RON/BIO N3 Lecture ORIGINAL

Help learners:
1. Acquire new information
2. Apply it in real-life situations
3. Develop critical thinking
4. Allow for problem-solving abilities

Maintaining/Promoting Health

Preventing illness

Restoring health

Facilitate coping

Promoting outcomes

Assess for knowledge deficit

What do they need to know to make an informed decision about their care?

Age and developmental level

Family/caregiver support networks

Financial resources

Cultural influences (i.e. language)

Health literacy

Learning style

1. One's self concept is likely to move from dependence to independence

2. Previous experiences of the adult is a rich resource for learning

3. Readiness to learn is often related to a developmental task or a social role

4. Learning material should be useful IMMEDIATELY (keep it short and simple, straight to the point)

Identify learning barriers (auditory, visual, etc.)

Allow extra time

Plan short teaching sessions

Relate new information to familiar activities or information

There are THREE main learning domains:
1. Cognitive
2. Psychomotor
3. Affective

Storing and recalling new knowledge in the brain

The "thinking" portion

Ex: Patient receiving information about how insulin works

Learning a physical skill involving the integration of mental and muscular activity

Psycho (thinking) + Motor (doing)

Best way for patient to learn

Ex: Patient practicing administering insulin

Changing attitudes, values, and feelings

How it affects the patient (what are their thoughts and feelings towards a subject)

Ex: Patient is eager to learn about how to manage their diabetes because they realize how having diabetes affects their life

Lecture

Panel

Discovery

Written materials

Role modeling

Discussion

Audiovisual materials (videos)

*Demonstration*

Discovery

Printed materials

It should NOT be the only form of patient education as it simply isn't enough for the patient to effectively learn

You probably shouldn't use it (unless patient is familiar with medical terms)

Instead teach using laymen's terms (plain English)

return demonstration (or teach back method)

Ex: "Okay, show me how you are going to administer insulin to yourself"

Summary of learning need

Plan of teaching

Implementation of the plan

Evaluation results

Transfer of responsibility while retaining accountability

TAPE acronym

T - teach

A - assess

P - planning

E - evaluate

also care for invasive lines and administering parenteral medications

1. Right task
2. Right circumstance
3. Right Person
4. Right direction and communication
5. Right supervision and evaluation

Acute unstable patients

TAPE

No IV meds

Initiate blood products

Start IV (only for NCLEX, not real life)

Hang IV meds

administer enemas

Assign tasks based on strengths and weaknesses of care team

Encourage best care possible

Ask about competency levels

Is it:
- clear?
- concise?
- correct?
- complete?

Ask for input

Give credit for effort

Share perceptions

Determine steps needed for desired outcomes

A: Airway (ensure pt's airway is clear)

B: Breathing (assess and support breathing prn)

C: Circulation (monitor and manage circulation and blood pressure)

ngl kinda obvious what it is

Characterized by speed, pitch, volume, clarity, etc.

Facial expressions, gestures, eye contact, touch

Space, time, boundaries

Body movements, posture, gait

General physical appearance

Sounds (like crying, gasping, sighing)

Risk for violating patient privacy and confidentiality

"self-talk"

communication within a person

Occurs between two or more people with a goal to exchange messages

Developmental level

Sociocultural differences

Roles and responsibilities

Space and territoriality

Physical, mental, and emotional state

Values

Environment

Dynamic (BOTH people are active participants)

Purposeful and time limited

Goals are determined cooperatively and defined in terms of the patient's needs

1. Orientation phase

2. Working phase

3. Termination phase

Sit when communicating with a patient

Maintain eye contact if appropriate

Use appropriate facial expressions and body gestures

DO NOT pretend to listen

Failure to listen

Using cliches

Using questions containing the words "why" and "how"

