SHERPATH Bipolar Disorder

Bipolar disorder :

formerly known as manic-depression, is a chronic reoccurring illness that needs lifelong management. It is characterized by shifts in mood, energy, and ability to function, and is the most expensive mental disorder to treat.

Bipolar disorder range :

from severe mania (exaggerated euphoria or irritability) to severe depression; it is characterized by alternating periods of excessive highs and lows, with periods of normal functioning.

Bipolar 1 :

- Manic phase lasts at least 1 week

- Sudden onset

- Symptoms escalate quickly

- Grandiosity (inflated sense of self)

- Flight of ideas (verbalized racing thoughts)

- Continuous, accelerated speech with abrupt changes from topic to topic

Bipolar 2 :

- Hypomanic episode lasts at least four days

- Increased self-esteem

- Increased talkativeness

- Racing thoughts

- Distractibility

-Increased goal-directed activity

- Excessive involvement in pleasurable activities that have a potential for painful consequences

Cyclothymic DIsorder :

- Similar to bipolar II; however, no extreme swings from manic to depressive states

- Hypomania alternated with minor depressive episode over at least a 2-year period

BIPOLAR ALERT:

he risk of suicide attempts is greater in the depressed state. The nurse and team members should be aware of suicidal ideation behaviors, which include moodiness, engaging in risky behavior, giving away possessions, and an increase in alcohol/drugs consumption.

Which factor has been shown to increase the risk of bipolar disorder up to 10 times in an individual?

a.) Substance use

b.) Hypothyroidism

c.) Low education status

d.) First-degree relative with bipolar disorder

d.) First-degree relative with bipolar disorder

Persons with a relative who has bipolar disorder are 5-10 times more likely than the general population to develop the disorder.

Which are signs of suicidal ideation?

SELECT ALL THAT APPLY

a.) Changing careers

b.) Increased risk-taking

c.) Giving away belongings

d.) Influx of substance abuse

e.) Breaking up with significant other

b.) Increased risk-taking

Risk-taking is directly associated with increased risk for suicide.

c.) Giving away belongings

Giving away belongings shows that a patient is no longer looking to the future and is at risk for suicide.

d.) Influx of substance abuse

Substance abuse is impairing, and using more substances than usual suggests impulsive behavior, which is associated with suicide risk

Grandiosity :

Inflated sense of self

Flight of ideas :

Verbalized racing thoughts

Hallucinations :

Sensations that are not really present

Delusions :

Distorted beliefs

Acute phase interventions :

The goal of the acute phase is to medically stabilize the patient while maintaining safety.

Some patients may require seclusion or electroconvulsive therapy (ECT).

Continuation Phase interventions

Once the patient is medically stabilized, interventions are directed toward maintaining the medication regimen, addressing the educational needs of the patient and family, and participating in cognitive-behavior therapy, and other psychotherapeutic treatments. The continuation phase typically lasts 4-9 months.

Maintenance Phase :

The maintenance phase is focused on preventing relapse and limiting severity and duration of future episodes. This is achieved by ensuring continued adherence to prescribed medications, as well as participation in psychoeducational and support groups that focus on health promotion. Periodic evaluations are necessary to maintain appropriate family, social, and occupational function.

ALERT MEDICATION :

Long-term risks of lithium therapy are hypothyroidism and impairment of the kidneys' ability to concentrate urine. Specifically, long-term usage of lithium is associated with increased risk of stage three chronic kidney disease, hypothyroidism, and raised total serum calcium concentration.

The nurse notices Ms. Harris has developed fine hand tremors. What does the nurse understand about this symptom?

a.) Fine hand tremors are a normal side effect of lithium carbonate.

b.) Fine hand tremors are likely due to a cause unrelated to bipolar disorder.

c.) Fine hand tremors are a sign of severe lithium toxicity and emergency measures should be taken.

d.) Fine hand tremors are a sign of advanced lithium toxicity and a drug level should be drawn STAT.

a.) Fine hand tremors are a normal side effect of lithium carbonate.

A normal side effect of lithium carbonate is fine hand tremors.

Ms. Harris develops lithium toxicity. Which symptoms may the nurse expect to Ms. Harris to develop?

SELECT ALL THAT APPLY

a.) Diarrhea

b.) Confusion

c.) Blurred vision

d.) Severe hypertension

e.) Small output of concentrated urine

a.) Diarrhea

Early signs of lithium toxicity include diarrhea.

b.) Confusion

Advanced signs of lithium toxicity include confusion.

c.) Blurred vision

Signs of severe lithium toxicity include blurred vision

Acute Phase :

Maintain safety and medically stabilize patient

Continuation phase :

Address patient education needs and maintain medication regimen

Maintenance Phase :

prevent relapse

After a manic patient has been acutely stabilized, what are the desired treatment outcomes for this patient?

