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NSG 322 > Bipolar + Impulse Control > Flashcards

Bipolar + Impulse Control Flashcards

1
Q

what are the two poles that bipolar disorder is characterized by?

A

mania & depression

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2
Q

bipolar 2 disorder

A

defined by a pattern of depressive episodes and hypomanic episodes, but not full-blown manic episodes

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3
Q

bipolar 1 disorder

A

consists of full manic episodes alternating with major depressive episodes

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4
Q

Cyclothymic Disorder (Cyclothymia)

A

defined by numerous periods of hypomanic symptoms as well numerous periods of dysthymic (lower-grade depression) symptoms lasting for at least 2 years

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5
Q

what kind of people is bipolar disorder more common in?

A

creative and highly- educated people

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6
Q

the more severe phases of bipolar disorder increase the _____

A

suicide risk

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7
Q

what are the three brain chemicals that have been implicated in bipolar disorder

A

serotonin, dopamine, and noradrenaline

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8
Q

Environmental Factors in Bipolar Disorder

A

A life event may trigger a mood episode in a person with a genetic disposition for bipolar disorder.
Even without clear genetic factors, altered health habits, alcohol or drug abuse, or hormonal problems can trigger an episode.

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9
Q

sleep disruption in bipolar disorder

A

some findings show that people with bipolar disorder have a genetic predisposition to sleep-wake cycle problems that may trigger symptoms of depression and mania.

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10
Q

Manic Episode vs Depressive Episode

A

manic: “wired” decreased need for sleep, loss of appetite, talking fast about different things, can do a lot at once, doing risky things with poor judgment
depressive: “down”, trouble falling asleep, waking up too early or sleep too much. increased appetite weight gain, trouble concentrating =, lack of interest in activities

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11
Q

Hypomania

A

less severe manic phases; A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless.

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12
Q

mania

A

a mood disorder marked by a hyperactive, wildly optimistic state

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13
Q

diagnosis of mania & hypomania s/s

A

*Abnormally upbeat, jumpy, or wired
*Increased activity, energy, or agitation
*Exaggerated sense of well-being and self-confidence
*Decreased need for sleep
*Unusual talkativeness
*Racing thoughts
*Distractibility
*Poor decision-making

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14
Q

acute phase of mania treatment

A

*Medical stabilization
*Maintaining safety
*Self-care needs

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15
Q

continuation phase of mania treatment

A

*Maintaining medication adherence
*Psychoeducational teaching
*Referrals

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16
Q

maintenance phase of mania treatment

A

*Preventing relapse

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17
Q

what are the interventions during acute mania

A

*Structure in a safe milieu
*Nutrition
*Sleep
*Hygiene
*Elimination

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18
Q

communication strategies for mania/bipolar episode

A

*Use a Firm, Calm Approach (short, concise explanations or statements, Remain neutral, firmly, safely redirect energy)
*Be Consistent (Conduct frequent staff meetings to agree on approach and limits for the client)
*Listen & Act (Hear and act on legitimate complaints.)

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19
Q

medications for MOOD STABILIZATION for bipolar disorder

A

*Lithium
*Certain anticonvulsants
*Certain atypical antipsychotics

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20
Q

medications for ACUTE MANIA for bipolar disorder

A

*Certain benzodiazepines
*Certain atypical antipsychotics

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21
Q

medications for MIXED MANIA for bipolar disorder

A

*Certain atypical antipsychotics

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22
Q

What is the first-line agent for bipolar disorder

A

lithium

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23
Q

How does lithium work?

A

*Alters sodium transport in nerve and muscle cells to inhibit the release of norepinephrine and dopamine

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24
Q

what are things to monitor for and remind the patient when taking lithium

A

*Do not limit sodium intake while taking lithium
*Monitor for dehydration
*Do not take diuretics with lithium

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25
Q

What can lithium cause?

A

Hypothyroidism
renal damage

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26
Q

what is the therapeutic level for lithium

A

0.6-1.2

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27
Q

what routine labs should be taken when taking lithium

A

*Serum lithium levels (0.6-1.2 mEq/L)
*Kidney function
*Thyroid-related hormones (TSH, T3, T4)

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28
Q

side effects of lithium

A

Fine hand tremors, polyuria, thirst, nausea, weight gain
renal toxicity, hypothyroidism

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29
Q

toxic vs severe toxicity level for lithium

A

Toxic level: ≥1.5 mEq/L
*Severe toxicity: >2 mEq/L

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30
Q

s/s of mild lithium toxicity

A

muscle weakness, muscle twitching & ataxia, confusion, slurred speech, GI effects (nausea, vomiting, diarrhea), thirst, polyuria

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31
Q

s/s of advanced lithium toxicity

A

significant coarse hand tremor, persistent GI upset, ataxia & clonic movements, incoordination, EEG changes

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32
Q

s/s of severe lithium toxicity

A

Ataxia & clonic movements, blurred vision, large output of dilute urine, significant EEG changes, seizures, tinnitus, stupor, severe hypotension, coma.

