Understanding Bipolar Disorder and Nursing Care

Hi guys, it's me, Professor D and welcome back to my YouTube channel. On this video, we're doing another Kahoot and we're going to be covering bipolar disorder. We're going to be going over the manic phase, the depressive phase. We're going to be going over some medications. It's going to be a great video. So a couple of things, as always, I'm going to encourage you to please subscribe to my channel if you haven't done so already. My handle is the same across the board, whether you're on TikTok, Instagram, Facebook, YouTube. My handle is Nexus Nursing. Go ahead and give this video a thumbs up. You're going to love this video. So go ahead and give it a thumbs up now so you don't forget. And be sure to check out my website, nexusnursinginstitute.com. There you can sign up for Next Generation NCLEX review session, part one, part two. Part one, I teach you how to think critically. I teach you the most important scenarios that you may be placed in, what the test is looking to draw out of you. I teach you about priority. I teach you about delegation. In part two, we actually go over NCLEX type questions, concepts, rationales that you need to understand. So no matter which way it's flipped to you, you should still be able to be led to the correct answer choice. So be sure to sign up for part one, part two, if you're, I can't speak, if you're studying for your boards. If you're a current nursing student and you really have to have a high grade on your next test to pass, check out my audio lessons. Again, you can sign up for Next Generation NCLEX Review. You can get yourself some audio lessons, or you can sign up for a one-on-one private tutoring session with me. Now, I book very, very quickly, but you do have that opportunity. Just keep checking that website. Again, nexusnursinginstitute.com. Now, with any further ado, let's get started. Bipolar disorder. First question coming up. All right. Your patient with bipolar disorder is currently in a manic episode. Which of the following behaviors should you expect to observe? Would it be increased need for sleep, depressed mood and withdrawal, grandiosity and inflated self-esteem, or difficulty concentrating on tasks? Which one would you expect to see in your patient that's going through the manic phase of bipolar disorder? grandiosity and inflated self-esteem. Here's what's so crazy. I knew that I was going to stump a good amount of you guys. A good amount of you were going to choose difficulty concentrating on tasks, which to be fair, that patient with bipolar disorder, they are going to have difficulty concentrating on tasks if they're in the manic phase, because they're all over the place, right? Remember, nursing is all about critical thinking. It's all about the best answer. So you will have two answers that are correct. But which one is the most correct answer for your question? So let's go back to what the question says. It tells us that the patient has bipolar disorder and they are in the manic phase. Which behavior would we expect to observe? Well, here's the thing. You see the 29 of you guys that chose difficulty concentrating on tasks. And again, because they're all over the place, they're not going to want to focus on one single thing. Yeah, absolutely. We may see this in the manic phase, but guess what? We can also see that in depressive phase. When the patient is in the depressive phase, they're so sad, they're so down, they can't concentrate. We're looking for something that is specific to the manic phase. And that's gonna be that grandiosity where they have an inflated sense of self, inflated self-esteem, okay? Look at the other choices, increased need for sleep. No, that's one of our biggest- problems, that patient that's in the manic phase, they're going and going and going and going and going. And what's one of our biggest concern, they're going to crash out, they need to sleep in order to function to survive. So that can't be it. Depressed mood and withdrawal, that would be what the patient that's going through depression. And of course, I just explained to you difficulty concentrating on tasks. So the only one here, guys, that's specific to that patient in the manic episode is going to be the grandiose grandiosity and inflated self esteem. And this is how I want you to think. When you're looking at these test questions, when you have two answers that are correct, and you're trying to figure out which one is most correct, say to yourself, okay, which one is more specific to what I'm being asked at this moment? All right, let's move on. All right, your patient's in the manic phase, and they are experiencing a high level of irritability. What's going to be your priority nursing intervention at this point? Would it be to encourage them to engage in physical activity? Would it be to establish a common structured environment? Would it be to provide the patient with a detailed schedule of daily activities? Or would it be to suggest the patient journal their feelings? What do you guys think? Very good. Establish a calm and structured environment because what's happening? When that patient's in the manic phase, they're going, they're going, they're going. They are not stopping for anything, right? Everything is hyper-stimulated. You're trying to calm them down. So you're going to put them in a calm, structured environment. So what you're not going to do is have them right next to the nurse's station where the family's complaining, where the nurses are giving report. where the phones are ringing, okay? You're going to have them at the end of the hall. You're going to make sure that the radio's not on, the TV's not on. You're going to make sure that the lighting is dim. You're trying to decrease stimulation. You're not going to put them in a room with a whole bunch of other patients acting the fool, right? We're trying to decrease stimulation. They are already irritable. You see what that question says? It says high level of irritability. You think they need anyone else to be getting on their nerves? Absolutely not. Okay, so your patient bipolar disorder is having a depressive episode. Which of the following symptoms should the nurse anticipate observing? Would it be increased energy and racing thoughts, feelings of worthlessness and hopelessness, decreased need for sleep, elevated mood and