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Mood DisordersPsychiatric Nursing: Contemporary Practice

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What do psychological and social theoriest attribute the cause of bipolar disorder to?
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Loss in genetically vulnerable individuals causes depression and mania develops in an attempt to overcompensate for the depression.
What are the priority care issues for a patient experiencing a manic episode?
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Protection of the patient. During mania the patient has poor judgment and impulsivity.
What is a priority concern for a patient experiencing a depressive episode?
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Assessing for suicide risks
What are the important biological assessments that should be conducted for a patient experiencing mania?
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Assess changes in sleep patterns, changes in diet, body weight, and thyroid function, as well as changes in sexual practices.
Why should a nurse assess previous use of antidepressants when evaluating a patient experiencing mania?
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Antidepressants can trigger a manic episode
What are common pharmacologic triggers for a manic or depressive episode?
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Use of antidepressants or discontinuation of mood stabilizing medications
What biological interventions are needed for a patient experiencing mania?
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Encourage rest, adequate nutrition, hydration, re-establishment of physical well-being, and limiting stimuli to decrease agitation and promote sleep.
What are the two major goals of pharmacological treatment of bipolar disorder?
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Rapid control of symptoms and prevention/reduction in future episodes
During the acute phase of pharmacological management of bipolar disorder, how often should serum level monitoring be conducted?
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Every 1-2 weeks during the first two months, and then every 3-6 months from then on
When is it recommended that long-term or lifetime prophylaxis with a mood stabilizer be instituted?
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After two manic episodes or after one severe manic or if there is a family hx of bipolar disorder
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What are the three most common medications used to treat bipolar disorder?
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Lithium carbonate, divalproex sodium/Depakote, and carbamazepine/Tegretol.
When is lithium not an effective treatment for bipolar disorder?
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During the acute phase. Benzodiazepines and antipsychotics are often supplemented during this phase.
What are predictors of a poor response to lithium as a treatment for bipolar disorder?
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Hx of poor response, rapid cycling, dysphoric symptoms, mixed symptoms of depression anf mania, psychiatric comorbidity and medical comorbidity.
What are the major concerns regarding fluid and electrolytes when a patient is on lithium?
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The higher the sodium levels in the body are, the lower the therapeutic effect of lithium will be and vice versa. It is imperative to maintain hydration and sodium intake to keep lithium levels consistent.
What happens to serum lithium levels if a patient experiences vomiting, diarrhea, or loss of fluids from strenuous exercise or hot climates?
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As the patient loses fluids the lithium level increases.
What ethnicity may develop toxicity from lithium more rapidly than other ethnicities, possibly limiting the therapeutic response?
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Persons of African descent, start the dose low and increase it slowly
What are the symptoms of a severe lithium toxicity?
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Cardiac arrythmia, blackouts, tremors, seizures
What should you do if you suspect a patient is experiencing lithium toxicity?
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Withhold the drug, immediately obtain a blood sample and push fluids if the patient can consume them.
What class of drug is Depakote?
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An anticonvulsant
What is the usual dosage range of Lithium?
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600-1800 mg
What is the usual dosage range of Divalproex sodium/Depakote?
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15-60 mg/kg
  
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