BIPOLAR

You are the NP in an outpatient mental health clinic.
S.T. is here for her outpatient mental health appointment. She has a diagnosis of bipolar disorder and has been stable for the past 3 years. Her last episode was one of mania that required hospitalization.
She is 29 years old, married, with two children ages 2 and 4. She reports that her mood is better than it has been in a long time and she has lots of energy. When asked whether she thinks this is a recurrence of mania, she says no, she thinks that things are just finally getting better.
1.It is common for patients with bipolar illness to deny the onset of mania because it feels good. What other information would be important to ask S.T.?
2.What other information would help determine whether S.T. is experiencing the onset of a manic or hypomanic episode?
3.Bipolar disorder is a disorder of mood, characterized by episodes of depression, mania, or hypomania. What symptoms might you see if S.T. is experiencing mania or hypomania?
4.How is hypomania different from mania?
Case Study Progress Lithium (Eskalith) is commonly used to treat bipolar disorder. S.T. has been taking lithium for several years.
5.When S.T. first started taking lithium, she would have been cautioned to report side effects. Which are common side effects of lithium?
(Select all that apply.)
a. Thirst
b. Nausea
c. Constipation
d. Tremor
e. Dizziness
Identify what medical workup must be performed before prescribing Lithium?

6. What is the therapeutic Blood Level for Lithium?
Lithium toxicity can occur in patients taking lithium. What are the symptoms of lithium toxicity?
(Select all that apply.)
a. Vomiting
b. Insomnia
c. Dyspnea
d. Diarrhea
e. Confusion
7.S.T.’s maintenance lithium level results are reported as 1.0 mEq/L. Interpret these results.
8.What other laboratory examinations should be routinely drawn while S.T. is taking lithium?
9.What instructions should have been given to S.T. when she began lithium therapy?
10.Aside from lithium, what other medications are used to treat bipolar disorder?
11.Given her history of bipolar disorder, what should you teach S.T. to minimize mood swings?
12. ST decides to go on a high protein low CHO diet for weight loss. What are the implications of this decision in relation to her Medical History?
13 Identify four other classifications of medication are administered along with Lithium for the treatment of bipolar disorder.
14, ST has a bout of food poisoning and has profuse diarrhea? What instructions would you give to ST?