Nursing 1445: Bipolar Disorders

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1.

_______and _________ are common defenses for the bipolar patient require gradual introduction of facts. Abnormal Circadian genes could lead to ________. Bipolar Disorder

Minimalization and denial

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ECT

May be used to treat severe manic behavior and those with depressive episodes, especially in treatmentresistant individuals. Also effective in those patients with rapid cycling and paranoid destructive features. Acutely assists suicidal patients. accelerated speech with abrupt changes of topic, usually based on understandable associations or plays on words. Rapid speech, verbosity, jokes, puns, and sexually explicit, vulgar, and loud language. Speech may become disorganized and incoherent. 1.mood 2.behavior 3.thought processes 4.cognitive functioning Delusion that 'God' is speaking to them, or that the FBI is out to stop them from saving the world. Hallucinations may also occur. (inflated self-regard) Patient may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. The boast of exceptional powers and status can take delusional proportions during mania. Thyroid hormone

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Flight of ideas

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Extreme insmonia secondary to superfast biological clock.

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Once commonly known as manicdepression, is a chronic recurrent illness that is marked by shifts in mood, energy, and ability to function. Symptoms range from severe mania to severe depression. Upper socioeconomic classes- achieve higher educational and occupational levels (Higher numbers in professions, artists, writers, highly educated people. At least one episode of mania alternating with major depression, psychosis is common, onset is 18 years of age, usually first episode is depression, episodes increase in severity and number, more common in males. Hypomanic episodes alternating with major depression, more suicides, onset 20 years of age, more common in females. Stringing together of words because of the way they sound (rhyming), without regard to their meaning. Hypomanic episodes alternating with minor depressive episodes (at least 2 years in duration), irritable hypomania, onset in adolesence, 50% develop bipolar disease. Anticonvulsant used in rapid cyclers. Side effects include: *Thrombocytopenia *Blood monitor for therapeutic levels Genome that encodes an enzyme (DGKH)

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General Assessment : mania Grandiose persecutory delusion Grandiosity

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Bipolar disorders may be more prevalent in what socioeconomic classes. Bipolar I Disorder

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Bipolar II Disorder

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Clang associations

High doses of this hormone has been suggested as a method to improve outcomes in treatment of mood disorders. Hypomania

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Cyclothymia

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Depekote/ Depakane (Valproic acid) Diacylglycerol Kinase Eta

An elevated mood with symptoms less severe than of mania. A person in hypomania DOES NOT experience impairment in reality testing, nor do the symptoms impair the person's social, occupational, or interpersonal functions. sociable and euphoric Mood disorders

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Hypothyroidism has been associated with __________ disorders.

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Implementing care for bipolar patient in Acute phase (Depressive episodes)

*Establishment of a therapeutic alliance is critical! *MUST ASSESS SUICIDAL IDEATION!!! *Hospitalization: Suicidal ideation, Psychosis, or Catatonia *Lithium and Lamictal are first line of treatment of acute depression. *Treatment with antidepressants not recommended (can overact the CNS causing mania.) *Atypical antipsychotic if there are psychotic features. *Firm calm approach *Short concise statements with no additional information (DO INTERRUPT!) *Remain neutral, no power struggles *Staff needs to be consistent in expectations of limitations. *Set limits. *Listen to legitimate complaints *Firmly redirect energy into appropriate constructive behaviors. *Absolutely NO CAFFEINE! *Reduce stimuli *Structured Solitary activities with Nurse *Frequent High Calorie finger food *Redirect violence *Use antipsychotics, antianxiety medications PRN *Observe for lithium, tegretol and depakote toxicity *Observe for therapeutic effect. *Monitor input and output; and vital signs *Minimize flamboyant dress *Make it your problem that you don't understand *Sleep log

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In Assessment/ early diagnosis treatment can help individuals with what concerning bipolar disorder. Mania

Avoid suicide, ETOH, substance abuse, marital/work problemes, and development of medical comormidity. An unstable elevated mood in which delusions, poor judgement, and other signs of impaired reality testing are evident. During an episode patients have marked impairment of social, occupational, and interpersonal functioning. Paranoia, hostility, and irritability. May be sexually indiscreet, manipulative, fault finding, profane, and adept to exploiting the vulnerabilities of others.

