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34 Cards in this Set

  • Front
  • Back
Bipolar
moods swinging from depression to mania. It is often referred to as manic
Mania
Mania is a feeling of euphoria, irritability, and unpredictability accompanied by increased energy and increased involvement in activities.
etiology of Bipolar
Bipolar disorder is considered by most researchers to be a chemical imbalance. The neurotransmitter changes are thought to be a change in serotonin, norepinephrine, and dopamine levels. When these neurotransmitters are decreased the person experiences a depressed mood. When these neurotransmitters are increased the person experiences a hypomanic or manic mood.
etiology of Bipolar
1.neurochemical
2.genetic link in the majority of people diagnosed with bipolar disorder. Children who have a parent with bipolar disorder are 4-6 times more likely to inherit the illness.
3.ages of 15-35;east 50% are diagnosed before the age of 25 years
4.environment
5.Two common defense mechanisms seen with bipolar disorder includes denial. It is difficult for a manic or hypomanic individual to see or hear the symptoms as being abnormal. The person perceives that the manic or hypomanic symptoms are normal.
6.substance abuse
7.ADHD-A person who is diagnosed with attention deficit hyperactivity disorder or ADHD runs a high risk for being diagnosed with bipolar disorder. The symptoms of hyperactivity, restlessness, talkative, interrupting, and difficulty with concentration is seen in both illnesses
8.Side effects of meds
S/S of Mania
Onset before "30"
Mood- elevated
expansive
irritable
Speech- loud & rapid
punning
rhyming
clanging
vulgar
?Wt. loss
Grandiose
Delusions
Distracted
Hyperactive
Decrease for Sleep
Inappropriate
Flight of Ideas
Begins suddenly escalates over several days
S/S of Depression
Previous manic episodes
Mood- dysphoric
depressive
despairing
Decrease interest in pleasure
Negative views
Fatigue
Decrease appetite
Constipation
Insomnia
Decreased Libido
Suicidal preoccupation
May be agitated or have movement retardation
Acronym for Mainia
DIGFAST
Distractibility -poorly focused, multitasking
Insomnia-decreased need for sleep
Gradiosity- inflated self-esteem
Flight of Ideas- complaints of racing thoughts
Activities- increased goal-directed activities
Speech- pressured or talkative
Thoughtlessness- risk taking behaviors(sexual, financial, travel, driving)
Mania
Outcomes with Nursing Interventions
Outcome: Pt. will be free from injury.
Intervention:
Assess for SI/HI
Decrease stimuli
Provide safe milieu
Administer Medication to prevent or treat escalating behaviors
Outcomes with Nursing Interventions
Outcome: Pt. will demonstrate improved mood stabilization and thought process
Intervention:
Assess moods and thoughts
Use therapeutic communication techniques
Monitor interactions
Provide individual and group therapy
Administer meds to stabilize moods
Outcomes with Nursing Interventions
Outcome: Pt will demonstrate an improved ADL's.
Intervention:
Assess nutritional intake, energy level, sleep patterns, dress, grooming and hygiene
Provide non-stimulating environment
Set limits on ADL's
Outcomes with Nursing Interventions
Teaching Outcome: Pt. will verbalize or demonstrate knowledge of_________
Intervention:
Assess learning barriers
Assess knowledge of illness and treatment
Implement teaching on illness, meds and other treatment modalities
Review discharge safety plan and relapse prevention
Antimanic Medications
Purpose: treat bipolar disorder (manic or depressed), seizure disorders, and/or CNS pain.
Route: po (for bipolar disorder-capsules, tablets, or concentrates)
Frequency: daily for treatment of bipolar disorder
Antimanic Medications
Effectiveness: 7-14 days before medication becomes effective.
Medications: Lithium carbonate (Eskalith, Eskalith CR, Lithane, Lithotabs, Lithobid, Lithicarb). Lithium citrate (Cibalith-S).
Action: May influence reuptake of neurotransmitters possibly by interfering with ionic pump mechanisms in brain cells and may compete with or replace sodium ions.
Antimanic Medications
Side effects
Side effects: These side effects usually decrease after the 6th week of treatment
-HA
-Fine hand tremors,
-Polyuria
-Mild thirst
-Mild nausea
-Weight gain
-Edema
-Dry mouth
-Metallic taste
-Hyperglycemia (nephrogenic diabetes insipidus)
-Hypothyroidism.
Antimanic Medications
Lithium
Lithium levels: Therapeutic levels are 0.5-1.5 mEq/L. Maintenance levels are
0.6-1.2 mEq/L. Drawn 8-12 hours after last dose given. Drawn weekly until therapeutic level is reached. Than, drawn monthly. Lithium has a narrow therapeutic margin of safety.
Antimanic Medications
Lithium Toxicity
Early toxicity symptoms (1.5-2.0 mEq/L):
-Diarrhea
-Vomiting
-Drowsiness
-Muscular weakness
-Lack of coordination.






