Affective Disorders Nursing Quiz
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Questions and Answers

Which intervention is most appropriate for a client experiencing acute mania?

  • Allow the client to set their own rules for behavior.
  • Encourage participation in group activities without limits.
  • Suggest the client avoids any form of medication.
  • Provide a structured environment to minimize stimulation. (correct)

    • What therapeutic communication strategy is best to establish trust with a depressed client?

  • Focus solely on the client's physical symptoms.
  • Ask open-ended questions to encourage expression. (correct)
  • Use sympathetic responses to convey pity.
  • Avoid discussing sensitive topics to prevent discomfort.

    • Which assessment finding indicates a client is at risk for suicide?

  • Continual reports of fatigue.
  • Frequent positive outlook statements.
  • Increased social engagement with family.
  • Expressing feelings of hopelessness. (correct)

    • In providing care for a client requiring seclusion, which safety measure is crucial?

    <p>Conducting frequent reassessments for the need of seclusion.</p> Signup and view all the answers

    Which group of medications is primarily used for mood stabilization in affective disorders?

    <p>Mood stabilizers.</p> Signup and view all the answers

    What is the primary purpose of using seclusion for a patient displaying acute hyperactivity?

    <p>To protect the patient from self-harm or harming others</p> Signup and view all the answers

    Which medication is considered a first-line agent for the treatment of bipolar disorder in acute mania?

    <p>Lithium Carbonate</p> Signup and view all the answers

    What is a common side effect of both Valproate and Divalproex Sodium?

    <p>Weight gain</p> Signup and view all the answers

    What is an important aspect of care when administering Lithium Carbonate?

    <p>Maintain sodium balance</p> Signup and view all the answers

    What should be the frequency of monitoring complete blood count (CBC) for patients on Valproate?

    <p>At baseline and every 3 months</p> Signup and view all the answers

    What communication strategy should a nurse employ when a patient becomes dangerously out of control?

    <p>Firmly redirect the patient's energy</p> Signup and view all the answers

    What is the toxic range of Lithium Carbonate that requires immediate intervention?

    <p>1.5 to 2.0 mEq/L</p> Signup and view all the answers

    When are restraints typically indicated for a patient with hyperactive behavior?

    <p>When the patient is dangerously out of control</p> Signup and view all the answers

    What is one key focus during acute mania interventions?

    <p>Ensuring safety for both the individual and others</p> Signup and view all the answers

    Which communication strategy is recommended for interacting with a patient in acute mania?

    <p>Displaying a firm, calm approach with concise statements</p> Signup and view all the answers

    Why is hydration an important aspect of physical needs during acute mania?

    <p>It helps reduce irritation and aggression</p> Signup and view all the answers

    What is a key team strategy when managing a patient in acute mania?

    <p>Frequent staff meetings to maintain a unified approach</p> Signup and view all the answers

    Which of the following should be part of the safety measures for a patient experiencing acute mania?

    <p>Maintaining a structured environment</p> Signup and view all the answers

    What is the purpose of maintaining consistency in communication with a manic patient?

    <p>To ensure clear expectations and limit-setting</p> Signup and view all the answers

    In what way can a manic patient's cognitive function be assessed?

    <p>Observing their patterns of thought processes and speech</p> Signup and view all the answers

    Study Notes

    Affective Disorders - Objectives

    • Assess client's mental status, focusing on areas impacted by affective disorders
    • Develop a nursing care plan based on etiological theories to meet safety and human needs, including medication management
    • Implement safety measures for clients at risk of suicide or violence
    • Assess clients for suicidal/violent thoughts and intentions
    • Safely and appropriately implement restraints or seclusion
    • Plan client teaching, outlining the benefits and potential side effects of antidepressant and mood-stabilizing medications
    • Describe the nurse's role in electroconvulsive therapy (ECT)
    • Use effective communication to meet basic needs, build trust, and set limits with depressed or manic clients
    • Create a discharge plan including medication education and community resources
    • Demonstrate self-awareness of nurse reactions to depressed or manic clients
    • Identify National Patient Safety Goals related to suicide risk

    Affective Disorders - Vocabulary

    • Mania: 1.4 or more mood episodes in 12 months, sometimes as short as 24 hours, accompanied by euphoria and increased energy lasting at least 4 days; may progress to psychosis.
    • Hypomania: Intense mood with elevation, energy, and irritability lasting longer than a week, potential psychiatric emergency; may lead to psychosis.
    • Normal mood: The patient's baseline mood.
    • Rapid cycling: Frequent shifts between mood episodes.

    Bipolar Disorder

    • Bipolar disorder presents as a continuum of mental health, just as all mental health issues do

    Bipolar Disorder - Symptoms (Graphic)

    • Manic: Elevated mood, expansive or irritable, rapid speech, racing thoughts, poor judgment, increased energy, decreased need for sleep, grandiose delusions, distractibility, hyperactivity, inappropriate dress, and flight of ideas.
    • Depressive: Previous manic episodes, feelings of worthlessness, guilt, hopelessness, increased anger and irritability, low interest in pleasurable activities, negative views, fatigue, reduced energy, changes in appetite, constipation, insomnia, and suicidal thoughts or actions.

