Summary NURS 355 Exam 2 Study Guide

NURS 355 PSYCH TEST 2: CH 13-22

CH 13: BIPOLAR & RELATED DISORDERS
 BIPOLAR 1 DISORDER
o Most severe form
o Highest mortality rate
o AT LEAST 1 MANIC EPISODE
o GRANDIOSE DELUSIONS (think
they are better than everyone
 BIPOLAR 2 DISORDER
o At least 1 HYPOMANIC
EPISODE
o At least 1 MAJOR DEPRESSIVE
EPISODE
 SYMPOTOMOLOGY
o DEPRESSION
 Feelings of worthlessness
 Isolation
 Extreme sadness
 Suicidal thoughts
 Eating more or less
 Guilt or shame
o MANIA
 Decreased need for sleep
 Racing thoughts
 Risky behaviors
 Distractibility
 Promiscuity (anyone can get it)
 Excessive talking
 Reckless sexual encounters
 ASSESSMENT:
o Ask family members and friends!
o Mood
o Behavior
o Thought process and speech patterns
 SPEECH:
 Tangential Speech: go on a tangent
 Pressured
 Word salads
 Loose associations
 THOUGHT:
 Grandiose: they’re the best

,  Persecutory: someone is out to get them
 SELF-ASSESSMENT:
o Manipulative
o Demanding
o Splitting: behavioral feature
 Ex: Patient ask AM nurse to go out on a smoke break earlier than usual
and AM nurse says NO, patients say well the PM nurse always lets us go
out early
 Then patient ask the PM nurse to go out on an early smoke break and PM
nurse says NO, and says well the AM nurse lets us go out early
o STAFF MEMBERS ALL HAVE TO BE ON THE SAME PAGE
 ASSESSMENT GUIDELINES FOR BIPOLAR DISORDER:
o DANGER TO SELF OR OTHERS
o NEED FOR PROTECTION FROM UNINHIBITED BEHAVIORS
 Due to grandiose thoughts
 Hyper sexual needs
o NEED FOR HOSPITALIZATION
 NURSING DIAGNOSIS
o RISK FOR INJURY
o RISK FOR VIOLENCE
 OTHER DIECTED
 SELF DIRECTED
o INEFFECTIVE COPING
 PLANNING
o Medical stabilization
o Maintaining safety
o Nursing care
 Managing meds
 Decreasing physical activities and increase food intake (due to losing a lot
of calories), ensuring at least 4-6 hours of sleep
 If use of ECT: assess neuro status and history of seizures
o ACUTE MANIC PHASE
 Meds
 Safety
 Seclusion, restraints
 Try ECT
 For BIPOLAR 2: need lithium or anticonvulsants (mood stabilizers)
 IMPLEMENTATION
o Depressive episodes
 Hospitalization for suicide, psychotic or catatonic signs
 Med concerns about bringing on manic phase
o Manic Episodes
 Hospitalization for acute mania (BIPOLAR 1 DISORDER)

,  Communicating challenges and strategies
 Pharmacological Interventions
o Two main FOCI:
 Agitation
 Mood stabilization
o Lithium Carbonate
 Monitor and test blood before administering more med
 Therapeutic Level: 0.8 to 1.4
 Maintenance Level: 0.4 to 1.3
 TOXIC LEVEL: 1.5 and above
 TEACH
 Adverse effects
 Toxic effects
 Purpose
 Need for periodic blood test
 Patients also need to know that two major long-term risks of
lithium therapy are hypothyroidism and impairment of the
kidneys’ ability to concentrate urine.
o ANTICONVULSANTS: Mood Stabilizers
 Valproate (Depakote)
 REQUIRES ROUTINE BLOOD TESTING
 Carbamazepine (Tegretol)
 Lamotrigine (Lamictal)
 NON-PHARMACOLOGICAL INTERVENTIONS
o TEAMWORK
o SUPPORT GROUPS
o CBT