Bipolar Disorder

The nurse manages acute manic and depressive episodes, monitors therapeutic drug levels, recognizes and manages lithium toxicity, and coordinates discharge planning for bipolar patients. Lithium monitoring requires understanding of factors affecting levels: dehydration increases levels (concentrated in reduced plasma volume), NSAIDs increase levels (reduce renal clearance), thiazide diuretics increase levels (enhance proximal tubule reabsorption), ACE inhibitors increase levels, low-sodium diet increases levels (kidney retains lithium instead of sodium). Lithium toxicity management: mild (1.5-2.0 mEq/L) -- hold lithium, IV normal saline hydration, monitor levels every 2-4 hours; moderate (2.0-2.5 mEq/L) -- aggressive IV hydration, continuous cardiac monitoring, consider nephrology consultation; severe (above 2.5 mEq/L) -- emergent hemodialysis, ICU admission, continuous cardiac monitoring. The nurse managing acute mania implements behavioral management strategies: provide structured environment, reduce stimulation (low lighting, quiet room, limited visitors), set firm consistent limits without escalating confrontation, redirect grandiose energy into safe activities, ensure nutrition (finger foods the patient can eat while moving) and hydration, monitor sleep (patients in mania may go days without sleeping). Involuntary hospitalization criteria must be known: danger to self, danger to others, or gravely...