BIPOLAR DISORDER
- Gen Information.:
- Onset usually
before age 30
- Characterized by
hyperactivity and euphoria that may become sarcasm or hostility
- Assessment findings
- Hyperactivity to
the point of physical exhaustion
- Flamboyant
dress/makeup
- Sexual acting out
- Impulsive behaviors
- Flight of ideas:
inability to finish one thought before jumping to another
- Loud, domineering,
manipulative behavior
- Distractibility
- Dehydration,
nutritional deficits
- Delusions of
grandeur
- Possible short-term
depression (risk for suicide)
- Hostility,
aggression
- Medical management
- 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.
- Antipsychotics may
also be given for hyperactivity, agitation, psychotic behavior.
Chlorpromazine (Thorazine) and haloperidol (Haldol) are most commonly
used.
- Nursing
intervention:
- Determine what
client is attempting to tell you; use active listening.
- Assist client in
focusing on a topic
- Offer finger foods,
high-nutrition foods, and fluids.
- Provide quite
environment, decrease stimuli
- Stay with client,
use silence
- Remove harmful
objects
- Be accepting of
hostile statements.
- Do not argue with
client
- Use distraction to
diver client from behaviors that are harmful to self or others.
- 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.
