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Summary NURS 355 Exam 2 Study Guide
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- Virginia Commonwealth University
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NURS 355 PSYCH TEST 2: CH 13-22CH 13: BIPOLAR & RELATED DISORDERS
BIPOLAR 1 DISORDER
o Most severe form
o Highest mortality rate
o AT LEAST 1 MANIC EPISODE
o GRANDIOSE DELUSIONS (think
they are better than everyone
BIPOLAR 2 DISORDER
o At least 1 HYPOMANIC
EPISODE
o At least 1 MAJOR DEPRESSIVE
EPISODE
SYMPOTOMOLOGY
o DEPRESSION
Feelings of worthlessness
Isolation
Extreme sadness
Suicidal thoughts
Eating more or less
Guilt or shame
o MANIA
Decreased need for sleep
Racing thoughts
Risky behaviors
Distractibility
Promiscuity (anyone can get it)
Excessive talking
Reckless sexual encounters
ASSESSMENT:
o Ask family members and friends!
o Mood
o Behavior
o Thought process and speech patterns
SPEECH:
Tangential Speech: go on a tangent
Pressured
Word salads
Loose associations
THOUGHT:
Grandiose: they’re the best
, Persecutory: someone is out to get them
SELF-ASSESSMENT:
o Manipulative
o Demanding
o Splitting: behavioral feature
Ex: Patient ask AM nurse to go out on a smoke break earlier than usual
and AM nurse says NO, patients say well the PM nurse always lets us go
out early
Then patient ask the PM nurse to go out on an early smoke break and PM
nurse says NO, and says well the AM nurse lets us go out early
o STAFF MEMBERS ALL HAVE TO BE ON THE SAME PAGE
ASSESSMENT GUIDELINES FOR BIPOLAR DISORDER:
o DANGER TO SELF OR OTHERS
o NEED FOR PROTECTION FROM UNINHIBITED BEHAVIORS
Due to grandiose thoughts
Hyper sexual needs
o NEED FOR HOSPITALIZATION
NURSING DIAGNOSIS
o RISK FOR INJURY
o RISK FOR VIOLENCE
OTHER DIECTED
SELF DIRECTED
o INEFFECTIVE COPING
PLANNING
o Medical stabilization
o Maintaining safety
o Nursing care
Managing meds
Decreasing physical activities and increase food intake (due to losing a lot
of calories), ensuring at least 4-6 hours of sleep
If use of ECT: assess neuro status and history of seizures
o ACUTE MANIC PHASE
Meds
Safety
Seclusion, restraints
Try ECT
For BIPOLAR 2: need lithium or anticonvulsants (mood stabilizers)
IMPLEMENTATION
o Depressive episodes
Hospitalization for suicide, psychotic or catatonic signs
Med concerns about bringing on manic phase
o Manic Episodes
Hospitalization for acute mania (BIPOLAR 1 DISORDER)
, Communicating challenges and strategies
Pharmacological Interventions
o Two main FOCI:
Agitation
Mood stabilization
o Lithium Carbonate
Monitor and test blood before administering more med
Therapeutic Level: 0.8 to 1.4
Maintenance Level: 0.4 to 1.3
TOXIC LEVEL: 1.5 and above
TEACH
Adverse effects
Toxic effects
Purpose
Need for periodic blood test
Patients also need to know that two major long-term risks of
lithium therapy are hypothyroidism and impairment of the
kidneys’ ability to concentrate urine.
o ANTICONVULSANTS: Mood Stabilizers
Valproate (Depakote)
REQUIRES ROUTINE BLOOD TESTING
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
NON-PHARMACOLOGICAL INTERVENTIONS
o TEAMWORK
o SUPPORT GROUPS
o CBT
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