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Mock Exam Flashcards

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1
Q

Outline four therapeutic communication techniques:

A
  • Listening (being fully present, lets patient be heard, convey interest)
  • Silence (gather thoughts)
  • Open ended questions (decide on manner of response)
  • Restating (repeat main message)
  • Reflection (reflect and interpret back)
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2
Q

Name four therapeutic approaches used in mental health setting:

A
  • Psychotherapy
  • Pharmacotherapy
  • ECT
  • CBT
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3
Q

List four reasons for carrying out a risk assessment:

A
  • Part of an overall assessment upon admission to mental health facility
  • Major changes in client circumstances
  • When moving clients between services
  • Prior to granting leave/discharge
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4
Q

State four side effects of atypical antipsychotics:

A
  • Hypotension
  • Dizziness
  • Fainting
  • Sedation
  • Weight gain
  • Insomnia
  • Dry mouth
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5
Q

Define depression and state four signs and symptoms of depression

A

A mood disorder characterised by depressed mood, pessimism, anhedonia and apathy

Social and emotional withdrawal, Impaired attention and conversation, delusions of guilt and worthlessness, fatigue, weight gain/loss

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6
Q

Briefly describe the powers and responsibilities of a Senior Mental Health Practitioner (SMHP) under the 1996 Mental Health Act.

A

May detain a voluntary patient at risk in the absence of a doctor for 6 hours

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7
Q

Assessments with substance abuse:

A

Alcohol and other drug history, physical appearance (general appearance, nutrition, intoxication and withdrawal), breathalyse, drug screening, AUDIT test, mental state examination

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8
Q

Effects of substance abuse on families:

A

Stress, financial problems, manipulation, lying, distrust

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9
Q

6 nursing management principles:

A
  • Consultation of a GP, counselling service or mental health clinic
  • Pharmacotherapy
  • AA/NA
  • Change peer group
  • CBT
  • Rehab
  • Therapy
  • Detox
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10
Q

Nursing diagnosis with anorexia:

A

Imbalanced Nutrition: less than Body Requirements R/T insufficient intake of nutrients to meet metabolic needs

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11
Q

One expected outcome for diagnosis:

A

The client will:

increase nutritional intake and increase weight within two weeks

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12
Q

6 nursing interventions:

A

Establish behaviour modification protocol to provide consistency and decrease power struggle

Provide a structure to mealtimes and state limits. Tell client when it is time to eat and present the food

Do not bribe, coax, or threaten the client to eat food but encourage, withdraw your attention if the client refuses to eat. When the mealtime is over and remove food.

Supervise client during and after meals. Do not allow client to use the bathroom until at least 30 minutes after each meal

Monitor client’s intake and record food intake and food not eaten. Document non-compliant behaviour in the progress notes

Encourage client to seek out for a staff member to talk about feelings of anxiety or fear

Grant and restrict privileges based on weight gain or loss

Weigh client before breakfast and after voiding

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13
Q

Antidepressants:

A

Treat depression, inhibit neurotransmitter breakdown and release neurotransmitters, increase serotonin levels

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14
Q

Types of antidepressant:

A

Tricyclic antidepressants (clomipramine), Selective serotonin reuptake inhibitors (sertraline-Zoloft), serotonin noradrenaline reuptake inhibitors (reboxitine), monoamine oxidase inhibitors (phenelzine)

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15
Q

Mood stabiliser:

A

Lithium carbonate

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16
Q

What is MSE:

A

Process of obtaining information about specific aspects of individuals mental experience and behaviour

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17
Q

Why we do MSE:

A

Determine risk and severity, identify signs and symptoms, monitor change and improvement, generate hypothesis, documentation

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18
Q

What done with history:

A

Individual details, identify present problems, history of illness, personal history, previous medical/surgical history, family history, illicit drug use, MSE

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19
Q

MSE includes (9):

A
  1. Appearance and behaviour
  2. Speech
  3. Mood and affect
  4. Form of thought
  5. Content of thought
  6. Perceptual disturbances
  7. Sensorium and cognition
  8. Insight
  9. Formulation
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20
Q

Symptoms of alcohol withdrawal:

A

Sweating, tremors, anxiety, agitation, nausea and vomiting, hallucinations, orientation, headaches, seizure

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21
Q

Principles of nursing care alcohol abuse + substance:

A

Initial assessment, friendly and calm, seizure precautions, limit environmental stimuli, dim lights, food and nourishing fluids, medication management, assist ADL’s, obtain history, teach about HIV, non-judgemental

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22
Q

Psychosis:

A

Group of disorders characterised by hallucinations and thought disorder

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23
Q

Schizophrenia:

A

Most common type of psychosis characterised by psychotic features.

