Depression

Mania
Cyclothymic

Bipolar disorder
Major depressive disorder
Neurotic vs psychotic

Nursing interventions (manic episode)

Goal:
To provide for basic human needs of safety and rest/activity.
A Reduce outside stimuli and provide a nonstimulating environment.
B Monitor food intake: provide a high-calorie, high-vitamin, high-fiber
diet with finger foods to be eaten as the client moves about.
NURSING PRIORITY
Physiologic needs are the first priority in providing client
care.
C Encourage noncompetitive solitary activities such as walking,
swimming, or painting.
D Assist with personal hygiene.
NURSING PRIORITY
During the manic phase, the client’s physical safety is at
risk because the hyperactivity may lead to exhaustion, and
ultimately, cardiac failure.
Goal:
To establish a therapeutic nurse-client relationship.
A Use firm, consistent, honest approach.
B Assess client’s abilities and involve client in his or her own care
planning.
C Promote problem-solving abilities; recognize that a false sense of
independence is often demonstrated by loud, boisterous behavior.
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D Do not focus on or discuss grandiose ideas.
Goal:
To set limits on behavior.
A Instructions should be clear and concise.
B Initiate regularly scheduled contacts to demonstrate acceptance.
C Maintain some distance between self and client to allow freedom of
movement and to prevent feelings of being overpowered.
D Maintain neutrality and objectivity: realize that client can be easily
provoked by harmless remarks and may demonstrate a furious reaction
but calm down very quickly.
E Use measures to prevent overt aggression (e.g., distraction, recognition
of behaviors of increased excitement).
Goal:
To promote adaptive coping with constructive use of energy.
A Do not hurry client; this leads to anxiety and hostile behavior.
NURSING PRIORITY
In a hyperactive state, the client is extremely distractible,
and responses to even the slightest stimuli are
exaggerated.
B Provide activities and constructive tasks that channel the agitated
behavior (e.g., cleaning game room, going for a walk, gardening, playing
catch).
Goal:
To assist in the medical treatment.
A Administer lithium carbonate (Lithobid or Lithonate).
B Teach client about lithium medication instructions (see Appendix 10-2).
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C Divalproex or valproic acid (Depakote) is used to treat lithium
nonresponders.
D Carbamazepine (Tegretol) can be used with Lithium or an
antipsychotic for treatment-resistant bipolar disorder.
E Antipsychotic drugs such as olanzapine (Zyprexa) and quetiapine
(Seroquel) may be better tolerated than Lithium.
F Risperidone (Risperdal) is a first-line treatment for severe mania.
G Lamotrigine (Lamictal) is a first-line treatment for acute manic
episodes and maintenance therapy.
a. Clients taking lamotrigine need to be instructed to seek immediate
medical attention if a skin rash appears because this drug can cause a
severe potentially life-threatening rash.

Terms:

Anhedonia is the inability to feel pleasure. It's a common symptom of depression as well as other
mental health disorders. Most people understand what pleasure feels like. They expect certain things in
life to make them happy