Susan is a 28-year-old married female admitted with a diagnosis of an acute manic episode. Prior to admission, police were called to her apartment for a domestic disturbance. Susan was running around in the street and began to undress in the front yard. Her husband asked the police to take her to the hospital because she would not take her medications and she was out of control. He stated that Susan had not slept for four days and she had eaten very little food, Susan has a history of bipolar disorder. On admission, Susan is easily agitated, grandiose, hypersexual and denies any need for hospitalization.


  1. The HCP is presently writing orders. What classifications of medications would you anticipate the HCP to order as scheduled medications to treat bipolar illness?


  1. What is the rational for the above medications?


  1. What additional medications would you need, as PRN’s to effectively manage Susan’s symptoms?

Answer. Anti-anxiety medications: Benzodiazepines may help with anxiety and improve sleep but are usually used on a short-term basis.


  1. Name three mood stabilizers to treat bipolar illness.


  1. Considering Susan’s age and marital status, before starting a mood stabilizer, it would be important to assess for:


  1. The HCP orders Lithium 300 mg po bid and a lithium level to be drawn in four days prior to the morning dose. Explain the reason for monitoring lithium levels.

Answer. To measure lithium levels in the blood in order to determine the therapeutic level when just starting lithium medication; to monitor levels to ensure they are maintained in the therapeutic range; and sometimes to determine lithium toxicity


  1. Two days after starting the lithium, Susan complaining of slight nausea, increased thirst, and urination prior to receiving her morning dose of lithium. Upon further assessment, Susan also is experiencing fine tremors and fatigue. How would you respond to Susan complaints? Why?


  1. State two nursing interventions to address Susan’s above symptoms.


  1. Four days later Susan’s lithium level is 0.4 and you are scheduled to give her next dose. What action would you take at this time?

Answer. Lithium has a very narrow range where it is effective and nontoxic. At a level of 1.2 mEq/L, lithium can start to cause problems. levels should be between 0.6 and 1.2 mEq/L, but not more than 1.2 mEq/L. If levels are too low, the medicine may not help your condition. Both salt and fluid can affect the levels of lithium in the blood, so it is important to consume a steady amount every day. Less salt can make your lithium levels rise, while increasing your salt intake can cause it to fall. For this patent  cutting back and limiting her salt intake would help to increase her lithium levels.


  1. Susan’s dose was tapered up and two weeks later her lithium level is 0.8 and she is being discharged home. What medication teaching would be necessary to include in her discharge instructions regarding safe administration of lithium