Using probing questions

False assurance

Giving advice

Protect public safety

Regulate nursing practice and education

Licensing: issue and renew nursing licenses

Standards: set practice and educational standards

Disciplinary Actions: investigate and enforce actions

Education: Completion of an approved nursing program

Examination: Passing of the NCLEX

Background Check: Criminal history check

Renewal cycle every 2 years

20 CE (continuing education) credit hours required every renewal cycle

Provides a framework for nursing education programs to ensure that graduates are prepared to meet the standards of practice required by the Texas BON

Member of the Profession

Provider of Patient-Centered Care

Patient Safety Advocate

Member of the Healthcare Team

common bond

Controlled pandemoniom

Mutual goals developed

able to work together

disengagement from tasks and group members

Rules don't apply to them

Show up late

Contribute very little

Talk just to hear themselves

Always interrupt

Fearful of voicing opinion

Takes no risks, no responsibilities

Criticizes any idea that is not his/her own

Obsessively negative

come prepared

listen - be open to other viewpoints

keep on track

present ideas and opinions

state disagreements --> be able to back them up

clarify when needed, don't assume

abuse

illness

War

Terrorist attack

Natural disaster

subconscious defense mechanism used to prevent recognition of a horrific or traumatic event

easier to enter dissociative state with REPEATED use

onset is sudden or gradual

Essential feature: disruption in usually integrated functions of consciousness, memory, identity, environmental perception

1. Dissociative amnesia

2. Dissociative identity disorder

3. Depersonalization/Derealization disorder

the patient cannot remember important personal information (usually of a traumatic or stressful nature)

a temporary state where a person loses memory and ends up in an unexpected place. People with this symptom can't remember who they are or details about their past (new identity).

patient displays 2+ distinct identities or personality states that recurrently take control of their behavior

accompanied by inability to recall important personal information

Patient has a persistent or recurrent feeling of being detached from mental processes or body (depersonalization) or sensation of being in a dreamlike state where environment seems foggy or unreal (derealization)

Patient is NOT psychotic or out of touch with reality

Therapy (individual or group) --> focus in therapy is on reassociation

Medications (for anxiety or depression or both)

Goal is to improve quality of life and functional abilities, reduce symptoms

set of techniques that help people reconnect with the present and detach from negative emotions
--> helpful with dissociation or flashback

Validate their feelings --> "I know this is frightening, but you are safe now"

Help patient focus on what they are currently experiencing through the senses --> "Can you see me and the room we're in? Do you feel your feet on the floor?"

connection between mind (psyche) and body (soma)

transferance of mental experiences/states into bodily symptoms

1. Physical complaints suggest major medical illness BUT have no demonstrable organic basis

2. Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining symptoms

3. Symptoms or magnified health concerns are NOT under patient's conscious control

Characterized by 1+ physical symptoms that have no organic basis

Individual spends a lot of time + energy focused on health concerns
--> increased distress and anxiety about health

Involves unexplained, usually sudden deficits in sensory or motor function (i.e. blindness, paralysis)

Deficits suggest neuro disorder, but is associated with psychological factors

May be an attitude of la belle indifference (lack of concern/distress) about functional loss

Primary symptom of pain --> unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance

Preoccupation with the fear that one has a serious disease or will get a serious disease

Patients with this disorder misinterpret bodily sensations or functions

Symptoms often experienced in adolescence

Diagnoses may not be made until early adulthood (~25 years of age)

Either chronic or recurrent (lasts for decades for many people)

Patients tend to be pessimistic about medical establishment and often believe their disease could be diagnosed if providers were more competent

Intentional production of false or grossly exaggerated physical or psychological symptoms

Motivated by external incentives (i.e. avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs)
--> Can stop physical symptoms as soon as they have gained what they wanted

Factitious disorder, imposed on self

Basically saying the patient is faking their symptoms to gain attention

Occurs when a person inflicts illness or injury on someonoe else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim

Ex: Nurse gives excess IV potassium to a client and then "saves their life" by performing CPR

Occurs most often in people who are in or are familiar with medical professions (i.e. nurses, physicians, medical technicians, or hospital volunteers)

They have voluntary control over symptoms vs. no voluntary control

no words for emotions

direct internal benefits of being sick (i.e. relief of anxiety, conflict, or distress)

