T1-Bipolar Disorder & Suicidal Client Flashcards Preview

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Flashcards in T1-Bipolar Disorder & Suicidal Client Deck (80):
1

A pervasive and sustained emotion that may have a major influence on a person's perception of the world

Mood

2

Examples of mood?

Depression
Joy
Elation
Anger
Anxiety

3

The emotional reaction associated with an experience

Affect

4

An alteration in mood that is expressed by feelings of elations, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking

Mania

5

How can mania occur?

-Biological (organic) disorder
-Psychological disorder
-A response to substance use
-General medical condition

6

Characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy

Bipolar disorder

7

Are delusions and hallucinations part of bipolar disorder?

May or may not be

8

What is a somewhat milder form of mania called?

Hypomania

9

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

10

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

11

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

12

Stage 1: Hypomania

Are symptoms sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization?

No

13

What are the characteristics of Stage 1: Hypomania?

-Cheerful mood
-Rapid flow of ideas, heightened perception
-Increased motor activity

14

Stage 2: Acute Mania

Is there marked impairment in functioning? Does this stage of mania require hospitalization?

Yes, yes

15

Stage 2: Acute Mania

Symptoms? (6)

-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

16

A grave form of the disorder (mania) characterized by an intensification of the symptoms associated with acute mania.

Stage 3: Delirious mania

17

Is delirious mania common or rare?

Rare--bc of antipsychotic medications

18

What are some characteristics of delirious mania?

-Labile mood, panic anxiety
-Clouding of consciousness, disorientation
-Frenzied psychomotor activity
-Exhaustion and possibly death without intervention!!

19

Lifetime prevalence of pediatric and adolescent bipolar disorders is estimated at about __.

1%

20

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)

21

How have guidelines for diagnosis and treatment been developed for diagnosing bipolar disorder in kids?

The Child and Adolescent Bipolar Foundation (CABF)

22

What does the CABF recommend the use of in making a diagnosis of bipolar disorder in children and adolescents?

FIND

23

What does FIND stand for?

Frequency
Intensity
Number
Duration

24

FIND
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

25

Childhood and adolescence: What are the 11 big symptoms for bipolar disorder?

1. Euphoric/expansive mood
2. Irritable mood
3. Grandiosity
4. Decreased need for sleep
5. Pressured speech
6. Racing thoughts
7. Distractibility
8. Increase in goal directed activity/psychomotor agitation
9. Excessive involvement in pleasurable or risky activities
10. Psychosis
11. Suicidality

26

What does it mean if a child is experiencing a euphoric/expansive mood?

Extremely happy, silly, or giddy

27

What does it mean if a child is experiencing an irritable mood?

Hostility and rage--ofter over trivial matters

28

What does it mean if a child is experiencing grandiosity?

Believes abilities to be better than everyone elses

29

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!

30

What is pressured speech?

Loud, intrusive, difficult to interrupt

31

What is racing thoughts?

Rapid change of topics

32

What is distractibility?

Unable to focus on school lessons

33

What is increase in goal-directed activity/psychomotor agitation?

Activities become OBSESSIVE--increased psychomotor agitation

34

What is excessive involvement in pleasurable or risky activities?

Exhibits behavior that has an erotic, pleasure-seeking quality about it

35

What happens if they experience psychosis?

May expreience hallucinations and delusions

36

What may the child exhibit if symptoms of suicidality arise?

Suicidal behavior during a depressed or mixed episode or when psychotic

37

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

38

What is the rest of the nursing diagnosis for bipolar mania RISK FOR VIOLENCE: SELF DIRECTED OR OTHER DIRECTED r/t:

-Manic excitement
-Delusional thinking
-Hallucinations
-Impulsivity

39

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

40

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

A

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

41

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

42

What are some things the client does in the recovery process of bipolar disorder?

-Identifies goals
-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

43

Is there cure for bipolar disorder?

No

44

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

45

Who is more at risk for suicide: single or married people?

Single

46

Who attempt suicide more? Who succeed more?

Attempt: women
Succeed: men

47

Risk of suicide ___ with age (especially among ___)

Increase, men

48

White men older than ___ are at greatest risk of all age/gender/race groups

80+

49

Affiliation with a religious group ____ risk for suicide.

Decreases

50

Who is more at risk: Catholics, Proestants, Jews?

Protestants or Jews

51

Individuals in the very highest and lowest social classes ____ suicide than those in middle class.

Increase

52

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

53

What is the most common risk for suicidal?

Mood disorders

54

What are some other problems that account for suicidal behavior?

Substance-Related disorders
Schizophrenia
Personality disorders
Anxiety disorders

55

_____ is associated with increase risk of suicide

Severe insomnia

56

Does ETOH and other barbiturates increase or decrease risk for suicide?

Increase

57

Does psychosis with command hallucinations put you at risk for suicide?

Yes

58

T/F: Chronic painful or disabling illness is an increased risk for suicide

TRUE

59

Does family history have anything to do with increased risk of sucide?

Yes

60

A mood disorder causing a persistent feeling of sadness and loss of interest

Major depression

61

4 S&S of depression?

1. Hypersomnolence (sleep a lot)
2. Lack of appetitie/ overeating
3. Anhedonia
4. Anergic

62

Loss of enjoyment of things that used to make a person happy

Anhedonia

63

No energy

Anergic

64

An alteration in mood that is expressed by feelings of ELATION, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerate thinking and speaking

Mania

65

Main 3 symptoms of mania?

1. Accelerated mood
2. Grandiosity
3. Decreased sleep

66

A lesser degree of mania

HYPOmania

67

Why is hypomania often hard to diagnose?

May be confused with someone who is outgoing and energetic

68

Are all people with mania happy and elated?

NO!!!---some can be angry and agitated

69

What are some disorders that increase risk for suicide?

Command hallucinations
Major depressive disorder
Bipolar Mania
Schizophrenia

70

What is a sentinel event?

Suicide or injury that occurs in a facility

71

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)

72

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

73

Should we argue, bargain, or try to reason with a bipolar client?

NO

74

What are nursing diagnosis for bipolar disorder?

1. Risk for injury r/t ..
2. Risk for violence: self directed or other-directed

75

What are 3 nursing interventions similar for persons with both major depression and bipolar mania?

1. Unobtrusive observation (line of sight)
2. Eating
3. Hygiene (they need to do it themselves)

76

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

77

What does SAD PERSONS stand for?

Sex (male higher risk)
Age (adolescents, elderly)
Depression

Previous attempt
ETOH use
Rational thinking LOSS
Social support DECREASE
Organized plan
NO spouse
Sickness

78

What is SAD PERSONS assessment used for?

To see if a person may be suicidal

79

Nursing diagnosis for suicide?

1. Risk for suicide
2. Hopelessness

80

If caring for a suicidal client, what are some good interventions to do?

-Dont leave person alone
-No-suicide contract
-Talk matter of faculty about suicide
-Identify areas of self control
-TRUSTING relationship
-Give antidepressant meds

*these are just a few; there are some others--these seem like most important