptoms a prominent issue?

First generation, or conventional, antipsychotics

400

Risk Factors

Genetics, neurobiologic or neuroendocrine disorders, stressful life events/sexual abuse, substance misuse

500

What basic questions should you answer to reassess patient status?

Is the client safe?

Is the client still having suicidal ideation?

Is the client functional?

Can the client verbalize their feelings?

Can the client identify resources and who to call for assistance?