Lithium in Mood Disorders: Nursing Implications, Patient Education, and Target Levels

This article discusses the nursing implications, patient education, and target levels for lithium therapy in mood disorders. It emphasizes the importance of monitoring blood levels and managing side-effects to prevent toxicity. The article also covers the salient information about bipolar disorder and the recommended treatment options.

Running head: LITHIUM IN MOOD DISORDERS
Lithium in Mood Disorders
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Salient information
Bipolar disorder brings an effect on patients’ social and occupational functioning. The
patients tend to behave in such manner that jeopardizes their social relations. Therefore, an
assessment should be performed to identify the alterations resulting from depressive episodes.
It is learnt from reading that nursing diagnosis on social domain includes impaired family
process and social interaction, interrupted parenting and compromised family coping. The
nursing interventions involve keeping these patients in rooms where they should be protected
from self-harm due to violent behaviours. Engaging these patients in support groups often
helps in improving their condition through learning preventive strategies (Baune&Malhi,
2015). Social support groups tend to help these individuals to cope up with social
interruptions. Family interventions provide occasional improvement in understanding and
coping with the disorder. Psychoeducation strategies to families shown promising outcomes
for these patients and help to minimize the risks of relapse and hospitalizations.
In termsof psychological domain of assessment, the stress and coping skills are
critical areas of assessment. The patient develops maniac symptoms due to stress triggers and
negative coping skills such as addiction and aggression lead to deterioration. Therefore
nursing interventions should identify these coping skills in times of stress triggers to develop
better intervention strategies. These patients often tend to cause self-harm and have suicidal
or homicidal tendency. The poorer treatment is often associated with obesity; therefore,
preventing obesity would provide mitigation of morbidity and mortality related to physical
sickness and enhance psychological wellbeing (Calkinet al., 2013). The recommended
treatment for psychological domain in bipolar disorder involves pharmacotherapy with an
integration of psychotherapeutic drugs (Geddes &Miklowitz, 2013).Commonly
recommended psychotherapeutic approaches involve psychoeducation and individual

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interpersonal therapy. The goals of psychosocial interventions is to identify the risk factors in
bipolar disorder and promote reduction of those factors which cannot be treated through
pharmacotherapy.
Patients with bipolar disorder often experience psychosis; mood stabilizers are
tolerated by these individuals as treatment options. They are given antipsychotics instead of
antidepressants for further mood stabilization.These patients often tend to avoid medication;
therefore monitoring the administration of medication is essential. The combined
administration of mood stabilizers and anti-depressants need to be monitored for drug
interaction s as they can lead to potential side-effects in patients (Givens, 2016). The
antidepressants can lead to potential side-effects such as weight gain, dry mouth, blurry
vision, hypotension, drowsiness. Prior to prescribing antidepressants, a baseline report of
vital signs and symptoms of the patient need to be obtained.Monitoring the effects of
medication involve objective observation of the patients’ treatment response and subjective
reports. Antidepressant alongwith mood stabilizers are recommended in lower dosage to
avoid the occurrence of side-effects.
Importance to do blood levels
Lithium is the prevalent mood stabilizer medication given to bipolar disorder patients.
However, lithium therapy causes side-effects, therefore the lithium levelsin blood is
important to be monitored. To prevent lithium toxicity in patients, it is necessary to regularly
monitor the blood levels of lithium in patients so as to ensure that they remain within the
therapeutic reference level of lithium during initial treatment stages (Oruchet al., 2014). Care
needs to be given in order to avoid any drug interactions while on lithium therapy. It is
necessary to notify the clinical prescriber to before any medication prescription as chances of
drug interactions can lead to severity. The therapeutic blood levels of lithium needs to be

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monitored; if the lithium level rises above 1.3mmol/liter, toxicity arises with inclusion of
worsening symptoms such as tremor, nausea, diarrhoea, muscle fatigue and kidney
problems(Oruchet al., 2014).
Major nursing implications for lithium
Nursing implications are required to monitor for lithium associated side-effects. For
side-effects such as edema on hands and feet with tremors, it is required to monitor the intake
and output levels; the urinary output levels and intake of sodium needs to be monitored.The
monitoring of patient’s body weight needs to done by the nursing staffs. To reduce tremor
episodes, it is necessary to provide support and reassurance so that it does not interfere with
the patient’s regular activities. The nurses should inform the prescriber that the drugs
administered should be in compliance to reduce the incidence of tremors and therefore should
not produce any stressors for the patient (Dolset al., 2013). If the patient suffers from mild
diarrhoea, muscle fatigue or memory difficulties, the nurses should provide for fluid
replenishment therapy and should notify the prescriber about the need to change medication.
The nurses should intervene through providing short term memory aids such as reminders to
enhance memory concentration. For patients with metallic oral tastes, the nursing
implications include administering sugary foods to the patients and encouraging the patients
to maintain oral hygiene at frequent intervals. When nausea or abdominal discomfort occurs
with polydipsia and polyuria, the nursing interventions should check for the medication
dosages provided to the patients(Dolset al., 2013). The nurses may be required to change the
dosage into smaller doses or provide drugs along with meals. A frequent administration of
drugs in smaller dosage may help patients to cope with side-effects. The nurses should
provide reassurance to the patient that polydipsia and polyuria are not having any harmful
effect on kidneys. The nurses may be required to withhold medications during polydipsia and
polyuria. The nurses need to keep the prescriber informed about the patients’ conditions and

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ensure that no toxicity arises.
Key factors in patient and family teaching on lithium therapy
The patient/family education should include information about avoidance of alcohol
consumption or other nervous system depressant drugs. It is important to notify drug
prescriber prior to taking any other medication. Once on medication, patients should not
discontinue abruptly. For patients who are on lithium therapy, it is imperative for the nurses
to explain that a change in salt intake leads to alterations in therapeutic blood levels, in which
case the patients’ body would try to retain lithium to maintain homeostasis (Haussmannet al.,
2015).This leads to toxicity and side-effects. Once the patient is stabilized on lithium therapy,
the salt level fluctuations would become constant.This maintenance become difficult during
summer due to high rate of perspirations and dehydration. Patients need to be alert on gaining
weight through antidepressants and mood stabilizers and should keep a check on their body
weight. The patients need to be informed about weight reduction techniques and need to
check with clinical physicians prior to taking any medications.
Target lithium level
The therapeutic target level for patients undergoing lithium therapy for bipolar
disorders has been established within a range of 0.6-1.2 milli mole per litre (Malhi&Outhred,
2016). Patients who fall within this target range, show no toxicity of treatment while
responding to the drug.

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