Increased risk for birth defects Not for liver disease and pancreatitis

Increased risk for birth defects not for liver

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Increased risk for birth defectsNot for liver disease and pancreatitis patients Lithium carbonate [MOST WIDELY USED]Not a fully adequate treatmentSupplemental use of antipsychotics and benzodiazepines is often beneficial for acute phase of maniaMonitor sodium intake Start a lower dose then increase it slowly Toxicity (i.e., blackouts, seizures, tremors)Withhold additional dosesObtain blood sample immediatelyPush fluids if the patient can take anyLithium blood levels [TABLE 24.2]Lithium interactions {TABLE 24.3]Lithium interventions for side effects [TABLE 24.4]
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Psychological DomainAssessmentMoodDepressed = assessment toolManic = quality of mood (i.e., elated, irritated, agitated)CognitionDepression ≄concentrationManic: impaired judgment; distorted thinkingThought disturbances (PSYCHOSIS) Delusional thinking Auditory hallucinationsStress→triggers episodesCoping→lays the groundwork for developing interventional strategies Risk assessmentSuicideHomicide Nursing DiagnosesDefensive copingIneffective copingNonadherenceRisk for suicideRisk for violence InterventionsPsychoeducation [BOX 24.12]Individual CBT Individual interpersonal therapyPromotes mood stability Adjunctive therapies
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Social DomainAssessmentCultural views of mental illnessInfluences acceptanceSocial and occupational changesLosing a job Going through divorce Any changes resulting from a manic or depressive episode Nursing DiagnosesIneffective role performanceInterrupted family processesImpaired social interactionImpaired parentingCompromised family coping InterventionsProtection from self-harm, as well as harm from other patientsSupport groupsLearn managementPrevention strategiesDealing with stigmasFamily interventionsParenting skillsCounseling sessionsIntensive family therapyFamily psychoeducation ↓ risk for relapse or hospitalization [BOX 24.11]
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Other Bipolar Disorders
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Bipolar IIIndividual is mostly depressed; Brief periods of elevated, expansive, or irritable moodsManic episodes are less dramatic (hypomania: mild form of mania)Severely affects the individual’s social and occupational life
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Cyclothymic DisorderChronic fluctuation mood disturbanceDoes not meet criteria for hypomania or depressive disorder
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ReferenceBoyd, M.A. (2018). Psychiatric Nursing: Contemporary Practice(6thed). Philadelphia, PA: Wolters Kluwer.
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