ATI Mental Health- Mood Disorders

Thought Content The client is experiencing a manic episode with grandiose thinking, racing thoughts and magical thinking.

"According to the literature, there is strong genetic predisposition for bipolar disorders." Bipolar disorders have a strong genetic link. The risk for the development of bipolar disorder may be 5 to 10 times higher for persons who have a relative with this disorder compared to those who do not.

"It is the expectation on this unit that there is no inappropriate physical contact. I need you to stop." The nurse is providing information about unit expectations and is giving clear instructions for the client to stop the inappropriate behavior.

Promote sedation, decrease agitation, and prevent mania relapse. A client who recieves olanzapine can experience sedation, decreased agitation and fewer mania relapses. Common side effects of olanzapine includes an increase of premenstrual syndrome symptoms and weight gain.

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Explain the benefits of the injection. The client has the right to refuse treatment because her admission to the mental health facility was voluntary. Therefore, explaining the benefit of an intramuscular injection can increase the understanding and facilitate adherence.

Ask the AP to assist the client out of the room. The client is experiencing a manic episode and has little ability to benefit from group therapy. Once the client is no longer in an acute state, she can participate in the group and recieve helpful peer support.

T3, T4, TSH BUN and serum creatinine HCG Lithium can lead to hypothyroidism. Therefore, the nurse should check the client's baseline thyroid function (T3, T4 and TSH) Lithium can lead to kidney damage. Therefore, the nurse should check the client's baseline kidney function (BUN and serum creatinine). Lithium use is contraindicated in pregnancy. There, the client should have a pregnancy test prior to starting therapy (HCG). There is no indication to check the clients baseline blood glucose or albumin levels before intiating lithium therapy.

Consume 2 to 3 L of fluid per day Maintain consistent sodium intake Take the medication with meals Client taking lithium should consume 2 to 3 L of fluid per day and maintain consistent sodium intake to prevent lithium toxicity. Sodium is reabsorbed through the kidney; lithium decreases sodium reabsoption causing hyponatremia. With low sodium levels, the client retains lithium, producing toxicity. Taking lithium with meals helps prevent gastrointestinal distress. Lithium does no cause orthostatic hypotention so it is not necessary to instruct the client to change positions slowly. Client taking MAOS should avoid foods high in tyramine to prevent hypertensive crisis.

Use a Firm, calm, matter of fact approach Offer frequent, high- calorie drinks decrease noise lights and interactions use distraction to redirect the clients energy

Peanut butter jelly sandwhich, chips, bannana and strawberry milkshake in a plast cup with straw. a client who is experiencing a manic episode is hyperactive and typically unable to sit for meals. This meal is appropriate for a client experiencing a manic episode because it offers "Finger foods" which the client can eat while moving around, the non-caffeinated beverage is appropriate. The meal also offers high-protein, high calorie foods with no utensils.

Ataxia The nurse should monitor for ataxia, blurred vision and oliguria which are signs of severe lithium tocxicity- lithium should be between 2.0 and 2.5 mQg/L

Sad Persons Nurses, particularily int he emergency department, should use the SAD PERSONS assessment tools to identify suicide risk factors and the need for hospitalization.

Stevens-Johnsons Syndrome immediately report rashes.

"Do you have a plan for how you would end your life?" When the client shares suicidal thoughts, the nurse shoudl ask if there is a specific plan and then determine the lethality of the method and whether or not the client has access to the desired method.

1. review education material about bipolar disorder and its management 2. Maintain consisten patterns in sleep, meals and activities. 3. Idenfity strategies for enhancing communication and problem-solving skills. 4. recognize support systems at home (family and friends) 5. carry names and contact information for local bipolar support groups, such as the national alliance for the mentally ill 6. attend the follow up appointment.