A small compilation of nurse anesthesia care plans
These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.
Mania
Mood disorder is characterized by elation, hyperactivity, and flight of ideas
Manic episodes may alter with depression in bipolar disorders
It is thought to be related to excessive norepinephrine activity in the brain
Treatment
Drugs of choice
Lithium (Eskalith, Lithobid) and lamotrigine (Lamictal). Concomitant administration of antipsychotic (haloperidol) or benzodiazepine (lorazepam) is usually necessary during acute mania
Alternative treatments are valproic acid, carbamazepine, and aripiprazole (Abilify), as well as electro-conversion therapy - ECT
Lithium
Therapeutic range 0.8-1.0 mEq/L
Treat acute episodes, prevent recurrence, and suppress episodes of depression
Side effects
Reversible T-wave changes, mild leukocytosis
Rarely: hypothyroidism, vasopressin-resistant diabetes insipidus-like syndrome
Toxicity
Confusion, sedation, muscle weakness, tremor, and slurred speech
We may also see a widening of QRS, AV block, hypotension, and seizures
Anesthetic considerations
- The most significant concern is perioperative toxicity, and blood levels should be checked perioperatively
- Sodium depletion decreases renal excretion of lithium and can lead to lithium toxicity
- Fluid restriction and over-diuresis should be avoided
- Lithium is reported to decrease MAC and prolong the duration of some NMBDs - effects appear to be minimal
- Monitor neuromuscular function