NURS 488 MIDTERM 2 TEST WITH
COMPLETE SOLUTION
Nursing outcomes for patients with bipolar - ANSWER - decreased risk of
harm to self or others
- realistic self appraisal
- increased self care
- develop healthy coping skills
- adherence to medications
phases of mania - ANSWER acute, continuation, maintenance
acute phase of mania - ANSWER - impose external control to maintain safety
- provide medication
- set limits and boundaries
continuation phase of mania - ANSWER - prevention of relapse
- provide additional resources
- facilitate medication adherence (difficult)
- recognize triggers
maintenance phase of mania - ANSWER - minimize frequency and severity of
relapse
eg. day treatment, community resources
nursing interventions occur in what three domains? - ANSWER 1)
,environmental
2) physiological
3) therapeutic communication
bipolar: self-care - ANSWER nutrition
- healthy choices
- adequate intake
- fast, unhealthy food b/c do not have time to eat during manic phase
- risk for dehydration
- pt on lithium: will drink lots
sleep
- encourage frequent rest periods (start with small amount of time)
- promote consistent sleep/wake cycle
- incorporate sleep hygiene
hygiene
- not normally a problem unless in depressed state
elimination
- risk for dehydration
- decreased peristalsis, constipation
purpose of therapeutic communication - ANSWER 1) build trusting rapport
(validation)
,2) decrease pt's defensiveness
3) increase pt's self esteem
4) manage consequences of past manic episodes
5) increase pt's social/life skills
6) improved strained relationships
- building rapport helps nurse gather pertinent info
- collaborate (find out what works/what doesn't)
- nurse's own strengths may impede pt (don't want to disappoint),
weaknesses may make them feel better
LEAP approach - ANSWER idea that building trusting relationships is key to
being able to help people heal
L: listen
- understand pt's experience from his/her perspective
- listen, watch for cues
E: empathize
- acknowledge what is said and emotion
- reflect message and feelings back
- make it concrete
A: agree
- identify points you can agree on
- needs to be reality based
, P: partner
- plan is co-constructed
- needs to be reality based
bipolar: health teaching - ANSWER - emphasis on chronic/recurrent nature of
the depressive and manic episodes
- educate patient and family
- often requires collaborative care approach
bipolar: environmental interventions - ANSWER milieu:
- decrease stimuli
- time for rest and nutrition
- monitor relationships, encourage socialization
- remove sharps, uniforms, strangulation items (strings, cords, shoe laces),
elastics, mechanical pencils
- safe blankets: shred/tear resistant, 4x4
group support
- structured activities
mood stabilizers (4) - ANSWER 1) lithium
2) carbamazepine (Tegretol)
3) valproic acid (Epival)
4) lamotrigine (Lamictal)
*all decrease excitability of nerve endings, anti seizure medications
COMPLETE SOLUTION
Nursing outcomes for patients with bipolar - ANSWER - decreased risk of
harm to self or others
- realistic self appraisal
- increased self care
- develop healthy coping skills
- adherence to medications
phases of mania - ANSWER acute, continuation, maintenance
acute phase of mania - ANSWER - impose external control to maintain safety
- provide medication
- set limits and boundaries
continuation phase of mania - ANSWER - prevention of relapse
- provide additional resources
- facilitate medication adherence (difficult)
- recognize triggers
maintenance phase of mania - ANSWER - minimize frequency and severity of
relapse
eg. day treatment, community resources
nursing interventions occur in what three domains? - ANSWER 1)
,environmental
2) physiological
3) therapeutic communication
bipolar: self-care - ANSWER nutrition
- healthy choices
- adequate intake
- fast, unhealthy food b/c do not have time to eat during manic phase
- risk for dehydration
- pt on lithium: will drink lots
sleep
- encourage frequent rest periods (start with small amount of time)
- promote consistent sleep/wake cycle
- incorporate sleep hygiene
hygiene
- not normally a problem unless in depressed state
elimination
- risk for dehydration
- decreased peristalsis, constipation
purpose of therapeutic communication - ANSWER 1) build trusting rapport
(validation)
,2) decrease pt's defensiveness
3) increase pt's self esteem
4) manage consequences of past manic episodes
5) increase pt's social/life skills
6) improved strained relationships
- building rapport helps nurse gather pertinent info
- collaborate (find out what works/what doesn't)
- nurse's own strengths may impede pt (don't want to disappoint),
weaknesses may make them feel better
LEAP approach - ANSWER idea that building trusting relationships is key to
being able to help people heal
L: listen
- understand pt's experience from his/her perspective
- listen, watch for cues
E: empathize
- acknowledge what is said and emotion
- reflect message and feelings back
- make it concrete
A: agree
- identify points you can agree on
- needs to be reality based
, P: partner
- plan is co-constructed
- needs to be reality based
bipolar: health teaching - ANSWER - emphasis on chronic/recurrent nature of
the depressive and manic episodes
- educate patient and family
- often requires collaborative care approach
bipolar: environmental interventions - ANSWER milieu:
- decrease stimuli
- time for rest and nutrition
- monitor relationships, encourage socialization
- remove sharps, uniforms, strangulation items (strings, cords, shoe laces),
elastics, mechanical pencils
- safe blankets: shred/tear resistant, 4x4
group support
- structured activities
mood stabilizers (4) - ANSWER 1) lithium
2) carbamazepine (Tegretol)
3) valproic acid (Epival)
4) lamotrigine (Lamictal)
*all decrease excitability of nerve endings, anti seizure medications
