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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 isfrom 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 othersbecause of their impulsiveness and manic episodes; what should

you do? (Im not sure if I have this question right!) assess forhomicidal 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 roomand 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

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long for some meds to take effect, and patient starts feeling better,more euphoric; know other signs of suicide risk (like giving awaypossessions)

How do you create the most therapeutic environment for a client

with depression? sit with the patient, in silence if need be; haveshort 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 hasbeen 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 orchild 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 (1:1care); think SAFETY! Do not leave patient alone!

What is a realistic goal for a patient that is suicidal? patientshows no self-harm by discharge (goal has to be measurable, timeframe 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 pumpcords, phone cords, call light cords, chemicals, curtains, silverwareoff 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

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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 medsand within a few days says that he feels great; what should you be

concerned about/what should you do? assess and monitor forsuicide ideation (patient is starting to feel great for whatever reason not from the meds, though and this should be a red flag for theRN!)

What medical dxs mimic depression? substance abuse/alcoholuse/withdraw; diabetes; hypothyroidism (among others)