Bipolar Disorder
The main difference between bipolar 1 and bipolar 2
What is BP1 Primarily mania with depression and psychosis
BP2 mostly depression with no psychosis
These antidepressants are the easiest to overdose on due to their rapid absorption.
What are cyclic antidepressants
What are ineffective coping, poor problem solvers, emotional instability, impulsivity, sexual abuse as a child.
#1 nursing diagnosis for someone in crisis
What clinical manifestations would a nurse assess for in a patient with bipolar disorder?
What is labile mood that changes from euphoric to irritation and anger, excessive hyperactivity, sexual indiscretion, excessive spending of money and crazy make-up or dress, bizarre behavior and sometimes hallucinations if psychosis.
What is the first line medication treatment for depression and what are some things the RN should educate the patient on when discharging a patient newly prescribed this medication?
SSRI:do not stop abruptly, may make you more suicidal before it makes you feel better, might cause anxiety if dose too high, insomnia and sexual dysfunction are common side effects.
How do genetics play a role in suicidal ideation?
Children with a parent who committed suicide are 3xs more likely to do so as well.
Marriage, a birth of a child, and retirement are all examples of which type of crisis?
What is Maturational
What are some nursing goals for a patient in the acute phase of mania?
Injury prevention, treatment of dehydration, hemodynamic stability, sleep promotion
What type of behavioral therapy is commonly used to treat depression and why?
Cognitive behavioral therapy because it takes negative ways of thinking and changes it to positive.
Of the mental health diagnoses, which has the highest risk of suicide?
What is bipolar disorder
The purpose of critical incident stress debriefing
In addition to bipolar 1 and 2, which additional "specifier" significantly increases the patient's risk of suicide?
What is mixed features (presence of depressed symptoms and manic symptoms at the same time).
Tell me some differences between women and men when it comes to a diagnosis of depression.
Women >men, women seek help, men abuse drugs or alcohol to cope
These 3 questions are the most important to ask someone who presents as depressed and are asked of every patient who are triaged in the ER
Do you have any thoughts of hurting yourself or anyone else?
Do you have a plan?
What is the lethality of the plan or do they have the means to carry it out?
A crisis varies from person to person and depends on what to determine how severe the crisis is?
Norepinephrine- increased with mania and decreased with depression.
This should be included in the nursing assessment of someone who presents with depression.
Some interventions for patients who are suicidal
1:1 sitter for patient safety, remove clothing and all personal belongings, administer antidepressants and antianixety meds as prescribed.
What is the nurses goal of crisis intervention?
To help a patient to achieve pre-crisis level of functioning.
Name some communication strategies the RN should use when dealing with a patient with bipolar disorder.
Setting limits, use a firm and calm approach, remain neutral, be consistent, firmly redirect energy.
When discharging a patient home with a new prescription for an Monoamine oxidase inhibitor, what would alert the nurse to call the healthcare provider?
The patient is already taking a medication that increases norepinephrine or dopamine (ie, sudafed- can lead to hypertensive crisis)
These suicide plans are considered to have a high lethality and these are considered to have low lethality
Low- cutting wrists, ingestion, natural gas
There are levels of crisis intervention. What are the nurse's goals during secondary care?
What is to ensure the safety of the patient, assess support systems, and assess the patient's coping skills.
What is the rationale for the use of electroconvulsive therapy for someone with bipolar disorder?
What is PDD and what are the major hallmark signs?
Persistent depressive disorder, chronic depression for at least a 2 year period, not usually enough for hospitalization, able to function at work and socially, appetite changes, sleep changes, no mania or psychosis.
This population has the lowest risk of suicide and why?
African American women due to strong ties to church and family.
During primary level of crisis intervention what is the nurse's #1 goal?
To teach coping skills
What is the #1 goal for a patient with bipolar disorder besides injury prevention?
Medication compliance
Which form of depression is the most dangerous and what are its hallmark clinical manifestations?
These are some examples of overt and covert clues of suicidal ideation
Overt= "I can't take it anymore", "Life isn't worth living", "I wish I were dead", "I am going to kill myself"
Covert= "Everything is going to be fine", "I won't be a problem much longer", "I want to give my body to science"
Discuss the four phases of crisis
phase 1- coping/problem solving skills or increased anxiety
phase 2- increased anxiety, thought processes become disorganized
phase 3- panic level anxiety, fight or flight activated
phase 4- overwhelming panic, confusion, violence or self harm