Term
| Bipolar Disorder has a strong ______ component. Twins who are Bipolar have a ___-____% chance of having it. There is also an _____ component. If a parent has Bipolar disorder, tehre's a ____% chance their child will have it. If both parents have it, there's an __% chance child will have it, even if child is ______ to another _____. |
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Definition
Hereditary, 10-20%
28%
80% if both have it, even if child is adopted to another family. |
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Term
| Bipolar disorder is associated with ______ of ______, _______, and/or ________ |
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Definition
| excess of norepinephrine, serotonin and/or dopamine |
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Term
| Bipolar disorder may have to do with an _______ imbalance. Particularly, high levels of _________ ___. If that is the cause, _______ _______ _________ will be and effective medication. |
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Definition
Electrolyte imbalance
High levels of intracellular calcium.
Calcium channel blockers will be effective. |
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Term
| A ______ on the ____side of brain may cause secondary ____ symptoms |
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Definition
| tumor (or lesion) on the right side of the brain may cause secondary mania symptoms |
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Term
| Medications like ____ and _______ for another reason they may have mania symptoms |
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Definition
|
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Term
| _________ theories associated with bipolar disorder have declined over the years, though ______ probably does play a role. |
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Definition
| psychosocial, environment |
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Term
| About _% of children are bipolar |
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Definition
|
|
Term
| What does FIND stand for? For whom is it used? |
|
Definition
Frequency of symptoms: symptoms occur most days of the week
Intensity of symptoms: cause extreme disturbance
Number of symptoms: 3-4x day
Duration of symptoms: 4 or more times an hour
Diagnosing children and adolescence with bipolar |
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Term
| It's challenging to differentiate ______ ______ and _______ in children. |
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Definition
Bipolar disorder and ADHD
*note if child isn't responding to ADHD medication, could it be bipolar as well? |
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Term
| ________ may be present in Bipolar disorder |
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Definition
| Psychosis (hallucinations.delusions) |
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Term
| _____ ____ may exacerbate mania symptoms, and they should be administered only ______ symptoms have been controlled |
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Definition
| ADHD agents may exacerbate symptoms and should be administered only after symptoms have been controlled |
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Term
| One of the scariest symptoms of Bipolar in adolescence is that they seek _____/_____ activities |
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Definition
|
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Term
| Some medications used in treating bipolar diorder in children are: ______, ________, _______, as well as _____ antipsychotics (like ______ ). The goal is to give ___ medication at ___ ____. |
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Definition
Lithium, divalproex, carbamazepine, atypical antipsychotics (like abiliphy)
Goal is to try one medication at a time. |
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Term
| _____ is the most common comorbid condition in bipolar disorder in teens and children |
|
Definition
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Term
| There is no _____ for bipolar disorder, but if it is recognized and treated early they may be able to taper off of medications. The majority of people need a ____ _____ ____. |
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Definition
No cure.
may be tapered off, but most need life-long treatment. |
|
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Term
| Stage I of bipolar disorder: |
|
Definition
Least severe.
Hypomania: symptoms not sufficiently severe to cause marked impairment or require hospitalization.
Mood is cheerful, expansive
Cognition and perception: self-exultation; easily distracted
Activity and behavior: increased motor activity; extroverted, superficial |
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Term
|
Definition
Acute Mania: intensification of hypomanic symptoms
Requires hospitalization*
Euphoric, elated mood.
Fragmented, disjointed thinking, *difficulty staying on point, pressured speech, flight of ideas, hallucinations and delusions
Increased sexual activity, excessive psychomotor behavior, inexhaustible energy, goes without sleep *bizzarre dress and makeup.
