Final Concepts other than Schizophrenia

Question 1

Pseudoparkinsonism

Answer 1

stiffening of the muscular activity in the face body arms and legs

Includes mask like faces, stiff and stooped posture, shuffling gait, drooling, tremor, pill rolling phenomenon

the onset of this includes 5 hours to 30 days

these effects can appear early in therapy and can be minimized with treatment

Question 2

What is the treatment for Pseudoparkinsonism

Answer 2

nursing measures: alert medical staff and anti-cholinergic agents maybe used

treatment usually consists of lowering the dosage of the prescribed medication or prescribing an anti-parkinsonism drug (especially a centrally acting anti-cholinergic drug)

common use drugs include Artane, cogentin, Benadryl, and symmetrel.

Question 3

In Pseudoparkinsonism if an anti-parkinsonism drug is used, Anti-cholinergic side effects of antipsychotics may be intensified……. this includes:

Answer 3

urinary retention constipation blurred vision cognitive impairment and delirium

Question 4

Tardive dyskinesia

Answer 4

facial protruding and rolling tongue, blowing, smacking, licking, spastic facial distortion, smacking movements.

onset of action is months to years

Question 5

What are the nursing measures for Tardive dyskinesia

Answer 5

no nursing treatment.

discontinuation of the drug does not always relieve symptoms

possibly 20% of clients taking these drugs for greater than two years may develop tardive dyskinesia

nurses and doctors should encourage clients to be screened for tardive dyskinesia at least every three months

Question 6

Agranulocytosis symptoms include

Answer 6

sore throat fever malaise and mouth sores

is a rare occurrence but is a possibility that the nurse should be aware of

any flulike symptoms should be carefully evaluated

usually occurs suddenly and becomes evident in the first 12 weeks of medication taking

Question 7

How do we screen for Agranulocytosis

Answer 7

blood work is usually done every week for six months and then every two months after

Doctor may order blood work to determine presence of leukopenia or agranulocytosis if test results are positive the drug is discontinued in reverse isolation may be initiated

mortality is higher if the drug is not ceased and treatment is not initiated

Question 8

Nurses need to know about some rear that serious and potential fatal toxic effects of antipsychotic drugs

toxic effects include:

Answer 8

neuroleptic malignant syndrome
agranulocytosis
and liver involvement

Question 9

neuroleptic malignant syndrome occurs

Answer 9

in about .2% to 1.0% of clients you have taken antipsychotic agents

is believed that the acute reduction in brain dopamine activity plays a role in the development of neuroleptic malignant syndrome

neuroleptic malignant syndrome is fatal in about 10% of cases and it usually occurs early in the course of therapy but has been reported in people after 20 years of treatment

Question 10

Neuroleptic malignant syndrome is characterized by:

Answer 10

decreased levels and consciousness
greatly increased muscle tone
and autonomic dysfunction

• including hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling

Question 11

What is the treatment for Neuroleptic malignant syndrome

Answer 11

the treatment consists of early detection discontinuation of the antipsychotic agent

management of fluid balance

reduction of temperature and monitoring for complications

mild cases of neuroleptic malignant syndrome are treated with parlodel

whereas more severe cases are treated with intravenous Dantrium
And ECT

Question 12

What is Countertransference

Answer 12

nurse’s response to a pt that is based on the nurse’s unconscious needs, conflicts, problems, or view of the world.

( a patient reminds the nurse of her grandparent or parent).

Question 13

What does the nurse do if a patient says

“please don’t tell anyone”

Answer 13

the nurse has to tell the patient that they have to share info with the other staff.

The nurse is also obligated to inform authorities in neglect, abuse cases and if the patient is in danger of harming himself or others.

Question 14

Orientation phase-

Answer 14

development of trust and rapport

In the first session the nurse should go over relationship parameters, contracts, confidentiality/ privacy rights, and the termination phase.

Question 15

Working phase-

Answer 15

nurse anticipates that identified pt issues will be explored and resolved.

A greater sense of independence, self-responsibility, and resolved transference occur in working phase.

Question 16

Termination is first planned in the

Answer 16

orientation phase

Question 17

Gifts should not be accepted by the nurse. But it is ok to accept

Answer 17

a drawing or painted picture from a patient.

Question 18

True or false

Advance practice nurse (APN) can prescribe psych meds.

Answer 18

true

Question 19

True or false

If a patient has previously been treated at another clinic and then comes to your clinic you need to restart at the orientation phase.

Answer 19

True

Question 20

Boundary blurring-

Answer 20

Example

A nurse having strong protective feelings for a patient, or inviting them to a staff party. ( role of patient and nurse shift).

Question 21

In Bipolar disorder, Manic symptoms can be controlled by

Answer 21

lithium after serum level is attained

teach: eat moderate amounts of sodium a day while taking lithium

Question 22

If a patient with Bipolar Disorder has a relapse of manic symptoms,________ can be added to lithium to bring hyperactivity under rapid control.

Answer 22

zyprexa

Question 23

Anticonvulsants for mood control-

Answer 23

Carbamazapine (Tegretol) or valproate would be used to treat bipolar disorder.

Carbamazapine may work better for severe paranoia or rapid cycling, or angry manic pts.

Question 24

Bipolar disorder has a genetic implication- exact cause is unknown.

Answer 24

A high rate of relatives with bipolar is found among pts with bipolar disorder.

Distraction techniques work best with bipolar-

Question 25

Hyperactive patient with acute mania- initial nursing intervention-

Answer 25

set limits on behavior as necessary

Neutral walls with simple, pale accessories for manic pts – provide a subdued environment

patients are easily stimulated by the environment

Question 26

Take lithium with meals to avoid ______.

Answer 26

nausea

Question 27

Monitor salt and fluid intake with lithium- watch for

Answer 27

sweating, weakness and nausea-

lithium should be taken everyday to prevent relapse-

Caution with lithium if pt has heart failure

Question 28

Why does Bipolar 1 require the closest supervision?

Answer 28

because psychosis may occur when manic and the patient is more unstable

Question 29

What is the primary prevention for suicide

Answer 29

teaching school aged children to manage stress and resiliency

Question 30

What is a clue to suggest a person is impending suicide?

Answer 30

They start to give away their valuable and important items

Question 31

SAD Persons scale—

Answer 31

evaluates 10 risk factors of suicide potential- age, sex, depression, previous attempts, alcohol use, rational thinking loss, social support lacking, organized plan, no spouse, sickness.

Question 32

Priority assessment for suicide

Answer 32

determine patients ability of means and lethality of method.

Example
Jumping off a bridge is more lethal than an overdose because in an overdose you could be saved at the hospital.

If you jump off a bridge or building youd just be dead most likely.

(remember, first priority in suspected overdose is to ask them What, When, and how much they took.

Question 33

_________ is predictive of suicide risk

Answer 33

Hopelessness

Question 34

True or False

Genetics are associated with suicide.

Answer 34

True

Question 35

What ethnic group has the highest suicide rate

Answer 35

Whites have suicide rates almost twice to that of non-whites—

older males and adolescents and young adults have the highest rate