External or personal benefits from others because one is sick (i.e. attention and comfort measures)

Treatment focuses on managing symptoms and improving quality of life

Depression and anxiety --> antidepressants (SSRIs)
Ex: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)

Pain disorder --> refer to chronic pain clinic (NSAIDs are usually used. AVOID NARCOTICS due to risk of dependence/abuse)

Involvement in therapy groups

Education

Patients usually provide a lengthy and detailed account of previos physical problems, numerous diagnostic tests, and perhaps even a number of surgical procedures

May have seen multiple HCPs over several years

May express dismay or anger at medical community (exception is patients with conversion disorder, who show little emotion when describing physical limitations or lack of a medical diagnosis)

Overall appearance usually not remarkable

Patients often walk slowly or with unusual gait b/c of pain or disability caused by symptoms

In many cases, they brighten and look much better as the assessment interview begins b/c they have the nurse's undivided attention

Mood is often labile (think playdoh soft)
Ex: shifting from seemingly depressed and sad when describing physical problems to looking bright and excited when talking about how they had to go to the hospital in the middle of the night by ambulance

Emotions are often exaggerated, as are reports of physical symptoms

Patients describing a series of persoonal crises related to their physical health may appear pleased rather than distressed about these situations

Patients with functional neurological symptom disorder (conversion disorder) display an unexpected lack of distress

Patients do NOT experience disordered thought processes

Content of thinking is primarily about often exaggerated physical concerns (ex: when they have a simple cold, they may be convinced it is pneumonia)

Unlikely to be able to think about or respond to questions about emotional feelings, instead answering about how they feel in terms of physical health or sensations

focus on fear of serious illness rather than the existence of illness

Alert and Oriented. Intellectual functions are unimpaired

Little to no insight into behavior

Firmly convinced their problem is entirely physical and often believe others don't understand

Unlikely to think about personal characteristics or strengths and are uncomfortable when asked to do so

Low self esteem - tend to deal with it by totally focusing on physical concerns

Little success in work situations

Difficulty managing daily life issues, which they relate solely on physical status

Unlikely to be employed --> might have past work history

Often lose jobs b/c of excessive absenteeism or inability to perform work '

Difficulty fulfilling family roles

Likely have few friends and spends little time in social activities --> most socialization occurs with members of the health care community

May report lack of family support and understanding

Often have sleep pattern disturbances

Lack basic nutrition

Get no exercise

May be taking multiple prescriptions for pain or other complaints

Carefully assess physical complaints

Validate feelings while trying to engage them in treatment (ex: I know you're not feeling well, but it is important to get some exercise each day)

Accept complaints without being judgemental

Remember complaints are not under their voluntary control

Diagnosed when there is impairment of personality functioning and personality traits that are maladaptive

Have identity problems --> egocentrism (self-centered), self-esteem comes from gaining power or pleasure at the expense of others

Dysfunctional relationships characterized by deceit, coercion, or intimidation

Often motivated by personal gratification

Lack capacity for empathy, remorse, or concern for others

Anger/hostility

Irritable, labile moods

Emotionally cold and uncaring

Impulsivity, poor judgement

Irresponsible, not acocuntable

Risk-taking, thrill-seeking behaviors

Entitlement

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive Personality Disorder

Depressive behavior

Passive-aggressive behavior

Characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts

Occurs more often in people with relatives who have major depressive disorders

Characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance

Mood may fluctuate rapidly and erraticaly

May be easily upset or offended

Developed through the interaction of hereditary dispositions and environmental influences

Genetic differences account for about 50% of the variances in temperament traits

Characterized by:
- pervasive mistrust/suspiciousness of others
- interpretation of others' actions as potentially harmful
- transient psychotic symptoms during periods of stress

more common in MALES

tend to have lifelong problems living and working with others

As a child:
- no friends and experienced social anxiety
- often teased

As an adult:
- very jealous, controlling
- unwilling to forgive
- hypervigilant
- anticipate hostility

