3450 Exam 3 Review
• bipolar
◦ if pt is manic
‣ feed them nger food because they are in caloric de cit because they forget about food
◦ if pt is angry/ belligerent/hostile
‣ remove the pt rst
◦ if pt too angry and you can't remove them
‣ remove everyone else rst
• safety is priority
◦ assess them
• on lithium
◦ don't change your sodium intake, especially don't decrease!
◦ drink 2-3 quarts of water a day
◦ continue same sodium intake
◦ 0.6-1.2 is therapeutic range
◦ toxicity is over 1.5
◦ if pt states they want to go on a low sodium diet, say no!
◦ Make sure they are eating normally b/c they burn off calories due to manic episodes (Bipolar)
◦ continue checking lab values
◦ if there is a sodium imbalance, hold lithium and call physician
‣ low sodium level = lithium toxicity
• know the lithium toxicity s/s
◦ refer to book
◦ n/v/d
◦ seeing halos
◦ similar to digoxin toxicity (both have narrow therapeutic range)
• SSRIs are used to treat depression
◦ can cause serotonin syndrome
‣ s/s: vomiting, diarrhea, sweating, fever
• know the 5 stages of grief and dying
◦ Denial: disbelief or shock about situation
‣ ex: “no, it can’t be true”
◦ Anger: toward the health care system, God, or even the deceased.
‣ ex: “why me? Why not someone else?”
◦ Bargaining: attempt to deal with overwhelming feelings of vulnerability and helplessness
‣ ex: “if only I had gone to the doctor sooner”
◦ Depression: sadness, regret, and pain settle in.
‣ ex: “I’ll never get to meet my grandchild when they’re born”, “we’ll never get to go to the
city we always wanted to visit”
◦ Acceptance: calm, if somewhat withdrawn, response.
‣ ex: Quiet peacefulness
• don't stop medications abruptly
• if you have multiple patients withdrawing from drugs, alcohol withdrawal patient is priority
◦ tx: benzo (for tremors, hallucinations)
‣ DT: delirium tremors
‣ can also use valium, lorazapam, librium
• antabuse
◦ deterrent for drinking - can't use anything with alcohol in it
• TPAPN -
◦ program offered to nurses that have substance abuse issues
◦ if a suspect a nurse to be impaired, report them
• eating disorder and anorexia
◦ family and individual therapy
‣ family because it is a bad parenting or controlling parenting situation
• withdrawal from alcohol
◦ seizures or delirium tremors can occur within the rst 12-24 hours - most concerning -
PRIORITY
◦ can take up to 72 hours for them to get well
• know your lab values
◦ CBC
• bipolar
◦ if pt is manic
‣ feed them nger food because they are in caloric de cit because they forget about food
◦ if pt is angry/ belligerent/hostile
‣ remove the pt rst
◦ if pt too angry and you can't remove them
‣ remove everyone else rst
• safety is priority
◦ assess them
• on lithium
◦ don't change your sodium intake, especially don't decrease!
◦ drink 2-3 quarts of water a day
◦ continue same sodium intake
◦ 0.6-1.2 is therapeutic range
◦ toxicity is over 1.5
◦ if pt states they want to go on a low sodium diet, say no!
◦ Make sure they are eating normally b/c they burn off calories due to manic episodes (Bipolar)
◦ continue checking lab values
◦ if there is a sodium imbalance, hold lithium and call physician
‣ low sodium level = lithium toxicity
• know the lithium toxicity s/s
◦ refer to book
◦ n/v/d
◦ seeing halos
◦ similar to digoxin toxicity (both have narrow therapeutic range)
• SSRIs are used to treat depression
◦ can cause serotonin syndrome
‣ s/s: vomiting, diarrhea, sweating, fever
• know the 5 stages of grief and dying
◦ Denial: disbelief or shock about situation
‣ ex: “no, it can’t be true”
◦ Anger: toward the health care system, God, or even the deceased.
‣ ex: “why me? Why not someone else?”
◦ Bargaining: attempt to deal with overwhelming feelings of vulnerability and helplessness
‣ ex: “if only I had gone to the doctor sooner”
◦ Depression: sadness, regret, and pain settle in.
‣ ex: “I’ll never get to meet my grandchild when they’re born”, “we’ll never get to go to the
city we always wanted to visit”
◦ Acceptance: calm, if somewhat withdrawn, response.
‣ ex: Quiet peacefulness
• don't stop medications abruptly
• if you have multiple patients withdrawing from drugs, alcohol withdrawal patient is priority
◦ tx: benzo (for tremors, hallucinations)
‣ DT: delirium tremors
‣ can also use valium, lorazapam, librium
• antabuse
◦ deterrent for drinking - can't use anything with alcohol in it
• TPAPN -
◦ program offered to nurses that have substance abuse issues
◦ if a suspect a nurse to be impaired, report them
• eating disorder and anorexia
◦ family and individual therapy
‣ family because it is a bad parenting or controlling parenting situation
• withdrawal from alcohol
◦ seizures or delirium tremors can occur within the rst 12-24 hours - most concerning -
PRIORITY
◦ can take up to 72 hours for them to get well
• know your lab values
◦ CBC
