Basics
How is bipolar disorder characterized?
Alternating of depression or mania (or hypomania) with periods of euthymia in between
What are depressive symptoms of bipolar?
-Flat/blunted affect
-Anhedonia
-Crying
-Lack of energy
-Suicidal thoughts
SX of bipolar in children
Mood changes that are unusual
-super silly, long violent temper tantrums
-older children may take on multiple task at a time and have grand ideas for their work
What meds are the first line treatment for MANIA
Mood stabilizers and antipsychotics are first-line treatment for MANIA
Nursing interventions during mania?
-Low stim environment
-Set clear, firm limits
-Ensure high calorie finger foods are given
-Monitor for risky behavior
What is Bipolar 1?
at least one episode of mania alternating with depression
What are manic symptoms of bipolar?
-Elevated/irritable mood
-Decreased need for sleep
-Increased energy
-Risky/impulsive behavior
-Rapid speech
SX of bipolar in older adults
take on multiple tasks, develop grandiosity
What med class is used in combination with mood stabilizer or antipsychotics?
Anticonvulsants
Nursing interventions during depression?
-Assess for suicidal ideation
-Encourage verbalization of feelings
-Assist w/self care
-Promote small, achievable goals
What is Bipolar 2?
One or more hypomanic episodes alternating w/depression
What are hypomanic symptoms of bipolar?
Similar to mania but:
-Less severe
-Do not impair function
-No hospitalization needed
What is the hallmark sign of mania?
Constant motor activity
What is the therapeutic range for Lithium?
0.6-1.2
Why stress the importance of follow up labs?
To check Lithium levels and check for toxicity
What is Mixed Bipolar?
Symptoms of depression experienced during mania or hypomania
Common risk factors of bipolar?
-Substance use/abuse
-Childhood abuse or neglect
-Prenatal viral infections
*men & women at equal risk
Indicators of improvement in someone with bipolar?
Free from injury, exhibits logical thought process, performing adequate self-care, can sleep through the night, behaves appropriately in social settings
1 episode lasts most of the day every day for at least 1 week
Nursing diagnoses for bipolar?
Risk for injury, risk for violence to self or others, risk for exhaustion (during manic phase), risk for suicide
What is Cyclothymic Disorder?
Two or more years of repeated hypomanic & depressive episodes
Are there ways to prevent bipolar?
No. There are ways to prevent relapse of manic episodes including avoiding substance use, getting adequate sleep, and recognizing triggers
Lifespan considerations of persons with bipolar disorder:
Often misdiagnosed as ADHD/ADD
Suicide risk is increased for all ages
Years of misdiagnosis
What are symptoms of Lithium toxicity?
Nausea/vomiting, diarrhea, thirst, polyuria, muscle weakness, tremors
What is the nursing priority for a patient during mania
SAFETY #1