Other
NUR114 Exam 2 Study Guide
- Course
- NUR 114 (NUR114)
- Institution
- Fayetteville Technical Community College
Study guide covering all topics and content related to those topics for NUR 114 Exam 2 (fall semester).
[Show more]
Seller
Follow
Content preview
NUR 114 Exam 2 Study GuideBipolar Disorder
Bipolar I: patient has at least 1 episode of mania alternating with major depression
Bipolar II: patient has 1 or more hypomanic episodes alternating with major depressive episodes
Cyclothymic: patient has at least 2 years of repeated hypomanic manifestations that don’t meet the
criteria for hypomanic episodes alternating with minor depressive episodes
Bipolar Behaviors:
mania: abnormally elevated mood which can also be described as expansive/irritable; usually
requires hospitalization; mania lasts approx. 1 week
hypomania: less severe episode of mania , lasting at least 4 days, accompanied by 3 or more
manifestations of mania; hospitalization not required; patient less impaired
rapid cycling: 4 or more episodes of hypomania/acute mania within 1 year associated with
increase recurrence rate/resistance to treatment
DSM-5 Criteria (Manic Episode):
Approximately 1 week of abnormal, persistently elevated/expansive/irritable mood
Persistence of 3 or more of the following (4 if mood is only irritable): (mnemonic DIG FAST)
o Distractibility
o Indiscretion
o Grandiosity
o Flight of ideas (racing thoughts)
o Activity increase
o Sleep deficit
o Talkativeness (pressured speech)
Expected Findings: Manic
onset before age 30
mood: elevated, expansive, irritable
speech: loud-rapid, punning, rhyming, clanging, vulgar
weight loss
grandiose delusions
distracted
hyperactive
need for sleep
inappropriate
flight of ideas
sudden onset and escalates over several days
Expected Findings: Depressive
previous manic episodes
mood: anxious, depressed, hopelessness
decreased interest in pleasure
negative views
fatigue
decreased appetite
constipation
insomnia
decreased libido
suicidal preoccupation
may be agitated/movement retardation
Pharmacology:
Mood stabilizers:
, o Lithium: low therapeutic threshold (narrow therapeutic window)
0.5-1.2 mEq/L
Toxicity: N/V, diarrhea, blurred vision, tinnitus, ataxia, tremors, confusion,
dysrhythmias
o Valproate and carbamazepine (acute mania)
o Lamotrigine (Lamictal) (maintenance therapy in bipolar mania)
1st Gen Antipsychotics:
o chlorpromazine
o loxapine
2nd Gen Antipsychotics:
o olanzapine
o risperidone
o lurasidone and quetiapine (treat depression in bipolar)
Nursing Care:
based on phase of bipolar that patient is in
Acute phase
o focus is on safety and maintaining physical health
o hospitalization can be required
o goals of treatment: reduction of mania/patient safety
o determination of risk of harm to self/others
o one-to-one supervision
Continuation phase
o treatment 4-9 months long
o relapse
Depression
Seasonal Affective Disorder (SAD): occurs seasonally, usually during winter when there’s less
daylight.
Persistent Depressive Disorder: previously known as dysrhythmic disorder); mild; onset usually
childhood/adolescence; last at least 2 years for adult, 1 year for kids.
Premenstrual Dysmorphic Disorder: associated with luteal phase of menstrual cycle
Substance-Induced Depressive Disorder: clinical findings of depression associated with use
of/withdrawal from drugs/alcohol.
Major Depressive Disorder (MDD): single or recurrent episodes of unipolar depression resulting in
significant change in pt normal function accompanied by at least 5 specific clinical findings. The
following must occur almost every day for min. of 2 wks and lasts most of the day:
depressed mood
difficulty sleeping/excessive sleeping
indecisiveness
decreased ability to focus
increase/decrease in motor activity
inability to feel pleasure
increase/decrease in body weight (>5% total body weight over 1 month
Mnemonic: SIGE CAPS (DSM-5 criteria) (MUST include either depressed mood OR loss of
interest)
Sleep disorder
Interest deficit
Guilt (worthlessness, hopelessness)
Energy deficit
Concentration deficit
Appetite disorder
Psychomotor agitation/retardation
, Suicidality
Risk factors:
more common in females
family hx
previous personal hx
age >65
neurotransmitter deficiencies
stressful life events
illness (esp. chronic)
postpartum period
comorbid anxiety/personality/substance abuse disorder
trauma early in life
Expected findings:
anergia (lack of energy)
anhedonia (lack of pleasure in normal activities)
anxiety
sluggishness, or unable to sit still/relax
somatic reports: fatigue, GI changes, pain
vegetative findings: change in eating patterns, constipation, sleep disturbances, decreased
interest in sex
psychomotor retardation (slowed physical movement, slumped posture)
psychomotor agitation (restlessness, pacing, finger tapping)
** Depression in the elderly can mimic early stages of Alzheimer’s
Patient Education for all Antidepressants:
don’t discontinue suddenly
therapeutic effects not immediate (usually several weeks)
avoid driving/operating heavy machinery due to possible sedation
notify provider of suicidal thoughts
avoid ETOH
Medications:
SSRIs
o 1st line treatment
o Citalopram (Celexa)
o Fluoxetine (Proxac)
o Sertraline (Zoloft)
SSRI Patient Education:
o adverse effects include nausea, H/A, agitation, insomnia, anxiety
o NEVER mix SSRI and St. John Wort
o weight gain can occur; follow healthy diet
SSRIs and Serotonin Syndrome:
o Suicide risk increased
o Slow onset and taper off
o Sweaty and hot fever
o Rigid muscles/restlessness/agitation
o Increased HR/BP
TCAs
o Amitriptyline (Elavil)
o Education:
minimize anticholinergic effects by chewing sugarless gum, eating foods high in
fiber, and increasing fluid intake to 2 or 3 L/day
MAOIs
o Phenelzine (Nardil)
o NEVER mix with TCA, SSRI, SNRI
o Education:
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller FutureRN24. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $8.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
74735 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now