Exam 2 Flashcards
(106 cards)
1
Q
Mental health disorder characterized by persistent sad mood or loss of interest in activities, causing impairment in daily life
A
Depression
2
Q
S/s of depression
A
Sadness /emptiness Low energy Decreased appetite General weakness Insomnia Low motivation/social withdrawal (apathy) Indecisive Negative thinking Loss ability to experience pleasure in life Low self esteem Excessive emotional sensitivity Irritability Suicidal ideation Guilt
3
Q
What is becks cognitive triad? (Three views)
A
Found that people process negative ways with positive factors
Negative self view of self (I never do anything well, everyone else is smarter)
Pessimistic view of the world (once your down, you can’t get up)
The belief that negative reinforcement will continue (it doesn’t matter what you do, nothing gets better)
4
Q
Who is more at risk for suicide
A
Men People with a weapon/gun Elderly with health issues Mental health conditions/hallucinations/delusions Hx of last suicide attempt Hx of depression People with a plan Lack of family support/no family Single/widowed/divorced Lonely/lives alone Alcohol/drug abuse Aggressive behavior Giving away items Unhealthy home environment Antisocial
5
Q
What questions to ask people with suicide idealizations?
A
Do you have a plan?
Do you have any weapons? (More likely to commit suicide faster)
Hx of depression/anxiety
Any support?
6
Q
Who is at low risk for suicide
A
Healthy people Good support systems Financially stable people Positive home environment Church goer (support)
7
Q
Depression nursing diagnosis
A
Risk for suicide Impaired memory/Maher to make decisions Ineffective role performance Decisional conflict Hopelessness Constipation Sexual dysfunction Risk for loneliness Self neglect Low self esteem Ineffective coping Spiritual distress Unusual sleeping pattern Inadequate nutrition Ineffective role performance
8
Q
Communication interventions with depression?
A
Help the patient question underlying assumptions and beliefs And consider alternate explanations to problems
Work with the patient to identify cognitive distortion that encourage negative self appraisal such as:
Self blame, mind reading not counting positive attributes
Discuss physical activities that the patient enjoys (explain benefits of 10-15 min or 3-4x a week has short term benefits
Encourage formation of supportive relationships such as support groups, therapy, peer support
Provide information referrals when needed for community resources
9
Q
Physical interventions to take with depression?
A
Nutrition
Sleep
Self care
Eliminations/constipation
10
Q
Nutrition interventions with depression
A
(offer small, high calorie/protein snacks frequently through out day, encourage family to stay with patient through meals, ask what food/drink they like, weight patient weekly
11
Q
Sleep interventions with depression
A
Provide rest periods after activities
Encourage to get up out of bed and dressed for day
Encourage relaxation measures
Reduce environmental and physical stimulants in evening
De caffeinated drinks, dim lights , quiet noise/activities
12
Q
Interventions for self care issues with depression patients
A
Encourage use of toothbrush, washcloth, soap, make up
Give reminders when needed
13
Q
Intervention on elimination/constipation on people with depression
A
Monitor I &O
Offer foods high in fiber
Exercise
Encourage fluids
Evaluate need of laxatives and enemas
14
Q
A Symptom of schizophrenia
Lack of pleasure or interest in life activities that one usually finds enjoyable
A
Anhedonia
15
Q
Tofranil
A
Nerve pain medication and antidepressant
16
Q
Generic name for Tofranil
A
Imipramine
17
Q
An MOA, intensifying effects of norepinephrine. An antidepressant for atypical depression such as bulimia, OCD
A
Phenelzine
18
Q
Classification on Citalopram and what it does ?
A
SSRI - tx of depression
19
Q
Side effects of SSRIs
A
Toxic side effect - serotonin syndrome (fever, tremors, seizures, diarrhea, dilated pupils, sweating)
If occurs DC the SSRI
20
Q
MAIO side effects
What not to take with?l and to avoid?
A
Parenthesis is a common side effect of this medication
(Numbness , tingling ,prickling,burning)
Do not take with an SSRI (needs to be out of system)
Avoid tyramine foods (aged cheese, comfort foods, greasy pizza, fried foods, fish, alcohol, beer, wine, etc
21
Q
TCA med side effects
Nortriptyline
A
Lethal overdose
Can cause hypotension
Rise slowly from sitting or laying
22
Q
Mental disorder that causes periods of depression and periods of abnormally elevated mood. (Patients can be manipulating)
A
Bipolar disorder
23
Q
Lithium normal levels
Why are they important to keep WNL
A
Must be kept below 1.5 or it could result in toxicity (tremors, GI upset, thirst, muscle weakness) and death could occur with levels above 2.5
0.5-1.5 normal range?