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Implementing care for bipolar patient in Acute phase (Mania episodes)

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Manic behavior may start off with many projects, and finishes few. Hyperactive, moving rapidly from on place to another. May spend money foolishly. What other behaviors should the nurse be wary of? Milieu Management

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Control during the acute hyperactive phase nearly always includes treatment with an antipsychotic med such as Haloperidol (Haldol) or Chlorpromazine (Thorazine). A euphoric mood associated with bipolar illness is unstable. Overjoyous mood may alternate with irritability and belligerence. The person may: laugh, jokes, talk with unihibited familiarity, enthusiastism, and concoct elaborate schemes to get rich and acquire unlimited power! Neurotransmitters and hormones

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Mood assessment of mania

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Mood disorders are likely the result of complex interactions between __________and ________.

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Nursing Self assessment must be constantly assessed while caring for the patient with mania. Feeling of anger and frustration may occur. What is essential, because the patient is out of control and resisting being controlled? Often the PRIORITY nursing diagnosis for Bipolar disorder.

[Consistently] Setting and maintaining limits is difficult, but essential. Patients with mania are masterful at pointing out staff faults and in splitting staff. Risk for injury *prevention of exhaustion *prevention of death from dehydration/ cardiac collapse *poor reality testing, constant motor activity, poor judgment 1.Patients with bipolar and their family need to know chronic nature of the disease. 2.Long term maintenance of treatment 3.Side effects of medications as well as toxic effects. 4. Signs and symptoms of relapse. 5.Phone numbers to emergency contact people. 6. ETOH, Substance abuse, Caffeine, and over the counter medications could produce relapse. 7. Good sleep, hygiene is CRITICAL to stability. Disturbed thought processes ineffective coping Impaired verbal communication

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Patient is failing to eat, groom, bathe, dress is too frantic and hyperactive. What is the nursing diagnoses?

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Imbalanced nutrition: Less than body requirements Deficient fluid volume Self-care deficit Interrupted family processes Caregiver role strain Impaired social interaction

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Patient is giving away valuables, neglect the family, impulsive major life changes (ie. divorce, career changes) What is the nursing diagnoses? Patient is in constant motor activity, going from one person to another. Annoyance or taunting of others, loud and crass speech along with provocative behaviors. What is the nursing diagnoses? Patient is intrusive, taunting others, inability to control behavior, and has rage reaction. What is the nursing diagnoses? Patient is loud, profane, hostile, combative, aggressive, and is demanding. What is the nursing diagnoses?

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Patient and Family teaching: Bipolar Disorder

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Ineffective coping Risk for otherdirected violence Risk for selfdirected violence Risk for suicide Defensive coping Ineffective coping

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Patient is manipulative, angry, hostile verbally or physically with others, impulsive speech and actions. Property destruction or lashing out at others in rage reaction. What is the nursing diagnoses? Patient presents with rapid speech, loud language, and is sexually explicit. When asked what his hobbies are patient response," Cinema I and II , last row. Row, row, row your boat. Don't be a cutthroat. Cut your throat. Get your goat. Go out and vote. And so I wrote...." This patient is displaying what speech pattern? Patient with "mania" may be willing to give: ?

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Clang association

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Patient has racing thoughts, grandiosity, poor judgment. What is the nursing diagnoses? Patient is continuous pressured speech, jumping from topic to topic (flight of ideas) What is the nursing diagnoses? Patient is excessive and constant motor activity, has poor judgment, and lacks rest/ sleep. Poor nutritional intake. What is the nursing diagnoses?

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Risk for injury

away money, gifts, lavish parties, and spend money freely.

