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S/s of Bipolar 1 disorder:
-experience manic episodes
-hypomania (nearly always)
-major depressive episodes
S/s of Bipolar 2 disorder:
-at least one hypomanic episode
-at least one major depressive episode
-absence of manic episodes
What is bipolar disorder?
Mood disorders with recurrent episodes of depression and mania
Nursing considerations for acute phase of bipolar disorder (mania):
-provide a safe environment during the acute phase.
-assess the client regularly for suicidal thoughts, intentions, and escalating behavior
-decrease stimulation without isolating the client if possible
-provide outlets for physical activity
Nursing considerations for continuation phase of bipolar disorder:
-remission of manifestations
-relapse prevention thru education, med adherence, and psychotherapy are goals
Nursing considerations for maintenance phase of bipolar disorder:
-increase ability to function
-prevention of future manic episodes is the goal
What is mania?
-An abnormally elevated mood, which can also be described as expansive or irritable
-usually requires hospitalization
-Manic episodes last at least 1 week
What is hypomania?
-A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania
-Hospitalization is not required, and the client who has hypomania is less impaired
-can progress to mania
What is rapid cycling?
Four or more episodes of hypomania or acute mania within 1 year
What is bipolar 1 disorder?
at least one episode of mania alternating with major depression
What is bipolar 2 disorder?
one or more hypomanic episodes alternating with major depressive episodes
Risk factors for bipolar disorder:
-genetics (family history)
-stressful events or major life changes
-substance use disorder
-circadian dysregulation
Things can increase likelihood of bipolar relapse:
-substance use (alcohol, cocaine, caffeine) leads to mania
-sleep disturbances
-psychological stressors (stress)
S/s of mania:
-labile mood w/euphoria
-agitation and irritability
-restlessness
-flight of ideas; rapid, continuous speech, frequent topic change
-impulsivity
-poor judgement
-decreased sleep
-onset before age 25
S/s of depressive bipolar:
-flat, blunted, labile affect
-tearfulness, crying
-lack of energy
-anhedonia
-self destructive behavior
-decrease in personal hygiene
-loss of appetite/sleep
What is ECT?
-can be used to subdue extreme manic behavior,
-done when pharmacological therapy, such as lithium, has not worked
Lithium:
-monitor blood levels
-the higher the sodium level the lower the lithium level
-the lesser body fluid the lower the lithium level
Which race has more prevalent hypertension?
Black Americans
-develop at younger age
-tend to be more severe/resistant
-associated w/SDOH, disparities, limited access, chronic stress
What is resistant hypertension?
blood pressure that remains above goal despite the concurrent use of three antihypertensive agents of different classes
Hypertension definition:
BP > 130/80 OR currently using prescription medication to lower BP
Nursing considerations for Hydrochlorothiazide:
Thiazide Diuretics
-monitor for hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia
-can cause hyperuricemia
-monitor for gout
Nursing considerations for Lisinopril:
Angiotensin-Converting Enzymes (ACEi) Inhibitors
-most common side effect is fatigue
-can cause dry, hacking cough (angioedema is rare)
-Hyperkalemia (when paired w/potassium-sparing diuretic or K supplements)
-avoid during pregnancy
Nursing considerations for Losartan:
Angiotensin II Receptor Blockers (ARBs)
-most common side effect is fatigue
-less likely to cause dry cough (angioedema is rare)
-Hyperkalemia (when paired w/potassium-sparing diuretic or K supplements)
-avoid during pregnancy
Nursing considerations for Amlodipine:
Calcium Channel Blockers (CCBs)
-results in blood vessel dilaton
Relationship between body position and preload:
-bringing the HOB down or putting someone in trendelenburg can increase BP
Nursing considerations for measuring BP:
-at first visit, record BP in both arms
-use higher BP for following visits
-requires two separate visits for diagnosis
-cuff's length is 80-100% of circumference
-cuff's width is 40%
-keep feet flat, don't talk, no exercise, sit upright
Hypertensive emergency guidelines:
BP higher than 180/120 mmHg is CRISIS
-can be symptomatic or asymptomatic
Stage 1 Hypertension guideline:
BP > 130/80
S: 130-139
D: 80-89
Stage 2 Hypertension guideline:
BP > 140/90
S: 140+
D: 90+
Relationship between cuff size and reading:
if cuff size is too small = high reading
if cuff size is too large = low reading
Modifiable risk factors for hypertension:
-smoking
-diabetes
-high cholesterol/salt/unhealthy diet
-sedentary lifestyle
-physical inactivity
Non modifiable risk factors for hypertension:
-increased age
-family history
-low socioeconomic status
-male
-obstructive sleep apnea
-psychosocial stress
Non-pharmacologic interventions for hypertension management:
-reduce weight (if BMI > 24.9)
-follow heart healthy eating plan (DASH diet)
-lower sodium intake and increase potassium intake
-increase physical activity (150 mins moderate OR 75 mins vigorous per week)
-limit alcohol intake (2x M and 1x W)
-avoid tobacco products
Recommended sodium intake:
2,300 mg of sodium per day for healthy adults
1,500 mg of sodium per day for higher risk factors
Recommended potassium intake:
aim for 3,500-5,00 mg per day
-potassium relaxes the walls of the blood vessels
What is primary hypertension?
elevated BP without an identifiable cause
-90-95% of adults
-obesity is in this category
What is secondary hypertension?
elevated BP with an identifiable cause
-5-10% of adults
-e: tumor on adrenal gland
S/s of hypertensive emergency:
BARKH acronym:
B: brain (stroke)
A: arteries (aortic or abd dissection)
R: retina (double vision, vision loss)
K: kidneys (acute kidney injury)
H: heart (chest pain, SOB, pulmonary edema)
Can a hypertensive crisis be asympomatic?
YES, patients can experience crisis and not be experiencing symptoms of target organ damage
-hypertension is silent killer
MOA for Hydrochlorothiazide
blocks reabsorption of electrolytes and water in the distal tubule to decrease preload and BP
MOA for lisinopril:
prevents conversion of angiotension 1 to 2
-should be given to pts with HTN, diabetes, chronic kidney disease
MOA for losartan:
-prevent vasoconstrictor effects
-prescribed when pts cannot tolerate ACEi
Nursing considerations for all antihypertensives:
-check VS (BP and HR trends)
-hold if VS do not meet parameters
-assess fluid volume status
-assess electrolytes
-educate pts to rise slowly to prevent falls due to orthostatic hypotension
Common s/s of antihypertensives:
-frequent voiding
-orthostatic hypotension
-feeling tired, weak, drowsy, lack of energy
-erectile dysfunction
Reasons why patients might not take antihypertensive medications:
-fear of side effects
-misunderstanding of need for medicine
-lack of symptoms (silent killer)
-depression
-cost
-too many meds
-worry about being dependent
-mistrust of medical professionals
