Chapter 25, Bipolar Disorders: Management of Mood Lability

The parents of a 16-year-old adolescent describe him as “addicted to online gaming with bouts of severe agitation and anger often directed at the family, including swearing, throwing furniture, and physical abuse directed toward his two younger brothers.” When you are interviewing the 16-year-old young man, he identifies a shift in his sleep pattern with recently only sleeping 3 to 4 hours a night; racing thoughts centered around the fictional world of the online game; and some grandiose thinking that he can change the world, become a millionaire, and does not need to do well in his school studies because that doesn’t matter as much as achieving the highest level in the game. His speech is noted to be fast paced and pressured. He demonstrates almost complete social isolation other than his game connections, poor judgment regarding school, and inattention to his hygiene. The teen’s mother states that she must prepare, plate, and serve his food to him while he is on the computer or he will not eat during the day. The parents and the patient both agree that 2 months ago, the patient was “depressed.” They both describe low mood and irritability, inattention to hygiene and other activities of daily living, increased sleep and withdrawal from friends and family, and hopeless or helpless ideation centered on the patient’s self-worth. The patient admits to experiencing suicidal thoughts at that time. (Learning Objectives #2 & 4)

1. 1. The nurse practitioner prescribes divalproex sodium (Depakote) 250 mg delayed-release capsules for the patient. List the major side effects to assess for with the use of divalproex sodium (Depakote).

1. 1. What are the major nursing concerns for this teenager who has recently been diagnosed with a bipolar disorder?

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