Question

A female client, diagnosed with Bipolar I, recently stopped taking her lithium. She has not slept, eaten or bathed in days. She is dressing in brightly-colored, flamboyant, and sexually suggestive clothing. She has been spending money freely and buying things she does not need and cannot afford. She recently purchased a trip to Tahiti as well as a motorcycle that she does not know how to ride. The client has even gambled away the family savings. Her husband calls her psychiatrist and tells him his wife has stopped taking her lithium and has not slept or ate in a couple of days. The psychiatrist suggests that the husband bring his wife to the emergency room for admission to the psychiatric unit.

Upon admission, the nurse observes that the client is dressed in a red mini skirt with a blue and orange flowered top. She is wearing bright red lipstick, false eyelashes, and bright blue eye shadow. While attempting to take a history, the client jumps from one subject to another. She talks loudly and rapidly and uses elaborate hand gestures. She cannot sit still and continually paces around the room. The client repeatedly says, “I feel good. I feel good like I know I should. I feel good!!!” The client’s husband informs the nurse that his wife has stopped taking her lithium and has not eaten, slept, or showered in days. He goes on to explain that his wife has maxed out the credit cards and has put the family in debt.

The client’s past psychiatric history includes 4 episodes of acute mania within the year. She has no known allergies. No other medical conditions noted. The psychiatrist orders a serum lithium level. The lithium level comes back at 0.8 mEq/L. In addition, electroconvulsive therapy (ECT) is scheduled for the next day.

Questions:

What is Bipolar I disorder? How does it differ from Bipolar II?

What behaviors are exhibited during a manic episode?

What nursing intervention should be implemented when a client is in the manic phase?

Why was a serum lithium level drawn? What is the therapeutic (maintenance) range for lithium? What serum level is considered toxicity?

What teaching needs to be reinforced with lithium therapy?

What are some potential nursing diagnoses for this client?

What is electroconvulsive therapy (ECT)? When is ECT indicated?

What preparation is needed prior to ECT?

What are some complications of ECT?

Answer 1

?bipolar disorder have manic episode. So bipolar disorder I and II have some differences. That is, bipolar disorder I is characterized by a full manic episode and less depression phases, and bipolar II characterized by less manic episode and more severe depressive phases.

?manic episode characterized by

hightened energy, poor sleep, euphoria, restlessness, hyperactive, talking a a mile in one minute, risky behaviour, poor concntrating.

? mainly management if manic phase include mood Stablizers. It includes litium, valporic acid, etc. Other includes making good talk with person, listen to the patient, try to avoid arguments with patient, avoid the harmful objects from near to the patient etc can help to reduce risks.

?serum lithium level drawn for checking the amount of lithium in blood whether, is appropriate amount of drug is there to treat disorder.

0 6 to 1.2 mmol/L us the normal range of lithium in blood.

Lithium range above 1.5mEq/L causes lithium toxicity.

?instruct regarding proper use if lithium. That are

Instruct patient to take exact dose of lithium.

Should not take more than doctor advice.

Do not take less.

Do not take long time more than doctor prescribed.

?self care deficit related to mania as evidenced by poor dress coding.

Risk for injury related to mania or delusion as evidenced by hyperactive.

?ECT is electro convulsive therapy , by done under general anaesthesia in which small electric currents passed into brain, for creating a brief seizure.

It is indicated in severe depression or bipolar disorder,in which other treatments are not effective.

?should not take food or water after midnight prior to Ect.

At time of ECT the patient should wear some loose dress.

?complications are posticated agitation, prolonged seizure, cardiovascular difficulties, Status epilepticus. Mostly these are associated with anaesthesia.