grandiosity? Which one would you expect in the bipolar patient that is going through a depressive episode? Very good. Feelings of worthlessness and hopelessness. So let's talk about bipolar disorder. This patient has fluctuating moods. Where their pneumatic phase are all the way up, then they're in the depressive phase are all the way down. Their pneumatic phase are all the way up. They're in the depressive phase are all the way down. So this patient that happens to be in the depressive stage phase, what we notice is feeling of worthlessness and hopelessness. This is what I want to say to you guys. Oh, sorry, guys. I moved the screen. This is how I want you to think of depression. And if you think of depression in the way that I'm about to explain it to you. You are going to get so many more test questions right. Okay? Depression. All depression is. I'm going to tell you what it is. And now this is the context that you have to think about it from now on. Depression is anger, resentment, and hostility turned towards self. Turned towards self. And that's why a famous test question that tricks students so much, a famous question, your patient has been depressed. How do you know they're getting better? And you'll have all these choices. And the correct answer is, you know, a family member said they were going to come visit. They didn't visit. And, and the patient got upset. The patient got so upset that they threw a pillow or, you know, they threw their phone, whatever the patient. exhibited anger. You would never pick that as a student, right? You're like, okay, that's not good, but actually it is. Why? Remember what I said? Depression is anger, hostility, resentment turned towards self. They're angry at themselves. They're hostile towards themselves. They resent themselves. They're not worthy. So the patient who is still in that deep depression, that family member who said they were going to visit. and never showed up, that patient wouldn't have been sad because guess what? I'm not worthy of that family member to show up. Who would want to show up for me? I don't have any value. I don't blame them. I wouldn't show up for myself either. But as the patient starts to get out of that depression, as that depression starts to lift, as that anger, that hostility, that resentment towards self that the patient has, as it starts to lift, they start to see value in themselves. So when someone lies to them, they feel righteous anger. Why? Because I'm valuable. How dare you say you were going to come visit me and you didn't do it? How dare you lie to me because I hold value? So the fact that we see that patient getting angry, that lets us know they're starting to value themselves and that depression is lifting. Guys, listen, I'm giving you pearls. I hope you're picking up what I'm putting down. All right. Anyway. Let's look at our other choices. Increased energy and racing thoughts. That would be the patient in the manic episode. A decreased need for sleep. That would be the patient in the manic episode because that patient who's depressed, all they want to do is sleep. They want to stay in bed with the sheets over their head, with the, what do you call those things you put on the window? Curtains. With the curtains closed, right? They don't want to interact with anybody. And of course, elevated mood and grandiosity. Grandiosity is when you think that, you know, you're better or higher than you really are. You think you're, you think you're Jesus Christ, or you think you're Oprah, or you think you're the president. Like you have just, you know, an inflated sense of self that all of those would be a patient in the manic phase, not the depressive state phase. Thank you, curtain. Listen, I've got three languages in my head. So it's sometimes it's hard for me to catch the word that I need. Okay. Next question. Your bipolar disorder patient is transitioning from a manic to a depressive episode. Nursing intervention is a priority. Here are your choices. Encourage participation in group therapy, monitor the patient for signs of suicidal ideation, promote a high calorie diet, encourage the patient to limit interaction with others. Very good. Monitor the patients for signs of suicidal ideation. The question just told us the patient went from a manic phase where they had the feeling of grandiosity, where they think they're better than everyone else. And they're happy and they're all over the place to now a depressive stage. And what did I tell you depression is? Again, hostility, anger, resentment turned towards who? Towards self. So you better be checking them for suicidal ideation. And here's what's so crazy. When it comes to suicide and when it comes to abuse, you do not beat around the bush. You ask that patient directly. Are you having thoughts of harming yourself? Ask them directly because many patients who are suicidal, they actually want help, but no one's ever asked them directly. So you ask them directly. And if they say yes, you need to find out the lethality of their plan. How do you find out the lethality of the plan? Well, the second question you're going to ask them is, do you have a plan? Duh, right? You ask them if they have a plan because what you're really trying to find out is if they have access to the means of the plan. So if they tell you, I plan on shooting myself, how? Oh, with my grandma's gun that is under the bed in the guest bedroom. Okay, that plan is pretty lethal because you have access. But what if that same patient, you said, how? And they said, by throwing myself off a mountain, but you're in the state of Florida. How lethal is that? Yeah, they can get on a plane and fly, but it's not something immediate, okay? So you're going to ask the patient directly, and you're going to ask them if they have a plan. And the purpose of that is to find out the lethality. Do they have access to whatever weapon or means that they want to harm themselves? How are you guys doing on the live? Okay, very good. Let's keep going. Okay, which of the following statements by the patient indicates a correct understanding of potential side effects of lithium? Expect to have increased energy levels and reduced need for sleep. I may experience excessive thirst and increased urination. Weight loss is a common side effect of this medication. I should not worry about any GI issues. We're talking about lithium. What