Mental Health exam 2 bp Flashcards
(148 cards)
1
Q
Typical Antipsych are
A
first gen
2
Q
Atypical Antipsych are
A
second gen
3
Q
When do we use Typical antipsych
A
positive symptoms
4
Q
When do we use Atypical anti
A
negative symptoms
5
Q
What are positive symptoms
A
symptoms present in a client that should not be there
hallucinations, delusions, illusions, bizzare behaviors
6
Q
What are negative symptoms
A
Symptoms that are not present or lacking,
5 a’s
7
Q
What are the 5 a’s?
A
Affect, Avolition, Anergia, anhedonia, Alogia
8
Q
Affect
A
loss of affect: instead flat or blunted
9
Q
Avolition
A
loss of motivation, hygiene
10
Q
Anergia
A
no energy
11
Q
Anhedonia
A
no pleasure
12
Q
Alogia
A
poverty in thought, and changes in speech
13
Q
What can happen when we are treating depression in a client?
A
can trigger an episode of mania
14
Q
Grief and depression…
A
mimic each other.
15
Q
Difference between Bipolar 1 and Bipolar 2
A
Bipolar one has an episode of mania and usually requires hospitalization
16
Q
Bipolar 2 is
A
hypomania and usually does not result in hospitalization
17
Q
What is the priority intervention for Bipolar Disorders?
A
safety
18
Q
1.9 lithium level or less interventions
A
hold medication, and notify provider, get blood lithium and sodium level.
19
Q
Carbamazepine is a
A
anticonvulsant and anti-epileptic
20
Q
Risk with Carbamazepine
A
blood dyscrasia:
leukopenia, anemia, thrombocytopenia
21
Q
What blood test should we do to test for with the use of Clozapine?
A
ANC(absolute neutrophil count)
22
Q
Monitor for what during Clozapine use
A
Agranulocytosis, neutrophil suppression
23
Q
MAOI can cause what to happen if patients ingest tyramine foods?
A
Hypertensive crisis
24
Q
What is a fatal side effect that should be included in patient education for clozapine?
A
agranulocytosis
25
What diet education should the nurse include for a client taking phenelzine?
restrict foods containing tyramine
26
Which client teaching is correct for sertraline?
sertraline will not have an immediate effect on the body. It will take even up to 3 months to see an effect
27
What symptoms only exist with bipolar 1
mania
28
a client experiencing confusion, blood pressure changes, and diaphoresis while taking an SSRI, you suspect?
Serotonin Syndrome
29
What statement might indicate a manic episode?
" I have not slept for seven days"
30
What nursing intervention should be implemented for a client experiencing mania?
Place client in a quiet, separate area and maintain safety.
31
A client replies, "hip hooray, the flip is cast and wide sprinting in the forest", this is an example of what finding?
Word salad
32
2 most common surgeries that cause delirium
cardiac and orthopedic
33
Unit with the most delirium in the hospital
ICU
34
Describe Echolalia
When a patient repeats the exact words you said to them during a conversation
35
Characteristics of mania
lasting one week and present most of the day, every day
decreased need for sleep, more talkative, flight of ideas, distractibility, inflated self-esteem, or grandiosity.
36
ECT
Need to do an ekg, before hand.
37
Phenelzine client education
risk for hypertensive crisis if patient eats tyramine.
38
Sertraline client education
can cause sexual dysfunction which can result in low medication adherence.
Monitor for seratonin syndrome.
39
Selegiline (MAOI) client education
Transdermal patch, observe for cns stimulation )anxiety, agitation, hypomania, and mania).
Remove old patch before applying new one,
40
Lithium client education
No NSAIDs, weight gain, (5 lb difference notify provider).
41
SSRIS and hyponatremia client education
ssris: citalopram, fluoxetine, sertraline
Seratonin syndrome can occur. If this occurs hold medication and notify provider.
sexual dysfunction can occur.
Hyponatremia risk
42
Meds that trigger mania?
anti-depressants
43
Why is it important to reduce stimulation in patients with Bipolar?
can increase mania
44
Promoting nutritional intake for Patients with Bipolar
finger foods, high protein, high calorie, and drinks
Chicken nuggets,
avoid caffeine
45
Delirium Vs Dementia
Delirium is short term with rapid onset and can be reversed.
