NSG 3450 Mental Health Exam - Questions and Answers Cyclothymic disorder Cyclothymic disorder, symptoms of hypomania alternate with symptoms of mild to
... [Show More] moderate depression for at least 2 years in adults and 1 year in children. Hypomania and depression symptoms do not meet the criteria for either bipolar II or major depression, yet the symptoms are disturbing enough to cause social and occupational impairment. Assessment guidelines for bipolar disorder 1. Assess whether the pt is a danger to self or others: -pts experiencing mania can exhaust themselves to the point of death -pts may not eat or sleep, often for days at a time -poor impulse control may result in harm to others or self -uncontrolled spending may occur 2. Assess the need for protection from uninhibited behaviors. External control may be needed to protect the pt from such consequences as bankruptcy, b/c pts experiencing mania may give away all of their money or possessions 3. Assess the need for hospitalization to safeguard and stabilize the pt 4. Assess medical status. A thorough medical examination helps to determine whether mania is primary (a mood disorder - bipolar disorder or cyclothymic disorder) or secondary to another condition -mania may be secondary to a general medical condition -mania may be substance-induced (caused by use or abuse of a drug or substance or by toxin exposure) Lithium Has FDA approval for both acute mania and maintenance treatment. The onset of action is usually within 10-21 days. Because the onset of action is so slow, it is usually supplemented in the early phases of treatment by atypical antipsychotics, anticonvulsants, or antianxiety medications. Lithium is effective in reducing -Elation, grandiosity, and expansiveness -Flight of ideas -Irritability and manipulation -Anxiety -Self-injurious behavior Expected side effects of lithium fine hand tremor, polyuria (producing too much urine), mild thirst, mild nausea, general discomfort, sedation, lethargy weight gain. Long term use can cause renal toxicity, goiter, and hypothyroidism. Early signs of lithium toxicity 1.5 mEq/L -2.0 mEq/L Gastrointestinal upset, course hand tremors, confusion, hyper-irritability of muscles, EEG changes, sedation, incoordination. Advanced signs of lithium toxicity 2.0-2.5 mEq/L -Ataxia (Many symptoms of Ataxia mimic those of being drunk, such as slurred speech, stumbling, falling, and incoordination). -Giddiness -Serious EEG changes -Blurred vision -Clonic movements -Large output of diluted urine -Seizures -Stupor -Severe hypotension -Coma Patient and family teaching: Bipolar Disorder 1. Patients with bipolar and their families need to know the chronic nature of the disease. 2.Long term maintenance of treatment 3.Side effects of medications as well as toxic effects. 4. Signs and symptoms of relapse. 5.Phone numbers to emergency contact people. 6. ETOH, Substance abuse, Caffeine, sleep deprivation, and over the counter medications could produce relapse. 7. Good sleep, hygiene is CRITICAL to stability. Major Depressive Disorder (MDD) -Depressed mood most of the day nearly every day -Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day -Significant weight loss when not dieting or weight gain or a decrease or increase in appetite nearly every day -Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day -Fatigue or loss of energy nearly every day -Psychomotor agitation or retardation nearly every day -The feeling of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day [Show Less]