Strict adherence to schedule and appointments

Avoid being too nice/friendly (such as social chitchat or jokes)

Project neutral but kind affect

If threatened, set limits

Antianxiety --> diazepam/Valium

Antipsychotic --> haloperidol/Haldol in small doses for brief periods of time

Characterized by:
- Pervasive lack of desire for involvement with others in ALL aspects of life
- Do not have or desire friends, rarely date or marry
- Little to no sexual contact
- May have some connection with a first-degree relative (often a parent)

Think of a loner

As a child:
- Loner
- Did poorly in school
- Ridiculed by peers

As an adult:
- Expressionless
- Appears odd and eccentric
- No close relationships
- May have imaginary friends/fantasies
- Depersonalization

Avoid being too nice/friendly

Do NOT push socialization (pt may resist)

May try to discuss coping/anxiety

Do NOT allow other patients to ridicule

Focus is on improved functioning in community

Greater chance of success if they can relate their needs to one person

Psychotherapy and group therapy (may form attachment to others in group)

Medications:
- antidepressants (bupropion/Wellbutrin)
- antipsychotics (risperidone/Risperdal)

Characterized by:
- Pervasive pattern of social and interpersonal deficits
- Acute discomfort + reduced capacity for close relationships
- Cognitive or perceptual distortions
- Behavioral eccentricities
- Odd appearance
- Lack the ability to experience and express a full range of emotions

Persons with schizotypal personality disorder may develop schizophrenia

Severe social and interpersonal deficits

Extreme anxiety in social situations

Paranoid; blames others

Very odd beliefs and magical thinking

Does NOT blend in with crowd

Focus on development of self-care and social skills --> improved functioning in the community

Encourage patient to establish a daily routine for hygeine and grooming

Respect patient's desire for social isolation

Psychotherapy and group therapy

Low-dose antipsychotics, antidepressants, and antianxiety meds

Schizoid = loner

Schizotypal = socially awkward

Characterized by disregard for rights of others

Central characteristics of deceit and manipulation --> check and validate info from other sources

Tend to peak in the 20s, dimishes significantly after 45 years of age

AKA Sociopath

Childhood or adolescence

Formal diagnosis is not made until 18 years of age

Hx of impulse control (like stealing) and conduct problems as children and adolescents (like killing animals)

Safety is priority

Therapeutic relationship --> listen to patient, show empathy

Provide consistency, support, and boundaries --> Do not become angry or respond to patient punitively

Document all behavior and signs of manipulation

Mood stabilizers --> lithium, valproic acid/Depakote

SSRIs --> fluoxetine/Prozac, sertraline/Zoloft

Benzodiazepines

If they have ADHD --> methylphenidate/Ritalin

Characterized by a pervasive pattern of unstable interpersonal relationships, self-image, affect; marked impulsivity

"Livin' on the edge"

Unable to control emotions

Emotionally labile - rapidly moving from one extreme to another

Splitting - person is either wonderful or horrible

Self-destructive behaviors (i.e. cutting, suicidal ideation, promiscuity)

Hostile, often physically violent

S/S seems to decrease with age

Maintain patient safety --> Priority (use a no-self-harm contract)

ALWAYS seriously consider suicidal ideation with presence of a plan

Set clear and consistent boundaries and limits

Straightforward communication

Self-destructive behaviors (like cutting) --> nurse should remain neutral; dress the wound

Structure daily activities

Long term treatment is necessary; focus on show behavioral changes (one at a time)

Psychotherapy

SSRIs

Anticonvulsants

Lithium

Naltrexone

Antipsychotics

Characterized by pervasive pattern of excessive emotionality and attention seeking

"Drama queen" --> more common in females

Begins by early adulthood hood

Extroverted, flamboyant, colorful personality

Self-centered

Excessive emotionality

Impulsive, flirtatious

Does NOT think they need help --> they think others are the problem

Provide feedback about social interactions with others (including manner of dress and nonverbal behavior)

Social skills training through role-playing (such as eye contact, active listening, respecting personal space, etc.)