Dementia is chronic and occurs gradually with no reversal
46
Which disorder is reversible?
delirium
47
Dementia does what at 65?
once you hit 65, every 5 years your chances double
48
Dementia is leading cause of death. Dementia does not lead to death but what does
bed sores, infections, aspiration pneumonia
49
First stages of dementia are?
symptomless
50
Risk for Dementia
age, head trauma, genetics, lewy body disease, hiv infection, vacular disease, prion disease
51
Sundown syndrome
insomnia, anxiety, agitation, pacing, walking, confusion, paranoia, hallucinations, restlessness
52
Interventions for dementia
safety, structured schedule activities, strict feeding and toileting times, walk with client, restrict access to departure on unit.
DO NOT come up behind them or put hands on them.
53
What is Catatonia
Refers to a significant motor disturbance (no motor activity) to excessive motor activity and agitation,
54
Symptoms of psychosis
Disorganization of the personality, deterioration in social functioning, and loss of contact with or distortion of reality.
55
Symptoms of Schizoaffective disorder
Client may appear, depressed with psychomotor delay, si, euphoria, grandiosity, and hyperactivity
56
Symptoms of dementia
aphasic, self-care deficit, isolation, difficulty naming objects, common personality changes, inability to carry out purposeful motor activities or use objects properly.
Vague language, inappropriate behavior.
57
Frontal lobe effects what?
A client has difficulty with brushing their teeth and buttoning their shirt.
58
Parietal lobe does what
recognizes my own environment and where things are located.
59
Temporal lobe
A client is experiencing hallucinations and cannot ask for help
60
Hippocampus
short term memory.
The client can remember her name but not your name
61
Amygdala
The client is scared and paranoid of the staff.
62
Occipital
a client sees a picture of a fork but cannot name the object
63
Black box warning for antipsychotic meds
do not give to people with neuro disorders.
64
What drugs are MAOI
Phenlzine, Selegiline,
65
Interventions for a client with hallucinations
ask client directly about the hallucinations
do not argue with them
provide safety
identify what triggers the hallucinations
66
Anticholinergic side effects
dry mouth, blurred vision, constipation, urinary retention
67
Tardive Dyskinesia
side effect of antipsych
lip smacking, tongue thrusting, irreversible. severe eps
68
Use of benztropine
Is used to treat symptoms of eps
69
What is a flat affect?
no facial expression
70
Neuroleptic Malignant syndrome
Lifethreatneing medical emergency that occurs with the use of anti-psych (typical)
71
Onset of Schizophrenia
high school and early in college
72
What is waxy flexibility
associated with catatonia
Client with Schizophrenia allows body parts to be placed in bizarre or uncomfortable positions.
73
What is word salad
a group of words put together but no logical connection
"most forward action grows life double plays circle uniform"
74
Clozapine client education
blood drawn every week for 6 months.
75
Disturbed sensory perception interventions
Observe patients for signs and symptoms of hallucinations.
"are you hearing other voices?"
"are you able to distinguish those voices?"
safety, keep the bed at the lowest position, reorient them, walking rhythmic dancing
76
Symptoms of alcohol intoxication
Behavioral/cognitive: mood liability, impaired judgement, slurred speech, incoordination, unsteady gait, nystagmous and facial flushing
PPhysical: Cns depression, hypoglycemia, hypothermia, hyper or hypotension, vomitting.
77
Symptoms of alcohol withdrawl
Coarse tremors of hands. tongue or eyelids. n/v, malaise and weakness, tachycardia, sweating, elevated bp, anxiety, depressed mood, and irritability, transient hallucinations or illusions, headaches and insomina.
78
Gambling addiction
Persistant and reoccurring problematic gambling behavior leading to clinically significant impairments or distress.
79
Benzo withdrawl
anxiety, insomnia, diaphoresis, hypertension, possible psychotic reactions, hand tremors, n/v hallucinations and illusions, psychomotor agitation, and possible seizure threshold.
80
Risk factors in substance use disorders
genetics, chronic stress, lowered self esteem, few life successes, risk taking tendencies, history of trauma, lowered tolerance of pain.
