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16 Cards in this Set
- Front
- Back
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Mania |
An alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking. |
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Bipolar Disorder |
Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy |
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Bipolar I Disorder |
Client is experiencing, or has experienced, a full syndrome of manic or mixed symptoms
May also have experienced episodes of depression |
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Bipolar II Disorder |
Characterized by bouts of major depression with episodic occurrence of hypomania
Has never met criteria for full manic episode |
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1. A suicidal client with a history of manic behavior is admitted to the ED. The client’s diagnosis is documented as Bipolar I Disorder: Current Episode Depressed. What is the rationale for this diagnosis instead of a diagnosis of Major Depressive Disorder? a) The physician does not believe the client is suffering from major depression. b) The client has experienced a manic episode in the past. c) The client does not exhibit psychotic symptoms. d) There is no history of major depression in the client's family. |
Correct answer: B The client’s past history of mania and current suicide attempt support the diagnosis of Bipolar I Disorder: Current Episode Depressed. According to the DSM-5 criteria, a manic episode rules out the diagnosis of Major Depressive Disorder. |
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Childhood and adolescence: Symptoms of Bipolar Disorder |
Euphoric/expansive mood: extremely happy, silly, or giddy Irritable mood: hostility and rage, often over trivial matters Grandiosity: believes abilities to be better than everyone else’s Decreased need for sleep: may sleep for only 4 or 5 hours per night and wake up feeling rested Pressured speech: loud, intrusive, difficult to interrupt Racing thoughts: rapid change of topics Distractibility: unable to focus on school lessons Increase in goal-directed activity/psychomotor agitation: activities become obsessive; increased psychomotor agitation Excessive involvement in pleasurable or risky activities: exhibits behavior that has an erotic, pleasure-seeking quality about it Psychosis: may experience hallucinations and delusions Suicidality: may exhibit suicidal behavior during a depressed or mixed episode or when psychotic |
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Psychopharmacology for Childhood and Adolescent treatment
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Lithium Divalproex (depakote) Carbamazepine (tegretol) Atypical antipsychotics (geodon, zyprexa, seroquel) |
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Stage I: Hypomania
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Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization
Cheerful mood Rapid flow of ideas; heightened perception Increased motor activity |
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Stage II: Acute Mania |
Marked impairment in functioning; usually requires hospitalization
Elation and euphoria; a continuous “high” Flight of ideas; accelerated, pressured speech Hallucinations and delusions Excessive motor activity Social and sexual inhibition Little need for sleep |
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Stage III: Delirious mania |
A grave form of the disorder characterized by an intensification of the symptoms associated with acute mania. The condition is rare since the advent of antipsychotic medication.
Labile mood; panic anxiety Clouding of consciousness; disorientation Frenzied psychomotor activity Exhaustion and possibly death without intervention |
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2. In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis? a) Risk for injury related to excessive hyperactivity b) Disturbed sleep pattern related to manic hyperactivity c) Imbalanced nutrition, less than body requirements, related to inadequate intake d) Situational low self-esteem related to embarrassment secondary to high-risk behaviors |
Correct answer: A According to Maslow’s hierarchy of needs, maintaining client safety is always a priority. The impulsiveness and hyperactivity seen in clients diagnosed with acute mania puts them at risk for injury. |
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Pharmacology for Bipolar |
Lithium Depakote Lamictal Tegretol Gabapentin Neurontin Lyrica Verapamil |
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Lithium |
Levels: 0.6-1.5
Check sodium levels and keep pt hydrated |
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Anticonvulsants for Bipolar |
Depakote/Lamictal/Tegretol
Do not give within week of ECT Tx
Check labs
SE: weight gain, CNS effects: ataxia, slurred speech, confusion, tremor, headache, solemnence, nervousness GI effects: n,v, d, c. CV/Resp effects: hypotension, bradycardia, respiratory depression. Gingival hyperplasia with Phenytoin/Dilantin
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Gabapentin/Neurontin/Lyrica |
Used to treat neuro pain but double as a mood stabilizer
Could be used for somatic disorder |
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3. A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client? a) Do not skimp on dietary sodium intake b) Have serum lithium levels checked every 6 months c) Limit fluid intake to 1,000 ml of fluid per day d) Adjust the dose if you feel out of control |
Correct answer: A Clients taking lithium should consume a diet adequate in sodium and drink 2,500 to 3,000 ml of fluid per day. Lithium is a salt and competes in the body with sodium. If sodium is lost, the body will retain lithium with resulting toxicity. Maintaining normal sodium and fluid levels is critical to maintaining therapeutic levels of lithium and preventing toxicity. |