Explore strengths and assets, and give specific feedback about positive characteristics

Recognize that flirting is a response to distress

Psychotherapy to deal with inner feelings

Group therapy may work, but patient may be disruptive to class

Medications: antidepressants, antipsychotics, antianxiety

Pervasive pattern of grandiosity; need for admiration; lack of empathy; arrogant or haughty attitude; superior view

Fragile ego, low self-esteem

Extremely sensitive to criticism

"greater than thou" attitude

Arrogant, inflated view of self

Neeeds constant attention

Very sensitive to criticism and rejection

Intense shame and fear of abandonment

Use therapeutic relationship to show/practice meaningful interaction

Do NOT become defensive or engage in power struggles - remain neutral qnd don't take it personally

Role model empathy

Set limits and expectations

Patient is not likelu to seek help for this problem (go figure)

Medications include lithium (for mood swings) and antidepressants

Characterized by a pervasive pattern of social discomfort, low self-esteem, and hypersensitivity to negative evaluation

Equally common among men and women

Infancy/Childhood:
- Shyness that increases during adolescence and early adulthood

Adulthood
- Avoids interpersonal contact
- Feels inferior to peers
- Reluctant to engage in new activities with new people

Friendly, accepting of patient and their fears

Do NOT push social situations

Encourage positive self-talk

Individual and group therapy

Medications: antianxiety, beta blockers (atenolol), antidepressants (SSRIs like Celexa, SNRIs like Effexor)

Characterized by a pervasive and excessive need to be taken care of --> leads to submissive and clinging behavior and fears of separation

Runs in familieis and is mroe common in the youngest child

Intense fears of separation

Submissive, clingy

Feelings of insecurity and no confidence

May leave them vulnerable to exploitation

Assistance in daily functioning

Teaching problem-solving --> promotes independence

Refrain from giving advice about problems or making decisions for clients (even though they might ask you to do so)

Psychotherapy, CBT (cognitive behavioral theory)

Medications: antidepressants, antianxiety meds, imipramine/Tofranil for panic attacks

Characterized by a pervasive patten of preoccupation with perfectionism, orderliness and control at the expense of flexibility, openness, and efficiency

Limited emotional expression

Stubborn

Indecisive

Low self-esteem, self-depreciating

Rigid and inflexible standards of self and others

May have background of harsh discipline

Different perspective on decision-making --> help patient accept or tolerate less-than-perfect work

Cognitive restructuring --> "What is the worst that could happen?" "What would your boss/partner see in this situation?"

Encourage patient to take risks (such as letting someone else plan a family activity)

Be prepared for power struggles --> recognize patient does not like change

Individual and group therapy

Medications: clomipramine/Anafranil, fluoxetine/Prozac

School committment or importance of school

Positive peer relationships

Parent or peer disapproval of antisocial behavior

Functional family relationship

Effective parenting skills

A psychotic disorder that causes disturbances in thought, behavior, and perception.

Positive symptoms - symptoms that are not usually present in schizophrenia

Negative symptoms - symptoms that are taken away from an individual that should be there

Ambivalence - holding seemingly contradictory beliefs or feelings

Associative looseness - fragmented thoughts/ideas

Delusions - fixed false beliefs that have no basis in reality (i.e. "I am the president of the US")

Echopraxia - copying movements of somebody else

Disorganized speech

Echolalia - involuntary copying of someone else's words

Hallucinations - false sensory perceptions (seeing and hearing things that aren't real)

Perserveration - persistent adherence to a single idea or topic, resisting change

Bizarre behavior

Alogia - tendency to speak little or to convey little substance of meaning

Anhedonia - feeling no joy/pleasure from life or any activities

Apathy - lack of interest

Asociality - social withdrawal

Blunted effect - restricted range of emotional feeling, tone, or mood

Catatonia - psychologically induced immobility, as if in a trance

Flat affect - abscence of any facial expression

Inattention - inability to concentrate or focus on a topic

Lack of volition - no will to do anything

Peak incidence of onset is 15-25 years of age for men; 25-35 years of age for women

