Podcast
Questions and Answers
What should be considered after monitoring the patient's speech patterns and motor activity?
What should be considered after monitoring the patient's speech patterns and motor activity?
- Ask the healthcare provider to prescribe an increased dose and frequency of lithium.
- Consider the need to check the lithium level. (correct)
- Monitor and document the patient's behavior.
- All of the above.
What should the nurse do for a patient with acute mania who has disrobed in the hall multiple times?
What should the nurse do for a patient with acute mania who has disrobed in the hall multiple times?
- Direct the patient to wear clothes at all times.
- Tell the patient that others feel embarrassed.
- Arrange for one-on-one supervision. (correct)
- Ask if the patient finds clothes bothersome.
To best assure safety, what should the nurse's first intervention be?
To best assure safety, what should the nurse's first intervention be?
- Assemble a show of force.
- Clear the room of all other patients. (correct)
- Tell the patient, 'You need to be secluded.'
- Help the patient down from the table.
What is the priority nursing intervention for a patient diagnosed with bipolar disorder about to be discharged?
What is the priority nursing intervention for a patient diagnosed with bipolar disorder about to be discharged?
Which findings demonstrate evidence of complications for a patient who takes lithium?
Which findings demonstrate evidence of complications for a patient who takes lithium?
What is the appropriate response to a patient asking about the necessity of continuing lithium while in a stable mood?
What is the appropriate response to a patient asking about the necessity of continuing lithium while in a stable mood?
What should be advised to a patient prescribed lithium who reports severe diarrhea and weakness?
What should be advised to a patient prescribed lithium who reports severe diarrhea and weakness?
Which patient's history indicates that monitoring serum concentrations of lithium will be critical?
Which patient's history indicates that monitoring serum concentrations of lithium will be critical?
Which patient in the behavioral health unit requires the most watchful supervision?
Which patient in the behavioral health unit requires the most watchful supervision?
What suggestions are appropriate for the family of a patient with bipolar disorder during a hypomanic episode?
What suggestions are appropriate for the family of a patient with bipolar disorder during a hypomanic episode?
Which nursing diagnoses are likely for a patient in an acute manic episode?
Which nursing diagnoses are likely for a patient in an acute manic episode?
What nursing diagnoses are supported by a patient’s statement about feeling ashamed of their bipolar disorder?
What nursing diagnoses are supported by a patient’s statement about feeling ashamed of their bipolar disorder?
Which interventions should be included in the care plan for a patient in a manic state?
Which interventions should be included in the care plan for a patient in a manic state?
Which statement about managing bipolar disorder should be emphasized to the patient and family?
Which statement about managing bipolar disorder should be emphasized to the patient and family?
Which patient statement indicates understanding of newly prescribed lithium indicates?
Which patient statement indicates understanding of newly prescribed lithium indicates?
Which early signs of lithium toxicity should the nurse stress to the patient?
Which early signs of lithium toxicity should the nurse stress to the patient?
What should the nurse initially do for a patient with a lithium level of 1.7 mEq/L?
What should the nurse initially do for a patient with a lithium level of 1.7 mEq/L?
Which intervention should the nurse follow when caring for a patient with manic behavior?
Which intervention should the nurse follow when caring for a patient with manic behavior?
What does the nurse recognize in a patient with bipolar disorder who drinks alcohol instead of taking prescribed medications?
What does the nurse recognize in a patient with bipolar disorder who drinks alcohol instead of taking prescribed medications?
What is recommended to reduce mania in a patient with bipolar I disorder?
What is recommended to reduce mania in a patient with bipolar I disorder?
What adjustment is made in therapy for a patient who has been stable on lithium for 11 months?
What adjustment is made in therapy for a patient who has been stable on lithium for 11 months?
What assessment findings support suspicion of lithium toxicity in a patient?
What assessment findings support suspicion of lithium toxicity in a patient?
What is the medic likely counting when responding to a patient in a manic episode?
What is the medic likely counting when responding to a patient in a manic episode?
What features of mania are evident in a person who was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks without sleep or food for 3 days?
What features of mania are evident in a person who was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks without sleep or food for 3 days?
How should the nurse document the mood of a patient diagnosed with bipolar disorder who is dressed in a red leotard and bright scarves, twirling and shadow boxing while cheerfully asking, 'Do you like my scarves?'
How should the nurse document the mood of a patient diagnosed with bipolar disorder who is dressed in a red leotard and bright scarves, twirling and shadow boxing while cheerfully asking, 'Do you like my scarves?'
Which assessment findings will have priority concern for a patient who has not slept or eaten for 3 days and is directing traffic with aggressive behavior?
Which assessment findings will have priority concern for a patient who has not slept or eaten for 3 days and is directing traffic with aggressive behavior?
Which nursing diagnosis has priority for a patient diagnosed with acute mania who has distributed pamphlets about a new business venture for 2 days?
