Bipolar Disorder Chapter 19


Question Answer
Bipolar disorders Mood disorders that include one or more manic or hypomanic episodes (elevated, expansive, or irritable mood) and usually one or more depressive episodes
Bipolar disorders consist of 3 different categories of disorders Cyclothymia, Bipolor I & II, and Bipolar disorder not otherwise specified
Bipolar I is more Serious
Cyclothymia Is a Chronic mood disturbance of at least 2 years duration. A swing in mood from hypomania to depression. Without remission for more thatn 2 months
Do people with cyclothymia have severe impairment in their social or occupational functioning? No, they do not.
Do clients with cyclothymia experience psychotic symptoms such as delusions? No, they don't experience delusions
Bipolar I Person has experienced a full syndrome of manic or mixed symptoms
Bipolar II Person has recurrent bouts of major depression with episodic occurrences of hypomania
Characteristics of Mania S&S begin suddenly, escalate rapidly, & last a few days to several months; Behavior, Mood, Thought processes
Mania Behavior Hyperactivity,Bizarre and colorful dress, Highly distractible, Impaired Daily Functioning (excessive involvement in pleasurable activities, risky behaviors, Impulsive), Pressured Speech, Circumstantiality, Tangentiality
Mood of Mania Hypomanic to manic, Sociality and euphora to hostility, Irritablitiy and Paranoia
Thought processes of Mania Flight of ideas, Grandiosity, Impaired judgement(social blunders occur, ETOH/ Drug use common, Distactiblity, Decreased need for sleep
Stages of Mania Hypomania, Acute mania, Delirious Mania
Hypomania Cheerful & expansive mood with underlying irritablitiy; volatile. No impairment in functioning, no psychotc features
What is acute mania? Euphoric, elated mood, flight of ideas, pressured speech loquaciousness), distractiblity, sexually uninhibibited, insomnia, inexhaustible energy, flamboyant dress/gromming, illusions and hallucinations
What is Delirious Mania? Very labile mood, confused, dlusional thinking, poss. hallucinations, agitated, purposeless activity and exhaustion
How do you communicate with a manic patient? Use firm, calm approach, Use short and concise explanations, Remain neutral: avord power struggles, Be consistent in approach and expectations, Firmmly redirect energy into more appropriate areas
What are some treatment modalities? Psychopharmacology, Individual psychotherapy, Cognitive Therapy/Group, Family, and Electroconvulsive Thereapy
What types of psychopharmacology are good treatments for a patient with bipolar disorders? Antidepressant, Antimanic, Antipsychotic
How is individual psychotherapy useful as a treatment for a patient with bipolar disorder? Helps increase client's compliance with meds
Is cognitive therapy/ group useful? Yes, it is useful when stabilized- support and education
What is Electroconvulsive therapy? ECT
Is bipolar disorder often misdiagnosed or underdiagnosed? Yes, it is both misdiagnosed and underdiagnosed
With early diagnosis and proper treatment can help people avoid what other problems? Suicide, Alcohol or substance abuse, Martial problems, and Development of medical comorbidity
Talks and jokes incessantly, is the "life of the party" gets irritated when not center of attention. (Communication) Hypomania
Treats everyone with familiarity and confidentiality; often borders on crude. (Communication) Hypomania
Talk is often sexual-can reach obscene, inappropriate propositions to total strangers. (Communication) Hypomania
Talk is fresh; flits from one topic to the next. Marked by pressure of speech. (Communication) Hypomania
May go suddenly from laughing to anger or depression. Mood is labile. (Communication) Acute Mania
Becomes inappropriately demanding of people's attention, and intrusive nature repels others. (Communication) Acute Mania
Speech may be marked by profanities and crude sexual remarks to everyone (nursing staff in particular). (Communication) Acute Mania
Speech marked by flight of ideas, in which thoughts reace and fly from topic to topic. May have clang associations. (Communication) Acute Mania
Totally out of touch with reality. (Communication) Delirious Mania
Most likely has clang associations. (Communciation) Delirious Mania
Full of pep and good humor, feeling of euphoria and sociability; may show inappropriate intimacy with strangers. (Affect & Thinking) Hypomania
Feels boundless self-confidence and enthusiasm. Has elaborate schemes for becoming rich and famous. Initially, schemes may seem plausible. (Affect & Thinking) Hypomania
Judegement often poor. Gets involved with schemes in which job, marriage, or financial status may be destroyed. (Affect & Thinking) Hypomania