Disturbed thought, perception, volition, emotion with impairment of judgement and behaviour

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24
Q

Subtypes of schizophrenia:

A

Paranoid (delusions of grandeur)
Disorganised (immature emotionally)
Catatonic (immobility or excited agitation, unusual motor response)
Residual (one episode but no longer shows major symptoms)
Undifferentiated (various symptoms not in one category)

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25
Positive schizophrenic conditions:
Delusions, hallucinations, disorganised thoughts, disturbance in language
26
Negative schizophrenic conditions:
Blunting effect, anhedonia, sociality, abolition, apathy, poverty of speech
27
Diagnosing schizophrenia:
At least 2 symptoms in a period of one month: - delusion - hallucination - disorganised speech pattern - behaviour disturbance - negative symptoms Social, occupational, duration (6 months), exclusions (other disorders)
28
Assessment in schizophrenia:
- Full psychiatric history - Physical examination - MSE - Risk assessment - Current medications and compliance - Family response and support
29
Phases of schizophrenia (4):
1. Prodromal phase (initial symptoms identified) 2. Acute phase (psychotic symptoms) 3. Maintenance phase (less severe symptoms) 4. Stabilisation phase (remission of symptoms)
30
Anxiety VS anxiety disorders:
Anxiety is a normal reaction of alertness and an adaptive response, anxiety disorder is when a client sows exaggerated or excessive anxiety with psychological changes
31
Types of anxiety disorders:
Panic attack, panic disorder, generalised anxiety disorder, obsessive compulsive disorder, acute stress disorder, PTSD
32
Symptoms of anxiety disorders:
Panic, fear, stress, worry
33
Management of anxiety:
Anti-anxiety medication, beta blockers, relaxation and controlled breathing, constructive thoughts, CBT, flooding, thought stopping
34
Somatoform disorders:
Somatization disorder, conversion disorder, pain disorder, body dysmorphic, undifferentiated somatoform
35
Dissociative disorders:
Amnesia, fugue, depersonalisation disorder, identity disorder, multiple personality
36
Cluster A personality disorders:
Paranoid, schizoid, schizotypal
37
Cluster B personality disorders:
Antisocial, borderline, histrionic, narcissistic
38
Cluster C personality disorder:
Avoidant, dependent, OCD
39
Kleptomania:
Theft of worthless objects, relieves tension
40
Assessments with personality disorders:
Full psychiatric history, history of physical and sexual abuse, history of drug and alcohol use, physical examination, MSE, risk assessment
41
Managing personality disorders:
Antipsychotics, mood stabilisers, antidepressants, anti-anxiety, CBT, family therapy
42
Basic counselling skills:
Active listening, attending behaviour
43
ECT:
Induction of a fit or seizure by passing controlled electric current through the brain via mental electrodes across the temples
44
Indications of ECT:
Major depression, bi polar, catatonic seizure, puerperal psychosis
45
Contraindications to ECT:
MI, pulmonary embolism, cerebral tumours, subdural hematoma
46
Types of risks:
Risk to suicide, risk of deliberate self harm, risk of self neglect, accidental harm, absconding OTHERS: Violence, harm to child, deliberate fire setting, sexual abuse, risk of exploitation, elder abuse
47
Antipsychotics:
Main treatment of psychotic disorders, schizophrenia associated with dopamine overactivity, antipsychotics assist brain to restore chemical balance, subdivided into typical and atypical
48
TYPICAL:
Older and conventional antipsychotics and AKA as neuroleptics, effective against positive symptoms
49
Typical drugs include:
Chlorpromazine, haloperidol, thioridazine, trifluoperazine, pericyazine
50
Effect of typical drugs:
Dopamine antagonist, target positive symptoms, calming effect, less expensive than atypical, do NOT treat negative symptoms or EPSE
51
EPSE:
Dystonia (stiffness/tonic contraction of muscles) Oculogyric crisis (rotate eyeballs) Akathisia (restlessness, agitation) Parkinsonism (tremor, rigidity, mask-like face) Tardive dyskinesia (involuntary face movements, tongue and lips) Neuroleptic malignant syndrome (severe EPS, sweating, muscle rigidity)
52
Atypical antipsychotics:
Newer antipsychotics, treat both positive and negative symptoms and have less side effects which include (risperidone, olanzapine, clozapine)
