Which of the following medications is indicated for long-term maintenance therapy of bipolar disorder (BPD)?

Nursing management during administration of opioid analgesics such as Morphine sulfate requires careful monitoring for both therapeutic effects and potentially serious adverse effects. Morphine acts on central opioid receptors to relieve pain but also depresses the central nervous system and gastrointestinal motility. Common complications include respiratory depression, constipation, urinary retention, and hypotension. Preventive care and continuous assessment are essential to ensure patient safety in the postoperative period.

Rationale:
A. Encouraging physical activity and offering increased fluids helps counteract opioid-induced decreased gastrointestinal motility. Morphine slows peristalsis by binding to mu receptors in the gut, leading to constipation. Early ambulation stimulates bowel function, while adequate hydration softens stool and promotes transit.

B. Monitoring the patient's blood pressure closely for hypertension is not appropriate because morphine more commonly causes hypotension rather than elevated blood pressure. It induces vasodilation through histamine release and decreased sympathetic tone, which can lead to orthostatic hypotension. Nursing assessment should therefore focus on detecting low blood pressure and signs of hypoperfusion rather than hypertension.

C. Requesting an order for Methylnaltrexone (Relistor) is appropriate for preventing or treating opioid-induced constipation. This medication is a peripherally acting mu-opioid receptor antagonist that reverses the constipating effects of opioids without affecting analgesia. It is useful when conventional laxatives are insufficient, especially in postoperative or chronically treated patients.

D. Palpating the patient's lower abdomen every 4 to 6 hours helps assess for urinary retention, a known side effect of opioids. Morphine can reduce bladder tone and inhibit the micturition reflex, leading to retention and bladder distention. Regular assessment allows early detection of complications such as bladder overdistension, which may require catheterization.

E. Counting respirations before and after giving the medication is critical due to the risk of respiratory depression. Morphine suppresses the respiratory center in the medulla, decreasing both respiratory rate and depth. Baseline and ongoing monitoring ensures early identification of hypoventilation, allowing timely intervention such as withholding doses or administering an opioid antagonist if necessary.

Management of Bipolar disorder often requires combination pharmacotherapy to address both acute symptoms and long-term stabilization. Lithium is effective for maintenance therapy and prevention of mood episodes, but additional medications may be needed during acute exacerbations. Risperidone is commonly added to control acute manic symptoms such as agitation, psychosis, and behavioral dysregulation. Combination therapy enhances symptom control and improves patient stability.

Rationale:
A. Elevating mood during depressive episodes is not the primary role of risperidone. While some atypical antipsychotics have antidepressant effects, risperidone is mainly used for controlling psychosis and mania. Mood elevation in depression is managed with antidepressants or mood stabilizers rather than this medication.

B. Preventing recurrence of depressive episodes is primarily achieved with mood stabilizers like lithium. Although some antipsychotics may contribute to mood stabilization, risperidone is not specifically indicated for preventing depressive relapses. Its main benefit lies in acute symptom control rather than long-term prevention of depression.

C. Managing tremors associated with lithium use is not an indication for risperidone. Lithium-induced tremors are usually managed by dose adjustment or medications such as beta-blockers. Adding an antipsychotic would not address this side effect and may introduce additional adverse effects.

D. Helping control symptoms during manic episodes is the correct rationale for adding risperidone. It works by blocking dopamine and serotonin receptors, reducing agitation, hallucinations, and impulsivity seen in mania. This makes it effective as an adjunct to lithium in managing acute manic phases.