May write large quantities of letters to rich and famous people regauding schemes or may make numerous world wide telephone calls. (Affect & Thinking) Hypomania
Decreased attention span to baoth internal and external cues. (Affect & Thinking) Hypomania
Good humor gives way to increased irritability and hostility, short-lived period of rage, especially when not getting his or her way or when controls are set on behavior. May have quick shifts of mood from hostility to docility. (Affect & Thinking) Acute Mania
Grandiose plans are totally out of contact with reality. Thinks he or she is a musician, prominent businessman, great politician, or religious figure, without any basis in fact. (Affect & Thinking) Acute Mania
Judgement is exteremely poor. (Affect & Thinking Acute Mania
Decreased attention span and distractibility are intensified. (Affect & Thinking) Acute Mania
May become destructive or aggressive-totally out of control. (Affect & Thinking) Delirious Mania
May experience undefined hallucinations and delirium. (Affect & Thinking) Delirious Mania
Overactive, distractible, buoyant, and busily occupied with grandiose plans (not delusions); goes from one actionto the next. (Physcial Behavior) Hypomania
Increased sexual appetite; sexually irresponsbile and indiscreet. Illegitimate pregnancies in hypomanic women and venereal disease in both men and women are common. Sex used for escape, not for relating to another human being. (Physical Behavior) Hypomania
May vhave voracious appetite, eat on the run, or gobble food during brief periods. (Physical Behavior) Hypomania
Physical Behavior: May go without sleeping; unarware of fatigue. Howver, may be able to take short naps. (Physical Behavior) Hypomania
Financially extravagant, goes on buying sprees, gives money and gifts away freely, cna easily go into debt. (Physical Behavior) Hypomania
Extremely restless,disorganized, and chaotic. Physical behavior may be difficult to control. May have outbursts, such as throwing things or becoming breifly assaultive when crossed. (Physical Behavior) Acute Mania
No time for sex- too busy. Poor concentration, distractibility, and restlessness are severe. (Physical Behavior) Acute Mania
No time to eat - too distracted and disorganized. (Physical Behavior) Acute Mania
Not ime for sleep - psychomotor activity too high; if unchecked, can lead to exhaustion and death. (Physical Behavior) Acute Mania
Same as in hypomania but in the same extreme; Financially extravagant. (Physical Behavior) Acute Mania
Dangerous state. Incoherent, extremely restless, dioreiented, and agitated. Hyperactive. Motor activity is totally aimless (must have physical or chemical restraints to prevent exhaustion & death. Delirious Mania
Same as in acute mania but in the extreme. No time for sex- too busy. Poor concentration, distractibility, and restlessness are severe. (Physical Behavior) Delirious Mania
Same as acute mania but in the extreme. Not time to eat - to distracted and disorganized. (Physical Behavior) Delirious Mania
Too diorganized to do anything. (Physical Behavior) Delirious Mania
What are a flight of ideas? A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations or plays on words.
What are clang associations? The stringing together of words because of their rhyming sounds, without regard to their meaning.
What are the assessment guideslines for a client bipolar disorder? Assess whether the client is a danger to self and others, Asses for need for controls; Asses for need for hospitalization to safeguard and stablize the client; Assess medical status; Assess for any coexisting medical that warrants invention.
Should the nurse assess the client's and family's understanding of bipolar disorder, knowledge of medications, and knowledge of support groups and organizations that provide information on bipolar disorder? Yes, the should.
What is the outcome citeria for a client with Phase I: Acute Phase Overall goal prevent injury. Outcome reflects physicological as well as psychiatric issues. (Be well hydrated, Maintain stablecardiac status, Maintain/obtain tissue integrity, Get sufficient sleep and rest, Demonstrate thought self-control, No self-harm
What are relevant NOC outcomes for Phase I: Acute Phase? Hydration, Cardiac Pump Effectiveness, Tissue Integrity: Skin and Mucous Membrane, Sleep, Distorted Thought Self-Control, and Suicide Self-Restraint
What Phase is the continuation phase and how long does it last? Phase II; Conuinuation of Treatment Phase last 4 to 9 months
What is the overall outcome of Phase II: Continuation of Treatment Phase? Relapse prevention



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