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Term 4 (PN) > 180 - Mental Health Exam 1 > Flashcards

180 - Mental Health Exam 1 Flashcards

1
Q

Describes certain settings/enviornments designed to help clients replace inappropriate behaviors w/ more effective personal/ psychosocial skills

Therapeutic tools include the use of eye contact, facial expressions, body movement, and other nonverbal behaviors

A

Therapeutic communication (milieu)

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2
Q

What makes a patient a candidate for inpatient psychiatric admission?

A
  1. Persons behavior becomes threat to themselves or others
  2. People w/in the enviornment are not able/willing to support mentally troubled patient
  3. Person Perceives himselves as unable to cope/ behavior control
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3
Q

Inpatient services are provided for what 3 main groups of people?

A
  1. People experiencing a crisis
  2. People with acute mental or emotional problems
  3. People with chronic mental illness
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4
Q

Repeat inpatient admission
* AKA “revolving door syndrome” - especially schizophrenia & chemical use patients

Becomes a way of life for chronically troubled

Client feels like failure & providers are frustrated by failed past techniques

Primary reason for patient return to inpatient enviornment is due to noncompliance

A

Recidivism

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5
Q

what is the goal of a therapeutic enviornment?

A

To provide protection, support, & education

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6
Q

What happens in a therapeutic enviornment during an inpatient stay ?

A

Care providers assist clients in meeting needs

Clients learn to replace maladaptive behaviors

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7
Q

What are the Maslow’s Hierarchy of Basic Human Needs in order?

A
  1. Physiological needs
  2. Security & safety
  3. Love & belonging
  4. Self-esteem
  5. Self-actualization

Must meet basic needs to move to the next

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8
Q

Focus on physical surroundings
* Breath, nourishment, hygiene, & enviornment

Encourage good hygiene

A

Physiological needs - Maslow’s Hierarchy

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9
Q

Most important

Feeling of physical safety & ability to feel secure

security of a limited setting
* Depressed/ SI patients protect from self harm

A

Safety & security - Maslow’s Hierarchy

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10
Q

Fulfilled w/in therapeutic setting through:
* Use of communication
* Social interactions
* Relationships

Need to be accepted & find a place in a group

Isolation of mental illness is intense

A

Love
& belonging - Maslow’s Hierarchy

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11
Q

Must respect yourself before others can love & respect you
* Client needs to be involved

Expectations play role in development of personal needs

A

Self-esteem needs - Maslow’s Hierarchy

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12
Q

Need to achieve ones full potential

Not everyone will become

Clients become better able to cope

A

Self-actualization needs - Maslow’s Hierarchy

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13
Q

What are the 4 malpractice elements?

A

Duty of care

Breach of duty

Causation

Injury/ harm

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14
Q

Described as power, privilege, or existence to which one has a just claim

Helps define social interactions bc they contain principles of justice
* Equal /fair tx applied to all citizens

Associated w/ obligations

A

Rights

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15
Q

Right to respectful care, privacy/confidentiallity, continuity of care, & relevant info
* Right to examin bills, refuse tx, & participate in research

A

Patient Rights

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16
Q

Rights relate to respect, safety, & competent assistance

Right to full & equal participation as member of health care team

Right to set standards for quality & develop policies that affect Pt care

A

Care provider rights

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17
Q

Set of rules/values that govern right behavior

Reflects:
* Values
* Principles of right/wrong
* Purpose - To protect rights

A

Ethics

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18
Q

Acts as guidlinges for standards of practice

Let public know what behaviors can be accepted from their HCP

Codes of ethics are based including the following:
* Autonomy
* Beneficience, justice
* Nonmaleficence
* Confidentiality, fidelity, veracity

A

Ethical Principles

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19
Q

Provide information to patients, be truthful, & support your Pts, but consult the supervisor if any question of appropriateness arises

A

Code of ethics

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20
Q

Dilemmas exist when there is uncertainty/ disagreement about moral principles related to corse of action
* arise when problems cannot easily be solved

A

Ethical conflict

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21
Q

What criteria does a Pt need to make in order to be admitted to Psych?