Which nursing diagnosis has priority for a patient diagnosed with acute mania who has distributed pamphlets about a new business venture for 2 days?
What is the most appropriate comment by the nurse to a patient diagnosed with bipolar disorder who threatens to hit another patient after becoming hyperactive following lithium discontinuation?
What is the most appropriate comment by the nurse to a patient diagnosed with bipolar disorder who threatens to hit another patient after becoming hyperactive following lithium discontinuation?
What is an appropriate outcome for a patient diagnosed with acute mania showing imbalanced nutrition related to insufficient caloric intake?
What is an appropriate outcome for a patient diagnosed with acute mania showing imbalanced nutrition related to insufficient caloric intake?
What is the rationale for the addition of olanzapine to the medication regimen for a patient who relapsed after discontinuing lithium?
What is the rationale for the addition of olanzapine to the medication regimen for a patient who relapsed after discontinuing lithium?
Which anticonvulsant medication should the nurse anticipate being prescribed for a patient diagnosed with bipolar disorder and rapidly changing mood cycles?
Which anticonvulsant medication should the nurse anticipate being prescribed for a patient diagnosed with bipolar disorder and rapidly changing mood cycles?
What is the best explanation for the cause of bipolar disorder in most patients?
What is the best explanation for the cause of bipolar disorder in most patients?
What evidence supports the possibility of genetic transmission of bipolar disorders according to the nurse's response?
What evidence supports the possibility of genetic transmission of bipolar disorders according to the nurse's response?
Which initial approach should the nurse select to intervene with a patient who commands other patients to do tasks, avoiding power struggles?
Which initial approach should the nurse select to intervene with a patient who commands other patients to do tasks, avoiding power struggles?
What do the test results showing a serum level of 1 mEq/L for a patient who took lithium 8 hours ago indicate?
What do the test results showing a serum level of 1 mEq/L for a patient who took lithium 8 hours ago indicate?
Which medication also belongs to the classification of anticonvulsants with divalproex (Depakote) and carbamazepine (Tegretol)?
Which medication also belongs to the classification of anticonvulsants with divalproex (Depakote) and carbamazepine (Tegretol)?
What is the initial nursing intervention for a hyperactive patient diagnosed with acute mania?
What is the initial nursing intervention for a hyperactive patient diagnosed with acute mania?
Which suggestion is appropriate for decor in a special room for patients with acute mania?
Which suggestion is appropriate for decor in a special room for patients with acute mania?
What action will the staff take initially when feeling defensive and fatigued by a patient demonstrating acute mania?
What action will the staff take initially when feeling defensive and fatigued by a patient demonstrating acute mania?
How should the nurse initially intervene with a patient experiencing acute mania who undresses and dances in the group room?
How should the nurse initially intervene with a patient experiencing acute mania who undresses and dances in the group room?
What is the nurse's appropriate intervention for a patient who demands immediate access to a computer to order dresses and shoes?
What is the nurse's appropriate intervention for a patient who demands immediate access to a computer to order dresses and shoes?
To reduce nausea effectively for a patient taking lithium carbonate, what should the nurse suggest?
To reduce nausea effectively for a patient taking lithium carbonate, what should the nurse suggest?
What should a health teaching plan for a patient taking lithium include?
What should a health teaching plan for a patient taking lithium include?
Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression and one experiencing acute mania?
Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression and one experiencing acute mania?
Which dinner menu is best suited for a patient with acute mania?
Which dinner menu is best suited for a patient with acute mania?
What is the focus of outcome identification in the treatment plan for a patient experiencing grandiose thinking associated with acute mania?
What is the focus of outcome identification in the treatment plan for a patient experiencing grandiose thinking associated with acute mania?
Which documentation indicates effectiveness of the treatment plan for a patient diagnosed with acute mania?
Which documentation indicates effectiveness of the treatment plan for a patient diagnosed with acute mania?
Which nursing intervention will best assist a patient experiencing acute mania who dances around the unit without sitting?
Which nursing intervention will best assist a patient experiencing acute mania who dances around the unit without sitting?
Study Notes
Key Features of Mania
- Hyperactivity and poor judgment are major indicators of mania, as shown by behaviors like continuous online posting without sleep.
- Euphoric mood can be characterized by excessive happiness and pleasant behavior, linked to manic episodes.
Nursing Priorities in Manic Episodes
- Prioritize hyperactivity, poor nutrition, and lack of sleep as they threaten physical health.
- Risk for injury is critical due to poor judgment and high activity levels during manic episodes.
- Initial intervention should include setting limits to ensure patient safety without engagement in power struggles.
Medication Management
- Use of olanzapine aids in rapidly controlling hyperactivity while lithium takes time to reach therapeutic levels.
- Patients with rapid cycling in bipolar disorder often benefit from anticonvulsants like carbamazepine and valproate.