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Planning care for bipolar patient in Acute phase

*Measures are taken to medically stabilize the patient while maintaining patient safety. Nursing care is geared toward lowering physical activity, increasing food and fluids, ensuring sleep, alleviating bowel and bladder problems, and intervening with self-care needs and medication management. *Seclusion, PRN medications, ECT may be part of plan as well. Focus is on maintaining medication compliance and preventing relapse. Patient and family psychoeducation is a MUST. The need for communication skills training and problem-solving skills is evaluated. Referrals are made to community programs, groups, and support groups. The goal is to continue to prevent relapse and limit the duration and severity of future episodes. Medication adherence.

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The 6 guidelines to assessment and the bipolar patient.

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Planning care for bipolar patient in continuation phase

1. Assess whether the patient is a danger to self and to others. 2. Protect patient from consequences of overgenerosity, intrusive behaviors. 3. Assess for need for hospitalization. 4. Assess medical status 5. Assess for coexisting conditions needing special interventions 6. Assess patient and family understanding of bipolar disorder, medications, support groups, and other teaching. highly distractible and has poor concentration.

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Planning care for bipolar patient in maintenance phase Rapid Cyclers

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* 4 or more episodes in a year *more severe symptoms *poorer functioning in all areas of their lives. *high recurrence risk *resistant to medications An isolation room with a bed with no windows. May be necessary to reduce overwhelming enviromental stimuli, protect patient from injuring self or others. Prevents destruction of property Personality disorders Anxiety disorders Anorexia Nervosa Bulimia Nervosa ADHD

The bipolar patient wear inappropriate, colorful, even bizarre dress and overdone makeup. The attention span may be _____________and ______________. The nurse has provided education for a patient in the continuation phase after discharge from the hospital. What indicates that the plan of care has been successful? The nurse is caring for a patient experiencing mania. Which is the most appropriate nursing intervention? The nurse is planning care for a patient experiencing the acute phase of mania. Which is the PRIORITY intervention? The overall Outcome for bipolar patient in Acute phase.

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Seclusion

*Patient identifies three signs and symptoms of relapse. *Patient describes the purpose of each medication he has been perscribed. *Patient identifies two ways to problem-solve a specific situation. Provide consistency among staff members when working with the patient.

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Substance use disorders commonly coexist with Bipolar disorder. Other associated disorders include? The _______________________axis is an area that is being studied in individuals with mood disorders.

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Prevent injury

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Hypothalamic-pituitary-thyroid-adrenal axis

Patient will be free of injuryCardiac status stable, well hydrated, free of abrasions. Patient will report absent of delusions, racing thoughts. Patient will have balanced sleep-rest-activity pattern. Patient will demonstrate adherence to medication regimen. Patient and family will participate in psychoeducational classes.

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The overall Outcome for bipolar patient in Continuation phase

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The overall Outcome for bipolar patient in maintenance phase

Patient and family are aware of prodromal signs of escalating mood or depression. Patient participates in ongoing supportive modality. 5 to 10 times *Lithium Carbonate (LiCO3) *Anticonvulsants *Antianxieties *Atypical Antipsychotics *Typical Antipsychotics Psychosocial areas. True

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The rate of bipolar disorder in relatives can be as high as __________ times over rates found in the general population. These medications should be expected if the patient is bipolar.

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Third of patients with bipolar disorder display significant and persistent cognitive problems in ________________. True or False: Manic nonstop physical activity and the lack of sleep and food can lead to physical exhaustion and even death if not treated; this therefore constitutes as an emergency. True or False: Seclusion or restraint requires consent of the patient, except during an emergency. What chromosomal irregularities may be linked to bipolar disorder? What critical information should the nurse provide about the use of lithium? What regions of the brain have been implicated in pathophysiology of bipolar disorders, due to neurocircuits surrounding these areas? Which behavior exhibited by a patient with mania should the nurse choose to address first?

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True. In an emergency, seclusion or restraint requires the written order of a physician as well. 13-15. "It will take 1 to 2 weeks and maybe longer for this medication to start working fully." Prefrontal cortex and medial temporal lobe Demonstration of flight of ideas

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