Flashcards in T1-Bipolar Disorder & Suicidal Client Deck (80):
A pervasive and sustained emotion that may have a major influence on a person's perception of the world
Examples of mood?
The emotional reaction associated with an experience
An alteration in mood that is expressed by feelings of elations, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking
How can mania occur?
-Biological (organic) disorder
-A response to substance use
-General medical condition
Characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy
Are delusions and hallucinations part of bipolar disorder?
May or may not be
What is a somewhat milder form of mania called?
What type of bipolar:
-Client is experiencing, or has experienced, a full syndrome of manic or mixed symptoms
-Client may also have experience episodes of depression
Bipolar 1 disorder
What type of bipolar:
-Characterized by bouts of major depression with episodic occurrence of hypomania
-Has never met criteria for full manic episode
Bipolar 2 disorder
A suicidal client, with a history of manic behavior, is admitted to the ED. The client’s diagnosis is documented as bipolar I disorder: current episode depressed. What is the rationale for this diagnosis instead of a diagnosis of major depressive disorder?
A. The physician does not believe the client is suffering from major depression.
B. The client has experienced a manic episode in the past.
C. The client does not exhibit psychotic symptoms.
D. There is no history of major depression in the client's family.
B--The clients past history of mania and current suicide attempt support the diagnosis of bipolar 1 disorder
Stage 1: Hypomania
Are symptoms sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization?
What are the characteristics of Stage 1: Hypomania?
-Rapid flow of ideas, heightened perception
-Increased motor activity
Stage 2: Acute Mania
Is there marked impairment in functioning? Does this stage of mania require hospitalization?
Stage 2: Acute Mania
-Elation and euphoria (a continuous high)
-Flight of ideas, accelerate/pressured speech
-Hallucinations and delusions
-Excessive psychomotor activity
-Social and sexual inhibition
-Little need for sleep
A grave form of the disorder (mania) characterized by an intensification of the symptoms associated with acute mania.
Stage 3: Delirious mania
Is delirious mania common or rare?
Rare--bc of antipsychotic medications
What are some characteristics of delirious mania?
-Labile mood, panic anxiety
-Clouding of consciousness, disorientation
-Frenzied psychomotor activity
-Exhaustion and possibly death without intervention!!
Lifetime prevalence of pediatric and adolescent bipolar disorders is estimated at about __.
Is it easy to diagnose bipolar disorder in childhood and adolescence?
No, difficult! (it is similar to ADHD, so thats why its hard to diagnose)
How have guidelines for diagnosis and treatment been developed for diagnosing bipolar disorder in kids?
The Child and Adolescent Bipolar Foundation (CABF)
What does the CABF recommend the use of in making a diagnosis of bipolar disorder in children and adolescents?
What does FIND stand for?
1. Frequency: symptoms occur ____
2. Intensity: How are the symptoms?
3. Number: How many times a day?
4. Duration: How many hours a day?
Frequency: Symptoms occur MOST DAYS OF THE WEEK
Intensity: Symptoms are SEVERE enough to cause EXTREME DISTURBANCE
Number: Symptoms occur 3-4x/DAY
Duration: Symptoms last FOUR OR MORE HOURS/DAY
Childhood and adolescence: What are the 11 big symptoms for bipolar disorder?
1. Euphoric/expansive mood
2. Irritable mood
4. Decreased need for sleep
5. Pressured speech
6. Racing thoughts
8. Increase in goal directed activity/psychomotor agitation
9. Excessive involvement in pleasurable or risky activities
What does it mean if a child is experiencing a euphoric/expansive mood?
Extremely happy, silly, or giddy
What does it mean if a child is experiencing an irritable mood?
Hostility and rage--ofter over trivial matters
What does it mean if a child is experiencing grandiosity?
Believes abilities to be better than everyone elses
What if a child has a decreased need for sleep-- How many hours do they get? What do they feel like?
May sleep 4-5 hours per night but still wake up feeling rested!
What is pressured speech?
Loud, intrusive, difficult to interrupt
What is racing thoughts?
Rapid change of topics
What is distractibility?
Unable to focus on school lessons
What is increase in goal-directed activity/psychomotor agitation?
Activities become OBSESSIVE--increased psychomotor agitation
What is excessive involvement in pleasurable or risky activities?
Exhibits behavior that has an erotic, pleasure-seeking quality about it
What happens if they experience psychosis?
May expreience hallucinations and delusions
What may the child exhibit if symptoms of suicidality arise?