24
Q
?What does a patient plan for suicide look like????
A
Giving away personal items
Making suicidal comments
Has a plan
Saying goodbye to friends and family
Talking about or threatening suicide
Not everyone shows s/s
Decreased appetite, difficulty sleeping, weight loss, headache muscle aches
25
Importance of mood stabilizers ?
| Lithium, depakote, lamictal, tegretol
They reduce s/s of agitation, sleep problems, hallucinations, delusions
26
Foods with tyramine in them?
Wine, aged cheese, pickles, fried fatty foods (pizza), fish, alcohol, beer, champagne (MAOIs)
27
Nursing interventions for manic phases
Establish nurse/client relationship
Use therapeutic communication
Maintain physiological integrity
Therapeutic milieu (safe environment)
Therapeutic activities
Patient teaching
Negotiate limits on demanding manipulative behavior
28
Depakote what labs to monitor
Liver function and amylase values
29
ECT teaching to patients - post op
What to know about it? What it does ?
What it’s used for?
What meds to d/c before hand
What to ask client after tx?
Safety precautions to take with patient
Risks/contraindications
Side effects of tx
Not permanent
Relapse decreases with regular tx
Ask how they feel and if they want to continue tx
Tx May enhance neurotransmitters such as serotonin, dopamine, norepinephrine in brain
Used in severe depression, schizophrenia, bipolar
Risks include: recent heart attack, intracranial mass lesion, cerebral vascular issues
DC MOAIs and lithium 2 weeks before tx
Tx consists on 6-12 tx
Give in AM 8-12 hours after fasting
Bite guard to be used
Induces 25-60 second seizure
Position pt to side to help drainage and prevent aspiration ,Orientate client often
s/e- Memory loss may occur , reactions to anesthesia, increased heart rate by 25% temporarily, headache, soreness, nausea
30
What does a manic episode look like in bipolar?
How long does it last
Rapid, racing thoughts, ideas, fast movements, disorganized speech, incoherent, euphoria, little sleep, feeling invincible. pacing, high energy, increased metabolism
Lasts more than a week
31
What factor to consider in a patient’s health with manic bipolar
Nutrition status (increased metabolism)
32
What does childhood depression look like ?
```
?
Rebelling
Changing lifestyle
New group of friends
Irritable
Change in dress
Grooming
Self harm
Physical complaints
Decrease in school performance
```
33
Sexual dysfunction and depression
What causes it
?? SSRIs are most likely to cause it
34
Anxiety nursing interventions
```
Provide safety
Meet physical needs
Fluids
Rest
Promote self care
Milieu
None stimulating environment
Simple clear communication
Counseling
Help patient talk about feelings
Evaluate coping mechanisms
Encourage problem solving
Health teaching
```
35
Anxiety meds
Short term rapid high potency meds-
Others-
High potency - benzodiazepines:
Alprazalam , clonazepam, lorazepam
SSRIs, tricyclics, MAOIs
36
PTSD nursing diagnosis
?Disturbed thought process
Sleep deprivation/nightmares with traumatic event
On edge,
(Prioritize for safety/self harm)
37
What does OCD look like?
Repeated persistent obsessive and unwanted thoughts and urges or images that are intrusive and cause distress or anxiety
38
Benzodiazepines and alcohol effects on body
When taken together it can cause potential fatal harm to the body
Both are depressants and relax muscles and bring the central nervous system down and may result in unconsciousness or coma
39
Panic disorder symptoms
Out of the blue fear, anxiousness, sweating, chest pain, muscle tension, urinary frequency , hyperventilation, breathing difficulties, nausea, chills, hot flashes, GI issues, feeling of choking, dizziness, fatigue
(Feeling of doom or that you are going crazy or having a heart attack)
40
Agoraphobia
An intense, excessive anxiety about fear of being being places or situations where you might not be able to escape or might be difficult or embarrassing
41
SMART goal for generalized anxiety disorder ?
??