SELECT ALL THAT APPLY

a.) Prevent relapse

b.) Taper off medication

c.) Eliminate mood changes

d.) Restore level of functioning

e.) Create dependent relationship with case manager

a.) Prevent relapse

Preventing relapse is an essential outcome to improving patient's quality of life and health

d.) Restore level of functioning

Restoring level of functioning is imperative for the patient to be able to achieve and maintain highest level of independence.

Evaluation of goals is an ongoing process. Examples of goals that may be appropriate for the individual with bipolar disorder include:

- Adherence to the medication regime

- Stable relationships with family, occupation, and social connections

- Improved mood

- Improved coping skills

- Reduced stress

Which tool is useful in assessing the patient diagnosed with bipolar disorder?

a.) Mood Disorder Questionnaire

b.) Beck Depression Inventory

c.) Patient Health Questionnaire-9

d.) Healthy Living Questionnaire

a.) Mood Disorder Questionnaire

The Mood Disorder Questionnaire determines the patient's risk for mood disorders, including bipolar disorder.

Which nursing diagnoses are appropriate for the patient diagnosed with bipolar disorder?

SELECT ALL THAT APPLY

a.) Risk for injury

b.) Hopelessness

c.) Low self-esteem

d.) Defensive coping

e.) Impaired verbal communication

a.) Risk for injury

Risk for injury is a crucial nursing diagnosis for the patient diagnosed with bipolar disorder.

d.) Defensive coping

Defensive coping is a nursing diagnosis for the patient diagnosed with bipolar disorder.

e.) Impaired verbal communication

Impaired verbal communication is a nursing diagnosis for the patient diagnosed with bipolar disorder.

Which goals are appropriate for the patient with bipolar disorder?

SELECT ALL THAT APPLY

a.) Stable relationships with family

b.) Adherence to medication regimen

c.) Reduced stress

d.) Decreased crying

e.) Improved appetite

a.) Stable relationships with family

Stable relationship with family is an appropriate goal for the patient with bipolar disorder.

b.) Adherence to medication regimen

Adherence to medication regimen is an appropriate goal for the patient with bipolar disorder.

c.) Reduced stress

Reduced stress is an appropriate goal for the patient with bipolar disorder.

The onset of bipolar II is typically around what age?

a.) 18

b.) 25

c.) 30

d.) 35

b.) 25

The onset of bipolar II is typically in the mid-20s.

Which is a characteristic of bipolar II?

a.) Clang associations

b.) Decreased social function

c.) Continuous, accelerated speech

d.) Excessive involvement in pleasurable activities

d.) Excessive involvement in pleasurable activities

Bipolar II is characterized by excessive involvement in pleasurable activities that have a potential for painful consequences.

Which are characteristics of hypomania associated with bipolar I?

SELECT ALL THAT APPLY

a.) Impulsivity

b.) Distractibility

c.) Risky behavior

d.) Poor global functioning

e.) Resistance to somatic treatments

a.) Impulsivity

Impulsivity is a characteristic of bipolar I.

b.) Distractibility

Distractibility is a characteristic of bipolar I.

c.) Risky behavior

Risky behavior is a characteristic of bipolar I.

Which are thought to be the causes of bipolar disorder?

SELECT ALL THAT APPLY

a.) Genetics

b.) Hypothyroidism

c.) Immune response

d.) Neurotransmitter disorders

e.) Hyperactive pituitary gland

a.) Genetics

Persons with a first-degree relative who has bipolar disorder are 5-10 times more likely than the general population to develop the disorder.

b.) Hypothyroidism

Hypothyroidism is associated with bipolar disorder.

d.) Neurotransmitter disorders

Neurotransmitter disorders are associated with bipolar disorder.

The hospital unit's psychiatrist has ordered a mood stabilizer and antipsychotic for a patient with bipolar disorder. The nurse is now administering medications and recognizes the patient has not been educated on the newly ordered medications. Which would be the appropriate education to provide this patient?

a.) "Valproate will help make you happier, and risperidone will help control the side effects of valporate."

b.) "Valproate will help to control your mood while risperidone will help your mind to think clearly."

c.) "Risperidone will give you more energy during the day while valproate will speed your thoughts."

d.) "Valproate and risperidone are common medications for bipolar disorder. You should notice improvement in a few weeks."

b.) "Valproate will help to control your mood while risperidone will help your mind to think clearly."

This response accurately identifies the effect of valproate, a mood stabilizer, and risperidone, an atypical antipsychotic.

A patient has just been started on lithium. The patient reports to the nurse that she has been experiencing increased urination, nausea, and a slight tremor. How should the nurse respond to the patient?

a.) "Those are typical side effects of lithium. We will continue to monitor you."

b.) "Those are signs of lithium toxicity. If you skip tonight's dose of lithium, the symptoms should subside. You should be able to continue with your regular lithium dose in the morning."

c.) "We need to alert your doctor immediately."

d.) "Let's check your lithium level before continuing with this medication."

a.) "Those are typical side effects of lithium. We will continue to monitor you."