Late toxicity symptoms (2.0 mEq/L or greater):
-Ataxia
-Giddiness
-Blurred vision
-Tinnitus
-Large amount of dilute urine
-Confusion
-Coma
-Death
Antimanic Medications
Interactions:
Thiazide diuretics or drugs that decrease sodium levels will increase toxic effects of Lithium.
Excessive salt intake, drugs containing large amounts of sodium, or ingestion of large amounts of caffeine decreases lithium levels.
Combination of Haldol and Lithium can cause lethargy and confusion after high doses.
Antimanic Medications
Contraindicated:
During pregnancy or breast feeding a baby. Lithium causes fetal abnormalities.
If person has renal or cardiovascular disease.
Use cautiously when person has thyroid disease or diabetes mellitus
Antimanic Medications
Nursing Interventions/Teaching:
Nursing Interventions/Teaching:
1. Inform patient of medication name, purpose, dosage, frequency, side effects, how to treat side effects, toxicity symptoms, call physician immediately if experiencing toxicity symptoms or if suspects pregnancy, compliancy, importance of regularly getting Lithium levels drawn, and what to do if a dose is missed. *See textbook for specific interventions for each side effect.
2. Encourage fluid intake of 2,500-3,000 ml/day to decrease chance of renal toxicity. Monitor that person does not increase water intake beyond 3,000 ml/day because fluid overload can cause a decrease in Lithium levels.
3. Monitor weight, intake, output, glucose, thyroid and renal function.
4. Assess diet. Encourage person to maintain balanced diet and salt intake since Lithium levels are related to sodium levels. The levels are inversely proportional.
5. Assess for diaphoresis, diarrhea, vomiting, fever, diuresis, or sodium changes.
6. Avoid driving until level is stabilized.
Anticonvulsant Medications
Action: Unknown, transports amino acids across neuronal membranes, increases GABA, or inhibits sodium transport.
Effectiveness: May take 1-2 weeks to stabilize bipolar disorder.
Anticonvulsant Medications Meds:
Meds:
Depakote (valproic acid)
Tegretol (carbamazepine)
Neurontin (gabapentin)
Trileptal (oxcarbazepine)
Lamictal (lamotrigine)
Gabitril (tiagabine)
Topamax (toprimate)
Anticonvulsant Medications Meds:
side effects
Side Effects:
1. Dizziness
2. Drowsiness
3. HA
4. Nausea
5. Vomiting/GI upset
6. Rash especially with Lamictal
7. Hepatotoxicity with Depakote and Tegretol
8. Weight gain
9. Fatigue
10.Tremor
Anticonvulsant Medications
Interactions:
Interactions:
1. Alcohol decreases effectiveness of medication.
Anticonvulsant Medications
Teaching:/intervention
1. Inform patient of medication name, purpose, dosage, frequency, side effects, how to treat side effects, compliancy, and what to do if a dose is missed. *See textbook for specific interventions for each side effect. When giving anticonvulsant meds to treat bipolar disorder, don’t teach seizures may occur if stopping the med. That is only if the patient is taking an anticonvulsant for seizure activity.
2. Patient should notify physician immediately if pregnant or is breast feeding a baby.
3. Advise not to stop medication abruptly.
4. Be cautious driving or operating heavy machinery especially while medication is being adjusted.
5. As medication stabilizes the mood swings, the chance for a successful suicide attempt increases.
6. Monitor Depakote and Tegretol serum levels for toxicity. Therapeutic Depakote level is 50-100 mcg/ml. Therapeutic Tegretol level is 6-12 mcg/ml. Monitor hepatic function for both medications.
Anticonvulsant Medications
Purpose: treat bipolar disorder (manic or depressed), seizure disorders, and/or CNS pain.
Route: po (for bipolar disorder-capsules, tablets, or concentrates)
Frequency: daily for treatment of bipolar disorder
What is the action of Lithium?
Unknown but may substitute sodium ions in the neurons.
What are the common side effects of Lithium?
Dry mouth and mild hand tremors.
What are the early signs of Lithium toxicity?
Vomiting and muscular weakness.
What are the late signs of Lithium toxicity?
Ataxia and large amount of dilute urine.
Is this a therapeutic range for Tegretol (oxcarbazepine)?
YES 9 mcg/ml is within the Therapeutic Tegretol level is 6-12 mcg/ml.
If sodium levels increase for a person who is taking Lithium, the nurse should anticipate the Lithium level to ________?
Decrease
A pt. is started on Lithium. What would be the most important teaching intervention?
Encourage pt. to drink 2500-3000 ml/day.
Onset of Lithium is within?
1-2 weeks
What is a common side effect of anticonvulsants?
Dizzieness
Anticonvulsant Meds.
Lamictal (lamotrigine)
Tegretol (carbamazepine)
Topamax (toprimate)