A

Patient initiates request for mental health survice
* Considered voluntary admission
* Voluntary admitted Pts may legally discharge self whenever

Involuntary psychiatric admission provide a protected, theraputic enviornment
* Pt can stay from days to years

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22
Q

What would the most common crime in a mental health care setting include?

A

Homicide, controlled substance violation, & theft
* Assult/battery
* Invasion of privacy
* False imprisonment

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23
Q

What are the 7 Principles of Mental Health Care?

A
  1. Do no harm
  2. Accept Pt as whole person
  3. Develop trust
  4. Explore behaviors & emotions
  5. Encourage responsibility
  6. Encourage effective adaptation-crisis intervention
  7. Provide consistency
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24
Q

Avoid any action that may result in harm to your Pt

Relates to “reasonable & prudent nurse” (caregiver)

A

Do no harm

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25
Q

Based on concept of “whole”
* Viewing Pts involves acceptance of their lifestyle, attitudes, social interactions, & living conditions

A

Holistic Health Care

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26
Q

Mental health care providers encourage what?

A

One step at a time

Crisis intervention

Learning coping mechanisms

Recovery begins when attempts to cope with the problem result in success

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27
Q

What should you do as the nurse during a crisis intervention?

A

Provide immediate attention / care

Control & assess

Pt’s dispossition is determined

Refferal & follow up

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28
Q

How can you provide consistancy in mental health?

A

Being steady, regular, and dependable

Setting limits & focusing on the positive changes that patients are making

Addressed in POC

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29
Q

How should you as the caregiver interact with a patient w/ mental illness?

A

Convey “ a consistent, thoughtful effort directed toward developing an awareness of self and others”

Approach must be monitored & adjusted continually

Role models for good mental & physical health
- serve as therapeutic instrument

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30
Q

How can you as the care giver be self-aware of a patient with a mental illness?

A

Objectively look w/in

Oversee own growth & development

Allows individuals to direct & mold the pattern of their lives

Caregiver who encourages self-awareness must practice self-awareness

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31
Q

Concern for the well-being of another person

Behaviors associated with:
* Accepting
* Comfort
* Being honest
* Listening attentively
* Having sensitivity

A

Caring

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32
Q

The ability to recognize & share the emotions of another person w/o actually experiencing them

A

Empathy

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33
Q

The ability to see clearly & understand the nature of things

Relies on common sense, good judgement, and prudence

A

Insight

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34
Q

What is the difference between risk taking & failure?

A

Risk taking implies the possibility of failure

Failure provides the opportunity for change
* One only fails when one refuses to grow from the experience

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35
Q

Receiving the entire person and the world in which s/he functions

Does not necessarily include approving behaviors

HCP must accept the entire person

A

Acceptance

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36
Q

What are vital elemants of health care, but must be balanced by professionalism, judgment, & theraputic actions that meet Pt needs?

A

Acceptance

Compassion

Empathy

Tip: Think “ACE”

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37
Q

A promise to do the best you can do in every situation & to be the best that you can be

A

Self-commitment

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38
Q

How can you keep a positive attitude as a caregiver?

A

Listen to yourself talk

Change recurrent negative themes

Be own cheerleader

Visualize future successes

Act the part

Nurture yourself to be able to nurture others

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39
Q

Energy exchanged between 2 people

A flow that moves patients toward constructive ways of thinking & effective ways of coping

Characteristics:
* Acceptance
* Rapport
* Genuineness
* Therapeutic use of self

Components (think TEACH):
* T = Trust
* E = Empathy
* A = Auonomy
* C = Caring
* H = Hope

A

Therapeutic relationship

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40
Q

What are the 3 types of relationships?

A

Social relationship

Work relationship

Therapeutic relationship

made up of concepts trust, empathy, autonomy, caring, & hope

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41
Q

What are the 5 dynamic components of a therapeutic relationship?