Suicidal behavior during a depressed or mixed episode or when psychotic
What is the rest of the nursing diagnosis for bipolar mania RISK FOR INJURY r/t:
Bipolar mania risk for injury r/t extreme hyperactivity, increased agitation, and lack of control over purposeless and potentially injurious movements
What is the rest of the nursing diagnosis for bipolar mania RISK FOR VIOLENCE: SELF DIRECTED OR OTHER DIRECTED r/t:
What is the rest of this diagnosis:
Bipolar mania DISTURBED THOUGHT PROCESSES r/t:
Biochemical alterations in the brain AEB delusions of grandeur and persecution and inaccurate interpretation of the environment
In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis?
A. Risk for injury related to excessive hyperactivity
B. Disturbed sleep pattern related to manic hyperactivity
C. Imbalanced nutrition, less than body requirements related to inadequate intake
D. Situational low self-esteem related to embarrassment secondary to high-risk behaviors
According to Maslows hierarchy of needs, maintaining CLIENT SAFETY is ALWAYS A PRIORITY. The impulsiveness and hyperactivity seen in clients diagnosed with acute mania puts them at risk for injury
Learning how to live a safe, dignified, full, and self-determined life in the face of the enduring disability which may, at times, be associated with serious mental illness
The recovery model
What are some things the client does in the recovery process of bipolar disorder?
-Develop a treatment plan (client and clinician)--and work on strategies to help manage the disorder
-Clinician= support person to help the individual achieve the goals they make
Is there cure for bipolar disorder?
If there is no cure for bipolar disorder, how is recovery possible??
In the sense of learning to PREVENT and MINIMIZE symptoms, and to successfully COPE with the effects of the illness on mood, career, and social life
AKA THERE IS HOPE
Who is more at risk for suicide: single or married people?
Who attempt suicide more? Who succeed more?
Risk of suicide ___ with age (especially among ___)
White men older than ___ are at greatest risk of all age/gender/race groups
Affiliation with a religious group ____ risk for suicide.
Who is more at risk: Catholics, Proestants, Jews?
Protestants or Jews
Individuals in the very highest and lowest social classes ____ suicide than those in middle class.
What is the ethnicity order for increased risk of suicide?
1. Whites followed by
2. Native Americans
3. African Americans
4. Hispanic Americans
5. Asian Americans
What is the most common risk for suicidal?
What are some other problems that account for suicidal behavior?
_____ is associated with increase risk of suicide
Does ETOH and other barbiturates increase or decrease risk for suicide?
Does psychosis with command hallucinations put you at risk for suicide?
T/F: Chronic painful or disabling illness is an increased risk for suicide
Does family history have anything to do with increased risk of sucide?
A mood disorder causing a persistent feeling of sadness and loss of interest
4 S&S of depression?
1. Hypersomnolence (sleep a lot)
2. Lack of appetitie/ overeating
Loss of enjoyment of things that used to make a person happy
An alteration in mood that is expressed by feelings of ELATION, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerate thinking and speaking
Main 3 symptoms of mania?
1. Accelerated mood
3. Decreased sleep
A lesser degree of mania
Why is hypomania often hard to diagnose?
May be confused with someone who is outgoing and energetic
Are all people with mania happy and elated?
NO!!!---some can be angry and agitated
What are some disorders that increase risk for suicide?
Major depressive disorder
What is a sentinel event?
Suicide or injury that occurs in a facility
How often do we monitor clients with major depression?
IRREGULAR intervals of 15 minute checks! (must be irregular so the client doesnt suspect when you will be coming back)
Nursing diagnosis for major depression?
1. Risk for suicide r/t depressed mood, feelings of worthlessness, anger toward self, misinterpretations of reality
2. Low self esteem r/t learned helplessness, feelings of abandonment by significant others, impaired cognition due to negative view of self
3. Spiritual distress r/t complicated grieving process over loss of valued object evidence towards anger toward God
Should we argue, bargain, or try to reason with a bipolar client?
What are nursing diagnosis for bipolar disorder?
1. Risk for injury r/t ..
2. Risk for violence: self directed or other-directed
What are 3 nursing interventions similar for persons with both major depression and bipolar mania?
1. Unobtrusive observation (line of sight)
3. Hygiene (they need to do it themselves)
Identify nursing interventions that would be different for persons with both major depression and bipolar mania.
Major depression: don't want to be group leader; may sleep too much
Bipolar mania: May want to make them a group leader; may be sleeping TOO LITTLE
What does SAD PERSONS stand for?
Sex (male higher risk)
Age (adolescents, elderly)
Rational thinking LOSS
Social support DECREASE
What is SAD PERSONS assessment used for?
To see if a person may be suicidal
Nursing diagnosis for suicide?
1. Risk for suicide