MIDTERM Study Guide NUR 211 091 FALL 2022
50 items (48- multiple choice; 2 Math) *Purple writing indicates Professor’s talking points from lecture!
1. Chapter 16- Bipolar Spectrum Disorders- 17 items
Different clinical manifestations of hypomania, and mania. Compare and contrast Bipolar 1 and Bipolar
2. (See Table 16.1 - Mania in Continuum) pg. 229- 230
Bipolar disorders are a group of brain diseases characterized by unusual shifts in mood, energy, and activity
level leading to difficulties in carrying out day-to-day tasks.
Bipolar I disorder is characterized by at least one episode of “persistent or elevated, expansive or irritable
mood” (MANIA), accompanied by changes in activity & energy. The diagnosis frequently includes a major
depressive episode as part of a person’s psychiatric history.
Bipolar II Disorder includes at least one period of hypomania alternating with one or more periods of
depression. Those w/it never experience a full manic episode. Typically, an individual seeks treatment during a
depressive disorder.
4-day period of elevated, expansive, or irritable mood
Stable to work just a little restless
Episode is a change in behavior (ex: sudden change – spending so much money, or order excessive amount in
store)
Disturbance in mood and change in functioning are observable by others (not aware themselves)
Not severe enough to cause marked impairment in functioning
Not attributable to a substance/medication, medical condition
Mania on a Continuum
Hypomania (Bipolar II Disorder) Acute Mania (Bipolar I Disorder)
Communication
1. Talks and jokes incessantly, is the “life of the 1. May change suddenly from laughing to
party,” and gets irritated when not center of anger or depression; mood is labile
attention
2. Becomes inappropriately demanding of
2. Treats everyone with familiarity and people’s attention, and intrusive nature
confidentiality; often borders on crude repels others
3. Talk is often sexual—can reach obscene, 3. Speech may be marked by profanities
inappropriate propositions to total strangers and crude sexual remarks to everyone
(nursing staff in particular).
4. Talk is tangential; jumps from one topic to the
next; pressure of speech (rapid talking, loud, and can 4. Speech marked by flight of ideas, in
be difficult to interrupt) which thoughts race and fly from topic to
topic; may have clang associations.
Affect and thinking
1. Persistently elevated, expansive, or irritable mood 1. Abnormally persistently elevated,
expansive, or irritable mood
2. Full of pep and good humor, feelings of euphoria
and sociability; may show inappropriate intimacy 2. Good humor gives way to increased
with strangers irritability and hostility and short-lived
, Hypomania (Bipolar II Disorder) Acute Mania (Bipolar I Disorder)
period of rage, especially when controls are
3. Feels boundless self-confidence and enthusiasm. set on behavior. May have quick shifts of
Has elaborate grandiose schemes for becoming rich mood from anger to submissive.
and famous. Initially, schemes may seem plausible.
3. Grandiose delusions—may come to
4. Judgment often poor. Gets involved with schemes believe they are famous or especially gifted
in which job, marriage, or financial status may be without any basis in fact
destroyed.
4. Judgment is extremely poor.
5. May write large quantities of letters to rich and
famous people regarding schemes 5. Decreased attention span and
distractibility are intensified.
6. Decreased attention span to internal and external
cues 6. Lack of insight about illness or
consequences of behavior
7. Limited insight
Physical Behavior
1. Overactive, distractible, buoyant, and busily 1. Extremely restless, disorganized, and
occupied with grandiose plans (not delusions); goes chaotic. Physical behavior may be difficult
from one action to the next to control. May have outbursts, such as
throwing things or becoming briefly
2. Increased sexual appetite; sexually irresponsible assaultive when crossed.
and indiscreet. Unplanned pregnancies and sexually
transmitted diseases. Sex used for escape, not for 2. No time to eat—too distracted and
relating to another human being. disorganized
3. May have a voracious appetite, eat on the run, or 3. No time for sleep—psychomotor activity
gobble food during brief periods too high; if unchecked, can lead to
exhaustion and death
4. May go without sleeping; unaware of fatigue; may
be able to take short naps 4. Same as in hypomania but in the extreme
5. Financially extravagant, goes on buying sprees,
gives money and gifts away freely, can easily go into
debt
Delirious Mania
1. Most severe form of mania; less common
2. Acute onset and rapid progression
3. Consists of symptoms of both delirium and mania
4. Severe clouding of consciousness, disorientation, fluctuating sensorium, psychosis, catatonia, and manic
symptoms (excitement, grandiosity, insomnia, etc.)
Acute mania has psychotic symptoms. Depression is a co-occurring illness with hypomania.
Symptoms Bipolar I (Acute Minia) Bipolar II (Hypo Minia)
Manic episode: Yes at least 1 week duration No
Distractibility
Impulsivity
Grandiosity
Flight of Ideas /racing thoughts
Activity/energy increase
Sleep needs diminish
Talkative
, Hypomanic episode Yes at least 4 days duration
Major depressive episode May be present and must be at least 2 weeks Yes at least 2 weeks (Minni Depress) (not
strong enough for admission)
Marked impairment in functioning Yes (i.e., hospitalization) No (hospitalization)
Know behaviors, speech patterns, thought processes and content of persons with bipolar disorder (listed
on chart above)
Prevalence and co-morbidity
- Onset of bipolar disorders occurs throughout the life span and can occur as late as 60 or 70 years.
- Average age of onset is 18 years
- 1/3 of the initial symptoms of BSD occurs before the age of 13 and nother 3rs occurs between the
ages of 13 & 18
- Early onset leads to greater comorbidity and functional impairment
- Initial presentation: Men – mania, female – depression
- Substance/Medication Induced Bipolar Disorder – something has caused it
o Street drugs uppers can cause this
o Need to have a very clear history
- Bipolar Disorder Due to Another Medical Condition – neurological in nature
o Ex: Parkinson
Population Prevalence
General population (if doesn’t run in family) 2.6%
Monozygotic twins (identical twins) 60-80%
Dizygotic twins 10-20%
Child of 1 parent with bipolar disorder 28%
Child of 2 parents with bipolar disorder 50-60%
Assessment guidelines
1. Assess physiological safety: QSEN
a. Need for hospitalization (physical stabilize pt)
b. Medical examination to determine of manic symptoms are
2. Other areas of safety. QSEN. Assess whether the pt is a danger to self
a. Not sleeping, eating, poor impulse control, poor judgement etc.
3. When the patient is clinically stable, assess the pt’s & family’s understanding of bipolar disorder + meds
Planning and implementation at different phases of illness (acute, continuation & maintenance)
Phase 1 (Acute Mania) - Goal: Prevent injury & maintain safety
- Planning: focus on physiological stability & maintaining safety for pt
o Hospitalization safest option
Nursing care: decrease excessive physical activity
Maintain adequate food & fluid intake