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33
Q

s/s of lithium toxicity >2.5mEq/L

A

clients decline rapidly due to cardiac dysrhythmias, peripheral circulatory collapse, proteinuria, oliguria, and death may occur. Death from lithium toxicity is most often due to pulmonary complications.

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34
Q

treatment for lithium toxicity

A

*Stop lithium administration
*Hydrate
*Supportive measures

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35
Q

if a patient does not respond to lithium and carbamazepine, what drug is given

A

divalproex

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36
Q

what is the drug for treatment-resistant bipolar disorder

A

carbamazepine

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37
Q

carbamazepine is often added to…

A

a lithium or antipsychotic drug regimen

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38
Q

For clients who do not tolerate lithium or who do not have a good response to treatment from lithium, what class of drugs can be used

A

anticonvulsant (anti-seizure, anti-epileptic)

39
Q

rapid cycling bipolar disorder

A

diagnosis given when a person has four or more cycles of mania and depression within 1 year

40
Q

Dysphoric (mixed) mania

A

manic & depressive features, mood variability, mood lability- sx: agitation, insomnia, suicidal ideation, psychosis, appetite disturbances

41
Q

what routine levels need to be assessed when taking Divalproex

A

ammonia

42
Q

what does abnormal ammonia levels look like in a patient

A

can have immediate brain effect, can get confused and aggressive all the sudden

43
Q

what is a major SE of Lamotrigine

A

Lamotrigine is notorious for Stevens-Johnson Syndrome
-Clients should report ANY sign of rash to their provider immediately

44
Q

How is lamotrigine dosed?

A

all clients will start at a very small dose and follow a titration regimen to increase to a dose that provides good symptom control

45
Q

if the client stops taking lamotrigine for a few days, what must be done

A

they need to NOT TAKE THE NEXT DOSE- they would need to re titrate the meds

46
Q

atypical antipsychotics

A

*olanzapine, risperidone, aripiprazole, ziprasidone

47
Q

when are Benzes used in bipolar patients

A

used in emergent situations primarily, during acute mania

48
Q

what benzo CANNOT be used for acute mania

A

alprazolam should NOT be used for acute mania - (increases agitation and aggression)

49
Q

Oppositional Defiant Disorder

A

a childhood disorder in which children are repeatedly argumentative and defiant, angry and irritable, and in some cases, vindictive LASTING FOR AT LEAST 6 MONTHS

50
Q

Conduct Disorder (CD)

A

repetitive, persistent pattern of aggressive, antisocial behavior violating societal norms or the rights of others

51
Q

childhood-onset conduct disorder

A

onset before age of 10
*Diagnosed as early as age 2
*Physically aggressive (to people and/or animals)
*Poor peer relationships
*Shows little to no concern for others
*Lacks guilt and remorse for actions
*More likely to continue into adulthood

52
Q

Adolescent-onset conduct disorder

A

onset between ages 10-18
*Less aggressive form of CD
*Acts out misconduct with peer group
*(e.g., truancy, early-onset sexual behaviors, drinking, substance abuse, risk-taking behaviors)
*Less likely to continue into adulthood

53
Q

treatments for childhood impulse control disorders

A

*Treatment goals:
-Developing problem-solving abilities, social skills, impulse control techniques, and empathy
*Parenting classes and management training necessary to help parents deal with these disorders, including limit setting
*Combined individual and parent management training (family therapy)
*Treatment of co-morbidities
*Mood stabilizers and acute hospitalization may be needed

54
Q

Intermittent Explosive Disorder (IED)

A

A type of impulse-control disorder characterized by repeated episodes of impulsive, uncontrollable aggression in which people strike out at others or destroy property

55
Q

pyromania

A

a compulsion to set things on fire

56
Q

kleptomania

A

insane impulse to steal

57
Q

impulse control disorders

A

involves a decreased ability to resist an impulse (or a drive) to perform certain acts. In most cases the pattern is one of increasing tension that builds until a particular action is taken

58
Q

psychopharmacology for kleptomania

A

*SSRIs
*bupropion
*naltrexone

59
Q

psychopharmacology for conduct disorders

A

*lithium
*methylphenidate
*risperidone

60
Q

nonpharmacologic treatments

A

*Hypnotherapy
*CBT:
*Focus: habit reversal & sensitization to consequences
*Biofeedback
*Behavioral conditioning/behavior modification
*Group psychotherapy

61
Q

Biofeedback

A

a technique in which individuals learn to control physiological responses such as breathing rates, heart rates, blood pressure, brain waves, and skin temperature (auditory biofeedback of the physiological response and then relaxation techniques such as slow, deep breathing or meditation)

62
Q

Behavioral conditioning

A

the use of positive rewards and negative consequences is research-supported for reducing problematic habitual behaviors.

63
Q

Group psychotherapy

A

provides for therapeutic confrontation from peers and tends to be particularly helpful for people who have poor insight or difficulty accepting responsibility for their behavior.

64
Q

Anger

A

*An emotional response to a frustration of desires, threat to one’s needs (emotional or physical), or a challenge.

65
Q

Aggression (anger’s motor counterpart)

A

*Goal-directed action or behavior that results in a verbal or physical attack.
*It is the act of initiating hostilities.
*It is hostility that arouses thoughts of attack and/or a disposition to behave aggressively.

