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Psych > Test Two > Flashcards

Test Two Flashcards

1
Q

Keep care plan stuff in mind —> interventions, meds, group/therapy
Therapeutic communication from first 2 weeks will be included in every test
Know crisis communication, psychosis, mood disorders, , meds for ALL
How to know whether or not meds are working therapeutically?
Groups, relaxation therapy, psychological ed group, coping skills, med management
ECT legal and ethical issues, tx in general with meds

A

-Psychosis: hallucinations, delusions, and dramatically distruebed thoughts
-maybe go back to bipolar and break down the types of meds: mood stabilizers, anticonvulsants, etc (in the book)
-Tricyclic antidepssants and SNRIs and MAOIs? specific drug names?
-mood disorders, anxiety disorders, suicide (nurses role in each)
Sleep disorders: Hyper somnolence
Narcolepsy
Breathing related sleep disorders
Circadian rhythm disorders
Nightmare disorders
Disorders of arousal
Insomnia
Substance induced
Restless leg syndrome
REM sleep behavior disorders

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2
Q

What are the early symptoms (prodromal/pre-psychosis) symptoms of schizophrenia?

A

Social withdrawal, Irritability, Depression, Conduct/behavior problems , Awkward, Obsessions, Anxiety, Phobias, Dissociation, Compulsions
-can be present in teenagers but missed bc people think they’re moody teenager

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3
Q

What are some of the positive symptoms of schizophrenia?

A

Hallucinations, Illusions, Delusions, Bizarre behavior, Paranoia, Abnormal movements, catatonia, motor retardation, motor agitation, waxy, posturing, echopraxia , Distorted thinking, Concrete thinking, Clang associations, Word salad, Neologisms, Echolalia, Religiosity, Magical thinking, Cognitive Retardation, Poverty of Speech, Pressured speech , Thought insertion or deletion, Poor Boundaries

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4
Q

What are some of the negative symptoms of schizophrenia?

A

Poor hygiene
Lack of motivation
Anhedonia: loss of pleasure
Flat, blunted, or incongruent affect

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5
Q

What are some of the cognitive symptoms of schizophrenia?

A

Loss or impaired memory
Lack of attention
Inability to make decisions, plans, or problem solve (executive thinking)

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6
Q

What are some of the affective symptoms of schizophrenia?

A

Depressed mood
Erratic
Unstable
Hostile

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7
Q

What is included in the assessment of a schizophrenic patient?

A

Safety (Assault Risk/Suicide Risk)
Medical assessment and Comorbidities (such as drug abuse)
Mental Status Exam
How do we assess for hallucinations? Ask directly
Delusions? Talk to them
Patient’s insight
Family History
Voluntary vs. Involuntary Treatment
Simple, loud, direct statement or instructions, Focus on reality but don’t discount the patients experience, Be open and genuine, Establish trust

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8
Q

What medications are given to a schizophrenic pt?

A

Antipsychotics, adjuncts to antipsychotics, and therapy (CBT and psychoeducational groups, mileu therapy)
-1st, 2nd, or 3rd generation antipsychotics

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9
Q

What are the side effects for each generation of antipsychotics? Which generation had the most EPS side effects?

A

First generation: Extrapyramidal Side Effects (EPS) such as dystonia, akathisia, tardive dyskinesia, pseudoparkinsonism (most common CPS symptoms)
Second generation: Clozaril causes agranulocytosis in about 1% of patients
Third generation: very little side effects

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10
Q

What 3 things are also given in adjunct with antipsychotics in schizophrenic patients?

