6005 Exam 2

Describe the different neurotransmitters and their effects (table 3.2 p 41)

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Identify defense mechanisms and consider one adaptive and maladaptive (positive/Negative) use of each. Table 15.2

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Identify the effects of Stress on the parasympathetic and sympathetic nervous system: fight or flight responses, stages. Table 10.1 & 10.2 Figure 10.2

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Define/explain a patient's rights to treatment

1. Right to be free from excessive or unnecessary medication 2. The right to privacy and dignity 3. The right to be in the least restrictive environment 4. The right to an attorney, clergy, and private care providers 5. The right to not be subjected to lobotomies, electroconvulsive treatments, and other treatments without fully informed consent

Identify and prioritize nursing diagnoses and outcome statements related to suicide

1. Risk for suicide 2. Ineffective coping 3. Hopelessness 4. Chronic low self-esteem

Describe the conditions of involuntary hospitalization

A court-ordered admission to a tactility without the patient's consent General criteria: 1. Mentally ill 2. Posing a danger to self or others 3. Gravely disables (no ADLs/basic needs) 4. In need to treatment

Define/explain a patient's right to informed consent

A patient should be told all information about treatment to make decision to accept or reject treatment Patient must be informed of the following elements: 1. The nature of the problem or condition 2. The nature and purpose of a proposed treatment 3. The risks and benefits of that treatment 4. The alternative treatment options 5. The probability that the proposed treatment will be successful 6. The risk of not consenting to the treatment

Identify the different types of common phobias

Acrophobia (heights) Agoraphobia (open spaces) Astraphobia (electrical storms) Claustrophobia (closed spaces) Glossophobia (talking) Hematophobia (blood) Hydrophobia (water) Monophobia (being alone) Mysophobia (germs or dirt) Nyctophobia (darkness) Pyrophobia (fire) Xenophobia (strangers) Zoophobia (animals)

Define/explain a patient's rights to refuse treatment

Allows patient to without consent at anytime, even if they are involuntary committed - An individual can be medicated in emergency if the following criteria are met: 1. Has a serious mental illness 2. The person's ability to function is deteriorating or he/she is suffering or exhibiting threatening behavior 3. The benefits of treatment outweigh the harm 4. The person lacks the capacity to make a reasoned decision about the treatment 5. Less restrictive services have been found inappropriate

Describe the conditions of emergency commitment

An admission with the primary purpose to observe, diagnose and treat Used when: - Too confused to make decision -Too ill

Describe the conditions of voluntary hospitalization

Apply to be admitted in writing General criteria - Must have a need for treatment and understand - Have right to request and obtain release with reevaluation

Describe risk factors for suicide: biological, cognitive, environmental, cultural, social, and other

Biological: low serotonin, genetics, SKA2 gene (lower in suicidal ideation) Cognitive: hopelessness, all or nothing thinking, inability to see different options, perfectionism Environmental: loss (love, self-esteem, freedom, etc), guilt, copycat suicide, diathesis stress model Cultural: religious belief, family values, sexual orientation, gender identity, bullying behavior, attitude towards death Social: isolation ( loneliness and despair) Other factors: - Race: Caucasian - Marital status (those who are married with kids have a decreased incidence in suicide) - Profession - Religion (being religious decreases suicide rates)

Invasion of privacy

Breaking an individual's confidences or taking photographs w/o permission

Define/explain a patient's capacity and competency

Capacity: a person's ability to make an informed consent; fluid concept - can go form having to lacking Competency: legal term - related to the degree of mental soundness a person has to make decisions or to carry out specific acts - If individual is not competent a guardian may be chosen

Define/explain implied consent

Consent that is obtained through patient's actions (i.e. sticking their hand out for the pills you are giving them)

Identify factors that effect stress: Cultural, age, gender, lifestyle.

