116 exam 3 mood disorders and bipolar

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116 exam 3 mood disorders and bipolar
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2014-04-24 01:17:27
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116 exam 3 bipolar and mood
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  1. Depression
    Biochemical
    • Serotonin
    • Norepinephrine
  2. to Dx Major Depressive Disorder patient must __
    • have 5 or more of the following daily for 2 consecutive weeks
    • Depressed Mood
    • Lack of Pleasure
    • Significant weight loss/gain
    • Insomnia/hypersomnia
    • increased/decreased motor activity
    • lack of energy
    • feeling of worthlessness
    • decreased concentration
    • suicidal ideation
  3. what is dysthymic D/O
    • depressed mood
    • occurs over 2 years with 2 or more of the following
    • Decreased/increased appetite
    • Insomnia/hypersomnia
    • chronic fatigue
    • decreased self-esteem
    • poor concentration
    • feelings of hopelessness
  4. 1st line medication for depression
    • SSRIs (less side effects, sexual dysfunction, compliance very important)
    • TCAs (more side effects, CardiToxic)
  5. 2nd line medications for depression
    • MAOIs (watch diet and do not give with SSRIs)
    • Electroconvulsive therapy (nurse watch ABCs)
  6. when patient wakes up from ECT therapy, what is the nurses primary role?
    Watch Airway
  7. contraindications for ECT therapy
    • recent MI
    • Recent CVA
  8. S/S for MDD major depressive disorder or DD Dysthymic disorder

    occurs over 2 years
    Dysthymic Disorder
  9. S/S for MDD major depressive disorder or DD Dysthymic disorder

    Recurrent thought of suicide
    • MDD
    • Major Depressive Disorder
  10. S/S for MDD major depressive disorder or DD Dysthymic disorder

    Must have 5 or more symptoms
    MDD
  11. S/S for MDD major depressive disorder or DD Dysthymic disorder

    Has significant weight loss/gain
    MDD
  12. S/S for MDD major depressive disorder or DD Dysthymic disorder

    has difficulty making decisions
    BOTH
  13. S/S for MDD major depressive disorder or DD Dysthymic disorder

    causes significant distress in social occupational or other functioning
    both
  14. what is Bipolar disorder
    • Chronic, recurrent
    • Shifts in mood, energy, ability to function
    • Moods alternate between mania, depression, and euthymia
    • Highest suicide rate of any psych illness
  15. Mania
    • inflated self-esteem/grandiosity
    • decrease need for sleep
    • more talkative, pressured speech clang association
    • Flight of ideas
    • Distractible and Irritable
    • Psychomotor agitation/ increased goal oriented behavior
    • excessive involvement in pleasurable activities
  16. Mania the nurse should watch...
    Nutrition and rest
  17. Bipolar I

    graph
    • Minor depression
    • Major depression
    • mania
    • Major depression
    • Mania
  18. BiPolar II
    Graph
    • Major depression
    • Hyopmania
    • Major depression
    • Hypomania
    • Major Depression
  19. Cyclothymia

    Graph
    • Minor Depression
    • Hypomania
    • Minor Depression
    • Hypomania
  20. Assessment
    • I: Acute, SAFETY
    • exhaustion and poor muscle control
    • CONTROLS
    • protect client form giving away money or possessions
    • HOSP NEEDS
    • MEDICAL STATUS, cause
    • Educate pt and family
  21. Phases of BiPolar
    Phase I
    • I ACUTE:
    • SAFETY
    • Hydration and Nutrition
    • Cardiac Status
    • Tissue Integrity
    • Sleep/Rest
    • Self Control
  22. Phases of BiPOlar
    • I=Acute
    • II=Continuation or Tx
    • III=Maintenance of Tx
  23. Phases of Bipolar
    Phase II
    • Continuation of Treatment
    • Med Compliance (VERY IMPORTANT)
    • Relapse Prevention
    • Education
  24. Phases of BiPolar
    Phase IIi
    Maintenance of Treatment

    • Relapse Prevention
    • Ongoing therapy
  25. Medications for BiPolar
    • Mood Stabilizers
    • Lithium

    • Antiepileptics
    • Depakote, Tegretol, Neurontin, Lamictal
  26. Lithium Levels
    • 0.5-1.0 therapeutic
    • 1.0-1.5 early signs of toxicity
    • 1.5-2.0 advanced signs of toxicity
    • 2.0-2.5 severe toxicity
    • >2.5 Convulsions/death may occur
  27. things to know about lithium
    takes 7-14 days to reach therapeutic levels in the blood

    excreted by the kidneys

    mood stabilizer used to treat manic and depressive episodes and prevention of future episodes
  28. Signs of toxicity
    Lithium

    2.0-2.5
    • Severe
    • confusion
    • incontinence of urine and feces
    • coma
    • cardiac arrhythmias
    • peripheral circulatory collapse
    • abdominal pain
    • proteinuria
    • Oliguria (life threatening below 30ml per hour)
    • Death
  29. sign toxicity

    lithium

    1.5-2.0
    • Advanced toxicity
    • coarse hand tremors
    • persistent gastrointestinal upset
    • mental confusion
    • muscle hyperirritability
    • incoordination
    • sedation
  30. Signs of toxicity

    Lithium

    1.0-1.5
    • Early signs of toxicity
    • vomiting
    • diarrhea
    • slurred speech
    • muscle weakness
  31. Treatment of Lithium Toxicity
    • Early and Advanced
    • withhold med, check levels and reevaluate dosage

    • Severe
    • Emetics, gastric lavage and diuretics to increase excretion
    • Hemodialysis for extreme cases
  32. when using lithium n the elderly be carefulĀ ...
    start low and go slw

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