HESI MENTAL HEALTH FINAL
Which are the symptoms associated with pseudo-Parkinsonism?
Mask like face, stiff and stooped posture, shuffling gait, drooling, tremor, pill-rolling" finger movements, dysphagia or reduction in spontaneous swallowing. Bradykinesia: slowing of motor behavior
Compare and contrast the following adverse effects associated with psychotropic drugs: agranulocytosis, cholinergic side effects, Serotonin Syndrome, and Neuroleptic Syndromes.
Agranulocytosis: reduce neutrophil counts and increased frequency and severity of infections. Can lead to Neutopenia Cholinergic side effects: Serotonin syndrome: is thought to be related to over-activation of the central serotonin receptors caused by either too high a dose or interaction with other drugs. Hyperactivity or restlessness, tachycardia(CV shock) fever(hyperpyrexia), elevated B/P, delirium, irrationality, mood swings, hostility, seizures- status epilepticus, myoclonus, incoordination, tonic rigidity, abdominal pain, diarrhea, bloating, apnea- death are some symptoms. Treated with serotonin receptor blockade with cyproheptadine, methysergide, propranolol, cooling blankets, chlorpromazine for hyperthermia, dantrolene, diazepam for muscle rigidity or rigors anticonvulsants, artificial ventilation are some interventions.Neuroleptic syndrome: rear but dangerous, severe muscle rigidity, dysphasia, flexor-extensor posturing, reduced or absent speech and movement, decreased responsiveness. Hyperpyrexia is the main feature temperature over 103F. Autonomic dysfunction: hypertension, tachycardia, diaphoresis, incontinence, delirium, stupor, coma.
Which classification of drugs are more at risk for causing the following adverse effects: agranulocytosis, cholinergic side effects, Serotonin Syndrome, and Neuroleptic Syndromes.
Agranulocytosis: second generation antipsychotics( Clozapine(clozaril)) Neuroleptic syndrome: First generation antipsychotics Serotonin Syndrome: When SSRI is administered in combination with a second serotonin- enhancing agent, such as monoamine oxidase inhibitor (MAOI) Cholinergic side effects:
Give the rationale why a nurse would not use humor as a nursing intervention for anhedonia.
Anhedonia: a reduced ability or inability to experience pleasure in everyday life.
How quickly can withdrawal symptoms appear?
Mild symptoms begin 6 to 24 hours after alcohol cessation ( agitation, lack of appetite, nausea, vomiting, insomnia, impaired cognition and mild perceptual changes) Moderate symptoms begin 24 to 72 (increases systolic BP, rapid respirations, tachycardia, mild hyperthermia) Withdrawal seizures may occur within 12 to 24 hours after alcohol cessation
4. Do the majority of Selective Serotonin Reuptake Inhibitors (SSRIs) cause anticholinergic side effects? Explain your answer, using the cause of anticholinergic side effects.
Anticholinergic drugs work by blocking the effects of acetylcholine, a substance that transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. A wide range of drugs—including tricyclic antidepressants like amitriptyline (Elavil) or doxepin (Deptran, Silenor, Sinequan)—have strong anticholinergic effects, which means they can have side effects like memory problems and confusion. These effects are more pronounced in older people, so these antidepressants are reserved for younger people. The selective serotonin reuptake inhibitors (SSRIs), like citalopram (Celexa) and duloxetine (Cymbalta), are commonly used to treat depression in people of all ages. Some of them have stronger anticholinergic side effects than others, but over all they have a relatively low anticholinergic effect. Other newer antidepressants, including serotonin/norepinephrine reuptake inhibitors such as venlafaxine (Effexor) and atypical antidepressants such as bupropion (Wellbutrin), have a very low anticholinergic effect.
What type of behavior does the person with ODD engage in?
Argumentative, defiant, deliberately annoys others, blame others for own mistakes or behavior
Why would a benzodiazepine be given for an anxious patient with suicidal intent?
Benzodiazepines are used to relieve acute anxiety and the patient's anxiety may be the underlying cause for their suicidal intent. The benzo is relieving the anxiety not the suicidal intent.
What are the risk factors for suicide?
