Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Outline
Mood Disorders (Bipolar, Depression):
Definition/Etiology:
Bipolar is characterized by unpredictable phases of euphoria (or mania), and depression. These can occur for varied amounts of time and there can be long periods of no episodes between them.
Pathophysiology:
While Bipolar does have a hereditary component, it is believed to be caused by a combination of genes, the environment and psychological stressors. No we are not going to have a nature vs nurture conversation here but know that it is caused by a multitude of factors.
Clinical Presentation:
The presentation of BiPolar has 2 components. For the depressive phase, pts will present with:
- Feelings of worthlessness, loneliness, sadness, helplessness
- Loss of interest in previously enjoyed activities
- Guilt
- Fatigue
- Sleep disturbances
- Decreased libido
- Irritability
- Decreased ability to concentrate
- Suicidal ideation and a preoccupation with death
The presentation of mania is quite the opposite:
- Elation
- Mental excitement
- Irritability
- Pressured speech – this is rapid and kind of difficult to interrupt
- Flight of ideas – all over the place
- Increased motor activity, restlessness
- Grandiosity
- Impulsivity
- High risk behaviors
- Sexual acting out or preoccupation with sex
- Delusional thinking
Collaborative Management:
With all patients presenting with a mood disorder, we would want to get some blood work. Basic labs as well as toxicology to rule out an external factor or a medical disease process.
Depression:
- Safety and security
- Suicide risk
- Do not isolate
- Decrease environmental stimuli
- Encourage talking and expression of feelings
- Find out about support systems
- Be empathetic and non-judgemental
- Refer for psych and medical eval
Mania:
- Provide for safety
- Decrease environmental stimuli – i realize this may be difficult in the ED but it’s much better to put these patients in a room with the lights off then in the middle of the hallway
- Be authoritative but non-threatening – set limits
- Provide a safe room and allow for pacing
- Do not encourage patient to talk, be direct with questions
- Medicate as indicated
- Restraints as a last resort. This will come into play if violence becomes a factor
Evaluation | Patient Monitoring | Education:
Evaluating these patients is simply a factor of observing as their symptoms diminish. While in the ED you may only see a slight return to baseline. Depending on if they get medicated will most likely speed this process up but there is always the possibility that during their time with you there may be no change. It’s never a bad thing here, especially if there is history, to consult psych. Be aware of possible admission to a psych unit and if they are involuntary (danger to self or others), they might not take that well. When delivering news like that, always maintain your safety above all else.
Linchpins: (Key Points)
- Rule out medical
- SAFETY
- Quiet Environment
- Proper follow-up
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
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References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Jain A, Mitra P. Bipolar Affective Disorder. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558998/
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
Katies NCLEX
Concepts Covered:
- Test Taking Strategies
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Microbiology
- Anxiety Disorders
- Depressive Disorders
- Nervous System
- Gastrointestinal Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Studying
- Newborn Care
- Adulthood Growth and Development
- Respiratory Disorders
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Tissues and Glands
- Factors Influencing Community Health
- Concepts of Population Health
- Community Health Overview
- Developmental Considerations
- Communication
- Legal and Ethical Issues
- Cardiovascular
- Emergency Care of the Neurological Patient
- Emergency Care of the Respiratory Patient
- Emergency Care of the Trauma Patient
- Delegation
- Multisystem
- Health & Stress
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Trauma-Stress Disorders
- Developmental Theories
- Concepts of Mental Health
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Prefixes
- Suffixes
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Cardiac Disorders
- Preoperative Nursing
- Intraoperative Nursing
- Vascular Disorders
- Noninfectious Respiratory Disorder
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Shock
- Immunological Disorders
- Postoperative Nursing
- Perioperative Nursing Roles
- Hematologic Disorders
- Disorders of Pancreas
- Neurological Trauma
- Neurological Emergencies
- Musculoskeletal Trauma
- EENT Disorders
- Peripheral Nervous System Disorders
- Respiratory Emergencies
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Documentation and Communication
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Disorders of Thermoregulation
- Basics of NCLEX
- Integumentary Important Points
- Urinary System
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Eating Disorders
- Personality Disorders
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Basics of Sociology
- Note Taking
- Basics of Human Biology