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NRSG 331 > Final Review Slides - both tests are comprehensive > Flashcards

Final Review Slides - both tests are comprehensive Flashcards

1
Q

Substance abuse: Hallucinogens

A

Hallucinogens, such as, Phencyclidine (PCP) and Lysergic acid diethylamide (LSD) often cause paranoia; can have flashbacks after ingestion of the drug. There are some therapeutic uses of LSD including for chronic alcoholism & intractable pain (more research is needed)

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2
Q

S. Abuse: Heroin:

A

Many people use for pain without intention of addiction. Not expensive, easily attainable. Depresses CNS: overdose can result in death. Naloxone is reversible medication (opioid antagonist)

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3
Q

S. Abuse: Opioid withdrawal

A

…is uncomfortable - can last about 10 days; w/d symptoms include: N/V, aches, rhinorrhea, diarrhea, yawning, fever, insomnia. Opiate reversal agent is Naloxone (Narcan)

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4
Q

S. Abuse: Cocaine withdrawal

A

Causes irritability, depression, anxiety, fatigue, insomnia, SI

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5
Q

Alcohol and benzodiazepine withdrawal

A
  • Can be fatal
  • Must use substitution therapy and withdraw pt. safely.
  • Most often used: Benzo’s such as chlordiazepoxide
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6
Q

Use of restraints

A
  • Understand they are used as a last resort - only to protect from harm to self or others. Most important to check extremities for circulation Q 15 min. Maintain airway, offer fluids, food, toileting
  • When threat is over they must be released
  • Seclusion is a form of restraint
  • Medication can also be a form of restraint
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7
Q

ECT

A
  • Safe and effective
  • Know how to prepare for procedure and expected S/E
  • Memory loss & confusion - usually temporary
  • ECT causes a seizure
  • Very effective for elderly with depression who cannot tolerate medications
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8
Q

Eating disorders

A
  • Know the difference between anorexia nervosa & bulimia nervosa
  • Understand aspect of control by patient
  • Need healthier coping mechanisms
  • Behavioral therapy is effective along with cognitive
  • Understand the role of family dynamics— remember perfectionism and control
  • Study nursing diagnosis and appropriate interventions/outcomes
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9
Q

Intellectual disability disorder (IDD)

A
  • Mild IDD - IQ 50 - 70 children progress up to about a 6th grade level/functions pretty well
  • Moderate IDD - IQ 35 - 49 use simple directions/statements; difficult in social/peer relations
  • Severe IDD - IQ 20 - 34 understand pts. will often “act out”; usually verbal skills are minimal
  • Profound IDD - IQ below 20 no capacity for independent function; needs constant assistance/supervision
  • YOU DO NOT NEED TO MEMORIZE IQ NUMBERS; BUT DO KNOW WHAT BEHAVIORS/INTERVENTIONS ARE MOST APPROPRATE FOR DIFFERENT LEVELS
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10
Q

1st generation antipsychotics know side effects

A
  • Thiothixene (Navane)
  • Chlorpromazine (thorazine)
  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
  • These may be on Kaplan!!
  • Remember TD and that the AIMS test was developed specifically to measure for TD.
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11
Q

2nd gen antipsychotics

A
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Clozapine
  • Be prepared for questions - you should know what these drugs are, uses & s/e
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12
Q

Antidepressants - SSRIs

A
  • Fluoxetine, Paroxetine, Sertraline
  • S/E: Sex dysfunction is common, and pts will stop due to this. Wt gain, sedation, increased SI (esp with initial tx)
  • Serotonin syndrome: agitation, restless, confusion, tachycardia, hypertension, muscle rigidity. STOP TX. GIVE CARE.
  • SSRIs are often used for OCD, often in higher doses than for depression
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13
Q

Tricyclic antidepressants

A
  • Imipramine & others
  • Smoking interfieres with metabolism, takes several weeks for effectiveness, highly lethal in overdose so not the best to use in suicidal pts.
  • If necessary, give small amounts at a time. Imipramine s/e is urinary retention so this is used for childhood enuresis
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14
Q

