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Nursing 2257Q/R/S/T
Alison Doherty

Living with Bipolar Illness Bipolar disorder is characterized byMood swings from depression to excitabilitymaniaMood swings are usually abruptOverview CausesRisk FactorsBipolar disorder results from disturbances in brain regulating moodCharacterized by mood swings from depression to maniaThree Major Groups BIPOLAR DISORDER IAt least one fully manic episode with periods of major depression or mixed episodesPreviously called Manic Depression BIPOLAR DISODER IISeldom experience full maniaExperience periods of hypomania increased levels of energy and impulsivenessRecurrent bouts of major depressionCYCLOTHYMIAmild form Hypomania and mild depressionDecreased severity of mood swingsNever without hypomanicdepressive symptoms for more than two monthsBPII or Cyclothymia may bemisdiagnosed as depression aloneStatsEffects small amount of population 06Effects men and women equallyUsual age of onset is 1530 yearsAverage age of onset between 2130 yearsSpecial populationsChildren 9 hallmark intense rangeChildren 9 more euphoria and grandiosity Elderly have more confusiondisorientation with maniaBipolar DisorderHospitalization rates increasing for BPD among womenmenMedical comorbidities High risk of suicide Cause is unknown Occurs more often in relatives Manic phase Alterations between euphoria and irritable mood lability at least one week Inflated selfesteem or grandiosity Decreased need for sleep increased energy hyperactivity Flight of ideas racing thoughts pressured speechOverinvolvement in activitiesLack of selfcontrol high risk behavioursEasily distracted decrease in attentionconcentrationPoor temper control Major DepressionPersistent sadnessVegetative symptoms fatigue or listlessness sleep disturbances and eating disturbancesDecreased selfesteem Worthlessness hopelessness guiltDifficulty concentration Withdrawal from friendsactivities Persistent thoughts of death Suicide risk during mania and depression Bipolar disorderAlcohol andor drug abuse is used as strategy to selfmedicate Personal relationships work and finance may suffer as a result of mood swings Treatment y Moodstabilizing medications o Dival proex Na anticonvulsant y Effective for both treating manic and depressive phases as well as preventing future symptomsy Antidepressant may be useful during depressive phase if used with mood stabilizery Mood stabilizers are very important with bipolar disorder Without mood stabilizers antidepressants may trigger mania in bipolar disorderNursing Diagnosis and Interventions Protection risk for injury to selfothers y Promote safe environment o Room in quiet location private room o Stay with if agitatedo Limit group activity unless less agitatedo If intrusive redirect and use distractiono Reduce stimulationo Set limitsscheduleo Use positive reinforcementy Administer medication o Antipsychoticso Anticonvulsantso Monitor adverse effectso Medication teachingy Lithium carbonate o Onset 13 weekso Recommended blood level 10 to 15 mEqL then06 to 12 mEqL narrow margin of safety 15 mEqL o Toxic symptoms nausea vomiting polyuria diarrhea muscle weaknesstwitching fine hand tremors headache blurred vision slurred speech dizziness sluggishness abdominal cramping tinnitus and dehydrationo Immediately hold medication and see doctory Conditions that could cause too much Lithium o older adults epilepsy increased exercise diabetes dehydration urinary retention increased perspiration thyroid disease Parkinson fluid retention and severe infectionsAltered thought processes y promote reality based thinking o avoid complicated ideas and involved explanationso consistent schedule and realitybased activitieso communicate acceptance of false belief while early stating you dont share their perceptionsImpaired social interaction y enhance socialization o manipulation increases sense of controlinterpersonal power o set limits and provide opportunities for clients to be in control when appropriateo provide positive reinforcement for nonmanipulative behaviours
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