Psych Exam 2: Bipolar

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Psych Exam 2: Bipolar
2015-02-19 15:49:28
Exam 2 ch 13
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  1. What disorder is characterized by at least 1 week-long manic episode that results in excessive activity and energy?
    Bipolar 1 disorder
  2. What is dysphoric mania
    mixed state or agitated depression
  3. What disorder is characterized by hypomania with profound depression
    Bipolar 2 disorder
  4. What disorder alternates with symptoms of mild to moderate depression for at least 2 years in an adult
    Cyclothymic disorder
  5. What is rapid cycling
    4 mood episodes in 12 months, 1 month, or even 1 day
  6. What is the median age of onset for bipolar disorder
  7. What two disorders are alike in that they share symptoms of impulsivity, inattention, and hyperactivity
    ADHD and Bipolar
  8. What is the first line of therapy for Bipolar disorder affecting the DGKH pathway
  9. What 3 neurotransmitters play a role in mania and depression and how?
    • norepinephrine, dopamine, serotonin
    • too much: mania
    • too little: depression
  10. What brain pathways are implicated in bipolar disorder
    • prefrontal cortex
    • medial temporal lobe
    • anterior limbic region
  11. What are nearly continuous flow of accelerated speech with abrupt changes from topic to topic usually based on understandable associations or play on words
    flight of ideas
  12. What are stringing together of words because of their rhythmic sound
    clang association
  13. What is grandiosity
    inflated self-regard
  14. What is the nurses primary consideration for a patient in acute mania
    prevention of exhaustion and death from cardiac collapse
  15. What is the primary outcome of acute mania
  16. How long does the continuation phase last of bipolar disorder and what is the overall outcome
    • 4-9 months
    • relapse prevention and medication adherence
  17. What are the overall outcomes for maintenance phase of bipolar disorder
    • prevent relapse
    • limit severity/duration of future attacks
  18. What are nursing interventions for acute phase of bipolar disorder
    • stabilize patient (SAFETY)
    • managing meds
    • decrease physical activity
    • increase food/fluids
    • 4-6 hrs of sleep
  19. What is a major cause of relapse in bipolar disorder
    nonadherence to mood-stabilizing medication
  20. What two meds are first line therapy for acute phase of bipolar disorder
    • lamictal
    • lithium
  21. How long does it take lithium to reach therapeutic levels in the blood
    7-14 days
  22. What may be prescribed for the patient to prevent exhaustion, coronary collapse, and death until lithium reaches therapeutic levels
    antipsychotics or benzos
  23. How do antipsychotics help during the acute phase (symptoms iit relieves) of bipolar disorder
    • slow speech
    • inhibit aggression
    • decrease psychomotor activity
  24. How much lithium is usually prescribed during the active phase of bipolar disorder
    300-600 mg q 2-3/day until therapeutic results or level 0.8-1.4
  25. To avoid serious levels of toxicity, what should lithium levels not exceed
  26. What four things can hasten lithium excretion
    • gastric lavage
    • urea
    • mannitol
    • aminophylline
  27. What intervention is necessary to prevent death when lithium levels reach over 2.5?
  28. What is the expected therapeutic level for lithium and what are the side effects
    • 0.4-1.0
    • fine hand tremors
    • polyuria
    • thirst
    • weight gain
  29. What level of lithium suggests early toxicity and what are some associated symptoms
    • 1.5
    • n/v/d
    • lethargy
    • slurred speech
  30. What steps should be taken is lithium level reaches 1.5
    • withhold meds
    • draw blood
    • reevaluate dose
  31. What lithium level shows advanced signs of toxicity an what are the associated symptoms
    • 1.5-2
    • coarse hand tremor
    • muscle hyperability
  32. What lithium level shows severe toxicity and what are associated symptoms
    • 2-2.5
    • ataxia
    • giddiness
    • clonic movements
    • seizures
    • stupor
    • severe hypotension
  33. What steps should be taken if lithium levels are 2-2.5
    • hospital
    • drug stopped
    • urea/mannitol/aminophylline/gastric lavage
    • emetic
  34. What are symptoms of severe toxicity >2.5 for lithium and what intervention may be necessary
    • convulsions, oliguria, death
    • hemodialysis
  35. How often should lithium levels be measured
    • 5 days after beginning treatment
    • any dose change
    • q month after therapeutic level achieved
    • q 3 months after 6mo-1 yr of stability
  36. When should lithium blood draw take place
    morning (12 hr after last dose)
  37. What are two major long term risks of lithium therapy
    • hypothyroidism
    • impairment of kidney's ability to concentrate urine
  38. What electrolyte should be monitored for a person on lithium and why
    • sodium
    • Lithium decreases sodium retention from kidney
  39. What should you instruct the patient on lithium to do if they are having severe v/d or sweating and why
    • dehydration raises lithium levels to toxic levels
  40. What medication should NOT be taken with lithium
  41. How should you instruct the patient to take lithium
    with meals
  42. What should be monitored for a person on Valproate
    liver and platelets
  43. How often should carbamazepine levels be drawn and why
    • q week for 8 weeks
    • increases liver enzymes that can speed its own metabolism
  44. What type of patients does carbamazepine work best in
    rapid cyclers with severe paranoia and anger
  45. What can an increase in liver enzymes when taking carbamazepine lead to
    liver inflammation and bone marrow suppression
  46. What are nursing responsibilities for patients under seclusion protocols
    • behavior observation (q 15 min)
    • food/fluids (30-60 min)
    • toiletry (1-2 hrs)
    • VS (1-2 hrs)
  47. Biggest side effect of mood stabilizers
    weight gain
  48. What can cause a relapse for bipolar disorder
    • alcohol
    • drugs
    • caffiene
    • OTC drugs
  49. What is an early sign of an oncoming manic episode
    lack of sleep