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Class 5: Mental Health Flashcards

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1
Q

Common outcomes for schizophrenia

A

Reduced risk of harm to self or others
Refrains from attending to and responding to delusions and hallucinations
Increased self-care, medication adherence
Asks for validation of reality, exhibits reality-based thinking

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2
Q

Nursing interventions for schizophrenia

A

-Self-care, milieu, & group therapy

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3
Q

Promoting self-care + nutrition

A

Antipsychotics cause weight gain leading to the onset or worsening of diabetes and metabolic syndrome

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4
Q

Self-care in schizophrenia + attire

A

Clean & weather appropriate clothing

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5
Q

Purpose of milieu therapy

A

-Decrease stimuli, protection from stressors and structured activities
-Monitor for signs of aggression

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6
Q

Structured activities provide…

A

Distraction from delusions and hallucinations

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7
Q

Signs of aggression

A

Externally responding to delusions and hallucinations

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8
Q

Purpose of group therapy in schizophrenia

A

-Increase social skills, modify unacceptable behavior
-Participate in constructive leisure activities
-Provide external support and opportunities to practice new skills

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9
Q

Antipsychotics: General information

A

-Known as neuroleptics
-Highly lipid soluble

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10
Q

Typical antipsychotics

A

-1st gen/conventional antipyschotics
-CHFPFZ
-Chloropromazine
-Haloperidol
-Fluphenazine
-Primozide
-Flupenthixol
-Zuclopenthixol

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11
Q

Typical antipyschotic MOA

A

Block D2 receptors (dopamine receptors that control synthesis, release & reuptake)

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12
Q

Typical antipsychotic indications

A

-Treat positive NOT negative symptoms
-Psychosis, Schizophrenia, Bipolar, Aggression/Agitation

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13
Q

Other information about typical antipsychotics

A

-2nd line tx
-Used for depot injection (long acting, 2 weeks)
-Less weight gain, decreased incidence of metabolic syndrome

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14
Q

Typical antipsychotic interactions

A

-CNS depressants (additive, increased sedative effect)
-Stimulant (competes, decreased effectiveness)

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15
Q

CNS adverse effects + typical antipyschotics

A

Sedation & reduced seizure threshold

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16
Q

Extra pyramidal symptoms + typical antipsychotics

A

Dystonia, akathisia, pseudo parkinsonism, tardive dyskinesia

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17
Q

Neuroleptic malignant syndrome + typical antipsychotics

A

-Muscle rigidity
-Increased temperature, HR & CK, aBP & mental status

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18
Q

Agranulocytosis + typical antipsychotics

A

Decreased neutrophils

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19
Q

Typical antipsychotics CV adverse events

A

Postural hypotension, tachycardia, non-specific ECG changes, arrhythmia

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20
Q

Typical antipsychotic anticholinergic adverse events

A

Dry mouth, blurred vision, constipation & urinary retention

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21
Q

Typical antipsychotic adverse events + endocrine/sexual side effects

A

-Increase prolactin
-Decreased sexual drive, ED, retrograde ejaculation

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22
Q

Typical antipsychotic GI adverse events

A

Constipation/diarrhea

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23
Q

Atypical antipsychotic medications

A

-2nd gen/unoconventional antipsychotics
-“pines”, “dones”, LAZCORQ
-Lurasidone, ziprasidone, risperidone
-Quetiapine, clozapine, olanzapine,
-Aripiprazole

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24
Q

Atypical antipsychotic MOA

A

-ACHS
-Blocks dopamine receptors D1 – D5 (serotonergic, alpha adrenergic, histamine, and cholinergic receptors)
-Preferential binding in the limbic area vs. the striatum area of the brain; reduces EPS

