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Mania 8-27-20 - Coggle Diagram
Mania 8-27-20
Nursing Interventions:
Acute mania might warrant the use of phenothiazines and seclusions to decrease any physical harm.
Maintain a low level of stimuli in client’s environment
Observe for signs of lithium toxicity (e.g., nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears).
Provide frequent rest periods.
Protect client from giving away money and possessions. Hold valuables in a hospital safe until rational judgment returns.
Provide structured solitary activities with the assistance of a nurse or aide.
Redirect violent behavior.
Patient Education
Pay attention to warning signs
Avoid drugs and alcohol
Take your medications exactly as directed
Monitor blood sugars
Give them on the disorders, maintaining weight.
Monitor change in symptoms and functions
Monitor Sodium Levels
Behavioral Interventions:
Explain the diagnose to the patient so they can accept the diagnosis
Monitor effectiveness of medications and behavioral nterventions
Determine the problem
Examine the thoughts, behaviors, and emotions associated with these problems
Identify negative or inaccurate thoughts, behaviors, and emotions
Change your reaction to personal issues
Medications:
Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
Divalproex sodium (Depakote)
Lamotrigine (Lamictal)
Lithium
Valproic acid (Depakene)
Tricyclic Antidepressants:
Elavil (amitriptyline)
Norpramin or Pertofrane (desipramine)
Pamelor (nortriptyline)
Tofranil (imipramine)
Anticonvulsants:
Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium)
Lamictal (lamotrigine)
Tegretol (carbamazepine)
Antipsychotic Medications:
aripiprazole (Abilify)
asenapine (Saphris)
cariprazine (Vraylar)
clozapine (Clozaril)
lurasidone (Latuda)
olanzapine (Zyprexa)
quetiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)
Calcium Channel Blockers:
Diltiazem
Isradipine
Nimodipine
Verapamil
Benzodiazepines:
alprazolam (Xanax)
clonazepam (Klonopin)
diazepam (Valium)
lorazepam (Ativan)
MAOI's:
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)
Lithium
Pathophysiology
Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.
Signs & Symptoms:
Abnormally upbeat, jumpy or wired
Increased activity, energy or agitation
Exaggerated sense of well-being and self-confidence (euphoria)
Decreased need for sleep
Unusual talkativeness
Racing thoughts
Distractibility
Poor decision-making
Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.
Cyclothymic disorder. You've had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
Risk Factors:
Having a first-degree relative, such as a parent or sibling, with bipolar disorder
Periods of high stress, such as the death of a loved one or other traumatic event
Drug or alcohol abuse
Complications:
Problems related to drug and alcohol use
Suicide or suicide attempts
Legal or financial problems
Damaged relationships
Poor work or school performance
Co-Morbid Conditions:
Anxiety disorders
Eating disorders
Attention-deficit/hyperactivity disorder (ADHD)
Alcohol or drug problems
Physical health problems, such as heart disease, thyroid problems, headaches or obesity
Important Assessments:
Complete blood count. A complete blood count with differential is used to rule out anemia as a cause of depression in bipolar disorder.
Erythrocyte sedimentation rate. The erythrocyte sedimentation rate (ESR) is determined to look for underlying disease process such as lupus or an infection; an elevated ESR often indicates an underlying disease process.
Fasting glucose. In some cases, a fasting glucose level is indicates to rule out diabetes.
Electrolytes. Serum electrolyte concentrations are measured to help diagnose electrolyte problems, especially with sodium, that are related to depression.
Proteins. Low serum protein levels found in patients who are depressed may be a result of not eating.
Thyroid hormones. Thyroid tests are performed to rule out hyperthyroidism (mania) and hypothyroidism (depression).
Creatinine and blood urea nitrogen. Kidney failure can present as depression; treatment with lithium can affect urinary clearances, and serum creatinine and blood urea nitrogen (BUN) levels can increase.
Substance and alcohol screening. Alcohol abuse and abuse of a wide variety of drugs can present as either mania or depression.
MRI. The total value of performing MRI in a patient with bipolar disorder remains unclear; however a couple of reasons do exist for performing an imaging study.
Electrocardiography. Many of the anti depressants, especially the tricyclic agents and some of the antipsychotics can affect the heart and cause conduction problems.