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What is mania?
- Elevated mood including 3 of the following:
- Inflated self-esteem or grandiose
- Decreased sleep
- Increase talkativeness
- Pressured speech: speaking on top of yourself. Words cannot flow fast enough.
- Flight of ideas
- Thoughts racing
- Distractible
- Agitation
- Increase in goal-directed activity (socially, at work or sexually)
- Excessive involvement in pleasurable activity
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What is hypomania?
- About the same as mania, but less so and no psychotic symptoms.
- Less severe than for mania
- Less impairment in social/occupational functioning
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Bipolar I vs. II?
- I: Is predominately manic with a few depressed episodes
- II: Is predominately depressed with a few manic or hypomanic episodes. Harder to diagnose
Both are genetic and are characterized by a chemical imbalance in the brain.
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What is Bipolar depression?
- More amendable for treatment
- Symptoms similar to Major Depression
- Monitor for suicidal ideation
- Medication used to treat are different than with depression.
- Use of Mood Stabilizers
- Antidepressants used with caution since they can precipitate manic episodes
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What are nursing interventions for pt with bipolar disorders?
- Administer medications & monitor side effects (1st line intervention is Rx)
- --Lithium (Therapeutic vs toxic levels)
- --Tegretol
- --Depakote
- --Others
- --Administer low doses of antipsychotics, to decrease impulsive behaviors.
- --PRN Benzodiazepines: helps to focus and relax.
- Give finger foods.
- Give fluids to drink
- --Want high calories because they will be burning them at a tremendous rate.
- Do not laugh at jokes
- Use firm, calm approach
- Use short, simple words & explanations
- Be consistent with approach
- Set limits on behavior
- Provide a structured environment
- Avoid power struggles
- Send to room to calm down if escalates
- De-escalation techniques (SAMA).
- Use time outs
- Direct/Redirect energy constructively
- Protect from self harm
- Above all, remain calm.
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How do you monitor for lithium toxicity?
- Vary narrow therapeutic level. (Level indicates multiple above therapeutic level.)
- 2.0 level: Anorexia
- Nausea/vomiting
- Diarrhea
- Coarse hand tremor
- Twitching
- Lethargy
- Hyperactive DTRs
- Tinnitus
- Vertigo
- Weakness
- Drowsiness
- Over 2.5:
- Fever, decrease urine output, decreased BP, irregular pulse, ECG changes, impaired consciousness, seizures, coma and death
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