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Bipolar disorders

Meds: Mood Stabilizer / lithium carbonate

QuestionAnswer
Lithium carbonate (normal range: 0.6 - 1.2) TX: bipolar, controls episodes of acute mania, helps prevent the return of mania or depression
lithium complications (some resolve w/in a few weeks) 1 GI distress - effects are transient take med w/meals or milk Fine hand tremors- exacerbated by stress or caffeine - adm. beta-adrenergic; propranolol, adjust to lowest dosage, divided doses or long-acting formulations. report an increase in tremors.
lithium complications 2 polyuria, mild thirst- use potassium sparing diuretic; spironolactone. intake 2000-3000ml fluids. weight gain - eat healthy diet and regular exercise renal toxicity-monitor I&O, keep dose low, monitor kidney function.
lithium complications 3 goiter & hypothyroidism w/long term TX; obtain baseline T3T4 & TSH levels and annually. client to monitor manifestations of hypothyroidism (cold, dry skin, decreased heart rate, weight gain). adm. levothyroxine
lithium complications 4 bradysrythmia, hypotension, & electrolyte imbalances RN considerations: encourage clients to maintain adequate fluid & sodium intake
lithium toxicity - early indications below 1.5 mEq/L diarrhea, n/v, thirst, polyuria, muscle weakness, fine hand tremor, slurred speech, lethargy. RN considerations; withhold med and notify HCP adm. new dosage based on serum lithium levels.
Lithium toxicity - advanced indications 1-5 to 2.0 mEq/L GI distress, n/v, diarrhea, mental confusion, poor coordination; coarse tremors; sedation. withhold med & notify HCP, adjust med based on serum lithium levels. if manifestations are severe, promote excretion
lithium toxicity - severe toxicity 2.0 to 2.5 mEq/L extreme polyuria, tinnitus, involuntary extremity movements, blurred vision, ataxia, seizures severe hypotension, coma, death from resp. complications. adm. emetic to clients who are alert. gastric lavage, mannitol or aminophylline for excretion
lithium toxicity greater than 2.5 mEq/L oliguria, seizures, rapid progression of symptoms leading to coma & death. RN considerations: hemodialysis
lithium contraindications/precautions pregnancy risk cat. D - teratogenic, do not breastfeed. cautious in client w/renal dysfunction, heart disease, sodium depletion or dehydration.
lithium interactions / NSAIDs (1) reduced serum sodium decreases lithium excretion which leads to toxicity - adequate diet in sodium, drink 2000-3000ml fluids. conct. w/NSAIDs increases renal absorption-lead to toxicity. avoid NSAIDs use aspirin as a mild analgesic
lithium interactions / anticholinergics (2) antihistamine, TCAs can induce urinary retention & polyuria, leading to abdominal discomfort. avoid meds w/anticholinergic effects.
Lithium nursing administration monitor plasma lithium levels during treatment. obtain lithium blood levels in the morning. monitor CBC, serum electrolytes, renal function tests, thyroid function tests during lithium therapy. lithium is adm 2-3 doses/day, take w/food
Created by: gdimanche