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Published by: Robin Porter Frankel on Mar 03, 2011
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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 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? (I’m 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

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. phone cords. don’t 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. call light cords. family member. curtains. silverware off meal tray. razors. have short frequent visits. spouse. and patient starts feeling better. sense of loss (job. any major life change • A mom and her severely disabled child come into the hospital. safe. 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 doesn’t want to do any ADLs?  self-care deficit . time frame has to be realistic) • What should the mileu look like for a depressed patient?  STRUCTURED. What should you be concerned about regarding the mom?  SAFETY. compliment if specific task has been done (this will help increase self esteem).long for some meds to take effect. divorce). in silence if need be. especially a child). encourage self care • What are some risk factors for depression/who is at risk for developing depression?  terminal illnesses (self or family member. chemicals. more euphoric. encourage patient to attend activities • What items should you consider removing from a patient’s room if she/he is suicidal? (think regular med-surg room)  IV pump cords. mom may want to harm self or child due to caregiver strain/stress • A patient has tried to commit suicide and doesn’t want to talk to you about it. plastic gloves (don’t throw away in room trash bin). financial problems. especially for the child. helpful. 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. what’s your next step?  stay with the patient (1:1 care).

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.• During an assessment on a patient who is depressed. though – and this should be a red flag for the RN!) • What medical dx’s mimic depression?  substance abuse/alcohol use/withdraw. diabetes. that the nurse is non-threatening • A patient comes into the hospital for depression. hypothyroidism (among others) . what is the most important thing to remember?  that the patient feels SAFE.

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