A

T = Trust
* Assured belief that others are capable of assisting in times of distress

E = Empathy
* Ability to walk a mile in anothers shoes

A = Autonomy
* Ability to detect & control one activities & density

C = Caring
* Energy that allows caregivers to unconditionally accept all people, even when they are most unlovable

H = Hope
* Expectation of acheiving a future goal
* Consists of 6 demensions - affective, affiliative, behavioral, cognitive, temporal, & contextual

42
Q

The working phase of the theraputic process is:

A) The final phase

B) The phase where goals are acheived

C) The phase where Pt & caregiver become aqcuainted

D) Countertransference

A

A) The final phase

43
Q

What are the 4 roles of the caregiver?

A

Change agent

Teacher

Technician

Therapist

44
Q

Which of the following is not on of the 3 qualities of a therapeutic relationship?

A) Confidentiality
B) Acceptance
C) Rapport
D) Genuiness

A

B) Acceptance

45
Q

What are the 3 characteristics of chronic mental illness?

A

Behavioral
* Unable to function socially / occupationally
* Assultive / criminal behavior may occur
* Increase sexual behavior / increased STI risk
* Violence

Physical
* Dress unusual / out of season
* Lacks personal hygiene
* Malnutrition
* Chronic medical conditions are common

Psychological
* Several intellectual, emotional, social, & spiritual features in common
* Chronic low self-seteem, depression, loneliness, & hopelessness
* Often see themelves as helpless, ineffective, & incapable of change

46
Q

Children with ________ have problems with the intellectual & emotional aspects of life.

A) Autism
B) Mental retardation
C) Eating disorders
D) Schizophrenia

A

B) Mental retardation

47
Q

Children with ________ are in a world of their own.

A) Autism
B) Mental retardation
C) Eating disorders
D) Schizophrenia

A

A) Autism

48
Q

What is the most common aquired mental health problem in older adults?

A

Alzheimer’s diseases & other dementias
* Depression is another but less common

49
Q

The presence of 2+ mental health disorders

Dual Dx

A

Comorbidity

50
Q

When would an individual with a chronic mental health issue be hospitalized?

A

When their behavior poses a threat to themselves or others

51
Q

How long is the average length of stay in an inpatient setting?

A

About 10 days

52
Q

Where are many chronically mentally disordered clients discharged?

A

Halfway house or other group homes

Many live at home with their families

53
Q

Offers opportunities for individuals with severe mental illness to meet their often neglected social needs

Uses special talents of physicians, psychologists, nurses, occupational & physical therapists, dietitians, and other specialists

A

Multidispilinary approach

54
Q

What are therapeutic interventions designed on the basis of?

A

Identification problems

Available resources

Clients willingness to cooperate w/ therapeutic regimen

55
Q

What data must the nurse gather when assessing a patient w/ a mental illness?

A

Thorough Hx

Physical status

Perceptions

Behaviors

56
Q

A depressed patient appears disheveled, unkempt, and neglected. This aspect of the mental health assessment would include which of the following?

A) Emotional state
B) General description
C) Affect
D) Sensorium

A

B) General description

57
Q

The nurse documents that a client is displaying a “flat affect”. The clients behavior most likely would consist of:

A) Rapid dramatic changes in emotion
B) Sadness & hopelessness
C) Lack of agreement of affect & mood
D) Unresponsive emotions

A

D) Unresponsive emotions

58
Q

A Pt w/ seasonal affective disorder (SAD) may be treated successfully w/ which of the following body-based practices?