A

Mood stabilizers: if they’re agitated or have mania
Antidepressants: if they have profound negative s/s or deeply depressed
Benzodiazepines: if anxiety

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11
Q

The most common antipsychotics given are …

A

Most common are thoradazine, Halodol

Combination of 1st and 2nd generations
They all have anticholinergic side effects
-not to everyone, but it can happen

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12
Q

List some of the anticholinergic side effects associated with antipsychotics

A

CNS: Sedation, blurred vision
Cardiac: Tachycardia, postural hypotension
GI: Constipation, urinary retention
Miscellaneous: Movement disorders, Sexual dysfunction, Weight gain, Dry mouth, Hyperglycemia, Dyslipidemia, Agranulocytosis (clozepine)

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13
Q

List some EPS symptoms

A

Tongue spasms, eye spasms, rigidity (you move their arm and it gets stuck), rock back and forth, tongue poking (through their cheek)
-these are all side effects of first and second generation drugs
DYSTONIAS: Oculogyric crisis, torticollis, retrocollis, opisthotonus, glossospasm
PSEUDOPARKINSONISM: Bradykinesia, akinesia, cogwheel/leadpipe rigidity, resting hand tremor, drooling, mask-like face, shuffling gait
AKATHESIA: Restlessness, uncomfortable sitting still, pacing
TARDIVE DYSKINESIA:Grimacing, lip smacking/puckering, tongue fasciculations, tongue poking, writhing movements of fingers/toes

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14
Q

List some of the newer antipsychotics:
Why are they better?
Side effects?

A 
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodone)
Aripiprazole (Abilify)
-more efficacious and safer (block DA & 5 HT
-Safer in regards to EPS symptoms
-however weight gain, high risk of seizure (Zyprexa), Possible cardiac issues
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15
Q

Atypical antipsychotics take ____ to work so…

A

Takes 1-2 weeks to work (some improvement immediately)
So you treat the agitation and anxiety first while you wait for the antipsychotics to kick in
-Compliance is really difficult bc they think they don’t need them, or that they’re poison, etc

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16
Q

What is an important nursing intervention to remember with the antipsychotic CLOZARIL (Clozapine)?

A
  • Weekly WBC for 1st six-months, then every other week thereafter
  • Agranulocytosis (a severe reduction in the number of white blood cells) is likely to have a rapid onset
  • If Agranulocytosis occurs, can NEVER try Clozaril again…pt name is placed on national registry
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17
Q

Other side effects of CLOZARIL (Clozapine) include:

A

REPORT “flu-like” signs and symptoms of lethargy, weakness, fever, sore throat or signs of infection and/or trends w/ WBC

SIDE EFFECTS: Seizure, myocarditis, sialorrhea(excessive salivation), weight gain, orthostatic hypotension, constipation

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18
Q

What type of medications are given to noncompliant pts with schizophrenia?

A

LONG-ACTING INJECTABLE ANTIPSYCHOTICS
Can range form every 2 weeks to once a month,
Usually start with a loading dose

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19
Q

What 3 medications are used to treat EPS symptoms?

A

Cogentin (Benztropine)
Artane (Trihexyphenidyl)
Benadryl (Diphenhydramine)

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20
Q

What are the 3 meds used for long-acting injectable atypical antipsychotics for schizophrenia?

A

Invega Sustana (paliperadone palmitate)
Risperdal Consta
Zyprexa Relprevv

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21
Q

What is NMS? Symptoms?

A

Neuroleptic Malignant Syndrome

  • Occurs when pts have multiple antipsychotics in their system over time
  • Severe EPS symptoms, muscular rigidity, Hyperthermia, Hypertension, Delirium, Stupor, Rhabdo, autonomic dysfunction (tachycardia and tachypnea)
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22
Q

What do we do if a pt has NMS?

A 
Stop all neuroleptics 
Parlodel for rigidity
Dantrolene for muscle spasms
Ice, cooling blankets, cold packs
IV fluids 
Benzodiazepines 
Most often these pts are transferred to ICU, must treat quickly and early to avoid the high risk of death
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23
Q

What is AIMS?

A

Abnormal Involuntary Movement Scale
Tests tardive dyskinesia
Assesses facial, oral, trunk, and extremities

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24
Q

What are some nursing diagnosis for schizophrenia?

