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Tuesday, June 5, 2012

Psychiatric Nursing: Bipolar Disorder


  1. Gen Information.:
    1. Onset usually before age 30
    2. Characterized by hyperactivity and euphoria that may become sarcasm or hostility

  1. Assessment findings
    1. Hyperactivity to the point of physical exhaustion
    2. Flamboyant dress/makeup
    3. Sexual acting out
    4. Impulsive behaviors
    5. Flight of ideas: inability to finish one thought before jumping to another
    6. Loud, domineering, manipulative behavior
    7. Distractibility
    8. Dehydration, nutritional deficits
    9. Delusions of grandeur
    10. Possible short-term depression (risk for suicide)
    11. Hostility, aggression

  1. Medical management
    1. Lithium carbonate (eskalith, lithane, lithotabs)  
    •   Initial doselevels: 600mg tid to maintain blood serum level of 1.0-1.5 mEz/L; blood serum levels should be checked 12 hours after last dose, twice a week.
    • Maintenance dosage levels: 300mg tid/qid, to maintain a blood serum level of 0.6-1.2mEq/L; checked monthly.
    •  Toxicity when blood levels higher than 2.0 mEq/L: tremors, nausea and vomiting, thirst, polyuria, coma, seizures, cardiac arrest.

    1. Antipsychotics may also be given for hyperactivity, agitation, psychotic behavior. Chlorpromazine (Thorazine) and haloperidol (Haldol) are most commonly used.

  1. Nursing intervention:
    1. Determine what client is attempting to tell you; use active listening.
    2. Assist client in focusing on a topic
    3. Offer finger foods, high-nutrition foods, and fluids.
    4. Provide quite environment, decrease stimuli
    5. Stay with client, use silence
    6. Remove harmful objects
    7. Be accepting of hostile statements.
    8. Do not argue with client
    9. Use distraction to diver client from behaviors that are harmful to self or others.
    10. Administer medications as ordered and observe for effects/side effects.
                                 i.     Teach clients early sings of toxicity
                               ii.     Maintain fluid and salt intake
                              iii.     Avoid diuretics
                              iv.     Monitor lithium blood levels
                                v.     Assist in dressing, bathing
                              vi.     Set limits on disruptive behaviors.
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