A) Acupuncture
B) Phototherapy
C) Chelation
D) Eye movement desensitization

A

B) Phototherapy

59
Q

The absence of disparties / avoidable differences among socioeconomic & demographic groups / geographical areas in health status & health outcomes such as disease, disability, or morality

Ex:
* Lack of health insurance & high health care costs
* Language barriers, Lack of transportation
* Provider / Pt communication
* Biased clinical decidion making
* Pt’s mistrust & refusal
* Unequal pain management, palliative care & breast cancer screening
* Unequal early / adequate prenatal care, & recommended immunizations

A

HRSA
“Health disparties” / “Health equity”

60
Q

Ineffective emotional states, ranging from deep depression to excited elation
* AKA - “ Affective disorder “ (Affective means emotions)

Disturbance in the emotional dimension of human functioning

A

Mood disorder

61
Q

Increase certain neruotransmitter activities

Divided into categories based on chemical formula:
* Tricyclic, atypical
* Selective seretonin / norepinephrine reuptake inhibitor (SSNRIs), monoamine oxidase inhibitor (MAOIs)

Use:
* Bipolar, panic disorders
* OCD, ADHD
* Enuresis (bed wetting), bulimia
* Neuropathic pain, conduct disorders in children

Require 1- 4 weeks before relief is noted

S/s:
* Hypertensive crisist
* Headache, stiff neck, palpitations (toxicity)
* Dry mouth, nose, & eyes, urinary retention, sedation (Anticholergic reactions)

Interventions:
* Report any behavior / physical changes
* Protect from falls (postural hypotension)
* Repost S/s of toxicity
* Monitor kidney / liver function

A

Antidepressant medications

62
Q

Why do antidepressants interact w/ other drugs?

A

They block the destruction of specific major transmitterrs
* higher levels of these chemicals circulate through the body

63
Q

What are 3 interactions w/ monoamine oxidase inhibitors (MAOIs)?

A

Anticholergic reactions:
* Dry mouth, blurred vision
* Decreased tearing, urinary hesitancy / retention
* Constipation, excessive sweating

Hypertensive crisis:
* Throbbing, radiating headache, stiff neck
* Palpitations, chest tightness, severe HTN, tachycardia
* Dilated pupils, sweating

CNS depression:
* Change LOC, disorientation, confusion, agitation
* Sedation, hallucinations, low seizure threshold

64
Q

What are side effects of Selective seretonin / norepinephrine reuptake inhibitors (SSNRIs)?

A

Dry mouth

N/V/D/C/A/H

Change in alertness

Increased sweating

Urinary & visual disturbances

Dizziness, Fatigue, weakness, tremor

65
Q

What are some dietary interactions w/ monoamine oxidase inhibitors (MAOIs)?

A

AVOID:
* Beer/ ale, red wines, sherry wines, liqueurs,cognac (Alcohol)
* Aged cheese, sour cream (Dairy)
* Avocados, bananas, fava & broad beans, canned figs, & overriped fruit (fruits/vegs)
* Pickled/smoked/ tenderizer, bologna, ck/beef, liver, dried fish, salami meats, sauasages (salami meats)
* Large amounts of caffeinated coffee, tea, or cola
* Chocolate, licorice, soy sauce, yeast

66
Q

What are some drug interactions w/ monoamine oxidase inhibitors (MAOIs)?

A

AVOID:
* prescription & OTC nasal sprays, sinus decongestions, cold/allergy/hay fever remides
* Inhalants for asthma
* Weight loss pills, pep pills, stimulants, local anesthetics
* Illicit drugs: Cocaine, any amphetamine (uppers), & narcotics

67
Q

Depression in adolescence usually related to what 4 factors?

A

Self-esteem

Loneliness

Family strengths

Parent-teen communication

68
Q

List the 3 reasons why teen depression must be recognized as serious:

A

Depression arising during adolescence tend to last

Have a high rate of recurrence

Associated w/ long lasting interpersonal problems

69
Q

Which adults are at risk for depression?

A

women

People between ages 35-44

Whites & hispanics

Individuals w/ fewer than 12 years of school

People who live in major urban areas

People w/ physical illnesses

Recently widowed older adults

People who live in western U.S

70
Q

What are some signals of depression in the elderly population?