Use cognitive and behavioral therapy with medications - it can help people learn stills to get rid of their panic and is helpful in the tx with people with panic attacks
42
Events that are extraordinary, external and often unanticipated (brief)
Situational crisis
43
What does decompensating mean
Failure of body system
44
Refusal to accept reality
Denial
45
Events that are extraordinary, external and often unanticipated (brief)
Situational crisis
46
What does decompensating mean
Failure of body system
47
Refusal to accept reality
Denial
48
A life threatening reaction that can occur while taking neuroleptic antipsychotic medication
S/s include fever, confusion muscle ridgety , flexible BP, sweating, fast heart rate, kidney failure, seizures, tremor, leukocytosis
Neuroleptic malignant syndrome
49
Medication used for management of both positive and negative s/s. Atypical antipsychotic med
Not recommended over 900mg
Cloazapine
50
Slow repetitive involuntary muscle movement such as grimacing , sticking out tongue, smacking lips, jerking due to long term use of neuroleptic medications (nerve damage)
Tardiness dyskinesia (TD)
51
Difference between echolia and word salad
Word salad is a jumble of random words and phrases
Echolailia is a repetition of words and phrases that have been vocalized by another person
52
Basic Dosage calculations
?
53
Whatbto know about taking SSRIs and MAOIs
Can’t take together , much be completely out of system
Do not eat foods high in tyramine or it will increase hypertension
54
Atomoxetine , strattera, revoxetine, vestra,
Not yet approved for depression
Not available yet in USA
Not FDA approved for depression
Possible sedation or anxiety
Good for cognitive symptoms and anxiety
Minimal sexual side effects
Some studies show it may not be useful in depression
Effective in improving energy and cognition is targeted for unipolar depression and anxiety
SNRIs
55
TCA
- s/s
- used for what? What ages?
(Amitriptyline/Elavil, or mines)
Anticholinergic (constipation, urine retention, dry mouth, drowsiness, impotence, blurred vision)
OCD- 10 yr or older
6 yr or older for -bed wetting
12 yr or older otherwise
56
SSRIs
What they do and how it works
How to start with someone
Side effects
Medications
Blocks reuptake= Increasing serotonin levels in the brain
o Low doses at first due to activating affect= increasing anxiety
```
o Medications
▪ Citalopram (Clexa)
▪ Escitalopram (Lexapro)
▪ Fluoxetine (Prozac)
▪ Fluvoxamine (Luvox)
▪ Paroxetine (Paxil)
▪ Sertaline (Zoloft)
o Side Effects
▪ Suicidal thoughts/ideation
▪ Insomnia
▪ Headaches
▪ Rash
▪ Blurred vision
▪ Dry mouth
▪ Reduced libido
```
57
Often 1st-line med for treatment of many anxiety disorders, depression, OCD & BDD
SSRIs
58
serotonin syndrome
What is it
Side effects
If left untreated
High levels of serotonin accumulation in the body
• Mild (shivering, diarrhea) to Severe (muscle rigidity, fever, seizures)
• Agitation, dizziness, tachy, dilated pupils
• If high levels left untreated= unconscious and death can occur
59
Tricyclics (TACs)
What it is /how it works
Medication
Side effects
Effect changes in brain chemistry and communicate in nerve cell circuitry to regulate mood, and help relieve depression
• Block the absorption (reuptake) of serotonin and norepinephrine= increasing the levels
```
• Medications
o Amitriptyline (Elavil)
o Clomipramine (Anafranil)
o Desipramine (Norpramin)
o Doxepin (Sinequan)
o Imipramine (Tofranil)
o Maxprotiline (Ludiomil)
```
```
• Side Effects
o Blurred vision
o Anticholinergic effects (dry everything)
o Orthostatic hypotension
o Urine retention
```
60
Monoamine oxidase inhibitors (MAOIs)
For what
How it works
Contraindications
Side effects
Meds
• Enzyme Monoamine oxidase removes norepinephrine, serotonin and dopamine for the brain.
MAOIs prevent this from happening making chemicals more available for the brain
• Affect neurotransmitters in the brain AND digestive system
• Patients CANNOT eat food containing tyramine
o Strong or aged cheese
o Cured or smoked meats, fish, sausage, salami, bacon
o Beer
o Soy products
• Contraindicated in patients with co-occurring substance use disorder due to hypertensive crisis with stimulant drugs
```
• Medications
o Isocarboxazid (Marplan)
o Phenelizine (Nardil)
o Selegiline (Emsam)
o Tranylcypromine (Parnate)
```
```
• Side Effects
o Dry mouth
o Nausea, diarrhea or constipation
o Headache
o Drowsiness
o Insomnia
o Dizziness or lightheadedness
o Skin reaction at the patch site
```
61
• 1st type of antidepressant developed
MAOIs
62
Electroconvulsive therapy
Treatment for what
Remission rate
Most effective treatment for major depression w/ psychotic symptoms and treatment of pts with life-threatening psychiatric conditions
• Useful in treating pts with major depressive and bipolar depressive disorders
• Same and effective---can achieve 70%-90% remission rate within 1-2 weeks. 6-112 treatments total
• Use of a general anesthetic and muscle-paralyzing agents has revolutionized the comfort and safety of ECT.