do you think it would be a correct statement? very good i may experience excessive thirst and uh urination excessive thirst that's polydipsia increased urination that's polyuria yeah those are side effects that you have to teach that patient about and that's why a patient who's taking lithium by the way guys lithium is the medication given to treat the patient with bipolar disorder That's one of the reasons that a patient who's taking lithium, do you expect for them to be on a diuretic? No. Lithium by itself. We can see polyuria, polydipsia. You think that's the type of patient that needs to be on the diuretic? Absolutely not. Let's talk about lithium because there are a couple of things about lithium that you absolutely need to be aware of. Now, um... Well, let me go over the wrong answer choices, and I'll talk to you guys some more about lithium, because when it comes to lithium, if you're taking psych, you're going to get a good amount of questions on lithium. You got to know this. The first option, expect to have increased energy levels and reduced need for sleep. Now, if that patient's taking lithium, you're expecting them to have decreased levels of energy and increased need for sleep, because that patient that's in the manic phase, they're going, going, going, going, and we don't want them to crash out. Now, because we understand that if you have bipolar disorder, you may be in a manic phase, then go down to the depressive stage. So what happens is when the patient goes to the depressive stage, that lithium is not discontinued. It's not. What happens is the dosage that the patient was on is usually just cut in half. Okay. Professor D, do I need to know that? Yes, you do. Next choice, weight loss is a common side effect. Because remember what lithium does, bring it down. So if anything, weight gain is a common side effect. And I should not worry, look at that. I should not worry about any GI issues. If you know anything about pharmacology, the two symptoms you'll see in almost every single med is gonna be what? Nausea, vomiting, GI issues, right? So absolutely false. The only correct answer here. is the polyuria polydipsia. You do have to know that about lithium. Now, a couple other things I'm going to tell you that you have to know about lithium. How are you guys doing on the live? No, simply, but I'm going to answer that question. That's actually what I'm about to talk about right now. The normal therapeutic range is 0.6 to 1.2, 0.6 to 1.2. Once you hit 1.4 or higher, you're now in lithium toxicity. Okay, not two. We don't want to kill our patient. 0.6 to 1.2. Once you hit higher than 1.4, you're now in lithium toxicity range. Another important thing you got to know about lithium. Your patient's taking lithium. You better be checking that sodium level, guys. Remember, normal sodium is 135 to 145. However, if the patient's hyponatremic, that can cause the patient to go into lithium toxicity. And if they're hypernatremic. That can cause the patient to have a sub-therapeutic level of lithium. So we got to be very careful with the sodium because it will affect the patient's lithium level in their bloodstream. Okay. All right. Your bipolar disorder patient has been prescribed lithium. Which laboratory value should the nurse monitor closely? Here are your options. CBC. serum lithium levels, liver function tests, or thyroid function tests. Very good for the people who are paying attention. I just talked to you about the normal value levels and how we need to stay within that range. We don't want our patient to go into lithium toxicity. Come on guys. Signs and symptoms of lithium toxicity. You guys need to be aware of vomiting, diarrhea, muscle weakness, ataxia. Ataxia, that word is, I'm going to tell you what that patient looks like. You ever seen someone stumbling out of the bar because they're drunk and they're just walking like this way and that way like that, that is ataxia. Okay. So we're going to be very careful with toxicity. A patient with bipolar disorder has been prescribed carbamazepine. What is your priority nursing action or intervention regarding this med? Assessing the patient's liver function, checking the patient's electrolyte level, evaluating the patient's blood glucose level. or monitoring for signs of dehydration what do you guys think very good assessing a patient's liver function. Wow. 15 of you guys chose blue. What's blue? Checking the guys. Okay. Checking the patient's electrolyte levels. I think you're still thinking of lithium when I was telling you about the sodium. We're not talking about lithium. We're talking about carbamazepine. Okay. So it's not that evaluating the patient's blood glucose levels. That would be like, you know, if we gave some patients something like insulin and then monitoring the patient for signs of dehydration, that would be. if we gave the patient something like, you know, a diuretic, but we're talking about carbamazepine. And by the way, not for nothing, but let's say you get a question about a drug and you have no idea what the answer is. You're going to take an educated guess. If you're going to take an educated guess, and it's about like a, you know, an adverse effect or something, the nurse is going to be concerned about. If you see the choice of assessing the liver or kidney function, Choose that. But guys, I'm only saying this if you don't know what the answer is and you have to take a guess, you are going to guess anyway. That's the only time I want you to do that. Go ahead and choose the kidneys and liver. And the reason for that, any drug that you take has to be broken down, metabolized by the liver, and it has to be excreted by the kidneys. So guess what? Any drug you take, it's making your liver work and it's making your kidney work. So you're going to want to, you know, check the test. for those organs. Now that's not always going to be the answer because there may be something worse going on. That's why I'm telling you, if you have to guess, you were going to guess anyway, choose something that has to do with checking the liver or the kidney function when it comes to a drug. Okay. Thank you guys. I see the gifts you're sending on the live. Thank you. All right. Which of the following should the nurse include as a common side effect of carbamazepine? Weight loss, drowsiness and dizziness, hypertension, increased