bipolar disorder (329 E2)

Question 1

risk factor for bipolar disorders

Answer 1

exact cause unknown

• genetic
• neurotransmitters: norepi, dopamine & serotonin
• neurobiological: prefrontal cortical region, hippocampus & amygdala
• neuroendocrine: HPTA axis
• stressful family life
• adverse events

Question 2

bipolar 1

Answer 2

• most severe form
• highest mortality rate
• at least 1 manic episode
• classically will have a psychotic episode (delusions/hallucinations)
• onset: 18
• more common in males

Question 3

bipolar 2

Answer 3

never has a manic episode

• at least 1 hypomanic episode
• at least 1 major depression episode
• onset: 20
• more common in females

Question 4

cyclothymic disorders

Answer 4

• alternate w/ symptoms of mild to moderate depression for at least 2 years (adults)
• rapid cycling possible
• will have hypomanic symptoms and depressive sx but not very extreme

Question 5

clinical features of mania “dig fast”

Answer 5

distractibility
indiscretion
grandiosity
flight of ideas
activity increase
sleep deficit
talkativeness

Question 6

behaviors of mania

Answer 6

• mood lability
• quick to anger/feels misunderstood/low frustration tolerance
• pacing
• dramatic mannerisms
• uses jokes
• flamboyant or sexually suggestive dress
• might forget to eat

Question 7

hypomanic episode

Answer 7

a distinct period of abnormally and persistent elevated expansive or irritable mood and abnormally and persistently increases activity or energy
needs to last at least 4 consecutive days
not severe enough to cause a marked impairment in social or occupational functioning or hospitalization

Question 8

specifiers for bipolar & related disorders: mixed features

Answer 8

sx of both depression and mania occur at the same time

Question 9

specifiers for bipolar & related disorders: w/ rapid cycling

Answer 9

four or more manic episodes for at least 2 weeks in 12 months. partial or full remission for 2 months at a time or switch to opposite episode. high risk of recurrence, resistant to drug therapy, greater severity of illness; depressive sx predominate

Question 10

nursing outcomes when pt is in an acute manic state

Answer 10

primary outcome is injury prevention

pt will:

• be hydrated
• maintain stable cardiac status
• maintain/obtain tissue integrity
• get sufficient sleep & rest
• demonstrate thought self control w/ aid of staff or meds
• make no attempt at self harm

Question 11

nursing care for acute mania

Answer 11

• manage meds
• decreasing physical activity
• increase food & fluid intake
• ensuring at least 4 to 6 hrs of sleep per night
• intervening so that self care needs are met and setting limits on behavior

Question 12

what is one way we can prevent hypomania from turning into a full manic episode

Answer 12

getting the patient to sleep