Biological? - May run in families - Genetic factors - Low levels of serotonin or its metabolites in the cerebrospinal fluid Psychobiological? - The wish to kill turned inwardly (revenge) - The wish to be killed (guilt) - The wish to die (hopelessness) Environmental? - Result of loss (love, self-esteem, job, freedom as result of incarceration, rage and guilt, and ID with an individual who committed suicide) Cultural? - Religious beliefs - Family values - Sexual orientation - Attitude towards death - Ethnicity (American Indians and Alaskan natives= highest rates of suicide) Societal? - Assisted suicide= moral and ethical issue Other risk factors? - Suicidal Ideation with intent - Lethal suicide plan - Hx of suicide attempt - Co-occurring psych illnesses - Co-occurring medical illnesses - Hx of child abuse - Family Hx of suicide - Isolation - Recent stressful life event - Panic attacks - Feeling shame or humiliation - Impulsivity - Aggressiveness - Lose of cognitive function - Access to firearm and other highly lethal means - Substance abuse - Low frustration tolerance
Define cataplexy.
Brief episode of bilateral loss of muscle tone while maintaining consciousness
What are the symptoms associated with Narcolepsy?
Cataplexy- brief episode of bilateral loss of muscle tone while conscious. This is usually triggered by strong emotions such as anger, frustration, laughter. (Cataplexy is probably the occurrence of REM sleep paralysis during wakefulness) Hypnagogic hallucination- false auditory, visual and tactile sensation. They occur from wakefulness to sleep. Sleep paralysis- an inability to move or speak during the transition from sleep to wakefulness
What are the restrictive repetitive behavior associated with Autism?
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, excessive adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route or eat food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or movement).
Describe lethality of suicidal plan. (high or low risk)
3 main elements: (1) Is there a specific plan with details? (2) How lethal is the proposed method? (3) Is there access to the planned method? · High risk= definite plans for the time, place and means · Higher risk methods: - Using a gun - Jumping off a high place - Hanging - Poisoning with carbon monoxide - Staging a car crash · Lower Risk methods: - Slashing one's wrists - Inhaling natural gas - Ingesting pills
What is Korsakoff Syndrome?
A chronic more severe form of Wernicke Syndrome, a short term memory disturbance associated with long term heavy alcohol users, that has only a 20% recovery rate. · Result of thiamine deficiency, which may be caused by poor nutrition or by malabsorption of nutrients. Chapter 22: Substance Related and Addictive...
How does tunnel vision relate to suicidal ideation?
A high degree of hopelessness or tunnel vision is a S/Sx of suicidal ideation.
Explain the causes of why circadian rhythms are disrupted, in patients diagnosed with psychiatric disorders.
A master biological clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus. The clock regulates not only sleep but also a host of other biological and physiological functions. SCN receives information from the retina, thalamus and midbrain. These pathways regulate sleep wake cycle, endocrine, autonomic, cognitive, attention, memory and emotion. Neurotransmitters also regulate sleep and wakefulness. Sleep promoting neurotransmitters: adenosine, GABSA and galanin. Wakefulness neurotransmitters: dopamine, norepinephrine, serotonin, acetylcholine, histamine, glutamine. Any medication that crosses the blood brain barrier used in psychiatry to manipulate the neurotransmitter system can cause circadian rhythm to be disrupted
What is Wenicke Syndrome?
A short term memory disturbance that is acute and reversable, experienced by long term heavy alcohol users. · Result of thiamine deficiency
What is DSM-V criteria for Oppositional Defiant Disorder?
A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood- Often loses temper. Is often touchy or easily annoyed. Is often angry and resentful. Argumentative/Defiant Behavior Often argues with authority figures or, for children and adolescents, with adults. Often actively defies or refuses to comply with requests from authority figures or with rules. Often deliberately annoys others. Often blames others for his or her mistakes or misbehavior. Vindictiveness Has been spiteful or vindictive at least twice within the past 6 months. B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g. family, peer group, work colleagues) or it impacts negatively on social, educational, occupational, or other important areas of functioning. C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder. Specify current severity: Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). Moderate: Some symptoms are present in at least two settings. Severe: Some symptoms are present in three or more settings.
1. Discuss why a nurse experiencing counter transference feelings, focused on one patient, was not granted a reassignment to another patient. What is the standard of practice that would justify denying the nurse's request?