- Lithium levels need regular monitoring to prevent toxicity; therapeutic range is 0.4 to 1 mEq/L.
Genetic Considerations
- Genetic factors are significant in the development of bipolar disorder, with a higher incidence in relatives of affected individuals.
- Multiple contributing factors such as genetics, neurotransmitter imbalances, and environmental stressors are involved in the disorder's etiology.
Patient and Family Education
- Patients should be instructed to maintain normal salt and fluid intake while taking lithium to prevent toxicity.
- Family education focuses on recognizing and managing symptoms, understanding the need for medication, and ensuring adherence.
Documentation and Outcome Evaluation
- Effective treatment is indicated when patients demonstrate appropriate behavior and functional levels without manic symptoms.
- Patient outcomes should target control over grandiose thoughts and improvement in sleep patterns while maintaining a balanced emotional state.
Environmental Considerations
- A simple and non-stimulating environment is crucial for manic patients to reduce distractions and support emotional stabilization.
- Appropriate meal planning, including finger foods, can help with nutrition while accommodating hyperactive behavior.
Managing Behavioral Symptoms
- Distracting a patient during manic episodes can avoid power struggles and redirect focus.
- Offering structured supervision is essential for patients displaying disruptive behaviors, such as disrobing in public.
Signs of Treatment Non-Adherence
- Persistent manic symptoms despite medication may indicate issues like "cheeking" or not swallowing pills, necessitating medication level checks.
Overall Care Strategies
- Emphasis on patient safety, regular communication with healthcare providers, and collaboration with the treatment team is essential throughout the management of bipolar disorder.### Psychoeducation and Treatment for Bipolar Disorder
- After the acute episode of bipolar disorder, ongoing psychoeducation becomes essential to maintain medication compliance and prevent relapse.
- Physical needs are less critical in the continuation phase compared to the acute phase.
Lithium Complications
- Early signs of lithium toxicity include diaphoresis, weakness, and nausea.
- Common side effects not related to lithium toxicity: alopecia, purpura, drowsiness, mydriasis, dystonia, ascites, dyspnea, and edema.
Long-term Lithium Use
- Patients may need to continue lithium indefinitely, even during stable mood phases, to reduce the risk of relapse.
- Education about medication adherence is crucial to ensure compliance.
Managing Lithium Toxicity
- Severe diarrhea, weakness, and worsening tremors are indications of potential lithium toxicity; immediate medical attention is necessary.
- In patients with congestive heart failure, monitoring lithium serum concentrations is critical due to potential fluid balance complications.
Patient Supervision Needs
- Patients with bipolar I disorder require the highest level of supervision due to risk factors like excessive energy, possible psychosis, and unstable behavior.
Family Support for Hypomanic Episodes
- Suggestions for family during a hypomanic episode include limiting access to credit cards, providing a structured environment, and monitoring sleep patterns.
- Group socialization should be minimized to prevent overstimulation.
Nursing Diagnoses in Mania
- Common nursing diagnoses for patients in a manic state include disturbed thought processes and sleep deprivation.
- Patients often experience hyperactivity affecting nutrition and social interaction, but not typically isolation.
Stigma and Patient Emotions
- Feelings of shame and powerlessness are prevalent among patients; addressing chronic low self-esteem and offering support can help.
Care Strategies for Manic Patients
- Providing a structured environment and meeting nutritional needs are priority interventions during an acute manic phase.
- Avoid triggering aggressive behavior by maintaining a calm, firm approach when giving directions.
Education on Medication
- Patients should learn that alcohol and caffeine can trigger relapses, and immediate communication with healthcare providers is vital if sleep patterns change.
- Recognizing early signs of mood swings is essential for timely intervention.
Monitoring Lithium Levels
- A lithium level of 1.7 mEq/L warrants holding the next dose and contacting the prescriber immediately.
- Early toxicity symptoms include upset stomach and hand tremors.
Substance Abuse in Bipolar Disorder
- Many individuals with bipolar disorder may self-medicate with alcohol, which is linked to underlying anxiety and mood regulation.
Treatment Adjustments
- Electroconvulsive therapy (ECT) is recommended for patients with a history of severe mania where medications may prove ineffective.
- Maintenance therapy may include dosage adjustments such as lowering the lithium prescription after a stable period.
Signs of Lithium Toxicity
- Key indicators of potential lithium toxicity include ataxia, severe hypotension, and large volumes of dilute urine.
Acute Mania Assessment
- Energy drink containers may indicate substance use contributing to manic symptoms observed in patients experiencing acute episodes.
Studying That Suits You
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Description
Test your understanding of Bipolar and Related Disorders with these flashcards from Varcarolis Chapter 13. Explore the characteristics of mania and how to identify key symptoms through engaging questions. Perfect for students of psychology and mental health professionals alike.
