Bipolar disorder

Question 1

Etiology of Bipolar d/o

Answer 1

genetic, too much NE and 5-HT, transmembrane CA2+ (that’s why Ca+ blockers work for manic pregnant pt), neuroanatomical factors, medication s/e

Question 2

types of bipolar d/o

Answer 2

bipolar 1, bipolar 2, cyclothymic d/o;

Question 3

which bipolar d/o has acute mania?

Answer 3

bipolar 1 only

Question 4

cyclothymic d/o is

Answer 4

a fluctuation of mood in a limited range; at least 2 yrs of episodes of hypomania and depressed mood of insufficient severity or duration to meet criteria for bipolar I or II

Question 5

cyclothymic rapid cycler is

Answer 5

x4+ episodes per year

Question 6

acute Mania is

Answer 6

seen in bipolar I only, euphoria and nonfunctioning; elation, frequently labile, fragmented thought, favorite color is red, often psychotic, flight of ideas, disorganized, hypersexuality d/t low impulse control and no bounderies (sex precaution); also safety issue (can assault or be assaulted); excessive pyschomotor activity, decreased need for sleep, hygiene neglect, flamboyant and bizarre, excessive make-up/jewelry (sharpied eyebrows)

Question 7

hypomania is

Answer 7

irritable and highly productive; cheerful, expansive, underlying hostility, volatile and fluctuating; exalted self perception, easily distracted by irrelevant stimuli, difficulty with goal directed activities, increased motor activity, extroverted, sociable, increased libido

Question 8

Elevated mood s/s for mania

Answer 8

expansive, flight of ideas, decreased sleep, grandiose ideas

Question 9

Bipolar II is

Answer 9

depression with hypomanic episodes; better functioning than Bipolar I

Question 10

Lithium will

Answer 10

decrease TSH, so outer eyebrow don’t grow

Question 11

Bipolar with psychotic features: Mood congruent

Answer 11

grandiose delusions (it is plausible)

Question 12

Bipolar with psychotic features: Mood INcongruent

Answer 12

Delusion of control, persecutory delusions, thought inertion (ppl sending pt messages)

Question 13

Delirious Mania Concern

Answer 13

frenzied then may die from exhaustion; #1 concern is SAFETY

Question 14

Delirious Mania characteristics

Answer 14

very labile, unrestrained ecstasy to despair, panic or anxiety, confused/disoriented, religiosity/grandeur/persecutory delusions, extremely distractable, incoherent

Question 15

Nursing dx for Mania

Answer 15

Risk for injury, impaired social interaction d/t no bounderies, feeding self care deficit (finger foods on the go), insomnia (no sleep = more stress); risk for violence self/other directed, imbalanced nutrition: less than body requirements, disturbed thought process, disturbed sensory perception

Question 16

If manic, activities should be

Answer 16

repetitive and simple

Question 17

Risk for Injury Intervention for mania

Answer 17

low stimuli, private room, remove hazards, stay with agitated pt, talking down, provide physical activities, tranquilizer, Olanzapine 15mg PO qd

Question 18

Risk for violence: self other directed intervention for mania

Answer 18

observe q15min, remove dangerous objects, be calm, talking down, sufficient staff, tranquilizer, Olanzapine 15mg PO qd, mechanical restraints

Question 19

Imbalanced Nutrition: less than body requirement intervention for mania

Answer 19

high protein, high calorie finger foods, juice snacks on unit, I&Os, calorie count, daily wt, provide favorite food, supplement with vitamins and minerals, sit with pt during meals

Question 20

3 Stages of bipolar d/o (mania)

Answer 20

1) hypomania, 2) acute mania, 3) delirious mania

Question 21

What is your last resort for tx mania?

Answer 21

physical restraints

Question 22

renew md order for physical restraints

Answer 22

q4 hrs for adults; q1-2hrs for children

Question 23

always choose (x) for physical restraint

Answer 23

least restrictive

Question 24

unconventional self tx of mood d/o

Answer 24

magnet, herb, accupuncture

Question 25

self medicating tx of mood d/o

Answer 25

illlicit drugs

Question 26

Diet and Lithium

Answer 26

need lots of salt and 2.5-3L of fluids/day

Question 27

hold lithium, blood serum >

Answer 27

1.5 mEq/L and call MD

Question 28

community resources

Answer 28

depression and bipolar support alliance (dbsalliance.org); national alliance on mental illness (nami.org)