Mental Health Care Strategies Quiz

Psychiatric Health Nursing (Seminar) - Bipolar Disorder

• Bipolar disorder is a complex mental health condition characterized by extreme mood swings impacting daily life.
• It includes its causes, diagnosis, and effective management strategies.
• This seminar aims to aid understanding and support for those affected.

Learning Objectives

• Define bipolar disorder.
• Describe mania and depression.
• Explain types of bipolar disorder.
• Identify sings and symptoms.
• Identify nursing assessment for bipolar disorder.
• Describe nursing interventions for bipolar disorder.
• Summarize the key points covered.

Bipolar Disorder: Types

• Bipolar I Disorder: Diagnosis includes experiencing a manic episode or a history of one or more manic episodes. May have experienced depression episodes.
• Bipolar II Disorder: Diagnosis includes symptoms of depression or hypomania but never met criteria for a full manic episode.
• Cyclothymic Disorder: A chronic mood disturbance lasting for at least two years, with periods of elevated and depressed mood that don't meet hypomanic or depressive episode criteria.
• Substance-induced bipolar disorder: Mood disturbance due to a substance's physiological effects. This includes elevated, expansive, or irritable moods, inflated self-esteem, decreased need for sleep, and distractibility.
• Bipolar disorder associated with another medical condition: Mood disturbance caused by another medical condition.

Bipolar Disorder: Prevalence

• Affects approximately 4.4% of adults in the United States.
• 82.9% of cases are severe.
• Average age at onset is 25 years.

Bipolar Disorder: Symptoms

• Manic Episodes: Overly happy for long periods, fast-talking/racing thoughts, easily distracted, overconfidence, risky behaviors (gambling).
• Depressive Episodes: Sad or hopeless feelings, significant mood changes, appetite changes, thoughts of or attempts at suicide, fatigue, lack of energy, memory/concentration problems.

Nursing Care for Bipolar Manic Episodes

• Focuses on patient safety through minimizing restraints.
• Managing medications.
• Promoting coping strategies.
• Collaborating with the interdisciplinary team.

Understanding Bipolar Disorder: Manic Phases

• Heightened Energy: Abnormal increase in energy, activity, and restlessness.
• Impaired Judgment: Engaging in risky or impulsive behaviors such as reckless spending or substance abuse.
• Decreased Need for Sleep: Staying awake for long periods.

Assessing and Monitoring Manic Symptoms

• Vital Signs: Monitoring heart rate, blood pressure, and temperature.
• Mental Status Exam: Assessing mood, thought processes, and level of orientation to evaluate severity of manic episodes.
• Behavior Monitoring: Observing activity levels, sleep patterns, and social interactions for any changes.

The Mental Status Examination

• Appearance: Assess grooming, dress, and motor activity.
• Behavior: Assess for impulsivity, aggression, or disorganization.
• Mood and Affect: Assess for elevated, irritable, or labile mood states. (Other components like thought processes, orientation, speech, insight, judgment and memory).

Pharmacological Interventions: Mood Stabilizers

• Lithium: Widely used mood stabilizer that helps regulate mood.
• Anticonvulsants (e.g., valproate, lamotrigine): Can be effective in stabilizing mood.
• Antipsychotics: May be prescribed to manage acute symptoms or augment mood stabilizers, used to treat symptoms of mania.

Non-Pharmacological Interventions: Psychotherapy

• Cognitive-Behavioral Therapy (CBT): Helps identify and modify negative thought patterns.
• Interpersonal and Social Rhythm Therapy: Focuses on improving social functioning and establishing regular sleep-wake cycles.
• Family Focused Therapy: Involves family in the treatment process to improve communication and support during manic episodes.

Ensuring Patient Safety During Manic Episodes

• **Restraint Minimization: ** Use de-escalation techniques.
• Environmental Modifications: Create a safe, predictable environment.
• Close Monitoring: Prevent impulsive or dangerous behavior.
• Suicide Prevention: Assess risk and intervene appropriately.

Coping Strategies

• Stress Management: Relaxation techniques such as breathing, meditation, and yoga.
• Sleep Hygiene: Establishing a consistent sleep schedule, and creating a calming bedtime routine.
• Emotional Regulation : Developing skills to identify and express emotions healthily.