63
• 1st line treatment for seasonal affective disorder w/ or w/o meds
Light therapy
64
Light therapy
Why it is used
* Is thought to be effective bc of the influence of light on melatonin
* Tx consist of exposure to light balanced to replicate the effects of sunlight for 30-60 mins a day
65
* Characterized by severe mood changes, ranging from extreme highs "mania" and equally extreme lows.
* This disorder is also known as manic depressive illness.
Bipolar
66
Interventions for bipolar disorder
Calm and firm approach
Short and concise statements
Remain neutral
Consistent
Frequent staff meetings
Tell patient concrete terms with consequences
Hear and act on legitimate complaints
Redirect energy into more appropriate channels
67
Nursing diagnosis related to bipolar
Injury risk
Ineffective coping
Ineffective mood control and impulse control
Self care impairment
Disturbed sleep pattern
68
Lithium (mood stabilizer)
Normal blood level?
Interacts with med?
Nutrition?
Side effects?
* Therapeutic blood level: 0.8 to 1.4 mEq/L
* Maintenance blood level: 0.4 to 1.3 mEq/L
* Toxic blood level: 1.5 to 2.0 mEq/L
• Nursing considerations
```
o Lost of drug interactions
▪ NSAIDS
▪ HTN meds
▪ Thyroid
▪ Antidepressants
▪ Antipsychotic meds
▪ High sodium food
o Ensure lots of water consumption
o Advise exercise/ be aware of dehydration
o Toxicity = increase salt intake
o Not toxic= increasing salt will dilute lithium by pulling in water which will lower lithium too low
```
• Side effects
o Ataxia, coma, confusion, depression, dizziness, drowsiness, headache, lethargy, seizures, syncope, tremor (in hands), vertigo, Arrhythmias (including bradycardia and tachycardia), ECG changes, edema,
69
Anticonvulsant
o Seems to work better in patients with rapid cycling and in severely paranoid and angry patients with mania than in patients with euphoric, overactive, and overfriendly manic behaviors.
o Thought to be more effective in patients who present with mixed bipolar disorders.
carbamazepine (Tegretol)
70
First line tx for bipolar depression
• lamotrigine (Lamictal)
71
anticonvulsant
o Valproic acid/valproate is useful in treating lithium nonresponders who are in acute mania
o Who experience rapid cycles
o Who are in dysphoric mania
o Who have not responded to carbamazepine. It is also helpful in preventing manic episodes.
• divalproex (Depakote
72
• lamotrigine (Lamictal)
How it’s tolerated
Concerns that may occur with this med?
anticonvulsant
o Generally, well tolerated, but there are two concerns with this agent
▪ One is a rare but serious dermatological reaction: a potentially life-threatening rash called Stevens-Johnson syndrome
▪ Aseptic meningitis is another rare but serious side effect
73
S/s of bipolar
Loud, hostile , combative , aggressive, demanding , manipulating, impulsive , property destruction , racing thoughts, poor judgement , inability to sleep, hygiene issues
74
chronic psychiatric disorder (6months) associated with severe distress different from other anxiety disorders in that there is pervasive cognitive dysfunction, impaired functioning, and poor health-related outcomes
Describe Generalized Anxiety Disorder
75
Defense mechanisms
Regression
Displacement
Rationalization
Denial
Projection
76
Exclusion of
Regression
77
Transfer of emotions
| Criticizing you as a nurse because of family not showing up
Displacement
78
- I didn’t get a raise because my boss dosent like me.
Rationalization
79
Ignoring unpleasant realities
Denial
80
Blaming or scapegoating
| Man subconsciously likes another woman but teases wife about liking another man
Projection
81
Potential Nursing Diagnoses for the Anxious Patient
Anxiety (moderate, severe, panic) Fear, Ineffective coping Deficient diversional activity, ineffective role performance, Ineffective coping
82
occurs in people who have experienced a traumatic event but also can occur in people who have witnessed an unbearable event
The common element in all these experiences is the individual's extraordinary helplessness or powerlessness in the face of overwhelming circumstances.
Symptoms of disturbing thoughts, dreams, feelings after a traumatic event last longer than a month.
PTSD nursing diagnosis
83
Difference between Acute Stress Disorder and PTSD
Acute stress disorder-severe reaction immediately following a terrifying event, often including amnesia about the event, emotional numbing, and derealization. Many people develop PTSD if s/s last longer than 1 month.
