Bipolar Disorders Student Version PDF

Affective Disorders Objectives Assess a client’s mental status, focusing on sections impacted by affective disorders. Develop a nursing plan of care (based on etiological theories) to meet the safety needs and other human needs of the client with an affective disorder, including medication ma...

Affective Disorders Objectives Assess a client’s mental status, focusing on sections impacted by affective disorders. Develop a nursing plan of care (based on etiological theories) to meet the safety needs and other human needs of the client with an affective disorder, including medication management. Assess for suicidal/violent thoughts/intentions in at-risk clients. Implement safety measures for the client at risk for suicide/violence. Safely and appropriately implement the use of restraints or seclusion. Plan for client teaching, including the benefits and possible adverse effects of each group of antidepressant medications/mood stabilization medications. Describe the nurse’s role in caring for the client who is undergoing ECT (electro-convulsant therapy). Utilize effective communication techniques to meet basic needs, develop trust, and set limits for the depressed or manic client. Develop a discharge plan for a client with an affective disorder, including medication education and community resources. Demonstrate self-awareness regarding the nurse's reactions to the depressed or manic client. Identify National Patient Safety Goals related to risk for suicide. Some vocab A. Mania 1.4 or more mood episodes in 12 months, sometimes as short as 24 B. Hypomania hours C. Normal mood 2.Euphoria accompanied with energy D. Rapid cycling for at least 4 days, does not progress to psychosis 3.Intense mood with elevation, energy, and irritability, lasting longer than 1- week, psychiatric emergency, may lead to psychosis 4.The patients baseline Just as mental health is a continuum so is bipolar disorder Cyclothymic versus Bipolar II (BPII) Cyclothymic (Bipolar III) Bipolar II Least severe form Moderately severe form Mild/moderate depression Severe depression to to hypomania hypomania Irritable hypomanic Depression may cause psychosis episodes Minimally interferes with No psychosis work 15-50% chance of Significant morbidity and progression to BPI or BPII mortality Bipolar 1 (the worst ONE) Most severe ONE Hypomania progresses to MANIC episodes Shifts in mood that impact functioning Severe mortality rate Chronic interpersonal and occupational difficulties Risk Factors Biological factors Genetic Neurobiological Neuroendocrine Peripheral inflammation Environmental factors Cognitive factors Assessment Mood Altman’s Self-Rating Mania Scale Behavior Can be manipulative and demanding Splitting: a need for staff unity Thought processes and speech patterns Thought content Cognitive function Assessment Thought processes and speech patterns Pressured speech Circumstantial speech Tangential speech Loose associations Flight of ideas Clang associations Thought content Grandiose delusions Persecutory delusions Mania versus Hypomania Safety and Physical Needs Interventions during acute mania: Safety self & others Hydration Nutrition Sleep Hygiene Elimination Structure Discharge Planning Acute Mania Interventions Communication Strategies Teamwork & Collaboration Display a firm, calm approach. Consistent limit setting Express short, concise explanations Communicate challenges or statements. Reestablish limit setting in clear Remain neutral. terms Maintain consistency. Pt may be ambivalent about Conduct frequent staff meetings to treatment agree on approach and limit setting. Medication nonadherence is a Hear and act upon legitimate major cause of relapse complaints. Therapeutic alliance is crucial Firmly redirect energy. Triangles/splitting Seclusion & Restraints Who? Purpose What? RN role When? Communication Where? Safety/Patient Care Issues How? Legal Issues & Trends How to? How long? Milieu Therapy - Seclusion Seclusion & Restraint Control during the acute phase of hyperactive behavior almost always includes immediate treatment with an antipsychotic medication. However, when a patient is dangerously out of control, seclusion or restraints may also be indicated. Use of seclusion: Protects a patient from harm to self or others. Reduces overwhelming environmental stimuli. Prevents the destruction of property. Lithium Carbonate (LiCO3) Mood Stabilizer SIDE EFFECTS VS. TOXICITY Lithobid, Lithonate, Lithotabs NARROW THERAPEUTIC RANGE blood levels mEq/L First-line agent for bipolar Therapeutic: 0.5 to 1.5 mEq/L disorder. Acute Mania: 0.6-1.5 mEq/L Maintenance: 0.4 to 1 mEq/L Toxic: 1.5 to 2.0 mEq/L Alters Na+ transport in nerve and muscle cells and inhibits Sodium (Na+) balance the release of norepinephrine Pt teaching and dopamine. Dose Range Does not inhibit the release of Acute: 1800 – 2400 mg/day serotonin Maintenance: 900 – 1200 mg/day Lithium Toxicity & Side Effects VALPROATE/VALPROIC ACID & DIVALPROEX SODIUM GI upset (N/V/D) Sedation Weight gain o Routine weights Prolonged bleeding Baseline & monitor minimum every 3 months & PRN CBC/diff o CBC (RBC, Hgb, HCT, WBC, platelets) o Diff (neutrophils, lymphocytes, monocytes, eosinophils, basophils) LFT o ALT, ALP, AST, Albumin, Total protein, Bilirubin, GGT, LD, Prothrombin time, AFP, Autoimmune antibodies. Pregnancy (and PRN) Carbamazepine (Equetro) Lamotrigine (Lamictal) Bone marrow depression Hepatotoxic Agranulocytosis GI distress Thrombocytopenia Sedation Aplastic Anemia Dizziness Sedation DRESS syndrome Other serious skin rashes ~ Steven-Johnson Syndrome – can be fatal ~ Which anticonvulsant medication might be prescribed for a patient with bipolar disorder? 1. Divalproex sodium (Depakote) 2. Clonazepam (Klonopin) 3. Olanzapine (Zyprexa) 4. Lithium (Lithobid) Which anticonvulsant medication might be prescribed for a patient with bipolar disorder? 1. Divalproex sodium (Depakote) 2. Clonazepam (Klonopin) 3. Olanzapine (Zyprexa) 4. Lithium (Lithobid) Non-Pharmacological Management Electroconvulsive therapy (ECT) Milieu management Support groups Health teaching, health promotion & wellness After the Manic Mood is Gone Picking up the pieces Discharge planning Family/Pt education Medication Adherence What to report to HCP Support groups Community mental health resources Medication clinics Support persons Outpatient tx Medical check-up