81
Inhalant intoxication
irritation around the eyes, nose, and mouth and blurred vision
82
opioid intoxication sx
Euphoria followed by apathy, dysphoria, psychomotor agitation, and impaired judgement.
Physical: anorexia, drowsiness, slurred speech, and impairment in attention and memory.
83
What is tolerance?
need more of a drug to reach a desired effect
84
Acamprostate indication
alcohol absteince
85
symptoms of alcohol use
Relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, and sleep .
86
Screening tools for substance use disorders
CAGE, cwa, SBRI used for after alcohol withdrawal,
87
Disulfiram education
avoid alcohol while on this medication. If patient drinks on this medication they can experiance a disulfiram reaction.
Reaction sx: Hangover symptoms. Flushed face, confusion, n/v, tachycardia, sweating, headache.
Too much alcohol ingestion can cause, Respiratory depression, cardiovascular collapse, arrthymias, mi, heart failure.
88
Carbamazepine client education
notify provider if indications of blood dyscrasias are present.
Do not get pregnant
avoid grapefruit
know fluid overload.
notify provider if steven-johnson syndrome occurs
89
Purpose of MMSE
evaluate client for Neurocognitive disorders. (dementia)
90
Perserving self esteem in neurocognitive disorders
we need to allow them time to do their own adls, recognize when their self esteem is low,
3 defense mechanisms: denial, confabulation (making up memories)
preservation (random words or phases to avoid answering questions)
91
Donepezil indications
used in tx for dementia, does not cure, just helps
92
Seratonin syndrome
can begin 2-72 hours after the start of treatment and can be lethal
93
Grief and depression difference
Grief is time limited. If a client gets stuck in the first stages of grief then they can slip into depression
94
Important for Electroconvulsive therapy.
get chest x ray, blood test, ekg before administering this therapy
95
What are the different neurotransmitters?
seratonin, dopamine, epi, nore epi, gaba
96
Gambling causes what to happen?
Gamblers experience a sensation of relief when they win a match causing them to have decreased stress. Many use gambling as a way to try and cope with stress or regain a sense of control.
97
What behavior might we see in an individual that has a gambling addiction?
absence from work, borrowing or stealing money from families, forgery and theft and embezzlement.
Acquiring money from illegal sources.
98
which receptor is believed to be connected to gambling addiction
dopamine.
99
Why is treating someone with a gambling addiction hard?
They have to come to the realization that they have a problem.
Most of the time they will only seek out treatment based on legal problems, family pressure or psychiatric complaints.
100
First gen(typical) meds include
Phenothiazines, Haloperidol.
These improve positive symptoms and cause negative symptoms to worsen
101
Second gen (atypical) meds include
Clozapine, aripiprazole, olanzapine, risperidone,
improvement of positive and negative symptoms.
102
How do first gen anti-psych work?
They lower the brain levels of dopamine by blocking dopamine receptors. This causes a reduction of psychotic symptoms.
103
First gen antipsych can have effects like,
EPS, and neuroleptic malignant syndrome
104
What are symptoms of EPS
dystonia, akathisia, pseudoparkinsonism and tardive dyskinesia
105
What medication can we give to treat eps
benzotropine
106
What are symptoms of NMS
sudden high fever, blood pressure flucuations, diaphoresis, tachycardia, muscle rigidity, d, loc, coma.
107
Interventions of NMS
stop antipsych med
apply cooling blankets
monitor vs
admin antipyretic
admin dantrolene or bromocriptine to induce muscle relaxation, immediate transfer to icu
108
What disorders does Catatonia appear in?
Schioaffective, Schizophrenia.
109
What symptom is used for dx of Schizoaffective disorder
presence of hallucination and or delusions that occur for at least 2 weeks in the absence of major mood episode
Prominant mood disorder sx must be evident most of the time
110
Loose association speech
speech ideas shift from one unrelated subject to another
"we wanted to take the bus but the airport took all the traffic. Driving is the ticket when you want to get somewhere. We all have it in our pockets"
111
Clang Association
Words are governed by sounds. Rhyming
"it is very cold, i am cold and bold, the gold has been sold."
112
Hallucinations are what?
False sensory perceptions not associated with real external stimuli. Can include any of the 5 senses.
113
Illusions are what?
