Assessment

• Assess mental status (orientation, mood, behavior) initially and periodically. Assess manic symptoms with Young Mania Rating Scale (YMRS) at baseline and periodically through treatment in patients with mania. Initiate suicide precautions if indicated

• Monitor intake and output ratios. Report significant changes in totals. Unless contraindicated, fluid intake of at least 2000–3000 ml/day should be maintained. Weight should also be monitored at least every 3 mo

• Evaluate renal and thyroid function, WBC with differential, serum electrolytes, and glucose periodically during therapy

• EKG for patients >50 years old

• Monitor serum lithium levels twice weekly during initiation of therapy and every 2–3 mo during chronic therapy. Draw blood samples in the morning immediately before next dose. Therapeutic levels range from 0.5 to 1.5 mEq/L

» Assess patient for signs and symptoms of lithium toxicity (vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, or twitching). If these occur, report before administering next dose

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