appetite. Common side effects of carbamazepine. Very good. You guys that's in this class and the Kahoot, you guys are doing very well. But on the live, a lot of you guys chose weight loss. So let me address you guys on the live first, then we're going to talk to you. Then I'm going to talk to you guys. Guys, if I'm asking you, or anyone's asking you about a common side effect of a drug, remember, when it comes to nursing, you're always thinking about safety. So even if you have many common side effects, you're going to care about the side effect that can cause harm to your patient. You're all about safety. So with that being said, if you didn't know what the answer was, you should have been between drowsiness and dizziness and hypertension. Why? Because both of those are safety issues. Hypertension, your patient can have a stroke, right? By the way, hypertension, that would have been an adverse effect, not really a side effect, but I digress. And then drowsiness and... You guys want to see my baby for homecoming? No. Oh, she just came in my room. So she looks so cute. Okay. I'm almost done though. Um, what was I talking about? You're explaining the question about drowsiness. Oh, thank you. Thank you, baby. So, um, yes. Hypertension. That's the adverse of, Oh honey, everybody said you're so cute. That's she said, thank you guys. That's the adverse effect, but I digress. So that would lead you to drowsiness and dizziness because guess what? Safety, safety, right? Who cares about weight loss? Cause it's, you're not going to have weight loss overnight, increased appetite. That doesn't happen. Like, you know, we're not going to, it's not going to kill you overnight. Weight loss isn't going to kill you overnight, but guess what? Hypertension could kill you overnight. And so can drowsiness and dizziness. So you should have, thank you guys. I see you on the live. Thank you. I'm going to show her these comments. She's going to be so happy. Um, So hypertension, drowsiness, dizziness, that's what you guys should have narrowed it down to. And this is how I want you guys to think. When you're looking at these test questions, think to yourself, safety. That's how you eliminate answers and you narrow it down. So yes, drowsiness, dizziness, guys, also sedation, other adverse effects, ataxia, aplastic anemia, congestive heart failure. Those are adverse effects of carbamazepine that you need to be aware of. Make sure you guys know this drug. make sure you know lithium and make sure you know the side effects and the adverse effects. All right, let's keep going. All right, which communication technique should the nurse use with the patient having a manic episode? Here are your options. Open-ended questions to encourage elaboration. Reflective listening to validate feelings. Simple direct statements to provide clarity. Humor to lighten the mood. Very good. Again, within the Kahoot room, you guys are doing very good, but on the live, I am about to ring your necks because so many people on the live chose open-ended questions. So let me get this right. You mean to tell me that a patient that is having a manic episode, they're going, they're going, they're going, they're going, they're going, they can't stop to concentrate on anything. That's the patient we're going to be asking open-ended questions. Remember, open-ended questions are questions that the patient has to actually describe or explain. You think they have time to describe or explain anything to you? Absolutely not. They can't even concentrate long enough. What you're going to do is provide simple and direct statements because you understand their attention span is about this much. We're not going to do open-ended questions. We're not going to do reflective listening. Don't get time for all of that. They're going to be gone. Okay? And I'm happy only two of you chose humor to lighten the mood. When in the history of nursing have we ever cracked a joke with a patient, especially in sight? That's how you get punched in the eye. You crack a joke and the patient thinks you're making fun of them and boom, you punch right in the throat. OK, we don't do that. So that's the first one you should eliminate it before anything else. Last question. Which therapeutic communication technique would be best when teaching about drug compliance? Here are your options. Giving advice on how to manage symptoms, using confrontation to challenge the patient's belief, encouraging the patient to express their concerns about medication, or providing educational pamphlets without further discussion. Very good. Encouraging the patient to express their concerns about medications. So we're teaching about compliance. The first thing we got to find out is why are you not being compliant? So we need to hear what their concerns are because they may have some misplaced concerns. They may have some false beliefs. So we have to do teaching, but we can't do teaching until we know what their thought process is. Okay. Look at the red one, giving advice. Do we ever give advice? We never give advice. We're never judgmental. We don't start sentences with I, or I think, I feel absolutely not. So we got rid of that. Using confrontation, stop right there. In psych, yeah, that's how you get punched in the throat. So we're not gonna choose that one. And then providing educational pamphlets, that's beautiful, but let's keep going without further discussion. We're gonna provide educational pamphlets to back up. everything that we just taught the patient, but you're not going to give a pamphlet as if that pamphlet is doing your job, right? So the only correct answer here is to find out what that patient's concerns are, to address the concerns, to educate that patient, and to basically empower them to be responsible for taking their medications. And guys, this is the last of the slide. I know that usually, actually, I'm talking to you guys on the live. Usually after the Kahoot, I stay on for about 10, 15 minutes and answer questions. And I talk to you guys. However, my daughter's homecoming is tonight and she's nervous. So I'm going to go just spend some time with her, talk to her, do her makeup and get her ready. So right after this live, I'm shutting off. I'm not going to be spending any time. Okay. So I'm giving you a heads up. Don't leave me any nasty messages. All right, guys, let's see how you did.