May be very manipulative to get people to behave like them |
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Term
|
Definition
Delerious Mania
A grave form of the disorder
Severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania
Has become rare since the availability of antipsychotic medication |
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Term
| Due to inability to stop to eat, a manic person may show _____, ______ |
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Definition
Weight loss, amenorrhea
High calorie, finger foods are ideal |
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Term
| The most serious nursing diagnoses for manic behavior are |
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Definition
risk for injury
risk for violence self-directed/toward others |
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Term
| It is important that ______ and _____ are educated about bipolar disorder, and they should know that this is a _______ disorder. So if they see symptoms worsen, they should call the doctor so that lithium levels can be checked. |
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Definition
Family and friends
Cyclical disorder |
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Term
| Lithium levels should be checked _____ or _____ at the beginning of treatment (until patient is very stable on a therapeutic level) |
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Definition
|
|
Term
| Phase I of individual psychotherapy behavior |
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Definition
Determine extent of person's illness
Develop trusting relationship with patient |
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|
Term
Phase II of individual psychotherapy
____ of therapy takes place, May last _____ or _______. Many times _______ _______ needs to be resolved. __________ in relationships with others that needs to be explored. |
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Definition
Work phase of therapy
May last months or years
Dysfunction grief is worked through
Ambivalence in relationships with others |
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|
Term
|
Definition
|
|
Term
| _______ therapy tells patient they are not alone |
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Definition
|
|
Term
| ____ therapy is when patients begin to recognized own dysfunctional thought process. |
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Definition
|
|
Term
| What kind of mania do they have (types) |
|
Definition
euphoria, elation
anger, irritability, rage
exaggerated sense of ability
emotional liability |
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|
Term
| When hyperactivity starts, you should...? |
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Definition
| Remove client from stimulating environment |
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|
Term
| Lithium carbonate (Eskalith, Lithane) |
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Definition
| Antimanic medication. "The original drug." |
|
|
Term
| Why do bipolar people take anticonvulsants? |
|
Definition
| seizure activity and mania are similar |
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Term
|
Definition
|
|
Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
| valproic acid (Depakote, Depkene) |
|
Definition
|
|
Term
|
Definition
Aripiprazole (Abilify)*
Chlorpromazine (Thorazine)*
Olanzapine (Zyprexa)
Quetapine (Seroquel)
Risperidone (Risperdol)
Ziprasidone (Geodon) |
|
|
Term
|
Definition
|
|
Term
| Chlorpromazine (Thorazine)* |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Risperidone (Risperdol)
Ziprasidone (Geodon) |
|
Definition
|
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Term
| The mechanism of action in Lithium is ____ _____. It is a ______ that competes for ____ ______. It is thought to normalize reuptake of several _______ and it is effective for about ___% of clients. |
|
Definition
Mechanism-->poorly understood
Salt that competes for salt receptors
neurotransmitters
Effective for about 75% of clients |
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|
Term
| The serum half life of Lithium is ____. It is metabolized in the ______. |
|
Definition
24 hours
metabolized in the kidneys |
|
|
Term
| Lithium is similar to ____ in structure. If _______ level is low, Lithium will be ________ rather than ______ by the kidneys. |
|
Definition
Similar structure to sodium.
If sodium is low, Lithium will be reabsorbed rather than excreted by the kidneys |
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|
Term
| Upon initiation of Lithium, blood levels are drawn every ________, until therapeutic level is reached |
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Definition
|
|
Term
| *When acute symptoms are resolved, Lithium is _____ for ______ _____. This dose is ____ to ____ the ____ does. Then, blood levels are drawn every ______, or when ________________ |
|
Definition
Lithium is decreased for maintenance treatment
1/2 - 2/3 the acute does
Blood levels are drawn every 2-3 months or when a problem is suspected |
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|
Term
| Antipsychotic drugs are specifically designed for the ______ and _______ they are having. It will _____ ______, but not _______ the mania. They must be used in combination with the _____________ or _________. |
|
Definition
hallucinations and delusions
treat psychosis, but not stop the mania
used in combination with the antimanic or anticonvulsants |
|
|
Term
|
Definition
| Drowsiness, headache, dry mouth, thirst Gi upset, N/V, fine hand tremors, hypotension, arrhythmias, pulse irregularities, polyuria, dehydration, weight gain, potential for toxicity |
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Term
| Lithium is prescribed for ______ and ______. _________ clients are sensitive to toxicity due to _____ _____ ____. It is no recommended during ______ and _____. |
