A female client, diagnosed with Bipolar I, recently stopped taking her lithium (Lithane). She has not slept, eaten or ba

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A female client, diagnosed with Bipolar I, recently stopped
taking her lithium (Lithane). She has not slept, eaten or bathed in
days. She is dressing in brightly-colored, flamboyant, and sexually
suggestive clothing. She has been spending money freely and buying
things she does not need and cannot afford. She recently purchased
a trip to Tahiti as well as a motorcycle that she does not know how
to ride. The client has even gambled away the family savings. Her
husband calls her psychiatrist and tells him his wife has stopped
taking her lithium and has not slept or ate in a couple of days.
The psychiatrist suggests that the husband bring his wife to the
emergency room for admission to the psychiatric unit.
Upon admission, the nurse observes that the client is dressed in
a red mini skirt with a blue and orange flowered top. She is
wearing bright red lipstick, false eyelashes, and bright blue eye
shadow. While attempting to take a history, the client jumps from
one subject to another. She talks loudly and rapidly and uses
elaborate hand gestures. She cannot sit still and continually paces
around the room. The client repeatedly says, “I feel good. I feel
good like I know I should. I feel good!!!” The client’s husband
informs the nurse that his wife has stopped taking her lithium and
has not eaten, slept, or showered in days. He goes on to explain
that his wife has maxed out the credit cards and has put the family
in debt.
The client’s past psychiatric history includes 4 episodes of
acute mania within the year. She has no known allergies. No other
medical conditions noted. The psychiatrist orders a serum lithium
level. The lithium level comes back at 0.8 mEq/L. In addition,
electroconvulsive therapy (ECT) is scheduled for the next day.
Questions
What is Bipolar I disorder? How does it differ from Bipolar
II?
What behaviors are exhibited during a manic episode?
What nursing intervention should be implemented when a client is
in the manic phase?
Why was a serum lithium level drawn? What is the therapeutic
(maintenance) range for lithium? What serum level is considered
toxicity?
What teaching needs to be reinforced with lithium therapy?
What are some potential nursing diagnoses for this client?
What is electroconvulsive therapy (ECT)? When is ECT
indicated?
What preparation is needed prior to ECT?
What are some complications of ECT?