Managing Disruptive Behaviors

• De-escalation : Use calming techniques to diffuse volatile situations.
• Conflict Resolution: Facilitate constructive discussions to address interpersonal issues.
• Emotional Support: Offer compassionate and non-judgmental listening.

Promoting Rest and Sleep

• Sleep Hygiene: Establish a consistent sleep schedule and bedtime routine.
• Environmental Modifications: Adjust lighting, temperature and noise levels for a calming environment.
• Relaxation Techniques: Encourage relaxation techniques like meditation and breathing.

Interdisciplinary Collaboration

• Psychiatrist: Oversees medication management and treatment.
• Psychologist: Provides psychotherapy and behavioral interventions.
• Social Worker: Coordinates community resources and discharge planning.
• Nurses: Implement nursing interventions and monitor patient progress.

Discharge and Ongoing Support

• Discharge Planning: Create a comprehensive discharge plan for smooth transitions.
• Outpatient Follow-up: Coordinate appointments with Psychiatrists, therapists and case managers for continuity.
• Family Education: Provide education and support to family members.
• Community Resources: Connect patients with local support groups.

Depressive Episode

• Definition: An affective state characterized by sadness, guilt, and low self-esteem.
• May be part of another illness.
• Manifestations can include decreased physical activity or psychomotor agitation.

Symptoms of Depressive Episode

• Feeling sad, hopeless, lack of energy.
• Difficulties concentrating.
• Loss of interest in activities.
• Delusions, hallucinations, and illogical thinking.
• Suicidal thoughts.
• Lack of appetite.
• Difficulty sleeping, waking up early.

Diagnosis: Depression

• Risk for suicide: Related to depressed mood and meeting with a professional.
• Low Self-esteem: Resulting from the disease process and the expression of worthlessness.
• Complicated grieving: Due to a disease process impacting daily living.
• Social isolation : Impacted ability to participate in usual activities.

Expected and Nursing Interventions for Depression

• Risk for suicide: Ask clients directly about thoughts of self-harm or suicide.
• Low self-esteem: Be accepting and offer support, promote attendance in therapy, teach effective communication, praise achievements, identify strengths and weaknesses.
• Complicated grieving: Determine the stage, build trust, encourage expression, and possibly utilize large motor activity for pent-up anger.
• Social isolation: Identifying reasons for isolation, encourage visits, phone calls. Provide items like clocks and radios for structure.

Risk for Injury / Mania and Increased Agitation

• Expected outcome: Client will not experience injury during manic episodes.
• Nursing Interventions: Reduce environmental stimulus, remove dangerous objects, stay with the client, provide physical activities, and administer tranquilizers as ordered by a physician.

Risk for Violence / Mania

• Expected outcome: Client will not harm self or others.
• Nursing Interventions: Maintain low-level stimuli, observe behavior, remove hazardous objects, and redirect violent behaviors towards physical outlets.

Imbalanced Nutrition (Mania)

• Expected outcome: Client will exhibit no signs/symptoms of malnutrition.
• Nursing Interventions: Serve high-protein, high-calorie, nutritious finger foods; Provide juice and snacks; Monitor intake/output, calorie count, weight and daily lab values. Offer favorite foods. Provide supplemental vitamins/minerals. Allow sitting/walking with client while eating.

Impaired Social Interaction (Mania)

• Expected outcome: Client will interact appropriately with others.
• Nursing Interventions: Recognize manipulative behaviors and explain consequences. Set clear, agreed-upon limits and ignore attempts to alter limits. Provide positive reinforcement for non-manipulative behaviors, encourage clients to identify positive aspects of self, and acknowledge accomplishments.

Additional Considerations

• Pharmacology: Includes specific medications for mania and depression such as antipsychotics, anxiolytics, antidepressants, and mood stabilizers (e.g., Clonazepam, Alprazolam, Carbamazepine, Valproic acid, Lithium).
• Specific nursing interventions are categorized for the risk factor: (e.g. safety plans, restraint policies).
• The information details various stages and treatment approaches for bipolar disorder. It’s important to note the importance of teamwork, patient safety, and effective communication across different disciplines in treating patients with bipolar disorder.