We're going to be going over some medications. It's going to be a great video. So a couple of things, as always, I'm going to encourage you to please subscribe to my channel if you haven't done so already.

My handle is the same across the board, whether you're on TikTok, Instagram, Facebook, YouTube. My handle is Nexus Nursing. Go ahead and give this video a thumbs up.

You're going to love this video. So go ahead and give it a thumbs up now so you don't forget. And be sure to check out my website, nexusnursinginstitute.com. There you can sign up for Next Generation NCLEX review session, part one, part two. Part one, I teach you how to think critically.

I teach you the most important scenarios that you may be placed in, what the test is looking to draw out of you. I teach you about priority. I teach you about delegation.

In part two, we actually go over NCLEX type questions, concepts, rationales that you need to understand. So no matter which way it's flipped to you, you should still be able to be led to the correct answer choice. So be sure to sign up for part one, part two, if you're, I can't speak, if you're studying for your boards.

If you're a current nursing student and you really have to have a high grade on your next test to pass, check out my audio lessons. Again, you can sign up for Next Generation NCLEX Review. You can get yourself some audio lessons, or you can sign up for a one-on-one private tutoring session with me.

Now, I book very, very quickly, but you do have that opportunity. Just keep checking that website. Again, nexusnursinginstitute.com. Now, with any further ado, let's get started. Bipolar disorder.

First question coming up. All right. Your patient with bipolar disorder is currently in a manic episode.

Which of the following behaviors should you expect to observe? Would it be increased need for sleep, depressed mood and withdrawal, grandiosity and inflated self-esteem, or difficulty concentrating on tasks? Which one would you expect to see in your patient that's going through the manic phase of bipolar disorder?

grandiosity and inflated self-esteem. Here's what's so crazy. I knew that I was going to stump a good amount of you guys.

A good amount of you were going to choose difficulty concentrating on tasks, which to be fair, that patient with bipolar disorder, they are going to have difficulty concentrating on tasks if they're in the manic phase, because they're all over the place, right? Remember, nursing is all about critical thinking. It's all about the best answer.

So you will have two answers that are correct. But which one is the most correct answer for your question? So let's go back to what the question says. It tells us that the patient has bipolar disorder and they are in the manic phase. Which behavior would we expect to observe?

Well, here's the thing. You see the 29 of you guys that chose difficulty concentrating on tasks. And again, because they're all over the place, they're not going to want to focus on one single thing. Yeah, absolutely. We may see this in the manic phase, but guess what?

We can also see that in depressive phase. When the patient is in the depressive phase, they're so sad, they're so down, they can't concentrate. We're looking for something that is specific to the manic phase.

And that's gonna be that grandiosity where they have an inflated sense of self, inflated self-esteem, okay? Look at the other choices, increased need for sleep. No, that's one of our biggest- problems, that patient that's in the manic phase, they're going and going and going and going and going. And what's one of our biggest concern, they're going to crash out, they need to sleep in order to function to survive. So that can't be it.

Depressed mood and withdrawal, that would be what the patient that's going through depression. And of course, I just explained to you difficulty concentrating on tasks. So the only one here, guys, that's specific to that patient in the manic episode is going to be the grandiose grandiosity and inflated self esteem.

And this is how I want you to think. When you're looking at these test questions, when you have two answers that are correct, and you're trying to figure out which one is most correct, say to yourself, okay, which one is more specific to what I'm being asked at this moment? All right, let's move on. All right, your patient's in the manic phase, and they are experiencing a high level of irritability. What's going to be your priority nursing intervention at this point?

Would it be to encourage them to engage in physical activity? Would it be to establish a common structured environment? Would it be to provide the patient with a detailed schedule of daily activities?

Or would it be to suggest the patient journal their feelings? What do you guys think? Very good.

Establish a calm and structured environment because what's happening? When that patient's in the manic phase, they're going, they're going, they're going. They are not stopping for anything, right? Everything is hyper-stimulated. You're trying to calm them down.

So you're going to put them in a calm, structured environment. So what you're not going to do is have them right next to the nurse's station where the family's complaining, where the nurses are giving report. where the phones are ringing, okay? You're going to have them at the end of the hall.

You're going to make sure that the radio's not on, the TV's not on. You're going to make sure that the lighting is dim. You're trying to decrease stimulation. You're not going to put them in a room with a whole bunch of other patients acting the fool, right? We're trying to decrease stimulation.

They are already irritable. You see what that question says? It says high level of irritability. You think they need anyone else to be getting on their nerves? Absolutely not.

Okay, so your patient bipolar disorder is having a depressive episode. Which of the following symptoms should the nurse anticipate observing? Would it be increased energy and racing thoughts, feelings of worthlessness and hopelessness, decreased need for sleep, elevated mood and grandiosity?

Which one would you expect in the bipolar patient that is going through a depressive episode? Very good. Feelings of worthlessness and hopelessness. So let's talk about bipolar disorder. This patient has fluctuating moods.

Where their pneumatic phase are all the way up, then they're in the depressive phase are all the way down. Their pneumatic phase are all the way up. They're in the depressive phase are all the way down. So this patient that happens to be in the depressive stage phase, what we notice is feeling of worthlessness and hopelessness.

