RNSG 1538- Mood & Affect

•Bipolar Disorder • Major Depressive Disorder • Suicide • Post-Partum Depression

Treatment

A patient with bipolar disorder has been prescribed Lithium for there manic episodes and depression. What should the nurse consider when giving the drug lithium

Rationale:

Nurse Considerations

1. Monitor BUN/Creatine, TSH, Hcg

2. pregnant people cant use this drug

3. therapeutic range: 0.6-1.2

4. provide fluids and salty foods

   • make sure they dont stop drinking fluids

Rationale:

1. lithium can damage the kidneys- BUN/CREAT will elevate

2. need a Hcg lab- due to fetal toxicity

3. >1.2 = toxicity

4. fluids promote kidney function + salty foods prevent retention of lithium and reduce toxicity risk

Treatment

A patient has been prescribed at home lithium. What education should the nurse provide prior to the patient's discharge

Nurse Considerations

• lithium takes 2-4 weeks to work

• take med with meals

• Know the signs of toxicity

  • hand tremors, confusion, vomiting, confusion, ataxia, ↓ urine output

Treatment

A patient with BPD is experiencing a red, blistery rash on their skin. What drug did the patient consume and what adverse effect is the pt experiencing

lamotrigine

• adverse effect: steven Johnson syndrome

Treatment

A patient with BPD is not having success with pharm logical interventions. What might nurse suspect the HCP will prescribe to treat the patients BPD & What should the nurse do before the start of treatment

Electroconvulsive therapy (brain shock)

• make sure pt empties bladder prior to treatment

• make sure pt is placed on a ECG monitor

Pathophysiology

What are the two types of BPD

Type 1- mania and depression

Type 2- hypomania and depression

Nurse Intervention

A pt appears hopeless, sad and states "I'm not sure how long I can go on like this". What might the nurse ask to determine is suicide precautions are necessary

“do you have a plan”

Pathophysiology

What are the dysregulated neurotransmitters in BPD

• increased dopamine + epinephrine → leads to mania

• decreased serotonin → leads to depression

Risk Factors

What are the risk factors for BPD

• Family history

• lack of sleep (even when on meds)

• young (21 years old)

Pathophysiology

• mania

• hypomania

• schophina

• anodonia

• aphesia

Manifestations

what are the manifestations of BPD

Mania

• decreased appetite

• elevated mood

• lack of sleep

• grandiosity

• impulsivity

Depression

• sad or hopeless

• poor concentration

• ignoring things they enjoy

• self doubt

Treatment

A nurse is explaining the lines of treatment a BPD might encounter. What are these treatments

1st line- lithium

2nd line- Psychotherapy

3rd line- ECT

Treatment

A nurse is educating on the what ECT does and what side effects a BPD must be aware of. What can the nurse say

• ECT is thought to reset the brain/

• side effects: memory loss

Treatment

A nurse notices that a patient is experiencing tremors, confusion and vomiting. What are these a sign of and what interventions should be done

• These are signs of lithium toxicity

  • stop the lithium

  • give IV fluids

  • admin benzos

  • place on dialysis

Nurse Education

A family member of a patient with BPD is being educated on the adherence of lithium medications. What should the nurse say

• adherence to BPD meds is important to reduce manic episodes

• BPD pts will stop medications because they miss their mania and increase manic episode risk

Pathophysiology

How can a nurse determine that a patient has MDD

when a patient reports manifestations of MDD for 2 weeks or greater

Risk Factors

What are some risk factors for MDD

substance abuse

Manifestations

What are manifestations of MDD

• anhedonia- loss of interest

• fatigue / slow speech

• sleep disturbances- sleeping excessively/ nightmares

• feeling worthless

• SI

• cant concentrate

• less physical movements

Treatment

A patient is given SSRIs to treat their MD. What nursing education should be provided and what side effects must the patient know?

Patient Education

• get eye exams every 6 months

Side Effects

• fracture risk

• SI thoughts

• sexual dysfunction

• cant sit still

• glaucoma

Treatment

A patient is taking a MAOI. What nursing education must be provided to the patient

• Dont consume foods rich in tyramine. They can increase the risk of hypertensive crisis

  • deli meats

  • cheeses

  • beer

• can take SSRI, spicy foods, cough syrups, narcotics

Treatment

A patient is taking tricyclic antidepressants. What side effects should the nurse be aware of

• dry mouth

• dry nose

• constipation

• urine retention

• fuzzy memory

Risk Factors for Suicide

S

A

D

P

E

R

S

O

N

S

S- sex (male)

A- age (65+)

D- depression

P- previous attempts

E- ethanol/ alcohol

R- rational thoughts

S- social support

O- organized a plan

N- no spouse

S- sick

Nurse Intervention

A nurse is caring for a patient who is at risk for suicide. The nurse has attempted to provided treatment. The patient has refused. What is the next step

Implement safety measures

• on an involuntary hold for 3 days until psych care can be completed

Nurse Intervention

What question can a nurse ask in a patient is at risk for an active suicide attempt

do you have a plan

Pathophysiology

What is the clinical timeframe to determine if a mother is suffering from postpartum depression

the depression has to last 2 weeks

Pathophysiology

What are the three signs that a mother is suffers from psychosis

• saying or doing things that are not normal

• needs to be hospitalized ASAP

  • at risk for suicide/infant death