A

Change in daily routine, eating, sleeping, or activity patterns

Decreased concentration, communication, & motivation

Feeling of envy, failure, indecisions, guilt & hopelessness

Loss of interest, self-confidence, & self-esteem

Worry or talk about death

71
Q

An emotional state in which a person has an elevated, expansive, & irritable mood accompanied by a loss of identity, increased activity, & grandiose thoughts & actions

Seen in Bipolar disorders
* Bipolar 1 & 2
* Cyclothymic disorders

Can last 3 months
* If allowed to continue, delirium & death from exhaustion may result - eventually depression phase begins again

Hospitalization breaks the cycle

A

Mania

72
Q

Feeling of sadness, disappointment, & despair

Classified into depressive episodes, depressive disorders, & dysthymia on time & recurring behavior patterns

Whole body illness that involves emotional, physical, intellectual, social, & spiritual disorders

A

Depression

73
Q

Sudden/dramatic shift to emotional extremes

Emotional extremes of mania & depression
* Their thoughts, moods, & behaviors swing from normal to grandiose to depressed

2 types: 1 & 2

A

Bipolar disorder

74
Q

Exaggerated sense of cheerfullness begins cycle the progresses to unstable “high of mania”
* Behaviors become more impaired

Still able to engage in daily living activities

A

Hypomania

75
Q

Episodes of major depression alternating w/ episodes of mania
* **More severe **

Delusions, & hallucinations can occur

A

Bipolar 1

76
Q

Associated w/ hypomanic moods that do not progress to full manic states, and are shorter than type 1

Often results in 1-2 weeks of severe lethargy, withdrawl, & melancholy, followed by several days of elevated ir irritable mood, constant activity, & risky decision making

A

Bipolar 2

77
Q

What are the 3 levels of mania?

A

1. Hypomania
* Outgoing, happy-go-lucky, unconcerned about the feelings of others , increased motor activity & sexual drives; moves quickly from one topic to the next, becomes easily irritated ;decreased need for sleep

2. Mania
* “High” expansive , angers quickly, pressured speech, flight of ideas, delusions of persecution & grandiosity; dresses inappropriately (layers, bizarre outfits, excessive makeup & jewlery), inappropriate behaviors (meddles in affaris, spends money recklessly, ect), sexually driven, little sleep but still hyperactive

3. Delirium
* Period of extreme excitement, anger, elation; has grandiose or religious delusions, becomes disoriented, incoherent, agitated; may injure self or others; poor hygiene, disheveled, physically drained; death from exhaustion if mania goes untreated

78
Q

Introduction of a controlled grand mal seizure by passing an electrical current through the brain

Works by raising the levels of the neurotransmitter norepinephrine (lower in people w/ depression)
* Tx 2-3x/week, takes about 15 min, 6-12 treatments over several weeks (out pt/ or in Pt)

Used only on clients w/ severe, long-lasting depression after attempts to stabilize the mood w/ various medications & therapies have failed

Common side effects: headache, confusion on awakening from the tx, short term amnesia, clients mood improves rapidly

A

Electroconvulsive Therapy (ECT)

79
Q

Electroconvulsive Therapy (ECT) is not prescribed for what type of clients?

A

Recent MI/Heart attack

Heart disease

High/low BP

Stroke

CHF

Why: Tx lowers BP and slows HR

80
Q

What Pt education & nursing interventions would you implement for Electroconvulsive Therapy (ECT)?

A

NPO 8 hours before treatment

Consent forms signed, remind client that confusion and memory loss are common after treatment

Baseline vital signs

Cardiac, BP, & O2 monitoring begins

Short acting muscle relaxants, sedatives, an anesthetics agents admin. IV

EEG

81
Q

Think “SIG E CAPS”:
* S: Sleep disturbance
* I: Interest decreases in pleasure activities & sex
* G: Guilty feeling
* E: Energy decreases
* C: Concentration
* A: Appetite fluctuation
* P: Psychomotor function decreases
* S: SI

A

Depression assessment

82
Q

What are tools to measure mental status?

