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33 Cards in this Set

  • Front
  • Back
What are the treatments for bipolar?
Drug therapy
What types of drugs are used to treat bipolar disease?
Lithium- to prevent and relieve manic episodes.
Anticonvulsants to slow electrical impulses.
Antidepressants to treat deprssive symptoms
What are the Signs and Symptoms of the Manic Phase in bipolar disease?
Elevated, grandiose, or hyperirritable mood; Increased psychomotor activity; Excessive social extroversion; Short attention span; Rapid/presured speech; Flight of ideas (frequent topic changes); decreased need for sleep or food; impulsivity and impaired judgment; exaggerated self-esteem.
What are the Signs and Symptoms of the Depressive Phase in bipolar disease?
Depressed mood; low self-esteem; Overwhelming inertia; Social withdrawl; feelings of hopelessness/helplessness or Suicidal ideation; difficulty concentrating or thinking clearly; psychomotor retardation; slowing of speech; anhedonism (inability to express pleasure); unintentional weight change; change sleep pattern; agitation; fatigue; worthlessness or excessive guilt; .
What type of Nursing Care does the nurse provide during a Manic episode?
Maintain a calm enviornment; protect pt from overstimulation; provide emotional support; set realistic goals for behavior; set firm limits; watch for early signs of frustration; tell pt hitting and threats are unacceptable; alert heathcare team when acting out escalates; do not try to manage adverse behaviors by yourself; administer medications as ordered; monitor for adverse effects of medications.
What type of Nursing Care does the nurse provide during a depressive episode?
Provide for the pt physical needs, help w/hygiene; encorage pt. to eat, feed if necessary; give continual positive reinforcement to improve self-esteem; provide structured routine; remove harmful objects from enviornment; institute suicide precautions per facility policy; strictly supervise medications.
What are the expected outcomes of bipolar treatments?
Pt. successfully cares for self
Pt exhibits appropriate behavior
Pt. experiences minimal adverse drug effects
Pt. identifies positive aspects of self.
Pt is free from self-harm.
What are the three major groups of bipolar disorders?
Bipolar I
Bipolar II
Cyclothymic disorder
Define Bipolar I.
Combination of major depressive, manic or mixed episodes (symptoms of both mania and depression).
Define Bipolar II
Combination of major depression and hypomania.
Define cyclothymic disorder?
Combination of hypomanic episodes intermixed with depressive episodes that do not fully satisfy the criteria for a major depressive episode.
What is bipolar disorder
A mood disorder with manic episodes that usually begin suddenly, with rapid escalation; Chronic cycling condition; results in severe functional impairments as manifestd by isolation from family, friends, and coworkers, financial difficulties, and job loss.
What are the causes/risk factors involved in bipolar disorder?
chronic abnormalities of neurotransmission
anxiety disorders, especially panic disorder and social phobia
substance use, most commonly alcohol and marijuana
family Hx
Sleep disturbances
What is the diagnostic criteria?
At least one manic or mixed episode, with at least one major depressive episode.
See signs and symptoms of mania and major depression.
Describe the action of Lithium.
Stabilizes bipolar disorder by decreasing degree and frequency of manic episodes or eliminating them altogether.; precise action unknown; enters nerve cells where it is believed to have effects on several neurotransmitters; Onset usually 5-7 days may take up to 2 weeks.
What are the Nursing implications/care when administering Lithium?
Administer as ordered; encorage pt to comply w/regimen; take w/food or after meals; Monitor blood levels closely (0.6-1.2 mEq/L) 2-3x's/week for first month, then weekly to monthly; inform importance of taking medication when pt doesn't think they need it; manitain fluid intake of 2500-3000 mL/day; do not drive until drowsiness, fatigue or blurrd vision clears; Monitor AE, document them, &n report toxic effects to Dr.; encourage pt and family to report AE to dr.
What are the expected outcomes of a patient taking lithium?
Pt takes as prescribed
Pt has Blood levels checked as ordered
Pt maintains and adequate fluid/Na intake
Pt.verbalizes understanding of possibe AE and controls them successfully; Pt resumes driving when no longer affected by adverse effects.
What are the Adverse Effects (AE) of lithium?
Excessive thirst
un;peasant metalic taste
Frequent urination
fine hand tremor
mild diarrhea
weight gain
elevated thyroid-stimulating hormone.
What effect does Na have on lithium?
high sodium intake decreases levels
Low sodium intake may lead to toxicity
What effect does alcohol have on lithium?
may increase serum lithium
What effect does caffeine have on lithium?
Increased lithium, increased tremor
What effect does angiotensin-converting enzyme inhibiors have on lithium?
Increases serum lithium levels.
What effect does acetazolamide (Diamox) have on lithium?
increased excretion of lithium, decreasing drug levels.
What effect does carbamazepine (Tegretol) have on lithium?
Increases neurotoxicity, despite normal dosage and serum levels.
What effect does fluoxetine (Prozac) have on lithium?
Increased serum Iithium.
What effect does haloperidol (Haldol) have on lithium?
Increased neurotoxicity, despite normal dosage and serum levels.
What effect does loop diuretics have on lithium?
Increased serum lithium.
What effect does Osmotic diuretics have on lithium?
increased excretion of lithium, decreasing levels.
What effect does thiazide diuretics have on lithium?
promote sodium and potassium excretion; increased lithium levels; may cause cardiotoxicity and neurotoxicity.
What effect does methyldopa (Aldomet) have on lithium?
Increased neurotoxicity without increasing serum levels.
What effect does nonsteroidal anti-inflammatory drugs have on lithium?
decreased lithium clearance
What effect does tricyclic antidepressants have on lithium?
Increased tremor; increased pharmacologic effects of TCAs.
What is ataxia?
is a neurological sign consisting of lack of voluntary coordination of muscle movements