Varcarolis: Chapter 13 - Bipolar Disorders

Questions and Answers

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?

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?

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?

Attending psychoeducation sessions. Signup and view all the answers

Which findings demonstrate evidence of complications for a patient who takes lithium?

Diaphoresis, weakness, and nausea. Signup and view all the answers

What is the appropriate response to a patient asking about the necessity of continuing lithium while in a stable mood?

Taking the medication every day helps reduce the risk of a relapse. Signup and view all the answers

What should be advised to a patient prescribed lithium who reports severe diarrhea and weakness?

Have someone bring the patient to the clinic immediately. Signup and view all the answers

Which patient's history indicates that monitoring serum concentrations of lithium will be critical?

Heart failure. Signup and view all the answers

Which patient in the behavioral health unit requires the most watchful supervision?

A patient diagnosed with bipolar I disorder. Signup and view all the answers

What suggestions are appropriate for the family of a patient with bipolar disorder during a hypomanic episode?

Monitor the patient's sleep patterns. Signup and view all the answers

Which nursing diagnoses are likely for a patient in an acute manic episode?

Sleep deprivation. Signup and view all the answers

What nursing diagnoses are supported by a patient’s statement about feeling ashamed of their bipolar disorder?

Powerlessness. Signup and view all the answers

Which interventions should be included in the care plan for a patient in a manic state?

Ensure that the patient's nutritional needs are met. Signup and view all the answers

Which statement about managing bipolar disorder should be emphasized to the patient and family?

Alcohol and caffeine can trigger a relapse of your symptoms. Signup and view all the answers

Which patient statement indicates understanding of newly prescribed lithium indicates?

I discussed the diuretic my cardiologist prescribed. Signup and view all the answers

Which early signs of lithium toxicity should the nurse stress to the patient?

An upset stomach for no apparent reason. Signup and view all the answers

What should the nurse initially do for a patient with a lithium level of 1.7 mEq/L?

Instruct to hold the next dose of medication. Signup and view all the answers

Which intervention should the nurse follow when caring for a patient with manic behavior?

Provide frequent protein drinks. Signup and view all the answers

What does the nurse recognize in a patient with bipolar disorder who drinks alcohol instead of taking prescribed medications?

Alcohol ingestion is a form of self-medication. Signup and view all the answers

What is recommended to reduce mania in a patient with bipolar I disorder?

Electroconvulsive therapy (ECT). Signup and view all the answers

What adjustment is made in therapy for a patient who has been stable on lithium for 11 months?

A lower dosage. Signup and view all the answers

What assessment findings support suspicion of lithium toxicity in a patient?

Ataxia and severe hypotension. Signup and view all the answers

What is the medic likely counting when responding to a patient in a manic episode?

Energy drink containers. Signup and view all the answers

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?

Poor judgment and hyperactivity Signup and view all the answers

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?'

Euphoric Signup and view all the answers

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?

Hyperactivity; not eating and sleeping Signup and view all the answers

Which nursing diagnosis has priority for a patient diagnosed with acute mania who has distributed pamphlets about a new business venture for 2 days?

Risk for injury Signup and view all the answers

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?

Do not hit anyone. If you are unable to control yourself, we will help you. Signup and view all the answers

What is an appropriate outcome for a patient diagnosed with acute mania showing imbalanced nutrition related to insufficient caloric intake?

Drink six servings of a high-calorie, high-protein drink each day. Signup and view all the answers

What is the rationale for the addition of olanzapine to the medication regimen for a patient who relapsed after discontinuing lithium?

Bring hyperactivity under rapid control. Signup and view all the answers

Which anticonvulsant medication should the nurse anticipate being prescribed for a patient diagnosed with bipolar disorder and rapidly changing mood cycles?

Carbamazepine (Tegretol) Signup and view all the answers

What is the best explanation for the cause of bipolar disorder in most patients?

Several factors, including genetics, are implicated. Signup and view all the answers

What evidence supports the possibility of genetic transmission of bipolar disorders according to the nurse's response?

A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder. Signup and view all the answers

Which initial approach should the nurse select to intervene with a patient who commands other patients to do tasks, avoiding power struggles?

Distraction: 'Let's go to the dining room for a snack.' Signup and view all the answers

What do the test results showing a serum level of 1 mEq/L for a patient who took lithium 8 hours ago indicate?

Within therapeutic limits. Signup and view all the answers

Which medication also belongs to the classification of anticonvulsants with divalproex (Depakote) and carbamazepine (Tegretol)?

Lamotrigine (Lamictal) Signup and view all the answers

What is the initial nursing intervention for a hyperactive patient diagnosed with acute mania?

Set limits on patient behavior as necessary. Signup and view all the answers

Which suggestion is appropriate for decor in a special room for patients with acute mania?

Neutral walls with pale, simple accessories Signup and view all the answers

What action will the staff take initially when feeling defensive and fatigued by a patient demonstrating acute mania?

Hold a staff meeting to discuss consistency and limit-setting approaches. Signup and view all the answers

How should the nurse initially intervene with a patient experiencing acute mania who undresses and dances in the group room?

Putting a blanket around the patient and walking with them to a quiet room. Signup and view all the answers

What is the nurse's appropriate intervention for a patient who demands immediate access to a computer to order dresses and shoes?

Invite the patient to sit together and look at new fashion magazines. Signup and view all the answers

To reduce nausea effectively for a patient taking lithium carbonate, what should the nurse suggest?

Meals. Signup and view all the answers

What should a health teaching plan for a patient taking lithium include?

Maintain normal salt and fluids in the diet. Signup and view all the answers

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression and one experiencing acute mania?

Disturbed sleep pattern Signup and view all the answers

Which dinner menu is best suited for a patient with acute mania?

Broiled chicken breast on a roll, an ear of corn, and an apple Signup and view all the answers

What is the focus of outcome identification in the treatment plan for a patient experiencing grandiose thinking associated with acute mania?

Distorted thought self-control. Signup and view all the answers

Which documentation indicates effectiveness of the treatment plan for a patient diagnosed with acute mania?

Converses with few interruptions; clothing matches; participates in activities. Signup and view all the answers

Which nursing intervention will best assist a patient experiencing acute mania who dances around the unit without sitting?

Provide a subdued environment. Signup and view all the answers

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.

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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.