Ati Rn 8.0 Bipolar

Front 1

mania

Back 1

an abnormally elevated mood, which may also be described as expansive or irritable; usually requires inpatient treatment

Front 2

hypomania

Back 2

less severe episode of mania that lasts at least 4 days accompanied by three to four symptoms of mania.

hospitalization usually not required

client with hypomania is less impaired

Front 3

mixed episode

Back 3

a manic episode and an episode of major depression experienced by the client simultaneously

the client has marked impairment in functioning

may require admission to an acute care mental health facility to prevent self-harm or other-directed violence

Front 4

rapid cycling

Back 4

four or more episodes of acute mania within 1 year

Front 5

Bipolar I disorder

Back 5

the client has at least one episode of mania alternating with major depression

Front 6

Bipolar II disorder

Back 6

the client has one or more hypomanic episodes alternating with major depressive episodes

Front 7

Cyclothymia

Back 7

the client has at least 2 years of repeated hypomanic episodes alternating with minor depressive episodes

Front 8

bipolar comorbidities

Back 8

Substance abuse - the client with substance abuse issues tends to experience more rapid cycling of mania, use is often use as a means of self-medication, can have a direct impact on the onset of a mental health disorder especially if a client is predisposed

Anxiety disorders

Eating disorders

Attention deficit hyperactivity disorder (ADHD)

Front 9

bipolar risk factors

Back 9

Physical illness, such as delirium due to a head injury

Substance abuse, such as cocaine or methamphetamine overdose

Front 10

bipolar risks for relapse

Back 10

Use of substances (alcohol, drugs of abuse, caffeine) can lead to an episode of mania.

Sleep disturbances may come before, be associated with, or be brought on by an episode of mania.

Front 11

manic characteristics

Back 11

• Persistent elevated mood (euphoria)
• agitation and irritability
• dislike of interference and intolerance of criticism
• increase in talking and activities
• Flight of ideas – rapid, continuous speech with sudden and frequent topic change
• grandiose view of self and abilities (grandiosity)
• impulsivity: spending money, giving away money or possessions
• demanding and manipulative behavior
• distractibility
• Poor judgment
• attention-seeking behavior: flashy dress and makeup, inappropriate behavior
• impairment in social and occupational functioning
• decreased sleep
• Neglect of ADLs, including nutrition and hydration
• Possible presence of delusions and hallucinations
• denial of illness

Front 12

depressive characteristics

Back 12

• Flat, blunted, labile affect
• tearfulness, crying
• lack of energy
• anhedonia: loss of pleasure and lack of interest in activities, hobbies, sexual activity
• Physical symptoms of discomfort/pain
• difficulty concentrating, focusing, problem solving
• self-destructive behavior
• decrease in personal hygiene
• loss or increase in appetite and/or sleep, disturbed sleep
• Psychomotor retardation or agitation

Front 13

Mood Disorders Questionnaire

Back 13

a standardized tool that places mood progression on a continuum for hypomania (euphoria) to acute mania (extreme irritability and hyperactivity) to delirium (completely out of touch with reality)

Front 14

bipolar nursing care

Back 14

Care of the bipolar client will be based on the phase of mania the client is experiencing.

* Focus on safety and maintaining physical health.
* Therapeutic Milieu (within acute care mental health facility).
* Assess the client regularly for suicidal thoughts, intentions, and escalating behavior.
* Decrease stimulation without isolating the client if possible.
* Follow agency protocols for providing client protection (restraints, seclusion, one-to-one observation)
* Implement frequent rest periods.
* Observe the client closely for escalating behavior.
(Do not involve the client in activities that last a long time or that require a high level of concentration and/or detailed instructions)

Front 15

communication with the bipolar client

Back 15

* Use a calm, matter-of-fact, specific approach.
* Give concise explanations.
* Provide for consistency among staff members.
* Avoid power struggles, and do not react personally to the client’s comments.
* Listen to and act on legitimate client grievances.
* Reinforce non-manipulative behaviors.

Front 16

medications for bipolar

Back 16

Mood stabilizers:
* Lithium carbonate (Eskalith)
* Antiepileptic agents that act as mood stabilizers, including: valproic acid (Depakote), clonazepam (Klonopin), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topax)

Benzodiazepines:
* lorazepam (Ativan), used on a short-term basis for a client experiencing sleep impairment related to mania

Antidepressants:
* SSRI fluoxetine (Prozac), used to manage a major depressive episode

Front 17

therapeutic procedures for the bipolar client

Back 17

Electroconvulsive therapy (ECT) may be used to subdue extreme manic behavior, especially when pharmacologic therapy, such as lithium, has not worked.

ECT may also be used for clients who are suicidal or those with rapid cycling.

Front 18

Bipolar Client Education

Back 18

* Case management to provide follow up for the client the family
* Group, family, and individual psychotherapy to improve problem-solving and interpersonal skills
* Health teaching regarding:
* The chronicity of the disorder requiring long-term pharmacological and psychological support
* Indications of impending relapse and ways to manage the crisis
* Precipitating factors of relapse (e.g., sleep disturbance, use of alcohol, caffeine, or drugs of abuse)
* The importance of maintaining a regular sleep, meal, and activity pattern
* Medication administration

Front 19

Client Outcomes

Back 19

- The client will refrain from self-harm.
- The client will rest 4 to 6 hr per night.
- The client will maintain adequate fluid and food intake.
- The client will use appropriate communication skills to meet needs.
- The client will participate in self-care.
- The client will not experience relapse.

Front 20

Bipolar Complications & Nursing Actions

Back 20

Physical Exhaustion and Possible Death:
- A client in a true manic state usually will not stop moving and does not eat, drink, or sleep. This can become a medical emergency.

Nursing Actions:
- Prevent client self-harm.
- Decrease client’s physical activity.
- Promote adequate fluid and food intake.
- Ensure a minimum of 4 to 6 hr of sleep each night.
- Assist the client with self-care needs.
- Manage medication appropriately.

Front 21

acute mania

Back 21

• treatment is generally 6 to 12 weeks in duration.
• hospitalization may be required.
• Reduction of mania symptoms is the goal of treatment.
• Risk of harm to self or others is determined.
• one-to-one supervision may be indicated.

Front 22

bipolar maintenance phase

Back 22

• increased ability to function

Front 23

Bipolar Continuation Phase

Back 23

• Remission of symptoms