PTSD- Symptoms of disturbing thoughts, dreams, feelings after a traumatic event last longer than a month.
84
Medications for Anxiety
Benzodizapines: Diazepam –abrupt stopping of med after 3-4 months may result in withdrawl.
Atypical anxiolyic: Buspar –does not cause dependence
SSRIs: Paroxetine-first line drug for anxiety/depression.
SNRIs: Venlafaxine
TCAs: Clomipramine- effective for chronic anxiety
Antihistamines: Hydroxyzine
Betablockers: Proranolol
Anticonvulsants: Gabapentin
85
Schizophrenia:
Describe signs and symptoms
Priority
hallucinations, delusions, stay at least arms, length away, don’t touch if you don’t have to.
Describe hallucinations, acknowledge their experiencing but don’t go along with them or tell them they are real.
Safety
86
Differentiate between positive and negative symptoms
Negative-takes away from normal personality- (poor concentration. Less movement)
Poisitve-hallucinations, delusions, altered speech. (adds to personality)
87
Describe alternations in speech with schizophrenia
flight of ideas, saying random things
88
they mumble and jumble alot of words together and different things together that doesnt connect.
Word salad
89
they talk like they're pressured, they sound is pressured,
Pressure speech
90
new words that no one else understands the meaning, they're the only one that knows what it means, they say words in sentences and you wonder what they are trying to say.
Coin words
91
made-up words that have special meaning for the person
Neologisms
92
repeating of another's words by imitation
Echolalia
93
, mimicking the movements of another
echopraxia
94
is the meaningless rhyming of words, often in a forceful manner
Clang association
95
Inpatient treatment team Residential alternative to hospitalization Community- Internist Neurologist. Crisis intervention Safety Acute symptom stabilization
Acute tx phase
96
- Understanding and acceptance of illness, Community support staff Family support groups Group therapists and self-help groups Practitioners of behavioral therapies using educational models and cognitive restructuring
Stabilization phase
97
- Social, vocational, and self-care skills Learning or relearning Identification of realistic expectations Adaptation to deficits, Group therapists Social, vocational, and self-care providers Family, employer, community support staff.
Maintenance phase
98
What is the reasoning for tx focus during different phases?
To help client adhere to med regimens , understand diagnosis, participate in education with family
99
Describe EPS vs NMS symptoms
(drug induced movement disorders)
EPS- Dyskinesia's (TD)-lip smacking, tongue rolling, dystonia (back arching), EPS includes things like flapping of the toungue, Akathisia (Rock back and forth), dyskinesia(muscle movements)
NMS-muscle rigidity, sweating, drooling NMS includes Hyperpyrexia (High fever) altered mental status - rare but life threatening after dose is increased or tx is started
100
Nursing Diagnosis associated with schizophrenia
∗Disturbed sensory perception: auditory or visual† Impaired environmental interpretation syndrome
Risk for self-directed/other-directed violence Ineffective impulse control
∗Disturbed thought processes† Defensive coping Disturbed personal identity
∗Impaired environmental interpretation syndrome
Impaired verbal communication
∗Disturbed thought processes† (Disorganized or disturbed speech patterns in schizophrenia are evidence of disordered thought processes.)
Social isolation Impaired social interaction Risk for loneliness Ineffective relationship
Risk for compromised human dignity Chronic low self-esteem
Risk for self-directed violence Risk for suicide
Ineffective coping Bathing self-care deficit Dressing self-care deficit Self-neglect Constipation Deficient diversional activity
23 / 23
Compromised family coping Impaired parenting Caregiver role strain Deficient knowledge Deficient community health
Nonadherence
101
Patient education in regard to medication compliance- alternative forms
Non-compliance is a big issue among psychiatric patients, can use alternative forms such as an injectable that will be administered every month.
102
Bipolar 1 Disorder or 2
•At least one episode of “persistent or elevated, expansive or irritable mood” (mania), and at least one clearly recognizable episode of major depression.
Bipolar 1
103
Bipolar one or Two Disorder
•Presents with recent severe and prolonged periods of depression that alternate with brief periods of hypomanic episode(s).
•Decreased need for sleep; daytime fatigue
Bipolar two
104
Drug Induced Movement Disorders.
Acute Dystonia
105
•is a movement disorder characterized by a feeling of inner restlessness
Akathisia
106
Phases of Schizophrenia
```
➢ Phase 1-Acute
o Onset or exacerbation of symptoms
o Disruptive positive symptoms
➢ Phase 2-stabilization
o ___________________________________________
o Movement toward baseline
➢ Phase 3-maintenance
o Nearing baseline
```