Cultural: emphasize certain problems of living compared to other - Western and north American cultures --> psychological stress and somatic stress - Asians, Africans, and central Americans --> distress is somatic - experience it physically Age: increased age --> decreased regulation of stress hormones = prolonged alarm stage Gender: women are more likely to face psychological stress than men Lifestyle: a balanced lifestyle = less stress and intensity of response

Define/explain psychiatric advanced directives

Designation of preferred physician and therapists Appointment fo someone to make mental health treatment decisions Preferences regarding medications to take or not take Consent or lack of consent for electroconvulsive therapy Consent of lack of consent for admission to a psychiatric facility Preferred facilities and unacceptable facilities Individuals who should not visit

Mood stabilizer education

Education: d/t small therapeutic index need to get regular blood draws, maintain hydration, maintain sodium levels, know s/s of lithium toxicity (lethargy, weakness, dizziness, n/v)

Which neurotransmitter is strongly related to the "fight or flight" response? What are signs and symptoms of high levels of this neurotransmitter?

Epinephrine S/s: tachycardia, tachypnea, high BP, tunnel vision, dilated eyes, sweating, blood only going to vital organs

Define Generalized Anxiety Disorder (GAD)

Excessive worry; common worries in generalized anxiety disorder are inadequacy in interpersonal relationship, job responsibilities, finances, and health of family members. Because of this worry huge amounts of time are spent in preparing for activities

Antianxiety (anxiolytic) and hypnotic medications main neurotransmitter affected

GABA

Which neurotransmitter is associated with creating a state of calm and relaxation in the body? Does this happen with high or low concentrations of this neurotransmitter?

GABA (increased)

Mood stabilizers neurotransmitters affected

Glutamate

Identify how stress effects the body.

HA, anxiety, depression, increased BP, increased HR, increased risk for MI, decreased immune response, decreased libido, ED, irregular menstrual cycle, infertility, fight or flight, increased risk for CVA, insomnia, decrease/increase appetite, rapid breathing, increased blood glucose, digestive problems, back aches

Antianxiety (anxiolytic) and hypnotic medications side effects

HA, dizziness, drowsiness, insomnia - Ataxia (benzos) - Bitter taste when you wake up (Lunesta) Urinary retention (silenor)

What disease do we associate with high levels of acetylcholine (ACh)? What about low levels of ACh?

High Ach = depression Low Ach = Alzheimer's

Define/explain a patient's rights regarding restraint and seclusion

In an emergency, a nurse may place a patient in seclusion or restraint but must obtain a written or verbal order as soon as possible thereafter Order may be renewed for 24 hours with limits depending upon the patient's age Patient's 18 or older are limited to 4 hours Children and adolescents age 9-17 are limited to 2 hours Children under 9 are limited to 1 hour Must assess the patient in restraint at regular and frequent intervals such as every 15-30 minutes for physical needs (e.g. food, hydration, toileting), safety, and comfort

Akathesia

Inability to remain still, motor restlessness, repetitive movements Can be mistaken for anxiety and agitation

Which neurotransmitter is most likely involved in the thought disturbances of schizophrenia? Does too much or too little of the neurotransmitter cause this?

Increased dopamine

Tardive dyskinesia

Involuntary movements of facial muscle, tongue, and limbs Involuntary rhythmic movements

Dystonia/dystonic reaction

Involuntary muscle contractions, possibly painful Sudden, sustained contraction of one or more muscle groups (usually head or neck)

Define lethality and the role of lethality assessments

Lethality: the capacity to cause death/serious harm/damage Lethality assessments are crucial for determining the degree of suicide risk There are 3 elements of the assessment - Is there a specific plan with details - How lethal is the proposed method - Is there access to the planed method (definite plans for time, place, and means are highest risk)

Mood stabilizers drugs

Lithium

Define negligence

Most common - failure to use ordinary care in any professional or personal situation when you have duty to do so Five elements to prove negligence: 1. Duty 2. Breach of duty 3. Cause infact 4. Proximate Damage

Extrapyramidal symptoms (EPS)

Motor abnormalities caused by the blockage of dopamine receptors Can occur with antipsychotic medications, most often first generation antipsychotics Symptoms include acute dystonic reactions, parkinsonism, akathisia, and tardive dyskinesia

Which neurotransmitter is most likely related to profound depression? Is depression caused by too much or too little of this neurotransmitter?

Norepinephrine, serotonin, dopamine, or a combo are the basis of depression. Too little of these (especially serotonin) is what causes depression.

Understand the implementation phase of the nursing process, psychosocial interventions, and safety planning.