A

Mini Mental State
* used to systematically and thoroughly assess mental status
* An 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. maximum score is 30 & a score of 23 or lower is indicative of cognitive impairment

Neecham Confusion Scale
* developed as an instrument for rapid and non-intrusive assessment of normal information processing, early changes in information processing, and for documentation of confusional behavior, including delirium
* It can be scored by the nurse “at the bedside” in a manner similar to other nursing assessments. It makes maximum use of already collected data

Confusion Assessment method instrument
* a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately
* Allow for monitoring during/between shifts day-day/ long term
* Do not replace continuous monitoring & documentation of mental status

83
Q

What are the 5 types of hallucinations?

A

Visual

Auditory

Tactile
* sensations of touch without any physical stimulus
* Patients with schizophrenia may sometimes experience the feeling of being kissed, the feeling of someone lying by their side or feelings an animal crawling on them

Olfactory
* Makes you detect smells that aren’t really there in your environment
* Consist of unpleasant smells: rotten fish or eggs, gasoline, excrement

Gustatory
* Cause tastes that are often strange or unpleasant
* Relatively common symptom for people with epilepsy and schizo.
* Often perceived as sour, bitter, or metallic

84
Q

How does a physician select the appropriate therapy?

A

Pt hx of responce to previous antidepressant

Potential adverse reactions

Physiologic manifestations alleviated within first week of therapy

Psychological symptoms improve after 2-4 weeks

85
Q

Prolonged action of norepinephrine, dopamine, & serotonin by blocking reuptake

Use:
* Antidepressants, phantom limb pain
* Chronic pain, post herpetic neuralgia
* Periphreal neuropathy

Adverse:
* Blurred vision, constipation, dry mouth/nose/throat (common)
* Parkinsonian, seizure activity, tachycardia (severe)
* HF, dysrhythmias, suicidal actions (severe)

Drugs:
* Amitriptyline (Elavil)
* Clomipramine (Anafranil)
* Doxepin (Silenor)

A

Tricyclin Antidepressants (TCA)

86
Q

Blocks metabolic destruction of norepinephrine, dopamine, & serotonin neurotransmitters

Used when tricyclic antidepressant therapy is unsatisfactory

Avoid tyramine (pickled foods, yeast, nuts, processed meats ect), ages cheese, wine/alcohol
* causes HTN crisis

Used for:
* Atypical depression
* Panic disorder, & some phobias

adverse reaction:
* Orthostatic Hypotension
* Restlessness, agitation
* Blurred vision, constipation, urinary retention
* Dry mucosa of mouth, throat, & nose
* Malignant HTN (Severe)

Drugs:
* Phenelzine (Nardil)
* Tranylcypromine
* Selegiline (Emsam)

A

monoamine oxidose inhibitor (MAOIs)

87
Q

Inhibits reuptake & destruction of seritionin from synaptic cleft, prolonging action of neurotransmitter

Use: Widley w/ antidepressants

Adverse:
* Restlessness, agitation, anxiety
* Insomnia, sedative effects
* GI effects, suicidal actions

Drug: Venlafaxine (Effexor)

A

Selective serotonin reuptake inhibitors (SSRIs)

88
Q

Normal mental state/mood in those w/ bipolar disorder that is neither manic or depressive

Behavior examples:
* Not feeling good or bad
* Feeling “okay”

A

Euthymia

89
Q

Prolonged emotional state influencing ones whole personality & life function

Behavior example:
* Good or bad/ likes or dislikes

A

Mood

90
Q

Outward expression of ones emotions - observable

Behavior example:
* Inappropriate response/action

A

Affect

91
Q

Moderate depression for 2 years or more

S/s of depression

Negative POV of the world

Behavior example:
* Chronically sad, major depressive episode
* Self critical

A

Dysthymia

92
Q

Focuses on helping clients w/ personal hygiene, maintaining adequate nutrition, & encouraging physical activities

PN responsibilities:
* Focus on personal hygiene, maintaining adequate nutrition, & encourage physical activity
* Maintain SI precautions

Concepts:
* Adherence
* Stress & coping
* Functional ability

A

Physical realm

93
Q

PN responsibilities:
* Care revolves around therapeutic relationships
* Acceptance/trust/support
* Encouragement/emotional support to cope w/ problems

