Nursing Considerations for Patients Receiving Lithium 服锂患者的护理考虑
Assessment: History and Examination 评估：病史与检查
• Assess for contraindications or cautions for the use of the drug, including any known allergies to lithium; renal or CV disease; dehydration; sodium depletion, use of diuretics, protracted sweating, or diarrhea; suicidal or impulsive patients with severe depression; pregnancy or lactation; and infection with fever.
• Assess temperature; skin color and lesions; CNS orientation, affect, and reflexes; bowel sounds and reported output; pulse, auscultation, and blood pressure, including orthostatic blood pressure; respiration rate and adventitious sounds; and urinary output for baseline status before beginning therapy and for any potential adverse effects. Also obtain liver and renal function tests, thyroid function tests, CBC, and baseline ECG, and obtain serum lithium levels as appropriate.
Nursing Diagnoses 护理诊断
Nursing diagnoses related to drug therapy might include the following:
与药物疗法相关的护理诊断可能包括下列内容：
• Acute Pain related to GI, CNS, and vision effects.
急性疼痛，与GI、CNS和视觉效应相关
• Risk for Injury related to CNS effects.
损伤风险，也CNS效应相关
• Impaired Urinary Elimination related to renal toxic effects.
排尿形态改变，与肾毒性效应相关
• Disturbed Thought Processes related to CNS effects.
思维过程紊乱，与CNS效应相关
• Deficient Knowledge regarding drug therapy.
知识缺乏，与药物疗法相关
Interventions 措施
• Administer drug cautiously, with daily monitoring of serum lithium levels, to patients with significant renal or CV disease, dehydration, or debilitation, as well as those taking diuretics, to monitor for toxic levels and to arrange for appropriate dose adjustment.
• Administer drug with food or milk to alleviate GI irritation if GI upset is severe.
GI不适严重时，与食物或牛奶同服，减轻GI刺激。
• Arrange to decrease dose after acute manic episodes. Lithium tolerance is greatest during acute episodes and decreases when the acute episode is over. 安排在急性躁狂性发作后减少剂量。急性发作期锂耐受性最强，急性发作过后减弱。
• Ensure that the patient maintains adequate intake of salt and fluid to decrease toxicity.
确保患者维持充分的盐和液体摄入量，减少毒性
• Monitor patient’s clinical status closely, especially during the initial stages of therapy, to provide appropriate supportive management as needed.
密切监护患者的临床状况，特别是治疗初始阶段，必要时，提供适当的支持性管理。
• Arrange for small, frequent meals, sugarless lozenges to suck, and frequent mouth care, to increase secretions and decrease discomfort as needed.
必要时，安排少量、多餐，提供吮吸用的无糖脆性硬糖，提供经常性口腔护理，以增加分泌，减少不适。
• Provide safety measures such as side rails and assistance with ambulation if CNS effects occur to prevent patient injury.
CNS效应出现时，可提供安全措施，如床边栏，协助步行，预防患者损伤。
• Provide thorough patient teaching, including drug name, prescribed dosage, measures for avoidance of adverse effects, cautions that it may take time to see the desired therapeutic effects, warning signs that may indicate possible problems, and the need to avoid pregnancy while taking lithium to enhance patient knowledge about drug therapy and to promote compliance.
1. A client who has been newly admitted to the mental health unit with a diagnosis of bipolar disorder is trying to organize a dance with the other clients on the unit at suppertime. The nurse should encourage which action to decrease stimulation with the clients?
A. Seek assistance from other staff members.
B. Engage the help of other clients on the unit to accomplish the task.
C. Stop the planning and firmly tell the client that this task is inappropriate.
D. Postpone organizing the dance and supper and engage the client in a writing activity. 2. The nurse provides home care instructions to a client who is taking lithium carbonate. Which statement by the client indicates a need for further teaching?
A. “I need to take the lithium with meals.”
B. “My blood levels must be monitored very closely.”
C. “I need to decrease my salt and fluid intake while taking the lithium.”
D. “I need to withhold the medication if I have excessive diarrhea or vomiting.”
1. D. Postpone organizing the dance and supper and engage the client in a writing activity. Rationale: Because the client with bipolar disorder is easily stimulated by the environment, sedentary activities are the best outlets for energy release. Most bipolar clients enjoy writing, so the writing task is appropriate. An activity such as planning a dance at suppertime may be appropriate at some point, but not for the newly admitted client who is likely to have impaired judgment and a short attention span. Options 1 and 2 encourage planning the activity, and therefore increase client stimulation. Option 3 could result in an angry outburst by the client. 2. C. “I need to decrease my salt and fluid intake while taking the lithium.” Rationale: A normal diet and normal salt and fluid intake (1500 to 3000 Ml per day) should be maintained because lithium decreases sodium reabsorption by the renal tubules, which could cause sodium depletion. A low-sodium intake causes a relative increase in lithium retention and could lead to toxicity. Lithium is irritating to the gastric mucosa; therefore, lithium should be taken with meals. Because therapeutic and toxic dosage ranges are so close, lithium blood levels must be monitored very closely: more frequently at first and then once every several months after that. The client should be instructed to withhold the medication if excessive diarrhea, vomiting, or diaphoresis occurs, and inform the primary health care provider if any of these problems arise.
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