Name:_______________________________________________________________________________
CASE Presentation: Bipolar Disease (BPD)
A 35 year old patient who has a history of Bipolar Disease has stopped taking her prescribed Divalproex Sodium (Valproate/Depakote). She is brought to the hospital because she has become increasingly hyperexcitable over the past 5 days. She has talked on the phone almost continuously because she says she is trying to start a business. She has called friends and relatives all over the country at all hours of the night to tell them her news. She went on a spending spree to buy new clothes and equipment for her business venture an accumulated almost $10,000 worth of bills before she was caught for writing bad checks. Her husband was called when she tried to purchase a car and the bank reported that she has insufficient funds to cover the check. She was brought to the hospital in an acute manic state.
On admission she moves about restlessly waving her arms in a threatening manner while loudly berating her husband and the hospital staff. She demanded to be released from” jail” and curses the nurse who interviews her.
Why might this patient have stopped taking her medication?
Adherence to drug therapy is often an obstacle for patients with managing Bipolar disease. How can the nurse increase the likelihood of this patient taking her medication and participating in therapy as prescribed?
Lithium Carbonate 300mg is prescribed 4 times a day. Why must lithium be taken in divided daily doses?
The patient complains that she cannot play cards or write letters. What should the nurse do?
What measures can the nurse teach the patient to prevent fluctuations in lithium levels?
What teaching does the nurse need to provide to the patient and family relating to prescribed and over the counter drugs that relate to the patient’s medical history and taking lithium?
Multiple Choice: Highlight the correct answer to the following multiple choice questions
It would be a priority to consult the prescriber of Lithium carbonate about monitoring Lithium levels if the Bipolar Disorder patient is diagnosed with hypertension and prescribed what drug?
Amlodipine
Atenolol
Hydrochlorothiazide
Valsartan
When administering Divalproex Sodium, which observation(s) would be a reason to withhold the drug and contact the prescriber (Select all that apply)
Constant mid-epigastric pain radiating to the back
Nausea, vomiting and dark colored urine
Pale conjunctiva
Petechial rash
Warm or hot skin and fruity breath
A patient is admitted with an acute episode of Bipolar Disorder. The patient is started on Divalproex Sodium and bupropion. What is the priority nursing concern?
Electrolyte imbalances
Hydration
Safety
Toxicity
Drug Calculation:
Lithium Carbonate 0.6mg three times a day is prescribed. How many capsules should be administered if 300mg are available? _______________________