BIPOLAR A patient asks why am I bipolar? What are some reasons/causes for bipolar disorder?

? explain specific causes, especially issues with neurotransmitters How would you deal with a manic patient in a group setting? give task, distraction, remove to quieter place, use ACTIVE, SMALLER groups Know therapeutic serum lithium levels 0.5 to 1.5 mEq/l (this is from HESI review book, page 340; double check range from class notes!) range in book is 0.6 1.2, I think o If level is low ask patient if he/she has been taking medication o If level is high ask if patient is has changed salt intake (DECREASED salt increased lithium levels!) What do you do if you have a manic patient on the unit? distract, remove from area to more quiet place, DECREASE STIMULI, provide for relaxation/deep breathing exercises What is one of the major side effects of lithium? What would you do as a nursing intervention? weight gain, check I & O What is another intervention for dealing with a manic patient (besides ones mentioned above)? offer PRN meds Patients with bipolar disorder are at risk for harming others because of their impulsiveness and manic episodes; what should you do? (Im not sure if I have this question right!) assess for homicidal ideation (HI); report this to someone else A bipolar patient is very manic and hypersexual, and is taking of his/her clothing; what should you do? take patient back to room and help him/her get dressed DEPRESSION When is a patient with depression at the highest risk for suicide ideation (SI)? 2-4 wks after meds have been started; it takes that

long for some meds to take effect, and patient starts feeling better, more euphoric; know other signs of suicide risk (like giving away possessions) How do you create the most therapeutic environment for a client with depression? sit with the patient, in silence if need be; have short frequent visits; dont push patient to do too much at once What should you do if a patient with depression does not want to perform ADLs? assist him/her; compliment if specific task has been done (this will help increase self esteem); encourage self care What are some risk factors for depression/who is at risk for developing depression? terminal illnesses (self or family member, especially a child); sense of loss (job, family member, spouse, divorce); financial problems; any major life change A mom and her severely disabled child come into the hospital. What should you be concerned about regarding the mom? SAFETY, especially for the child; mom may want to harm self or child due to caregiver strain/stress A patient has tried to commit suicide and doesnt want to talk to you about it; whats your next step? stay with the patient (1:1 care); think SAFETY! Do not leave patient alone! What is a realistic goal for a patient that is suicidal? patient shows no self-harm by discharge (goal has to be measurable, time frame has to be realistic) What should the mileu look like for a depressed patient? STRUCTURED, safe, helpful, encourage patient to attend activities What items should you consider removing from a patients room if she/he is suicidal? (think regular med-surg room) IV pump cords, phone cords, call light cords, chemicals, curtains, silverware off meal tray; razors, plastic gloves (dont throw away in room trash bin), sheets (in some cases) What is a critical intervention for a patient that is suicidal? frequent checks (like every 15 mins) and 1:1 contact What would be an appropriate dx for patient who doesnt want to do any ADLs? self-care deficit

 During an assessment on a patient who is depressed, what is the most important thing to remember? that the patient feels SAFE, that the nurse is non-threatening A patient comes into the hospital for depression, is put on meds and within a few days says that he feels great; what should you be concerned about/what should you do? assess and monitor for suicide ideation (patient is starting to feel great for whatever reason not from the meds, though and this should be a red flag for the RN!) What medical dxs mimic depression? substance abuse/alcohol use/withdraw; diabetes; hypothyroidism (among others)