66
Q

aggression is not the same as _____

A

violence

67
Q

when may aggression be appropriate

A

Self-protective, as in protecting oneself or one’s family
*Protective, as in protecting self from being bullied

68
Q

violence

A

defined as an unjust, unwarranted, or unlawful display of verbal threats, intimidation, or physical force.
*Its intent is to inflict harm, damage, or violate.

69
Q

Bullying

A

is offensive, intimidating, malicious, and condescending behavior designed to humiliate and to terrorize.

70
Q

Lateral bullying

A

bullying by a person of equal status

71
Q

what direct questions can you ask an aggressive client during assessment

A

*Have you ever thought of harming someone else?
*Have you ever seriously injured another person?
*What is the most violent thing you have ever done?

72
Q

when collecting data about an agressive client, where can you gather the history from

A

*Both medical and psychologic/psychiatric history
*Family, friends, and client (when calm)

73
Q

Signs and symptoms that usually precede violence are:

A

*Angry or anxious, irritable affect
*Hyperactivity
*Increasing anxiety and tension

74
Q

hyperactivity

A

*Is the most important predictor of imminent violence (e.g., pacing, restlessness, slamming doors).

75
Q

Increasing anxiety and tension is demonstrated by

A

*a clenched jaw or fist, rigid posture, fixed or tense facial expression, and/or mumbling to self; Is expressed through verbal abuse

76
Q

Client characteristics of potential violence

A

*Loud voice, change of pitch (or very soft voice, stone silence)
*Intense eye contact (or avoidance of eye contact)
*Recent violence, including property violence
*History of past violence
*Suspiciousness and/or paranoid thinking
*Alcohol or drug intoxication (or withdrawal)
*Possession of a weapon (or use of an object as a weapon)

77
Q

Milieu characteristics conducive to violence

A

*Loud
*Overcrowded
*Environment is too warm
*Staff inexperience
*Provocative or controlling staff
*Poor limit setting by staff
*Staff inconsistency (e.g., arbitrary revocation of privileges)

78
Q

what is always the first priority when managing an agressive client

A

safety
*Risk for self-directed violence
*Risk for other-directed violence

79
Q

Stages of the Violence Cycle

A

-Pre-assaultive stage
-Assaultive stage
-Post-assaultive stage

80
Q

preassultive stage

A

*De-escalation approaches

81
Q

assaultive stage

A

medication, seclusion, restraint

82
Q

post-assaultive stage

A

debriefing

83
Q

De-escalation Techniques

A

*EMPHASIZE THAT YOU ARE THERE TO HELP; ACKNOWLEDGE NEEDS
*Stand at an angle to appear nonconfrontational 45 DEGREE ANGLE
*Assess and provide for personal safety
*Appear calm and in control SET CLEAR CONSISTENT AND ENFORCABLE LIMITS
*Do not try to speak while the person is yelling
*Speak softly: be nonprovocative and nonjudgmental
*Demonstrate genuineness and concern LISTEN
*Do not treat the individual in a humiliating manner
*Ask “What will help now?”

84
Q

Alternatives to Seclusion and Restraint

A

*Comfort rooms — Individuals can voluntarily isolate to self-manage anxiety and distress
*Trauma-Informed Care model

85
Q

seclusion and restraints

A

SHOULD BE USED LAST
Remember, less restrictive interventions should be tried before these.

86
Q

Seclusion

A

*Involuntary confinement alone in a room or area; the client is physically prevented from leaving.

87
Q

Restraint

A

*Any manual method, physical or mechanical device, or material or equipment that restricts freedom of movement.

88
Q

Chemical Restraint

A

*If needed, obtain an order for a NOW dose of a sedating drug. Usually administered by IM injection.
*Med administration without client consent is a chemical restraint, which requires the provider’s order.

89
Q

Post-Assaultive Stage: Critical Incident Debriefing: Staff analysis

A

*Assures quality of care
*Provides an opportunity for self-care for staff members

90
Q

Post-Assaultive Stage: Documentation

A

*The violent episode itself
*Staff responses

91
Q

Practice Self-Management First

A

In order to be effective in a crisis, you must first manage yourself before you can manage other people.

92
Q

Knowing Yourself

A

Without self-knowledge, nurses are likely to make impulsive, emotion-based responses that are nontherapeutic and may be harmful.
*Take a moment to breathe
*Quickly assess the situation
*Think before responding
(Choice of words,Tone of voice, Nonverbal communication,Personal triggers, Personal sense of competence)

93
Q

what can you ask when a patient is aggressive/upset

A

Ask the person why they are upset or what they wish to achieve.
-work together

94
Q

3 guiding principles for every situation

A
  1. Meet the NEEDS of the person that you’re working with (Meet their individual needs in that moment, as well as their long-term needs)
  2. Reflect RESPECT AND DIGNITY toward the person you’re working with. (Regardless of the person’s behavior, a lack of dignity or respect will not help resolve the situation productively)
  3. Maintaining the SAFETY of everyone involved (including yourself) is always the best response and is the nurse’s legal obligation.

NSG 322 (12 decks)

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