53
Anxiolytics:
Diazepam, clonazepam, lorazepam, buspirone
54
Sedatives and hypnotics:
Zopiclone, zolpidem, temazepam
55
Nursing diagnosis of depression:
Risk of suicide, imbalanced nutrition, self care defecit, hopelessness, impaired social interaction, ineffective coping
56
Nursing diagnosis of mania:
Risk of violence, disturbed sensory perception, disturbed thought processes, impaired verbal communication, ineffective coping, non compliance
57
MHA:
Police have the power to apprehended any person they suspect has a mental illness. Either a medical practitioner or an authorised mental health practitioner must examine the patient who could be released or referred for further psychiatric examination
58
MHA legal forms:
Form 1- Referral by MP or AMHP for examination by psychiatrist within 24 hrs Form 2- Detention of voluntary patient at risk by SMHP in the absence of doctor for 6 hours Form 3 - Transport Order Form 4 - Detention for further assessment for 48 hrs Form 5 - Order for receival into authorised hospital for further assessment for 72 hrs Form 6 - Involuntary patient order. Patient is detained for 28 days Form 7 - Transfer between authorised hospitals Form 8 - No longer involuntary patient Form 9 - Continuation of involuntary order for up 6 months Form 10 - Community Treatment Order (CTO) Form 11 – Revocation of a CTO Form 12 - Extending or varying a CTO Form 13 - Breach of CTO Form 14 - Order to attend treatment
59
Medication treatment of AWS:
Naltrexone, benzodiazepine, thiamine, acamprosate, methadone
60
Anorexia nervosa:
Anorexia nervosa is a serious mental disorder characterised by significant weight loss resulting from excessive dieting Anorexic clients consider themselves to be fat, no matter what their actual weight is Usually strive for perfection Set very high standards for themselves and feel they always have to prove their competence They feel the only control they have in their lives is in the area of food and weight If they cannot control what is happening around them, they can control their weight
61
Complications of AN:
Cardiac irregularities due to protein-calorie malnutrition Electrolyte abnormalities: low potassium and sodium levels GIT effects: feeling bloated or full even after eating small amounts Renal dysfunction: Reduced glomerular filtration rate Neurological changes due to brain atrophy Cognitive changes: impairment in attention & concentration Skin changes due to protein-calorie malnutrition Re-feeding syndrome due to imbalance in electrolytes and fluids
62
Bulimia nervosa:
Bulimia is mental disorder characterised by a cycle of dieting, binge eating followed by purging to try and lose weight A binge may range from 1,000 to 10,000 calories Purging methods usually involve vomiting and laxative abuse Other forms of purging can involve use of diuretics, diet pills and enemas People with bulimia usually do not feel secure about their own self- worth They often strive for the approval of others Food becomes their only source of comfort Bulimia also serves as a function for blocking or letting out feelings Unlike anorexia, people with bulimia do realise they have a problem & are more likely to seek help
63
Potential nursing diagnosis of AN and BN:
``` Anorexia nervosa Imbalanced Nutrition: Less than Body Requirement Distorted Body Image Ineffective Individual Coping Chronic Low Self-Esteem ``` Bulimia nervosa and binge eating Anxiety Ineffective Individual Coping Compromised Family Coping
64
Assessments with ED:
Psychiatric evaluation/ mental state assessment Body image assessment Disordered eating behaviours & rituals assessment Nutritional assessment Family assessment Physical examination Routine laboratory investigations: TFT, FBC, LFT, RFT Blood chemistry: Electrolytes Cardiac assessment: ECG
65
BMI calculation:
Height squared divided by weight
66
Managing ED:
Psychopharmocotherapy Antidepressants, anti-anxiety & antipsychotics such as olanzapine to reduce image distortions & severe obsessions Other medications Multivitamins, Phosphate Sandoz, Calcitrate Plus Vitamin D ``` Psychosocial therapy Cognitive behaviour therapy - behaviour modification Motivational enhancement therapy Psycho-education and goal setting Supportive therapy Family support and education Interpersonal relationship therapy Individual & group psychotherapy ```