Nursing intervention focuses on prevention, treatment and postvention - Prevention = primary interventions (ex. Activities that provide support, information, and education to prevent suicide) Psychological interventions - establish therapeutic relationship realistic problem solving - Safety planning: a written six-step plan that includes 1. Identification of warning signs 2. Internal coping strategies 3. Social setting 4. People to provide distraction 5. Instructions on where/who to go get help from 6. How to make environment safe 7. Identify something worth living for

Describe the nursing assessment of suicide including non verbal and verbal clues.

Overt Statements: - I cannot take it anymore - Life isn't worth living anymore - I wish I were dead - Everyone would be better off if I died Covert statements - It's okay now. Soon everything will be fine. - Things will never workout - I won't be a problem much longer - Nothing feels good to me anymore and probably never will - How can I give my body to medical science? Nonverbal cues: - Sudden brightening of mood with more energy (especially after recently being prescribed an antidepressant medication) - Giving away possessions - Writing letters - Organizing financial affairs

Two categories of stressors: Explain and understand physiological and psychological stressors.

Physiological stressors: environmental conditions and physical conditions (ex. trauma, excessive cold/heat, infection, hemorrhage, hunger, pain) Psychological stressors: a situation/event (ex. Divorce, loss of job, unmanageable debt, arrival of a new child)

Define assault

Placing a person in fear of immediate bodily harm

Define malpractice

Professional negligence

Understand unconditional discharge

Released without conditions, the patient-hospital relationship is over

Drugs for GAD

SSRIs (Escitalopram, Paroxetine), Serotonin norepinephrine reuptake inhibitors (venlafaxine, duloxetine); Benzodiazepines (alprazolam, chlordiazepoxide, clorazepate, diazepam, lorazepam, oxazepam); others (buspirone)

Drugs for OCD

SSRIs (Fluoxetine, Fluvoxamine, Paroxetine, Sertraline)

Drugs for social anxiety disorder

SSRIs (Paroxetine, sertraline), Serotonin norepinephrine reuptake inhibitors (venlafaxine)

Drugs for panic disorder

SSRIs (fluoxetine, paroxetine, sertraline), Serotonin norepinephrine reuptake inhibitors (venlafaxine); Benzodiazepines (alprazolam, clonazepam)

Antidepressant medications drugs

SSRIs (fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine); NASSA (mirtazapine); Na5ht (bupropion); serotonin antagonist and reuptake inhibitors (nefazodone, trazodone); serotonin modulator and stimulators (vortioxetine); serotonin norepinephrine reuptake inhibitors (venlataxine, desventalataxine, duioxetine); serotonin partial agonist and reuptake inhibitor (vilazodone); TCA (nortriptyline, imipramine); MAO-I

Identify the different types of anxiety disorders

Separation anxiety Specific phobia Social anxiety Panic disorder Agoraphobia GAD Obsessive-compulsive and related disorders - OCD - Body dysmorphic disorder - Hoarding disorder - Trichotillomania (hair pulling) - Excoriations (skin picking)

Understand and describe different ways to manage stress through positive coping mechanisms.

Sleep Exercise Reduction or cessation of caffeine intake Music Pets Massage

o Pseudoparkinsonism

Temporary group of symptoms that look like Parkinson's disease including: Tremor, difficulty finishing thoughts, still facial muscles, reduced accessory muscle, gait impairment, bradykinesia

Rights to confidentiality and exceptions to the rule (i.e. duty to warn and child and older adult abuse).

The ethical responsibility of a healthcare professional that prohibits the disclosure of privileged information without the patients consent Exceptions to the rule: - Duty to warn and protect third parties - Duty to warn: an obligation to warn third parties when they might be threatened/endangered due to a patient - Right to protect obligation to call and warn an individual/intended victim, family, or police - Reporting child/elder abuse

Define and understand tort law relevant to psychiatric nursing (intentional and unintentional).