This is what I want to say to you guys. Oh, sorry, guys. I moved the screen.

This is how I want you to think of depression. And if you think of depression in the way that I'm about to explain it to you. You are going to get so many more test questions right. Okay?

Depression. All depression is. I'm going to tell you what it is.

And now this is the context that you have to think about it from now on. Depression is anger, resentment, and hostility turned towards self. Turned towards self. And that's why a famous test question that tricks students so much, a famous question, your patient has been depressed. How do you know they're getting better?

And you'll have all these choices. And the correct answer is, you know, a family member said they were going to come visit. They didn't visit. And, and the patient got upset. The patient got so upset that they threw a pillow or, you know, they threw their phone, whatever the patient.

exhibited anger. You would never pick that as a student, right? You're like, okay, that's not good, but actually it is. Why?

Remember what I said? Depression is anger, hostility, resentment turned towards self. They're angry at themselves.

They're hostile towards themselves. They resent themselves. They're not worthy.

So the patient who is still in that deep depression, that family member who said they were going to visit. and never showed up, that patient wouldn't have been sad because guess what? I'm not worthy of that family member to show up. Who would want to show up for me?

I don't have any value. I don't blame them. I wouldn't show up for myself either. But as the patient starts to get out of that depression, as that depression starts to lift, as that anger, that hostility, that resentment towards self that the patient has, as it starts to lift, they start to see value in themselves. So when someone lies to them, they feel righteous anger.

Why? Because I'm valuable. How dare you say you were going to come visit me and you didn't do it? How dare you lie to me because I hold value?

So the fact that we see that patient getting angry, that lets us know they're starting to value themselves and that depression is lifting. Guys, listen, I'm giving you pearls. I hope you're picking up what I'm putting down.

All right. Anyway. Let's look at our other choices.

Increased energy and racing thoughts. That would be the patient in the manic episode. A decreased need for sleep.

That would be the patient in the manic episode because that patient who's depressed, all they want to do is sleep. They want to stay in bed with the sheets over their head, with the, what do you call those things you put on the window? Curtains. With the curtains closed, right? They don't want to interact with anybody.

And of course, elevated mood and grandiosity. Grandiosity is when you think that, you know, you're better or higher than you really are. You think you're, you think you're Jesus Christ, or you think you're Oprah, or you think you're the president.

Like you have just, you know, an inflated sense of self that all of those would be a patient in the manic phase, not the depressive state phase. Thank you, curtain. Listen, I've got three languages in my head.

So it's sometimes it's hard for me to catch the word that I need. Okay. Next question. Your bipolar disorder patient is transitioning from a manic to a depressive episode.

Nursing intervention is a priority. Here are your choices. Encourage participation in group therapy, monitor the patient for signs of suicidal ideation, promote a high calorie diet, encourage the patient to limit interaction with others. Very good. Monitor the patients for signs of suicidal ideation.

The question just told us the patient went from a manic phase where they had the feeling of grandiosity, where they think they're better than everyone else. And they're happy and they're all over the place to now a depressive stage. And what did I tell you depression is?

Again, hostility, anger, resentment turned towards who? Towards self. So you better be checking them for suicidal ideation.

And here's what's so crazy. When it comes to suicide and when it comes to abuse, you do not beat around the bush. You ask that patient directly.

Are you having thoughts of harming yourself? Ask them directly because many patients who are suicidal, they actually want help, but no one's ever asked them directly. So you ask them directly. And if they say yes, you need to find out the lethality of their plan.

How do you find out the lethality of the plan? Well, the second question you're going to ask them is, do you have a plan? Duh, right? You ask them if they have a plan because what you're really trying to find out is if they have access to the means of the plan. So if they tell you, I plan on shooting myself, how?

Oh, with my grandma's gun that is under the bed in the guest bedroom. Okay, that plan is pretty lethal because you have access. But what if that same patient, you said, how?

And they said, by throwing myself off a mountain, but you're in the state of Florida. How lethal is that? Yeah, they can get on a plane and fly, but it's not something immediate, okay? So you're going to ask the patient directly, and you're going to ask them if they have a plan. And the purpose of that is to find out the lethality.

Do they have access to whatever weapon or means that they want to harm themselves? How are you guys doing on the live? Okay, very good.

Let's keep going. Okay, which of the following statements by the patient indicates a correct understanding of potential side effects of lithium? Expect to have increased energy levels and reduced need for sleep.

I may experience excessive thirst and increased urination. Weight loss is a common side effect of this medication. I should not worry about any GI issues.

We're talking about lithium. What do you think it would be a correct statement? very good i may experience excessive thirst and uh urination excessive thirst that's polydipsia increased urination that's polyuria yeah those are side effects that you have to teach that patient about and that's why a patient who's taking lithium by the way guys lithium is the medication given to treat the patient with bipolar disorder That's one of the reasons that a patient who's taking lithium, do you expect for them to be on a diuretic?