A 
Non-adherence to medications
Changes in normal sleep pattern
Acute confusion
Alteration in mental status
Risk for self injury
Risk for suicide
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25
Q

What is the difference between Bipolar I, Bipolar II, and Cyclothymia?

A

Bipolar I: one week of mania that may alternate with mixed depression or agitation.
Bipoloar II: hypomania for at least 4 days and profound periods of depression
Cyclothymia: hypomania with mild depression

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26
Q

What (5) meds are used to treat bipolar patients?

A

Lithium, Lamotrigine (Lamictal), DIVALPROEX SODIUM (Depakote, Valproic Acid), CARBAMAZEPINE (Tegretol), OXCARBAZEPINE (Trileptil)

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27
Q

What is important to remember regarding Lithium?

A

Lithium toxicity

  • *Lithium is excreted primarily by the kidneys
  • Exercise and sweating without adequate hydration may affect Lithium levels
  • Stay hydrated!
28
Q

What are some nursing diagnoses for bipolar disorders?

A

Risk for injury, Wandering, Risk for other-directed violence, sleep deprivation, defensive coping, ineffective coping, self-care-deficit, interrupted family processes, caregiver role strain, impaired verbal communication, impaired social interaction

29
Q

What are some nursing interventions with a bipolar pt?

A

Acute phase: Injury prevention- focus on medically stabilizing pt, safety, managing meds, decreasing physical activity, increasing food and fluid intake, ensuring adequate sleep, meeting self-care needs
Continuation phase: (4-9 months) relapse prevention, stress-reduction skills, interpersonal skills, cognitive functioning, employment, social support system, substance related problems, psychoeducational teaching, referrals to community programs, problem-solving skills training, CBT
Maintenance: preventing relapse and limiting severity and duration of future episodes, medication, psychotherapy, support groups, psychoeducational groups, and periodic evaluations

30
Q

What are the 2 major long-term risks of lithium therapy?

A

hypothyroidism and impairment of the kidney’s ability to concentrate urine

31
Q

interventions, meds, and group therapy

A

sdf

32
Q

What type of medications are available for depressed patients?

A

Antidepressants: SSRI, SNRI, Tricyclic antidepressants, MAOI, and atypical antidepressants

33
Q

What are the common SSRI’s given?

A 
Prozac/Sarafem (fluoxetine)
Zoloft (sertraline)
Celexa (citalopram)
Paxil (paroxetine)
Paxil CR (paroxetine)
Lexapro (escitalopram) 
Luvox (fluvoxamine)

-etine, -aline, -opram, -amine

34
Q

________ have the greatest potential to be lethal in an overdose

A

Tricyclic antidepressants

35
Q

Foods containing tryamine must not be consumed when taking______ (due to interactions)
And may cause ________

A

MAOIs
Severe headache
*Hypertensive Crisis

36
Q

What are the 3 atypical antidepressants?

A

Trazadone
Remeron
Welbutrin

37
Q

What type of therapy is recommended to treat depression?

A

Cognitive behavioral therapy

38
Q

Generalized Anxiety disorder is often associated with what comorbidities?

A

MDD, OCD, Panic

39
Q

What medications are given to treat anxiety?

A

BENZODIAZEPINES and/or SSRIs

40
Q

What are the side effects associated with benzos?

A

possibility of paradoxical reaction of rage, agitation, disinhibition

  • BZDs used regularly for long periods of time, may lead to seizures and death if stopped abruptly
  • Withdrawal symptoms (agitation, tremor, seizures)
  • addictive
41
Q

What are the 3 benzos?

A

Alprazolam (Xanax)
Lorazepam (Ativan)
Clonazepam (Klonopin)

42
Q

What are the pros to using SSRIs (instead of benzos) for anxiety?

A

Non-sedating
Low abuse potential
(Works in 7-10 days, but has delay of 1-6 weeks for optimal efficacy)

43
Q

What are some interventions for OCD?

A

Cognitive behavioral therapy
Exposure therapy
Antidepressants

44
Q

What are 3 depressant drugs?