|
Definition
Children and adults
Elder clients are sensitive to toxicity due to decreased renal function
Not recommended for pregnancy or lactation |
|
|
Term
| Lithium Contraindications (3) |
|
Definition
1. Hypersensitivity
2. Renal disease
3. Thyroid disease |
|
|
Term
| Decreased levels of lithium may occur with 5 medications |
|
Definition
1. acetazolamide
2. theophylline
3. mannitol and other osmotic diuretics
4. sodium bicarbonate
5. xanthines |
|
|
Term
| Increased toxicity of lithium occurs when used in conjunction with 5 meds |
|
Definition
1. anesthetics
2. ACE inhibitors
3. NSAIDS
4. tetracycline
5. thiazide diuretics |
|
|
Term
| *How does sodium intake effect lithium toxicity |
|
Definition
sodium intake LESS than 2g/day
sodium and fluids lost due to excessive exercise, dehydration, gi illness, fluid intake less than 6-8 glasses a day |
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|
Term
| *Nursing interventions to prevent lithium toxicity: restrict _____ intake, maintain adequate _____ and _______ intake, contact health care provider for ______ _____ symptoms, inform all healthcare providers about lithium therapy especially when _______ is planned contact Dr. if signs of ________, maintain appointments for _____ |
|
Definition
restrict caffeine
maintain adequate h2o and sodium
contact dr with s/s of toxicity
inform all heathcare providers of lithium, especially if surgery is planned*
maintain appts. for blood levels |
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|
Term
| *Normal therapeutic blood level for lithium is ____ to _____. Greater than ____ is toxic. |
|
Definition
*0.6 to 1.2 --> therapeutic
*Greater than 1.5 ---> toxic |
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|
Term
| Mild Lithium toxicity is a range of ___-____. S/S are: ______, decreased ______, mild _____, confusion, ______ speech, hand ______ and muscle ______ |
|
Definition
Mild toxicity ---> 1.5- 2.0
Apathy, decreased concentration, mild ataxia, muscle weakness, hand tremors, muscle twitching |
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|
Term
| Moderate lithium toxicity s/s are: severe _____, ____, moderate ______, confusion, ______ speech, ________, ________, ________ |
|
Definition
| Moderate lithium toxicity ---> 2.0-3.0 Severe diarrhea, nausea and vomiting, moderate ataxia, confusion, slurred speech, *tinnitus, *hyperflexia, *pruritis |
|
|
Term
Severe lithium toxicity
S/S: ______, muscle ______, ______, cardiac ______, decreased _____, ______-_____ seizures, coma, _____ |
|
Definition
severe toxicity >3.0
Nystagmus, muscle fasiculations, hyperflexia, cardiac arrhythmia, decreased LOC, tonic-clonic seizures, coma, death |
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|
Term
| The nurse notes a patient is disinterested in attending a group he has previously always attended. She prepares to give him his daily does of Lithium and notes a slight nose bleed. She should...? |
|
Definition
Withhold lithium (even if toxicity is only suspected)
Obtain immediate serum lithium level
Monitor VS, electrolytes, BUN and creatinine
Administer IV of normal saline |
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|
Term
| For SEVERE lithium toxicity, ________ is needed |
|
Definition
|
|
Term
| Thyroid impairment is a _____ _____ _____ of lithium treatment. Thyroid function studies should be monitored every __________ on clients receiving _________ _______ treatment |
|
Definition
Serious side effect
Thyroid function studies ever 3-6 months on clients receiving long-term treatment |
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|
Term
| _____ _____ is a serious side effect of lithium treatment and _____ function studies should be done every _-_ _____ on clients with long term lithium treatment |
|
Definition
Renal impairment
Renal function studies ---> 3-6 months for clients on long term lithium treatment |
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|
Term
| Anticonvulsants stimulate ______, which produces a _____ effect |
|
Definition
|
|
Term
| There is a range in the serum half life of ___________, depending on which is being used. Tegretol or carbamazepine has a half-life of ___-___ ____, while the serum half life of valproic acid (Depakote) is _______. For both drugs ____ _____ are monitored. |
|
Definition
Range in serum half life of anticonvulsants
Tegretol (carbamazepine)---->15-30 hours
Depakote (valproid acid)----> 8 hours |
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|
Term
| contraindications of anticonvulsants |
|
Definition
| cardiovascular disease, hepatic disease, hypersensitivity reactions, blood dyscrasias (ex leukemia and hemophilia) |
|
|
Term
| Interactions specifically associated with carbamazepine (Tegretol): potential INCREASED levels |
|
Definition
| Potential increased levles with: erythromycin, cimetidine, proproxyphene, isoniazid, channel blockers, SSRIs |
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|
Term
| Potential DECREASED levels associated with carbamazepine (Tegretol) |
|
Definition
Potential decreased levels:
with divalproex, phenytoin, phenobarbital |
|
|
Term
| carbamazepine (Tegretol) may decrease the levels of other medications: |
|
Definition
| oral contraceptives, wafarin, theopyline, antipsychotics, divalroex |
|
|
Term
| There is a potential for increased levels of valproic acid (Depakote) when taken with _______. It also increases the effects of 6 other substances. There is an increased risk of seizure when taken with _____ or _____. |
|
Definition
Aspirin
increases the effect of alcohol, warfarin, aspirin, phenobarbitol, primidone, MAOIs
Increased seizures --->phenytoin or clonazepam |
|
|
Term
| Serious side effects of anticonvulsant medications include _____ _____ and ________ |
|
Definition
| hepatic toxicity and agranulocytosis |
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