MAOIs

A
  • Trancypromine, phenelzine: FRESH IS BEST. avoid tyramine.
  • Remember not to give other antidepressants with MAOIs cause of potential for hypertensive crisis (can be fatal)
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15
Q

Mood stabilizers

A
  • Know S/E of lithium & range
  • Symptoms of Lithium toxicity?
  • Lithium is a salt…
  • Atypical antipsychotics and anticonvulsants are often used for mood stabilization
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16
Q

Misc. drug info

A
  • Remember which ones need blood-level monitoring, valproic acid, lithium, and clozapine
  • Know S/E of clozapine - agranulocytosis can be fatal
  • Which meds with EPS?
  • Benztropine and diphenhydramine for EPS tx
  • Danger of benzos with ETOH
  • Limit sun exposure with many meds
17
Q

ADHD

A
  • Meds: Specifically know S/E of methylphenidate, best to administer earlier in day
  • Just because a child is disruptive does not mean they have ADHD
18
Q

Autism

A
  • Symptoms: withdrawal into self, lack of eye contact, hand flapping, repetitive behaviors, speech delays, often do not like being touched or hugged
  • consistency of caregivers/trust is important
  • Safety: helmets, pads
  • No known cause
19
Q

Children

A
  • Play therapy is important as children are not able to effectively verbalize their feelings; they will often re-enact things they see
  • Pic books
  • symptoms of depression in children can include aches and pains, boredom with things they used to find interesting, wont be interested in playing with others. Ask parents!
  • Children with separation anxiety often have a parent who experiences anxiety
  • Antipsychotic meds can be effective for Tourette’s
  • Teach parents about development levels
20
Q

Antisocial personality disorder

A
  • Initially will be friendly, engaging, ingratiating
  • No remorse
21
Q

Narcissistic personality disorder

A
  • Gain self-esteem by putting down others
  • Inflated sense of self-worth
22
Q

Borderline personality disorder

A
  • Rules must be consistently enforced by all staff
  • Manipulative/staff-splitting
  • Self-harm / suicidal gestures
  • Testing limites/boundaries; difficult time regulating emotions
23
Q

Dependent personality disorder

A
  • Complete reliance on others
  • May not be able to problem solve or make decisions on their own
24
Q

Gen info

A
  • Pts with schizophrenia are often paranoid, have concrete thinking, black and white thinking
  • Understanding triggers that exacerbate mental illness symptoms is important
  • Structure and routines are important: Avoid caffeine (esp with bipolar)
  • Psych units should be structured. Not overly-stimulating or overly restrictive; provide hope
  • Understand informed consent and duty to warn
25
Q

Gen info 2

A
  • Domestic violence/crisis: victims feel powerlessness. Help patients with choices and alternatives. Always remain non-judgmental.
  • Know cycles of abuse: 1) tension building (2) acute battering (3) honeymoon
  • Provide education: safety plans (shelters, numbers to call, etc)
  • Psych disorders in elderly, know that depression is often dx for the first time in older pts
  • NCDs –> keep pts safe and comfy. Often get lost.
26
Q

Gen info 3

A
  • Agoraphobia: fear of being in open or crowded spaces which leads to patients being home bound
  • OCD comes from underlying anxiety: They are not able to stop the compulsion (such as hand-washing)
  • Conversion disorder: pt may become blind after witnessing a horrible event (easier to deal with physical symptoms)
  • Coping skills: Goal is to help patient regain pre-crisis level of mental illness; gain skills to better cope with future problems
27
Q

Suicide

A
  • Guns are leading method used in the U.S.
  • Giving away items can be a sign of impending suicide
  • Those with black and white (dichotomous) thinking are more prone to suicide
  • Always ask - important part of mental status assessment
  • Safety is always first
28
Q

Therapeutic comm.

A
  • Communication (verbal & non-verbal) are most important foundation for understanding mental illness
  • Always validate feelings
  • Best to ask open-ended questions
  • “Tell me how much alcohol you use each day?” NOT “Do you drink?”
29
Q

Ego defense mechanisms

A
  • Review chapter 1
  • Normal to use these unless they interfere with adaptation:
  • Denial
  • Rationalization
  • Regression
  • Reaction formation

NRSG 331 (26 decks)

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