A

alcohol, benzos, and marijuana

45
Q

What are the withdrawal symptoms from depressant drugs?

A

The opposite of what the drug did

Anxious, agitated, insomnia, tremors

46
Q

What are the symptoms of depressant overdose?

A

Opposite of fight or flight

Respiratory depression, dilated pupils, weak pulse

47
Q

Alcohol withdrawal must be done…

Nurse needs to…

A
  • Must be done under care of a provider, you can’t just stop
  • Nurse needs to assess vitals every 4 hours
  • Pt placed on detox protocol
48
Q

What are some symptoms of alcohol withdrawal?

A

Irritability, insomnia, loss of appetite, tremors, sweating, increased pulse, hypersensitivity to noise and light, hallucinations, hyperthermia, and restlessnes

49
Q

What is the nurses role/goals for alcohol withdrawal management?

A

Safety (assess risk for suicide), monitor sleep patterns, monitor nutrition and fluid I&O, monitor severity of withdrawal symptoms, maintain detox protocols and meds, assess coping skills

50
Q

What are some alcohol withdrawal medications?

A

Tegetol, Librium, Phenobarbital, Seroquel, Valium (or other benzo), Naltrexone, Clonidine

51
Q

What are some s/s of stimulant use?

A

sudden rush of energy, increased agitation, hyperactivity, and pressured speech

52
Q

What are some s/s of upper/stimulant withdrawal?

A

the opposite of how you were when you were on them

Depressed mood, withdrawn, no spontaneous talking or movements

53
Q

What are some s/s of stimulant overdose?

A

HTN, tachycardia, and hyperthermia

54
Q

What are 3 dissociative drugs?

A

Ketamine, PCP, and Salvia

55
Q

What are 3 hallucinogens?

A

LSD, Mescaline (peyote), and mushrooms

56
Q

What are some s/s of opioid use?

A

Heroin, opiates
You feel euphoric, relief from pain (think of morphine), detached from reality, resp. depression, drowsy, impaired coordination, confusion

57
Q

What are the s/s of opiate withdrawals?

A

the opposite of what you feel when you were on the drug

Agitated, anxiety, muscle aches, insomnia, nodding out, runny nose, n/v

58
Q

What are some s/s of opiate overdose?

A

Decrease respirations, pinpoint pupils, decreased BP, seizure, coma, death

59
Q

What are some interventions that help promote healthy sleep habits?

A

Changes to routine, medications, etc.
Therapy
Relaxation therapy
Journaling

60
Q

What are some of the nurse’s roles/goals with a pt experiencing crisis?

A
  • Assess the potential for violence and initiate/maintain safety precautions (e.g., suicide, homicide, self-destructive behavior)*
  • Identify client in crisis
  • Use crisis intervention techniques to assist client in coping
  • Apply knowledge of client psychopathology to crisis intervention
  • Guide client to resources for recovery from crisis (e.g., social supports)
61
Q

What is the nurses role in stage 1 (early intervention) of a crisis?

A

Recognize
Support
Teach stress management techniques

62
Q

What is the nurses role in stage 2 of a crisis?

A

Teach self management
Cognitive interventions
Refer if necessary

63
Q

What is the nurses role in stage 3 of a crisis?

A

Treat illness
Teach stress reduction
Then teach stress management

64
Q

What are some questions you could ask the patient assessing their ability to cope in times of crisis?

A 
Has anything like this happened before?
Has anything similar to this happened before?
How did you cope in the past?
Was it effective?
Do you have support?
65
Q

What is the immediate goal of crisis intervention?

A

Return the patient to the pre crisis functioning level

66
Q

What are some crisis intervention steps?

A
  1. Problem solving attitude: Who can help you? What resources do you have? What resources can we get you?
  2. Reality oriented approach is used
  3. Working relationship from the start
  4. Nurse needs to listen, understand, and help the patient make a plan

Psych (3 decks)

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