Concepts:
* Anxiety
* Mood & affect
* Self management

A

Emotional Realm

94
Q

Extreme emotional response altering ones ability to think

PN responsibilities:
* Use gentle, nonjudgemental guidance when attempting to follow through on tasks
* Give instructions clear & slow (repeat if needed)
* Provide extra patience

Concepts:
* Cognition
* Psychosis
* Sleep

A

Intellectual Realm

95
Q

Most individuals are lonely & afraid of associating w/ others
* involves spiritual realm

PN responsibilities:
* Stabilize moods w/ medications
* Gental encouragment to begin intercating w/ others

Concepts:
* Anxiety
* Family Dynamics
* Stress & coping

A

Social Realm

96
Q

Antimanic
* Naturally occuring salt
* Once Pt is no longer manic, the need for drug drops dramatically

Interaction between the level in the blood & common table salt

Theraputic level: 0.6-1.2 mEq/L (MV-250)
* Always be aware of level prior to admin

Actions:
* Replaces intracellular & intraneuronal sodium
* Stabilizes neuronal membrane
* Reduces release of norepinephrine & increase uptake of tryptophan
* Exact action unknown

Uses:
* Mania
* Prevention of recurrent cycles

Premedication assessment labs, electrolytes, glucose, BUN/Cr, UA, thyroid function

A

Lithium

97
Q

What are side effects and interventions of Lithium?

A

Side effects:
* Abd. discomfort, N/D/A, soft stool, cramps
* Edema (feet especially)
* Hair loss, hypothyroidism
* Muscle weakness, fatigue
* Polyuria (can progress to diabetes insipidus),
* Thirst, tremors, weight gain

Interventions:
* Give Lithium w/ food or milk
* Reassure s/s are temporary
* Check salt restrictions w/ Dr.
* Obtain thyroid function test
* Monitor I/O (report if >3000Ml/24 hr)
* Encourage to quench thirst, eliminate caffeine
* Moderatly restrict calories, reassure weight gain is common

98
Q

What are S/s of lithium toxicity?

A

Mild - Blood serum level 1.5mEq/L
* Apathy, sluggishness/drowsines /lethargy
* Diminished concentration, mild incoordination
* Muscle weakness, muscle twitches, course hand tremor

Moderate - Blood serum level 1.5-2.5mEq/L
* N/V/D, Apathy
* Slurred speech, blurred vision, tinnitus
* sluggishness/drowsiness/lethargy, muscle weakness
* Irregular tremors, ataxia, frank muscle twitching

Severe - Blood serum level 2.5mEq/L
* Irregular muscle tremors
* hyperactive deep tendon reflexes
* Oliguria, dereased urine O/P
* Severe LOC changes, hallucinations
* Grandmal seizures, coma, death

99
Q

Anticonvulsants - PO/ IV

Decreases seizures

Use:
* Simple/complex/absent/ mixed sizures
* Bipolar episodes, ADHD, Schizo.

Side effects:
* N/V/D/C/A, Rash
* Sedation

Adverse:
* Coma
* SI
* Hepatotoxicity

Interventions:
* Assess seizure disorder & mental status
* Blood studies (Hct, HB, RBC, PT/PTT, platelets)

A

Valproic Acid (Depakene)

100
Q

Antidepressant - PO
* SSRI

Potent inhibitor of neuronal serotonin & norepinephrine uptake

Use: Prevention/Tx of major depression

Adverse:
* SI, SJS
* Tachycardia
* Angioedema

Interventions:
* Mental status
* Blood studies (CBC, WBC, Cardiac enzymes)

A

Venlafaxine (Effexor XR)

101
Q

Antipsychotic - PO/IM

Exact mech. unknown

Uses:
* schizo., bipolar disorder
* Mania, major depressive disorder

Adverse:
* Seizures
* SI
* Tachycardia, agranulocytosis

BBW: assess mental status before use

Interventions:
* Take BP, RR, & HR Q4h during initial tx

A

Aripirazole (Abilify)

Term 4 (PN) (11 decks)

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