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25
Atypical antipsychotic indications
-Treat positive & negative symptoms of schizophrenia -TX of bipolar disorder, and for aggression/agitation
26
Atypical antipsychotic: Other information
-Less EPS & prolactin elevation, lower risk of TD -Improve cognition -Considered 1st Line Treatment
27
Atypical antipsychotic interactions
CNS depressants & stimulants
28
Atypical antipsychotic adverse reactions
-Headache, nausea, sedation, fatigue -Anticholinergic effects -Weight gain, edema, dyslipidemia, hyperglycemia, hyperthermia -HTN, hypotension, tachycardia, increased prolactin, prolonged Q-T -EPS, NMS
29
Antipsychotic implications for nursing
-Thorough physical assessment, change positions slowly -Supports, finances (meds can be very expensive) -Assess for safety concerns (more energy but same mood for first few weeks)
30
Adverse drug reactions: Metabolic syndrome
-Abdominal obesity: Waist circumference >40” in men & >35” in women -Dyslipidemia, elevated fasting glucose & BP -Lead to CVD
31
Adverse Drug Reaction: Metabolic Syndrome monitoring
-BP, BMI and waist circumference at baseline, 1, 2, 3, 6, 9, & 12 months -Lipid panel & FBG at baseline at 3, 6, & 12 months
32
Adverse Drug Reaction: Metabolic Syndrome tx
-Diet, exercise, smoking cessation -Medications PRN for BP, diabetes, cholesterol, and weight
33
Adverse Drug Reaction: Extrapyramidal symptoms (EPS)
-Dystonia, tardive dyskinesia, akathesia, & parkinsonism -DTAP
34
Parkinsonism
Tremor, shuffling gait, drooling, cogwheel, rigidity
35
Akathesia
Muscle weakness, restlessness & rigidity
36
Dystonia
Spasms & cramping in face, arms, legs, and neck
37
Tardive dyskinesia
Bizarre facial, tongue, and upper/lower extremity movement: Lip smacking, blinking or grimacing, stiff neck, difficulty swallowing
38
Medications For the Treatment of Extrapyramidal symptoms (EPS): EPS can be minimized by
-Decreasing antipsychotic dose -Adding an antiparkinsonian drug or anticholinergic agent
39
Medications For the Treatment of Extrapyramidal symptoms (EPS): General (trade) name
-TBD -Trihexyphenidyl -Benztropine mesylate -Diphenhydramine hydrochloride
40
Trihexyphenidyl & benztropine mesylate + Medications For the Treatment of Extrapyramidal symptoms (EPS)
-Antiparkinsonian drugs & anticholinergic agents
41
Diphenhydramine hydrochloride + Medications For the Treatment of Extrapyramidal symptoms (EPS)
Antihistamine (used for its anticholinergic properties)
42
Adverse Drug reaction: Neuroleptic malignant syndrome (NMS)
-Has been treated with neuroleptics within 7 days -aMental status & BP, tachycardia, hyperthermia -Muscle rigidity, leukocytosis, & incontinence
43
Managing toxicity of antipsychotics in order
-Hold medication -Manage life threatening adverse reactions -Notify physician -Document
44
Benzodiazepines may be used to...
Treat intermittent episodes of intense anxiety
45
Other medications may be used for...
-Their off-label sedative effects -Examples: Imovane (hypnotic), Trazadone (antidepressant), Seroquel (antipsychotic) -SIT
46
Caffeine
May be helpful for patients who exhibit negative psychotic symptoms
47
Nicotine can...
Decrease the release of dopamine, resulting in less intense hallucinations
48
Stimulants such as cocaine...
Mimic dopamine and are contraindicated in the treatment of psychotic disorders
49
Health teaching & promotion + schizophrenia
-Emphasis on the chronic and recurrent nature of the illness -S&S of impending episodes: Vegetative shifts (changes in nutrition, sleep and activity) -Side effects of medication
50
Evaluation of schizophrenia
-r/t quality of life -Frequent assessment, do not evaluate presence or absence of delusions and hallucinations
51
BPD patient outcomes
-Personal behaviors promote effective relationships -Positive adaptation to significant events -Patient can exercise self-restraint of negative and destructive behaviors
52
Guidelines for interventions
-Set realistic goals -Communication is clear & straightforward -Avoid rejecting and rescuing patient when problem behaviors arise -Consistently implement the care plan
53
Avoid rejecting and rescuing patient when problem behaviors arise: Examples
-Attributing behavior to past events (reminds pt of all the bad things that have happened to them) -Attributing behavior to the diagnosis (says that patient IS a personality disorder) -Not offering hope for change
54
Facilitating consistent client care
Slide 48
55
Nursing intervention strategies: Limit setting
-Establishing boundaries of acceptable behavior: -Create a plan with consequences -Accommodate reasonable changes but be careful that accommodation does not turn into bargaining -ACE
56
Nursing intervention strategies: Controlling anger
-Assist the patient to identify the source of their anger -Encourage patient to seek assistance to manage anger -Can be a warning sign -ACE
57
Nursing intervention strategies: Managing impulsivity + problem solving strategies
-Identify the problem -Use a stop and think approach -Brainstorm alternative courses of action -Evaluate the outcome for the chosen course of action
58
Nursing intervention strategies: Managing self-harm
Slide 53
59
BPD dialectical behaviour therapy (DBT) premise
-Combines cognitive and behavioral techniques with mindfulness -Emphasizes being aware of your thoughts and actively shaping them
60
BPD dialetical behaviour therapy (DBT) goal
Increase distress tolerance & improve social skills
61
BPD dialetical behaviour therapy (DBT) tx targets
Identify interventions for suicidal behavior & interrupt destructive behaviors
62
DBT core strategies
-Acceptance Strategies: Validation & cheerleading -Change Strategies: Observing Limits & skill Teaching
63
Acceptance strategy: Validation
-Recognize the kernel of truth -Communicates that staff accept the pt
64
Change strategies: Skills training
Mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness
65
Skills training: Mindfulness
-Helps to distinguish between thoughts, assumptions, and FACTS
66
Skills training: Distress tolerance
-Used in the moment to reduce stress and increase safety. NOT an effective long term survival skill -Tasks: Stay present, tolerate and accept distress, avoid impulsive actions
67
Skills training: Emotional regulation (emotions can be...)
Important for effective communication, can be self validating and guiding
68
BPD medications do...
Not treat the underlying personality disorder
69
BPD health teaching & promotion
-Emphasis on chronic nature of the illness -Education r/t understanding triggers, behaviours contributing to safety risks, and establishing a safety plan
70
BPD long term evaluation
-Develops relationships, positive coping strategies and free from self-harm

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