2. A disorder which is characterized by mood
swings from profound depression to extreme
euphoria (Mania), this coexists with periods
of normalcy.
Mania: an alteration in mood that is
expressed by feelings of elation, grandiosity,
hyperactivity, agitation, and accelerated
thinking and speaking.
4. High genetic relationship
Imbalances in neurotransmitters
Lesions or brain trauma in the limbic system
Medications (steroids/seizure
meds/antidepressants/ narcotics)
Psychosocial- this theory is declining due to
the evidence based research which
acknowledges this disease as a biological
disease of the brain.
6. Milder clinical picture
No marked occupational/ social impairment
Cheerful and expanded personality
Does not require hospitalization
Rapid flow of ideas, hyperactivity, social butterfly
Does not include psychosis
Increased libido
Anorexia, weight loss, spending large amts without
thinking of any repercussions
7. Mood is elevated, expansive, irritable
Euphoric, on a huge “high”, that changes to anger
or crying without any warning.
Impaired occupation/social functioning and
relationships
May become psychotic, thoughts are disjointed,
flight of ideas, pressured speech
Excessive/frenzied motor activity/no impulse
control/ sexually manipulative
8. Hallucinations/ delusions
Inexhaustible/ no sleep/ no eat!
Hygiene and grooming neglected
Dress may by flamboyant/ excessive makeup/
bizarre
You feel pressured and nervous talking to
them and after your interview you are tired
9. This is an emergency because the client can
have a severe clouding of consciousness with
the mania symptoms intensifying
Confusion/ disorientation/panic
Delusions of persecution/ grandeur/
religiosity
Safety is at stake; they are so physically
exhausted and have been overworking their
cardiovascular system for days.
10. Bipolar I
Bipolar II
Cyclothymic
Rapid Cycling
12. Level of mood
Elated mood
▪ (hypomania)
▪ VS
MANIA, EUPHORIC
▪ (manic)
13. Assess Behavior
Assess Thought Process
Flight of ideas, speech, communication,c lang
associations, grandiosity
Assess Cognitive Functions
Cognitive difficulties in psychosocial areas
Impairment core features
15. Danger to self and others
Controls
Hospitalization
Medical Status
Co-existing condition
Pt/family education
16. See page 548 for excellent concept map on this!!!!
17. The client will:
Exhibit no signs of physical injury
Not harm self or others
No longer exhibit physical anxiety/agitation
Eat a balanced diet
Accept responsibility for their behaviors
Will sleep 6-8 hours a night
Will not manipulate others for self gratification
18. Any thoughts?
I’ll start:
▪ Risk for violence: self directed or other directed
▪ Short term goal- client will recognize increasing anxiety
and will report this to staff for assistance
▪ Longterm goal- client will not harm self or others
19. Therapies once meds initiated
Cognitive therapy
ECT/TMS
Basic interventions:
Reduce stimuli
Lower lights in room
Remove dangerous items from room/observe for safety
per unit protocal
Provide finger foods/high calorie/ juice/ milk
Set limits on manipulative behavior/ remain calm
21. Initially mania treated with antipsychotics or
Valproic Acid until Lithium level is
therapeutic (7-10 days)
Therapeutic level
Maintenance level
Normal side effects expected:
Drowsy, headache, thirst, pulse irregularities, polyuria,
and weight gain ….look at Lithium as a SALT..it causes
similar effects
22. Early Toxicity signs
Ataxia, severe diarrhea, blurred vision, N/V, tinnitis
Advanced Toxicity signs
Excessive dilute urine, tremors, seizure, impaired
consciousness, arrhythmias, coma, ..death
* There is a very slim margin between
therapeutic and TOXIC
Levels must be checked weekly until therapeutic level
reached, then monitored monthly during maintenance
therapy.
23. So what do we do if the client is experiencing
toxicity?
STOP THE LITHIUM
The monitor for arrythmias
Hydrate maintaining fluid and electrolyte balance
24. Antiepileptics
Depakote/ Tegretol/ Lamictal
These drugs are sometimes used while Lithium
is reaching levels or may be used alone. It
decreases the firing of neurons, therefore
slowing down the client.
25. Anxiolytics- Clonazepam and Lorazepam
Acute Mania / psychomotor agitation
Antipsychotics
▪ Olanzapine
▪ Quetiapine
▪ Risperidone
▪ (These can be used alone or with lithium)
26. Severe treatment resistant mania
Rapid Cyclers
Paranoid
Acutely Suicidal
Used when meds have failed. ECT creates a grand
mal seizure which “reboots” the brain. TMS are more
specific waves of electricity to specific nerve cells,
this does not cause a grand mal. TMS is one of the
newer technologies being used.
27. Seclusion / Restraints (what is seclusion)
Rationale
Documented Justification
Complex therapeutic, ethical and legal issues
Restraint/ Seclusion policy/ Protocal
NEVER USED AS PUNISHMENT/ STAFF
CONVIENENCE
28. Depression and Bipolar Support Alliance
(DBSA)
National Alliance for the Mentally Ill (NAMI)
National Mental Health Association
Manic-Depressive Association
29. Drink???
Do drugs????
Why knowing their diagnosis do you think a
bipolar client will become noncompliant with
meds and then use substances?
31. Mostly application questions, what will you say???
Remember restate for clarification, set limits
Know the drugs and any client teaching ( ie MAOI, TCA etc).
Meds that are used for EPS , anticholinergic effects, side
effects
Treatments : ECT (interventions and monitoring) , seclusion
(removing stimuli)
Documentation of care, planning care
Client teaching for meds, resources, diet
Nursing diagnosis priorities
Chemical dependency, care of client, crisis intervention
Notes de l'éditeur
How about some others?
For acute mania: therapeutic level is 1-1.5 For maintenance: .6- 1.2 Not used in pregnancy.