No. Lithium by itself. We can see polyuria, polydipsia. You think that's the type of patient that needs to be on the diuretic? Absolutely not.

Let's talk about lithium because there are a couple of things about lithium that you absolutely need to be aware of. Now, um... Well, let me go over the wrong answer choices, and I'll talk to you guys some more about lithium, because when it comes to lithium, if you're taking psych, you're going to get a good amount of questions on lithium.

You got to know this. The first option, expect to have increased energy levels and reduced need for sleep. Now, if that patient's taking lithium, you're expecting them to have decreased levels of energy and increased need for sleep, because that patient that's in the manic phase, they're going, going, going, going, and we don't want them to crash out. Now, because we understand that if you have bipolar disorder, you may be in a manic phase, then go down to the depressive stage.

So what happens is when the patient goes to the depressive stage, that lithium is not discontinued. It's not. What happens is the dosage that the patient was on is usually just cut in half. Okay.

Professor D, do I need to know that? Yes, you do. Next choice, weight loss is a common side effect. Because remember what lithium does, bring it down.

So if anything, weight gain is a common side effect. And I should not worry, look at that. I should not worry about any GI issues. If you know anything about pharmacology, the two symptoms you'll see in almost every single med is gonna be what?

Nausea, vomiting, GI issues, right? So absolutely false. The only correct answer here.

is the polyuria polydipsia. You do have to know that about lithium. Now, a couple other things I'm going to tell you that you have to know about lithium. How are you guys doing on the live?

No, simply, but I'm going to answer that question. That's actually what I'm about to talk about right now. The normal therapeutic range is 0.6 to 1.2, 0.6 to 1.2.

Once you hit 1.4 or higher, you're now in lithium toxicity. Okay, not two. We don't want to kill our patient.

0.6 to 1.2. Once you hit higher than 1.4, you're now in lithium toxicity range. Another important thing you got to know about lithium. Your patient's taking lithium. You better be checking that sodium level, guys.

Remember, normal sodium is 135 to 145. However, if the patient's hyponatremic, that can cause the patient to go into lithium toxicity. And if they're hypernatremic. That can cause the patient to have a sub-therapeutic level of lithium. So we got to be very careful with the sodium because it will affect the patient's lithium level in their bloodstream.

Okay. All right. Your bipolar disorder patient has been prescribed lithium.

Which laboratory value should the nurse monitor closely? Here are your options. CBC. serum lithium levels, liver function tests, or thyroid function tests. Very good for the people who are paying attention.

I just talked to you about the normal value levels and how we need to stay within that range. We don't want our patient to go into lithium toxicity. Come on guys.

Signs and symptoms of lithium toxicity. You guys need to be aware of vomiting, diarrhea, muscle weakness, ataxia. Ataxia, that word is, I'm going to tell you what that patient looks like.

You ever seen someone stumbling out of the bar because they're drunk and they're just walking like this way and that way like that, that is ataxia. Okay. So we're going to be very careful with toxicity. A patient with bipolar disorder has been prescribed carbamazepine. What is your priority nursing action or intervention regarding this med?

Assessing the patient's liver function, checking the patient's electrolyte level, evaluating the patient's blood glucose level. or monitoring for signs of dehydration what do you guys think very good assessing a patient's liver function. Wow.

15 of you guys chose blue. What's blue? Checking the guys.

Okay. Checking the patient's electrolyte levels. I think you're still thinking of lithium when I was telling you about the sodium. We're not talking about lithium.

We're talking about carbamazepine. Okay. So it's not that evaluating the patient's blood glucose levels. That would be like, you know, if we gave some patients something like insulin and then monitoring the patient for signs of dehydration, that would be. if we gave the patient something like, you know, a diuretic, but we're talking about carbamazepine.

And by the way, not for nothing, but let's say you get a question about a drug and you have no idea what the answer is. You're going to take an educated guess. If you're going to take an educated guess, and it's about like a, you know, an adverse effect or something, the nurse is going to be concerned about. If you see the choice of assessing the liver or kidney function, Choose that. But guys, I'm only saying this if you don't know what the answer is and you have to take a guess, you are going to guess anyway.

That's the only time I want you to do that. Go ahead and choose the kidneys and liver. And the reason for that, any drug that you take has to be broken down, metabolized by the liver, and it has to be excreted by the kidneys.

So guess what? Any drug you take, it's making your liver work and it's making your kidney work. So you're going to want to, you know, check the test. for those organs. Now that's not always going to be the answer because there may be something worse going on.

That's why I'm telling you, if you have to guess, you were going to guess anyway, choose something that has to do with checking the liver or the kidney function when it comes to a drug. Okay. Thank you guys.

I see the gifts you're sending on the live. Thank you. All right. Which of the following should the nurse include as a common side effect of carbamazepine?

Weight loss, drowsiness and dizziness, hypertension, increased appetite. Common side effects of carbamazepine. Very good. You guys that's in this class and the Kahoot, you guys are doing very well.

But on the live, a lot of you guys chose weight loss. So let me address you guys on the live first, then we're going to talk to you. Then I'm going to talk to you guys.