Misperceptions or misinterpretations of real external stimuli.
114
With waxy flexibility, once the body part has been placed in a position, will the patient immediately drop that part?
no, they will hold it for a long period of time regardless of how uncomfortable it may be for them.
115
what are signs and symptoms in a client experiencing a hallucination?
Listening pose, laughing or talking to self, stopping mid sentence.
116
What is important to remember when intervening with a patient experiencing a hallucination?
Do not touch them without permission. Approach them from the front and keep a distance. Keep an attitude of acceptance.
117
Why is it important to keep an attitude of acceptance with patients having hallucinations?
This will encourage the patient to share the content of the hallucination with you.
118
What question should we ask to assess the source of the voices in hallucinations?
"Do these voices seem familiar to you, or do they seem to be unfamiliar?"
119
How do we avoid reinforcing the hallucinations?
use "the voices" instead of referring to the voices as, "they".
120
Dopamine blockage can result in?
EPS and prolactin increasage (galactorrhea, gynecomastia)
121
What can we teach our patients taking a second gen antipsych (atypical) to minimize weight gain?
Follow a healthy low cal diet, monitor weight and encourage regular exercise.
122
SNRIs
duloxetine, venlafaxine, levomilnacipram, desvenlafaxtine
123
What is a major manifestation of inhalation withdrawl?
Flashback hallucinations can occur immediately or years later for years.
124
How do SSRI work?
selectively block reuptake of the monoamine neurotransmitter seratonin in the synaptic space. This intensifies the effects of seratonin.
125
Hyponatremia with SSRI education and intervention
IF patient is taking diuretics can increase risk for hypnatremia,
obtain baseline sodium level and periodically obtain levels throughout tx.
126
manifestations for seratonin syndrome
mental confusion, abd pain, diarrhea, hyperflexia, diaphoresis, tremors, hallucinations,
127
Nursing interventions for seratonin syndrome
admin meds to create a seratonin receptor blockade and muscle rigidity, cooling blankets, anticonvulsants and artificial ventilation.
128
SSRIs can not be taken in conjuction with which meds?
MAOIS and TCAS, NSAIDs,
129
SNRI teaching
do not stop abruptly, need to gradually quit. Sexual dysfunction can occur. teach patient how to deal with this.
130
Selegiline is contraindicated in?
patients taking carbamazepine or oxcarbazpine. Taking these meds with MAOI can increase blood levels of maoi
131
Tyramine foods
beer, aged cheese, pepperoni, salami, avacados, figs, bananas, red wine, smoked fish, some dietary products.
132
Donepezil does what
increases acetylcholine that ultimately increases the availability of acetylcholine at receptor sites. This helps aid in improving ability to preform self care and slow cognitive deterioration.
133
lithium toxicity 1.9 less
tremors, mental confusion, ongoing gi distress
134
meds given during electroconvulsive therapy
glycopyrolate, atropine, propofol, etimidate, succi
135
acronym for cage
C: Has anyone told you to cut down your drinking?
A: does anyone get annoyed by your drinking
G: Do you every feel any guilt when you drink?
E: Do you ever start out your day drinking or do you ever need it to relax
/
136
acetylcysteine
reduces seeking withdrawal and toxicity
137
Chlordiazepoxide (benzo)
given for alcohol withdrawal,
138
Withdrawal occurs within ____ after cessation or reduction
4-12 hours
139
If we don't treat alcohol withdrawal within 24-48 hours, (Delirium Tremons).
delirium
140
Benzodiazepine withdrawal interventions
seizure, fall and suicide precautions
141
prevent benzo withdrawal
taper and do not stop abruptly
142
opioid abuse starts off with what
an injury
143
Benzodiazepines can do what
and decrease seizure threshold.
144
When do we give clonidine?
reduction of alcohol abstinence.
Treat with benzo first then clonidine
clonidine works with blood pressure.
145
what brain structures are most associated with the drive complex for compulsive substance use?
Amygdala, Prefrontal cortex, Basal ganglia
146
Exposure to acetaldehyde leads to which of the following symptoms?
flushing, n,v, hypertension,
147
A cns depressant such as a sedative works on which areas of the body?
nerves, brain, muscle, heart,
148