Usually diagnosed in late adolescence or early adulthood

Diagnosis is usually made when person begins to display more actively POSITIVE symptoms (such as delusions, hallucinations, and disordered thinking) --> 2+ symptoms that last >6 months

Onset may be abrupt or insidious (gradual)

Most patients slowly and gradually develop s/s such as social withdrawal, unusual behavior, loss of interest in school/work, neglected hygeine

Patient is severely ill and has a mixture of psychotic and mood symptoms

S/S include those of both schizophrenia and a mood disorder (such as depression or bipolar disorder)

Two patterns:
1. Ongoing psychosis, never fully recovering (symptoms may shift in severity over time)
2. Episodes of psychotic symptoms that alternate with episodes of relatively complete recovery from the psychosis

Intensity of psychosis tends to diminish with age

Many patients with long-term impairment regain some degree of social/occupational functioning

However, many have difficulty functioning in the community

While treatment does NOT cure the disease, they are crucial to its successful management

Genetic factors

Neuroanatomic and neurochemical factors --> less brain tissue and CSF, excess dopamine and serotonin modulation of dopamine

Immunovirologic factors --> viral exposure; cytokines

Psychopharmacology is the primary medical treatment for schizophrenia

Conventional Antipsychotics (dopamine antagonists)
- Targets positive signs
- No observable effect on negative signs

Second-Generation Antipsychotics (dopamine, serotonin antagonists)
- Diminish positive symptoms
- Lessen negative symptoms

May take several weeks of PO therapy before IM injections

Control the positive symptoms of schizophrenia (i.e. hallucinations, delusions, etc.)

Medications include:
- chlorpromazine
- haloperidol
- droperidol

If you have hallucinations, then you might need haloperidol

They have MANY serious side effects

*Extrapyramidal Syndrome (EPS)

*Neuroleptic malignant syndrome (NMS)

Agranulocytosis (decrease in WBC)

Anticholinergic effects (Can't see/pee, spit/shit)

Sedation

Seizures

Symptoms include:
- Dystonia (involuntary muscle contractions)
- Akathisia (restlessness + repetitive movements)
- Parkinsonian symptoms (rigid muscles, tremors, shuffling gait)
- Tardive dyskinesia (involuntary movements of tongue, neck, and facial muscles)

Many of these symptoms will resolve spontaneously or will resolve upon d/c of medication

Tardive dyskinesia is IRREVERSIBLE; symptoms persist even after d/c of medication

Administer medications as ordered

Assess for effectiveness

Reassure patient if they are frightened by the dystonia

Administer medications as ordered

Assess for effectiveness

Assess using tools such as AIMS

Report occurence or score increase to physician

Potentially fatal side effect of agranulocytosis (failure of bone marrow to produe adequate WBC)

S/S of agranulocytosis include fever, malaise, ulcerative sore throat, and leukopenia (no shit sherlock)

Drug must be discontinued IMMEDIATELY if s/s of agranulocytosis appears

Weekly absolute neutrophil counts (ANC) required for first 6 months of treatment --> ANC of <1,500/μL = discontinue

an anticholinergic medication like benztropine can be used to control the extrapyramidal symptoms associated with a typical antipsychotic

Life-threatening condition caused by the use of an antipsychotic agent or withdrawal from an antipsychotic agent

S/S includes:
- high fever
- muscle rigidity
- decreased LOC
- arrhythmias
- tachycardia
- diaphoresis
- BP fluctuations

D/C the medication (or restarting it if withdrawal is what caused it)

Administer dantrolene (muscle relaxant)

Implement cooling measures

Stabilize electrolyte levels

Notify physician

Help to control the positive and negative symptoms associated with schizophrenia

Medications include:
- Risperidone
- Olanzapine
- Clozapine

Carries a much LOWER risk for EPS and NMS

Clozipine is for schizophrenia

increased risk for DM Type II - Monitor blood glucose levels

Weight gain

elevated cholesterol

anticholinergic effects (can't see/pee spit/shit)

sedation

decreased libido

Increased risk for seizures, neutropenia, and agranulocytosis --> monitor for signs of infection