Guys, if I'm asking you, or anyone's asking you about a common side effect of a drug, remember, when it comes to nursing, you're always thinking about safety. So even if you have many common side effects, you're going to care about the side effect that can cause harm to your patient. You're all about safety. So with that being said, if you didn't know what the answer was, you should have been between drowsiness and dizziness and hypertension.

Why? Because both of those are safety issues. Hypertension, your patient can have a stroke, right? By the way, hypertension, that would have been an adverse effect, not really a side effect, but I digress. And then drowsiness and...

You guys want to see my baby for homecoming? No. Oh, she just came in my room. So she looks so cute.

Okay. I'm almost done though. Um, what was I talking about?

You're explaining the question about drowsiness. Oh, thank you. Thank you, baby.

So, um, yes. Hypertension. That's the adverse of, Oh honey, everybody said you're so cute. That's she said, thank you guys.

That's the adverse effect, but I digress. So that would lead you to drowsiness and dizziness because guess what? Safety, safety, right? Who cares about weight loss? Cause it's, you're not going to have weight loss overnight, increased appetite.

That doesn't happen. Like, you know, we're not going to, it's not going to kill you overnight. Weight loss isn't going to kill you overnight, but guess what?

Hypertension could kill you overnight. And so can drowsiness and dizziness. So you should have, thank you guys. I see you on the live.

Thank you. I'm going to show her these comments. She's going to be so happy. Um, So hypertension, drowsiness, dizziness, that's what you guys should have narrowed it down to. And this is how I want you guys to think.

When you're looking at these test questions, think to yourself, safety. That's how you eliminate answers and you narrow it down. So yes, drowsiness, dizziness, guys, also sedation, other adverse effects, ataxia, aplastic anemia, congestive heart failure.

Those are adverse effects of carbamazepine that you need to be aware of. Make sure you guys know this drug. make sure you know lithium and make sure you know the side effects and the adverse effects.

All right, let's keep going. All right, which communication technique should the nurse use with the patient having a manic episode? Here are your options. Open-ended questions to encourage elaboration. Reflective listening to validate feelings.

Simple direct statements to provide clarity. Humor to lighten the mood. Very good. Again, within the Kahoot room, you guys are doing very good, but on the live, I am about to ring your necks because so many people on the live chose open-ended questions.

So let me get this right. You mean to tell me that a patient that is having a manic episode, they're going, they're going, they're going, they're going, they're going, they can't stop to concentrate on anything. That's the patient we're going to be asking open-ended questions. Remember, open-ended questions are questions that the patient has to actually describe or explain.

You think they have time to describe or explain anything to you? Absolutely not. They can't even concentrate long enough. What you're going to do is provide simple and direct statements because you understand their attention span is about this much.

We're not going to do open-ended questions. We're not going to do reflective listening. Don't get time for all of that. They're going to be gone. Okay?

And I'm happy only two of you chose humor to lighten the mood. When in the history of nursing have we ever cracked a joke with a patient, especially in sight? That's how you get punched in the eye. You crack a joke and the patient thinks you're making fun of them and boom, you punch right in the throat. OK, we don't do that.

So that's the first one you should eliminate it before anything else. Last question. Which therapeutic communication technique would be best when teaching about drug compliance? Here are your options.

Giving advice on how to manage symptoms, using confrontation to challenge the patient's belief, encouraging the patient to express their concerns about medication, or providing educational pamphlets without further discussion. Very good. Encouraging the patient to express their concerns about medications. So we're teaching about compliance.

The first thing we got to find out is why are you not being compliant? So we need to hear what their concerns are because they may have some misplaced concerns. They may have some false beliefs. So we have to do teaching, but we can't do teaching until we know what their thought process is. Okay.

Look at the red one, giving advice. Do we ever give advice? We never give advice. We're never judgmental. We don't start sentences with I, or I think, I feel absolutely not.

So we got rid of that. Using confrontation, stop right there. In psych, yeah, that's how you get punched in the throat. So we're not gonna choose that one.

And then providing educational pamphlets, that's beautiful, but let's keep going without further discussion. We're gonna provide educational pamphlets to back up. everything that we just taught the patient, but you're not going to give a pamphlet as if that pamphlet is doing your job, right?

So the only correct answer here is to find out what that patient's concerns are, to address the concerns, to educate that patient, and to basically empower them to be responsible for taking their medications. And guys, this is the last of the slide. I know that usually, actually, I'm talking to you guys on the live.

Usually after the Kahoot, I stay on for about 10, 15 minutes and answer questions. And I talk to you guys. However, my daughter's homecoming is tonight and she's nervous. So I'm going to go just spend some time with her, talk to her, do her makeup and get her ready. So right after this live, I'm shutting off.

I'm not going to be spending any time. Okay. So I'm giving you a heads up.

Don't leave me any nasty messages. All right, guys, let's see how you did.

Transcript for:Understanding Bipolar Disorder and Nursing Care

Transcript for:
Understanding Bipolar Disorder and Nursing Care