Tort: a wrongful act or infringement of a right Intentional tort: - A wrongful act knowingly committed - Recklessness, intended to do harm, not obtaining consent - Ex. Negligence, assault, battery, false imprisonment, invasion of privacy, defamation of character Unintentional tort: - Unintended acts against another person that produces injury or harm Ex. Negligence, malpractice

Define false imprisonment

Unlawful restraint or restriction of a person's freedom of movement

Define battery

Unlawfully touching a person

Understand conditional discharge

Used for involuntary patients sometimes Requires outpatient treatment for a specified period to determine if the patient follows the medication regimen, can meet basic needs, and is able to reintegrate into the community

Understand AMA discharge

When a patient is released from an institution where treatment seems beneficial but no compelling reason

Cholinesterase inhibitors (used for Alzheimers) neurotransmitters affected

acetylcholine

Cholinesterase inhibitors (used for Alzheimers) side effects

anticholinergic

Antianxiety (anxiolytic) and hypnotic medications drug names

benzodiazepines (diazepam, clonazepam, alprazolam); short-acting sedative-hypnotic sleep agents (zolpidem, zaleplon, eszopiclone); melatonin receptor agonist (ramelteon); old tricyclic antidepressant (doxepin); suvorexant; buspirone

Antipsychotic medications side effects

blurred vision, dry mouth, constipation, urinary hesistance, decreased BP - EPS (1st gen) - Gynecomastia, galactorrhea, amenorrhea, low libido, EPS (2nd gen) - Convulsions (clozapine) - Weight gain, sedation, sexual dysfunction (risperidone) - Hyperglycemia (olanzapine) - Orthostatic htn (iloperidone, asenapine)

Antipsychotic medications education

change position slowly, teach EPS s/s, monitor dm

Antipsychotic medications drugs

clozapine, risperidone, quetiapine, olanzapine, ziprasidone, aripiprazole, paliperidone, iloperidone, lurasidone, asenapine

Antipsychotic medications neurotransmitters affected

dopamine (both first and second generation)

Psychostimulants (used for ADHD) side effects

fatigue, irritability, throat pain, insomnia, nightmare, emotional disorders, constipation, increased body temp, dry mouth, ear pain, decreased appetite, weight loss, dizziness

Cholinesterase inhibitors (used for Alzheimers) education

maintain nutrition, monitor for improvements, monitor for "drying" effects

Psychostimulants (used for ADHD) drugs

methylphenidate, dextroamphetamine, atomoxetine, guanfacine, clonidine

Antianxiety (anxiolytic) and hypnotic medications education

monitor for respiratory depression, warn about engaging in dangerous activity requiring attention, reflexes or mobility, need to wean/taper dosing when stopping

Antidepressant medications education

monitor sedation, avoid drugs with tyramine (MAOi)

Psychostimulants (used for ADHD) neurotransmitters affected

norepinephrine and dopamine

Mild Anxiety

occurs in the normal experience of everyday living and allows an individual to perceive reality in sharp focus. A person experiencing a mild level of anxiety sees, hears, and grasps more information, and problem solving becomes more effective

Severe Anxiety

perceptual field greatly reduced, problem solving not possible, difficulty noticing what is going on in the environment, even when another points it out, more somatic s/s

Moderate Anxiety

perceptual field narrows, sees, hears, and grasps less information and may demonstrate selective inattention in which only certain things in the environment are seen or heard unless they are pointed out; SNS kicks in

Antidepressant medications side effects

sedation, appetite simulation, and weight gain - Apathy, low libido, n/v (SSRI) - Insomnia, tremors, anorexia, weight loss (NEDA reup. Inhibitors) - HA, fatigue, dry mouth, constipation, blurred vision (5HT antagonist and reuptake inhibitors) - Orthostatic hypotension, painful prolonged erection (trazo) - Hyponatremia, hypomania (5HT modulator and stimulator) - HTN (5HT NE reupt. Inhibitors) - Diarrhea (vilazodone) - Anticholinergic (TCAS) - Hypertensive crisis (MAOi)

Antidepressant medications main neurotransmitters

serotonin, norepinephrine, and dopamine

Cholinesterase inhibitors (used for Alzheimers) drugs

tacrine, donepezil, galantamine, rivastigmine

Mood stabilizers side effects

tremor, ataxia, confusion, convulsions, N/V, diarrhea, arrhythmias, polyuria, polydipsia, edema, goiter, hypothyroidism

Panic

unable to process what is going on in the environment and may lose touch with reality; hallucinations, erratic and impulsive behavior, terror