Nursing Interventions
Risk for Suicide
What is 1 support group resource?
Depression and Bipolar Support Alliance (DBSA)
National Alliance on Mental Illness (NAMI)
Mental health America
What is the main difference between mania and hypomania?
Hypomania does not experience psychosis
A family history of bipolar disorder increases the risk of development.
TRUE!!!!!
What is the normal lithium therapeutic range?
0.6-1.2
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,
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
What are the 4 states a person with bipolar disorder can be in?
Hypomania, mania, depression, psychosis
What is 1 environmental factor that can influence bipolar disorder.
emotional neglect
childhood abuse
adverse stressful life events
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
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
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
What is the first sign of relapse?
Disturbed sleep
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
What are 2 contraindications to lithium
Cardiovascular disease, brain damage, renal disease, thyroid disease, myasthenia gravis, pregnancy, breastfeeding mothers, children younger than 12 years
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
List the 3 document data that is needed for a secluded and restrained client.
Patient is unable to control actions
Other measures have failed
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
What is 2 neurotransmitter involved in bipolar disorder?
Norepinephrine
dopamine
serotonin
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
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
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
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
What portion of the population is at 4x greater risk of developing bipolar disorder?
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)