This response accurately identifies the expected side effects of lithium and identifies that in a non-emergent, non-toxic state, the patient should continue to be monitored.

Which medication should the nurse anticipate will be ordered for a manic patient who is highly agitated?

a.) Clonazepam

b.) Citalopram

c.) Clozapine

d.) Clonidine

a.) Clonazepam

Clonazepam, which is a benzodiazepine, is useful in controlling agitated behavior.

An ICU nurse has just been assigned to a patient transferred for treatment of lithium toxicity. Which treatments should the nurse expect to be ordered for this patient?

SELECT ALL THAT APPLY

a.) Gastric lavage

b.) Mannitol

c.) LFT monitoring

d.) Urea

e.) Aminophylline

f.) Haloperidol

a.) Gastric lavage

Gastric lavage is an indicated treatment for lithium toxicity.

b.) Mannitol

Mannitol is an indicated treatment for lithium toxicity.

d.) Urea

Urea is an indicated treatment for lithium toxicity.

e.) Aminophylline

Aminophylline is an indicated treatment for lithium toxicity.

A patient has just been put into seclusion. Which information should the nurse include in her documentation of the event?

SELECT ALL THAT APPLY

a.) Type of behavior exhibited by the patient

b.) What items have been permitted in the seclusion room with the patient

c.) Time patient entered seclusion

d.) Time when patient is planned to be released

e.) Less restrictive interventions used first

a.) Type of behavior exhibited by the patient

Documentation of the behavior that led to the seclusion is important to include in documentation to show the necessity of seclusion.

c.) Time patient entered seclusion

The time that the patient entered seclusion is important to document in order to know when seclusion orders need to be discontinued or re-ordered.

e.) Less restrictive interventions used first.

Documentation of less restrictive interventions used first is important to include in documentation to show the necessity of seclusion.

A patient presents to a psychiatric outpatient office and reports a history of bipolar disorder and epilepsy. Which medication would present a high risk for treatment for this patient?

a.) Lithium

b.) Carbamazepine

c.) Valproate

d.) Lamotrigine

a.) Lithium

Lithium can cause seizures when serum level exceeds therapeutic range.

A patient has been exhibiting significant and worsening mania. He has developed paranoia that has advanced to the point that the patient is not eating because he believes food is poison. The treatment team wants to choose a treatment that will act quickly. What would be an appropriate option considering the patient's state?

a.) Lamotrigine

b.) Mirtazepine

c.) Electroconvulsive therapy (ECT)

d.) Phototherapy

c.) Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is sometimes used to reduce severe manic behavior. It can be especially useful in decreasing severe depression, catatonia, paranoid-destructive symptoms, and treatment-resistant depression.

A patient was admitted to an inpatient psychiatric unit for acute mania. The patient has since stabilized and is preparing for discharge with his treatment team who has recommended he enter psychotherapy. The patient asks his nurse why psychotherapy is necessary. Which is the best response by the nurse?

a.) "Psychotherapy will give you someone to talk to."

b.) "Psychotherapy will show your doctor you are invested in treatment."

c.) "Psychotherapy will eventually replace your medication."

d.) "Psychotherapy will help you cope with stressors that present after discharge."

d.) "Psychotherapy will help you cope with stressors that present after discharge."

When the patient is not experiencing acute mania, psychotherapy may be used to help the patient cope more positively to stressors in the environment and decrease the risk of relapse.

A patient diagnosed with bipolar disorder presents for his medication evaluation with the outpatient psychiatric nurse. The patient states that he has significantly decompensated since his last appointment, now endorsing fatigue, anhedonia, insomnia, and suicidal ideation. He also admits to smoking more cigarettes to help him try to relax. Which nursing diagnoses apply to this patient?

SELECT ALL THAT APPLY

a.) Risk for injury

b.) Sleep deprivation

c.)Ineffective coping

d.) Interrupted family processes

e.) Impaired verbal communication

a.) Risk for injury

Risk for injury presents the highest imminent priority for this patient due to his suicidal risk.

b.) Sleep deprivation

The patient is at risk for sleep deprivation due to excessive fatigue caused by manic and depressive states

c.)Ineffective coping

The patient is at risk for ineffective coping as evidenced by the increase in cigarette smoking to help him relax.

A patient diagnosed with bipolar disorder is seen by the outpatient psychiatric nurse for the medication evaluation. The patient states,

"I just can't see things getting better in the future. Why am I even here anymore?" Which nursing diagnosis is most appropriate for this patient?

a.) Hopelessness

b.) Risk for injury

c.) Ineffective coping

d.) Self-care deficit

a.) Hopelessness

Based on the statement made by the patient, he describes a lack of hope for the future.