    Types of Bipolar Disorders

    • Bipolar I: Includes full manic and depressive episodes.
    • Bipolar II: Includes hypomanic and depressive episodes.
    • Cyclothymic disorder: Least severe form, with mild to moderate depression and hypomania; episodes of irritable hypomania.
    • Cyclical moods: Often rapid, mixed, or lasting longer.

    Misdiagnosis Monday (Bipolar 1 vs Bipolar 2)

    • Bipolar 1: Common depression but not required, about 50% experience psychosis during manic episodes, highly disruptive to functioning, episodes show a ratio of at least 3 depressive episodes for every manic one.
    • Bipolar 2: For diagnosis, both hypomanic and a depressive episode are required, depression dominant, with a ratio of about 10 depressive episodes per hypomanic one.

    Cyclothymic vs Bipolar II

    • Cyclothymic: Least severe form of bipolar disorder, featuring minimal disturbances in mood.
    • Bipolar II: Displays moderately severe features. Severe depression to hypomania. Depression can cause psychosis. Minimal impact on work but significant impact on mortality.

    Bipolar 1 (Worst Case)

    • Most severe form progressing to manic episodes.
    • Significant mood shifts impacting functioning
    • Presents a high mortality rate
    • Associated with chronic interpersonal & occupational challenges

    Risk Factors

    • Biological: Genetic predisposition, neurobiological factors, neuroendocrine factors, and peripheral inflammation
    • Environmental: Factors that contribute to the disorder from outside forces of biology
    • Cognitive: Factors related to thinking styles

    Assessment - Mood

    • Altman's Self-Rating Mania Scale (ASRM)
    • Assess mood, behavior patterns, thought processes & content

    Assessment - Thought Processes & Speech Patterns

    • Pressured speech
    • Circumstantial speech
    • Tangential speech
    • Loose associations
    • Flight of ideas
    • Clang associations
    • Grandiose delusions
    • Persecutory delusions

    Pressured Speech

    • Rapid, intense and uncontrollable talking.
    • Feels like an urgent or compelling need to keep talking
    • Distinguishable from fast talking

    Mania vs Hypomania

    • Mania: Lasts at least 7 days, Causes severe impairment in social or occupational functioning, and may necessitate hospitalization to prevent harm to self or others. Can include psychotic features
    • Hypomania: Lasts at least 4 days, has no serious impact on social or occupational functioning, does not require hospitalization and does not include psychotic features

    Safety & Physical Needs (Acute Mania)

    • Safety: Self-and others
    • Physical health: Hydration, Nutrition, Sleep, Hygiene, Elimination, and Structure
    • Discharge planning: Considerations for long-term wellness

    Acute Mania Communication Strategies

    • Firm, calm approach
    • Concise explanations
    • Maintain neutrality
    • Regular staff meetings to align on management approach & limits
    • Address legitimate complaints
    • Redirect energy appropriately

    Seclusion & Restraints

    • Seclusion is warranted when the client poses a risk of harm to themselves or others, unable to control their actions, and other measures have failed.
    • Use as last resort, indicated during hyperactive behavior.
    • Protects the client from harming themselves or others, reduces overwhelming environmental stimuli and prevents property damage.

    Milieu Therapy - Seclusion

    • Seclusion is warranted if there is a documented risk of the patient harming themselves or others.
    • The client must be unable to control their actions.
    • Other approaches like verbal de-escalation and chemical restraints should have been exhausted first.

    Medications (Lithium, Valproate/Valproic Acid, Divalproex Sodium, Carbamazepine, Lamotrigine)

    • Lithium: A mood stabilizer, first-line treatment for bipolar disorder; Alters sodium (Na+) transport, inhibits norepinephrine & dopamine release
    • Valproate/Valproic Acid & Divalproex Sodium: Mood stabilizer, used to prevent seizures.
    • Carbamazepine: Mood stabilizer and anticonvulsant; can cause serious side effects including rashes, bone marrow depression, and other serious complications.
    • Lamotrigine: Mood stabilizer and anticonvulsant, Hepatotoxic

    Non-Pharmacological Management

    • Electroconvulsive therapy (ECT): Electrodes deliver electric shocks.
    • Milieu management: The physical environment & support.
    • Support Groups: Groups that provide support and resources for clients & their caregivers.
    • Health teaching & health promotion & wellness: Teaching concerning health & well-being.

    After the Manic Mood is Gone

    • Picking up the pieces
    • Discharge planning
    • Family/patient education
    • Medication adherence
    • Reporting to healthcare providers
    • Support groups
    • Community mental health resources
    • Medication clinics
    • Support persons
    • Outpatient treatment
    • Regular medical checkups

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    Related Documents

    Bipolar Disorders Student Version PDF

    Description

    Test your knowledge on the nursing care for clients with affective disorders. This quiz covers mental status assessment, safety measures, medication management, and the nurse's role in electroconvulsive therapy. Prepare to demonstrate your understanding of effective communication and discharge planning.

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