Row 1
Ch. 13
Ch. 13
A patient who has been on the unit for 3 days wants to call her sister on the phone. She tells the RN that her sister doesn't answer for the 3rd time during the last hour. What is the nurse's best reply?
A. "Here is the phone"
B. "You cannot call right now"
C. You can try again in one hour"
C.
What is the Nurse's goals in the Maintenance phase of Bipolar disorder?
A. Stabilize, 1:1 sitter
B. Prevent relapse, support
C. Redirect and discharge
B.
A. "Let's sit down....Please sit"
B. "Tell me more"
C. "Walk with me..... Was...."
C. (this is redircting)
what is the definition of Hypomania?
A. Characteristic of Bipolar I
B. Depression
C. Low-level mania
C.
What are some therapies we can use or recommend to help patients with bipolar disorder? Name a few! :)
--Integrative therapy--dietary
-- Brain stimulation therapies (Electroconvulsive therapy (ECT) and Repetitive transcranial magnetic stimulation (rTMS)
--Psychological therapies (Cognitive behavioral therapy (CBT), Interpersonal and social rhythm therapy, Family focused therapy.
If a patient with bipolar disorder has increased agitation, what are some drugs we give them?
--Lithium, divalproex, and a second-gen antipsychotic (olanzapine or risperidone); Benzodiazepines (clonazepam (Klonopin), Lorazepam (Ativan) for short term use.
-May need seclusion and/or restraints if less invasive, verbal de-escalation measures are ineffective.
- May need to arrange for one-on-one supervision. Stay with the pt. Redirect the pt.
Tx: Pharacotherapy
Mood stabilizer
(1) what should we give pts that cannot be on Lithium carbonate?
(2) What are the names of these drugs?
(3) what should we watch for when a pt is taking these drugs and what should we teach our pts?
(300 points added if correct)!
(1) Anticonvulsants
(2) Valproate (Depakote)--Do not take with pregnancy! Carbamazepine (Tegretol), Lamotrigine (Lamictal)
(3) Watch for rash (Steven's Johnson's syndrome), Teach your pts to report rash, abd pain, jaundice, pale/pasty stools (hepatotoxicity).
Monitor LFTs
Tx: Pharmacotherapy
Mood stabilizer
Lithium Carbonate
(1) Why do we have to know the therapeutic levels while on Lithium? What is that safe range?
(2) What should we teach our pts that are on Lithium? (name a few)!
(3) What are the signs of toxicity that need to be reported immediately?
(4) What should we be closely monitoring?
(5) What pts should NOT take Lithium?
(300 points added if correct)!
(1) Narrow therapeutic index (can reach toxicity levels quickly if not monitored closely). Therapeutic levels: 0.6-1.2 mEq/L
(2) Consistent fluid and salt intake, TAKE WITH FOOD, avoid NSAIDS, do not stop!
(3) course tremor, confusion, blurred vison, N/V/D
(4) Monitor sodium, creatinine, TSH/T3/T4
(5) Contraindicated: CV disease, renal disease, thyroid disease, pregnant women
What are the 4 Risk factors for Bipolar disorder?
-- Genetic: higher risk when there are family members who are affected
-- Neurobiological: Proprotions of neurotransmitters in relating to another. Receptor site insensitivity may be involved.
-- Neuroendocrine: Hypothalamic/pituitary, adrenal (HPTA) axis has been researched
-- Peripheral inflammation: This has been seen to be increased in pts with bipolar disorder.
(1) What is pressured speech?
(2) What is circumstantial speech?
(3) What is tangential speech?
(300 points added if correct)!
(1) when pt feels as if they cannot get words out fast enough to express their thoughts (speaking quickly, suddenly, and erratically).
(2) When a pt includes a lot of unnecessary and insignificant details in the convo (takes away from the main point of what the pt may be trying to say).
(3) a communication disorder in which the train of thought of the speaker wanders and shows lack of focus, never returning to the initial topic of the conversation.
(1) What is loose associations?
(2) What is clang associations?
(200 points added if correct).
(1) lack of connection between ideas
(2) grouping of words, usually rhyming words that are based on similar-sounding sounds, even though the words themselves don't have nay logical reasoning to be grouped together.
Name some some categories that fall under Acute phase for bipolar disorder.
(Think about how we can help our patient)!
-- Safety/trust no self harm or violence (trust and rapport)
-- Hydration (drinking enough? offer beverages)
-- Nutrition--Finger foods
-- Sleep/rest--short periods (offer rest time throughout the day)
-- Stabilize cardiac function
-- Elimination (assess bm, urination, offer laxative if appropriate)
-- Redirect and distract pt
-- Demonstrate thought self control
Name some categories that fall under maintenance phase.
(Think, how can I help my patient)!
--Safety and Trust
-- Prevent future exacerbations
-- Teach about symptom management, medication regimen, follow-up appointments, and structured routine at home.
-- Support system
-- Group therapy and new coping skills
What is Bipolar I disorder and the comorbidities?
-- Major depressive and manic episodes
-- Ma experience psychosis
-- HIGH MRTALITY RATE---SUCIDE RISK
--Comorbidities: social anxiety, panic attacks, phobias, ADHD, Substance use, metabolic syndrome, self-harm
What is Bipolar II disorder and the comorbidities?
-- Major depressive and hypomanic episodes (lower mania)
-- Underdiagnosed because commonly mistaken for MDD (major depressive disorder)
-- Comorbidities: anxiety disorders, eating disorders, substance use.
What is Cyclothymic Disorder?
-- symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children.
-- May be difficult to distinguish from Bipolar II Disorder
Mood, Behavior, Thought process and speech patterns, Thought content, and Cognitive functions are the assessments we look at in patients that may have bipolar disorder.
Name what we would assess (look for/observe) with the assessments listed above.
(If you get this correct, 200 points added)!
--Mood: Unstable, euphoric or dysphoric, overly-friendly, belligerent, confrontational, intrusive, ask very personal questions.
--Behavior: Decreased sleep, distractibility, push limits, disinhibited behaviors.
-- Thought process and speech patterns: Pressured speech, circumstantial speech, tangential speech, loose associations, flight of ideas, clang associations
-- Thought content: Delusions--persecutory (belief they are a victim, being singled out) and grandiose (belief that they are powerful or inflated self-importance) are common.
-- Cognitive functions: Diminished ability to logically think and reason
Nursing interventions for Mania (learning slide, no points)
Communication, Safe and structured milieu, Nutrition and Hydration, Sleep, Hygiene, Elimination
--Think of how we interact, assess, plan, evaluate, and help our patients in general with mania.
Communication: firm and calm approach, short and concise statements, redirect energy into a healthier outlet, state clear expectations, matter-of-fact.
-- Safe and structured milieu: Low stimulation, structured solitary activities with staff, redirect aggressive behavior, de-escalation techniques, seclusion/restraint, store valuables
-- Nutrition and Hydration: High calorie finger foods, provide reminders to drink fluids.
-- Sleep: Sleep hygiene techniques, low stimulation environment, rest periods
-- Hygiene: Step-by-step reminders to complete ADLs, encourage appropriate clothing choices
-- Elimination: Offer high fiber fluids and foods, offer laxative if appropriate.