67
Dementia:
Dementia denotes a group cognitive disorders characterised by: Cognitive impairment Deterioration of language and motor skills Disturbance in perception Mood changes The distinguishing landmark in dementia is the significant change in cognitive functions
68
Causes of dementia:
Some of the causes include: Infection to the brain (meningitis, encephalitis) Head injury Poisons and toxic sprays Alcohol and drug abuse Metabolic and endocrine disturbances: myxoedema Degenerative diseases: parkinson’s disease Vascular disorders: stroke/CVA Hereditory
69
Types of dementia:
``` Alzheimer's disease AD Huntington Chorea Creutzfeldt-Jakob Disease Dementia with Lewis Bodies Frontal lobe dementia - Pick’s Disease Vascular dementia Wernicke-Korsakoff Syndrome ```
70
Assessment with dementia:
Thorough Physical examination Collateral history Mini-Mental State Examination (MMSE) Mental Status Examination (MSE) Neurological examination Beck Depression Inventory (R/O depression) Routine blood checks - FBC TFT, B12, Folate Blood chemistry - Renal function, metabolic, hepatitis, HIV, VDRL CT scan- Computerised Tomography MRI - Magnetic Resonance Imaging test
71
Treatment of dementia:
Psychopharmacotherapy Symptomatic treatment with: anti-anxiety, anti-psychotic, anti-depressants and sedatives Cholinesterase inhibitors are used to treat mild to moderate dementia and include the following drugs: Aricept (donepezil), Galantamine and Rivastigmine - prevent cognitive deterioration Memantine used to treat mild to moderate dementia to slow memory deterioration Psychosocial therapies Cognitive Behaviour Therapy (CBT) Occupation therapy Recreational therapy and music therapy Validation therapy Reminiscence, reviewing past events using photos albums – by looking at school days, wedding day photos
72
Delirium:
``` Delirium is an acute organic mental syndrome characterised by: Cognitive impairment Altered level of consciousness Poor concentration and attention Psychomotor activity Sleep-wake disturbances ```
73
Delirium causes:
Any conditions affecting the brain - Head injury, brain tumour, epilepsy, subdural, CVA Drug toxicity, interaction or withdrawal Hypoxia secondary to respiratory or circulatory disorder Infections: meningitis, encephalitis, sepsis, HIV, CCF: due to diminished cerebral blood flow Biochemical disturbances: calcium, sodium, urea Metabolic and endocrine disorders: thyroid, blood glucose abnormalities Psychiatric disorders: depression or psychosis Hyperthermia or hypothermia Nutritional deficiencies especially B12 and iron
74
Assessment of delirium:
``` Routine BLOOD screening: FBC, LFT, TFT, B12 Blood chemistry: drug screening, renal function, hepatitis, HIV, VDRL Neuropsychological testing CT scan - Computerised Tomography MRI - Magnetic Resonance Imaging test Thorough physical assessment Assess medication effects or withdrawal Mini-Mental State Examination (MMSE) Mental Status Examination (MSE) ```
75
Nursing care of patient with delirium:
Provide safe and familiar environment to prevent injury Evaluate the need for one to one to protect patient Provide non-stimulating environment to promote rest Provide good nurse patient relationship Offer continuity of care with familiar faces to alley fear Communication should be simple, clear, call patient’s name, tell who you are, where she/he is, what time it is Avoid sudden movement as patient is frightened Obtain urine, blood and other specimen as ordered by the doctor Assist with ADL’s: hygiene, bowels, bladder and ensure patients wear glasses or hearing aids if they wear them Provide adequate light diet and fluids Restore and maintain fluid and electrolyte balance Give medication as ordered to treat cause or symptoms Offer support and reassurance to patient and family
76
Differentiating the 3 D's:
``` Differentiating 3 D’s (depression, delirium and dementia) needs comprehensive assessment including: A complete medical/surgical/psychiatric and collateral history Examine the presenting symptoms A full physical examination Neurological examination Mental State Examination Blood checks and urine test ECG and EEG CT scan and MRI Check support offered to the patient ```

NUR206 (2 decks)

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