Bipolar

Question 1

Bipolar 1

Answer 1

more common in males
runs in families
most severe
at least 1 manic episode
psychotic episode (delusions/hallucinations)
highs mirror the lows in intensity

Question 2

clinical features of mania (DIGFAST)

Answer 2

D- distractibility
I- Indiscretion
G- Grandiosity
F- Flight of ideas
A- Activity increase
S- Sleep Deficit
T- Talkativeness

Question 3

what does mania look like?

Answer 3

mood lability: extreme mood swings
quick to anger/ feels misunderstood/ low frustration tolerance
pacing
dramatic mannerisms
uses jokes, puns
flamboyant or sexually suggestive
spends extravagantly on self or others
hostile/physically threatening

Question 4

Bipolar 2

Answer 4

NEVER had a manic episode
more common in women- onset at 20
NO psychosis with hypomania; but may have psychosis during depressive side
presence of at least one major depressive episode

Question 5

specifiers for bipolar and related disorders

Answer 5

mixed features- symptoms of both mania and depression at the same time
rapid cycling- 4 or more manic episodes for at least 2 weeks in 12 months
high risk of recurrence; resistant to drug therapy, greater severity of illness, depressive symptoms predominate

Question 6

hypomanic episode

Answer 6

definite noticeable change in functioning uncharacteristic of person
NOT severe enough to cause marked impairment in social or occupational functioning or hospitalization
NO psychotic features in hypomanic phase
Elevated, expansive, or irritable mood for at least 4 days

Question 7

cyclothymic disorder

Answer 7

presence for at least 2 years in adults, 1 in child/ado
multiple hypomanic symptoms but not hypomanic episodes
has not been without symptoms for more than 2 months at a time
fluctuating hypomanic symptoms and depressive symptoms
rapid cycling

Question 8

nursing assessment for bioplar

Answer 8

mood
behavior
thought process
thought content
speech patterns
cognitive functioning

Question 9

assessment guidelines for bipolar

Answer 9

danger to self or others
need for protection from uninhibited behaviors
need for hospitalization
medical status
coexisting medical conditions
family’s understanding

Question 10

what is the primary outcome for an acute manic phase?

Answer 10

injury prevention

Question 11

nursing care for acute mania

Answer 11

managing meds
decreasing physical activity
increase food and fluid intake
ensuring at least 4 to 6 hours of sleep per night
intervening for self care needs and setting limits on behaviors

Question 12

patient/family teaching for biplar

Answer 12

bipolar is chronic and episodic
long term condition
whom to call and where to go incase of adverse reaction
signs and symptoms of relapse
preventing full relapse
emergency contact people
use of drugs, ETOH, caffeine (energy drinks), and OTC meds can cause relapse
good sleep hygiene is critical. early symptom of manic episode is lack of sleep.

Question 13

meds for acute mania

Answer 13

mood stabilizer- Lithium plus antipsychotic or valproate plus antipsychotic
atypical antipsychotic- rispiridone, quetiapine, aripiprazole, olanzapine
benzodiazepines (rare and short term)- diazepam, lorazepam, clonazepam

Question 14

meds for mood stabilizaion

Answer 14

Anticonvulsants (valporate, carbamazepine, lamotrigine, gabapentin- good for rapid cycling)
Lithium carbonate
combo med: symbax (olanzapine and fluoxetine)
Second generation antipsychotics- olanzapine, rispiridone, aripiprazole, lurasidone, quetiapine, ziprasidone

Question 15

Lithium Carbonate

Answer 15

acute mania and maintenance treatment
therapeutic level: 0.6-1.4
TOXIC at 1.5 and above
contraindicated for: cardiovascular disease, renal disease, brain damage, thyroid disease, pregnant or breast feeding

Question 16

early symptoms of lithium toxicity

Answer 16

coarse hand tremors
GI upset, confusion
hyperirritability of muscles
incoordination
1.5-3.0

Question 17

sever toxicity

Answer 17

convulsions
oliguria
death
>2.5

Question 18

Lithium as a mood stabilizer

Answer 18

most widely use mood stabilizer
onset 5-7 days may take as long as 2 weeks
monitor creatinine, thyroid, and CBC q6 months
kidney damage may be at risk
thyroid function may decrease, usually after 6-18 months; observe for dry skin, hair loss, constipation, bradycardia, and cold intolerance

Question 19

teaching points of lithium

Answer 19

increased risk of SI with lithium discontinued
DO NOT restrict sodium; maintain normal sodium intake
hydrate
if sweating hydrate more
if illness causes loss of fluid contact MD
intermittent blood tests required.

Question 20

valproate

Answer 20

depakote
anticonvulsant mood stabilizer
check serum levels
broad spectrum of efficacy
longer periods of mood stabilization

Question 21

carbamazepine

Answer 21

tegretol
risk of low WBC and renal function
effective in pt’s who have no response to lithium or with secondary mania
RASH MAY BE LIFE THREATENING

Question 22

lamotrigine

Answer 22

lamictal rash
stop med immediately
can advance to steven Johnson syndrome (occurs within first few months)
flu like symptoms
sore throat, fever, chills, blisters, burning in eyes
its an allergic reaction
can advance to toxic epidermal necrosis

Question 23

lamotrigine uses

Answer 23

rapid cycling and depressed phase of bipolar illness
rash may be life threatening
used as add on therapy on refractory mood disorders

Question 24

gabapentin

Answer 24

neurontin
may be effective for acute mania, mood stabilization, and rapid cycling

Question 25

other treatments of bipolar

Answer 25

ECT
teamwork and safety
seclusion
support groups
health teaching and promotion

Question 26

ECT

Answer 26

used in pts treatment-resistant mania ad pts with rapid cycling
used in depressive disorders particularly those with sever, catatonic, or treatment-resistant depression

Question 27

advanced practice interventions for bipolar

Answer 27

CBT
family focused therapy
interpersonal and social rhythm therapy

Question 28

suicidal ideation

Answer 28

thinking about, considering, or planning to take ones life

Question 29

suicide intent

Answer 29

at the time of injury or death, the person had thoughts of taking one’s own life

Question 30

suicidal behavior

Answer 30

acts associated with suicidal intent

Question 31

suicidal plan

Answer 31

the organized plan and time frame or taking one’s own life

Question 32

interrupted self-directed violence by self of other

Answer 32

other: person takes steps to injure self but stopped by someone else prior to injury
self: takes steps to injure self by stops prior to fatal injury

Question 33

suicide attempt

Answer 33

non fatal self directed potentially injurious behavior with intent to die

Question 34

suicide

Answer 34

the voluntary and intentional act of taking ones own life by any means

Question 35

suicide survivor

Answer 35

family and friends grieving a loved ones suicide

Question 36

non-suicidal self directed violence

Answer 36

no evidence of suicidal intent, behavior is self directed and deliberately results in injury or the potential for injury to ones self

Question 37

suicidal self directed violence

Answer 37

self directed and deliberately results in injury or the potential for injury to oneself with evidence of suicidal intent

Question 38

unacceptable terms for suicide

Answer 38

completed suicide/committed suicide
successful suicide
failed attempt
nonfatal suicide
parasuicide/suicide gesture
suicidality

Question 39

levels of intervention

Answer 39

prevention: activities that provide support, information, and education to prevent suicide
treatment: treatment of the actual suicidal crisis
postvention: interventions with a circle of surviors left by individuals who have died by suicide and the traumatic effects