EPS (extrapyramidal syndrome)

Tardive dyskinesia

Seizures

NMS (neuroleptic malignant syndrome)

Weight gain --> encourage balanced diet and regular exercise

Sedation --> caution with activities requiring alertness (like driving a car)

Anticholinergic symptoms --> increase fluid and fiber intake, use ice chips or hard candy

Orthostatic hypotension --> rise slowly from sitting or lying positions

Safety of patient and others = PRIORITY

Acknowledge patient may be paranoid and suspicious --> give them ample personal space and time

Do NOT confront patient's delusions (also don't reinforce them)

Reorient to reality --> "I don't see anything, but you must be frightened. You are safe here in the hospital"

Help patient with social skills, self-care, nutrition

Characterized by pervasive alterations in emotions manifested by depression, mania, or both

Interference with life; long-term sadness, agitation, or elation

First manic episode generally occues in a person's teens, 20s, or 30s

More common in highly educated people

Difference is in the severity of symptoms

Bipolar I = more severe highs (mania) and may or may not have depressive episodes

Bipolar II = less severe high (hypomania), includdes depressive episodes

DIG FAST

D - distractinility
I - indiscretion
G - grandiosity
F - flight of ideas
A - activity increase
S - sleep deficit
T - talkativeness

Begins suddenly and escalates over several days

Lithium

Anticonvulsants

Response to lithium in acute mania is about 70%-80%

Lithium competes for salt receptor sites --> too little salt puts the pt at risk for lithium toxicity; too much salt means the lithium might not be as effective

therapeutic range = 0.5-1.5 mEq/L

do NOT use in pregnant women

coarse hand tremors

confusion

hypotension

seizures

tinnitus

Drink adequate fluids (~2L uncaffienated fluids/day)

Monitor fluid balance --> daily weights, intake and output

Don't eat too much salt (also definitely don't eat too little)

Contact physician if patient has diarrhea, fever, flu (or any other condition that leads to dehydration)

Thyroid tests @ baseline and q.6 months during treatment (b/c lithium can increase levels of TSH, which can cause anxiety, labile emotions, and sleeping difficulties)

Assess for renal function (BUN, Creatinine)--> b/c lithium is excreted in the urine (lithium is contraindicated in people with compromised renal function or urinary retention)

Lithium is contraindicated in people with brain or cardiovascular damage

Diuretics and NSAIDs are contraindicated when patient is taking lithium

Diuretics = because you don't want fluid loss during lithium therapy as it can lead to toxicity

NSAIDs = they can cause damage to the kidneys and cause increased levels of lithium

Decrease stimuli

Remove dangerous items from the environment

Remain calm

Set clear limits

Monitor intake and output and sleep patterns

Provide high protein, high calorie finger foods that can be eaten on the go

Protect patient from poor judgement (i.e. unsafe sex, excessive spending)

A lot of side effects --> makes it difficult for patient to maintain medication regimen

Nephrotoxicity --> contraindicated in renal disease

polyuria

increased thirst

fine hand tremors

hypothyroidism --> weight gain, fatigue

electrolyte imbalances

leukocytosis --> monitor for infection

GI upset

decrease synaptic transmission in the CNS, which helps to decrease mania associated with bipolar disorder

blood dyscrasias (anemia, leukopenia, thrombocytopenia) --> low RBC, WBC, and PLT = MONITOR CBC LEVELS

Vision issues

Potential for serious rashes. --> Report rashes to physician

4-12 µg/mL

Increases levels of GABA, which is an inhibitory neurotransmitter in the CNS --> decreases manic episodes associated with bipolar disorder

hepatotoxicty --> baseline and frequent LFTs (AST and ALT levels)

pancreatitis

thrombocytopenia --> low platelet = PLT count and bleeding times

50-125 µg/mL