Mania and Bipolar Disorders

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  1. 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
  2. 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
  3. 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.
  4. 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
  5. 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. 
  6. 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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Mania and Bipolar Disorders
2013-01-28 13:32:44

Mental Health
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