Countertransference involves ... when the experience of transference is reversed. Countertransference, a normal occurrence as well, involves the nurse's reactions, behaviors, thoughts, and feelings toward the patient (Wilson & Kniesl, 1996). Unresolved conflicts from the nurse's past may evolve as countertransference. For example, a patient who displays childlike dependency toward a nurse may evoke a parental attitude from that nurse, depending on the meaning that he or she assigns to the relationship with the patient, and if past conflicts are significant to the present situation. Nurses may be completely unaware or only minimally aware of the countertransference as it is occurring. Interventions Interventions for countertransference involve identification, observation, and feedback by other nurses and staff members. Once again, the relationship usually should not be terminated in the presence of countertransference. Rather, the nurse or staff member experiencing the countertransference should be supportively assisted by other staff members to identify his or her feelings and behaviors and recognize the occurrence of the phenomenon. The therapeutic relationship can often be improved by offering the nurse or other staff member feedback about the progression of the relationship. It may be helpful to have evaluative sessions with the nurse or staff member after their encounters with the patient, in which both they and other staff members (who are observing the interactions) discuss and compare the exhibited behaviors in the relationship. Importantly, a staff member who is helped to identify their own countertransference in dealing with a particular patient might be able to recognize and manage this on their own when they encounter other patients later on who evoke similar personal reactions.
What side effects are possible when taking atomoxetine (Strattera)?
Decreased appetite and weight loss, fatigue, and dizziness. It is contraindicated for patients with severe cardiovascular disease due to its potential to increase blood pressure and heart rate.
What is DSM-V criteria for Conduct Disorder?
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the following categories with at least one criterion present in the past 6 months: Aggression to People and Animals Often bullies, threatens, or intimidates others. Often initiates physical fights. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). Has been physically cruel to people. Has been physically cruel to animals. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). Has forced someone into sexual activity. Destruction of Property Has deliberately engaged in fire setting with the intention of causing serious damage. Has deliberately destroyed others' property (other than by fire setting). Deceitfulness or Theft Has broken into someone else's house, building, or car. Often lies to obtain goods or favors to avoid obligations (i.e., "cons" others). Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting but without breaking and entering; forgery). Serious Violations of Rules Often stays out at night despite parental prohibitions, beginning before age 13 years. Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period. Is often truant from school beginning before age 13 years. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder. Specify whether: Childhood-onset type: Individuals show at least one symptom characteristic of conduct disorder before age 10 years. Adolescent-onset type: Individuals show no symptom characteristic of conduct disorder before age 10 years. Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years. Specify if: With limited prosocial emotions Specify current severity: Mild, Moderate, Severe
How is DTs medically managed? (What drugs are given?)
Diazepam and Chlordiazepoxide for symptomatic relief · IV benzodiazepines are required once delirium appears
3. Discuss why it is important for parents to rear their children so that they are allowed to express their own values and beliefs instead of being reprimanded when the views of the children differ from those of their parents.
Differentiation of Self (Bowen Theory) Families and other social groups tremendously affect how people think, feel, and act, but individuals vary in their susceptibility to a "group think" and groups vary in the amount of pressure they exert for conformity. These differences between individuals and between groups reflect differences in people's levels of differentiation of self. The less developed a person's "self," the more impact others have on his functioning and the more he tries to control, actively or passively, the functioning of others. The basic building blocks of a "self" are inborn, but an individual's family relationships during childhood and adolescence primarily determine how much "self" he develops. Once established, the level of "self" rarely changes unless a person makes a structured and long-term effort to change it. People with a poorly differentiated "self" depend so heavily on the acceptance and approval of others that either they quickly adjust what they think, say, and do to please others or they dogmatically proclaim what others should be like and pressure them to conform. Bullies depend on approval and acceptance as much as chameleons, but bullies push others to agree with them rather than their agreeing with others. Disagreement threatens a bully as much as it threatens a chameleon. An extreme rebel is a poorly differentiated person too, but he pretends to be a "self" by routinely opposing the positions of others. A person with a well-differentiated "self" recognizes his realistic dependence on others, but he can stay calm and clear headed enough in the face of conflict, criticism, and rejection to distinguish thinking rooted in a careful assessment of the facts from thinking clouded by emotionality. Thoughtfully acquired principles help guide decision-making about important family and social issues, making him less at the mercy of the feelings of the moment. What he decides and what he says matches what he does. He can act selflessly, but his acting in the best interests of the group is a thoughtful choice, not a response to relationship pressures. Confident in his thinking, he can either support another's view without being a disciple or reject another view without polarizing the differences. He defines himself without being pushy and deals with pressure to yield without being wishy-washy. Every human society has its well-differentiated people, poorly differentiated people, and people at many gradations between these extremes. Consequently, the families and other groups that make up a society differ in the intensity of their emotional interdependence depending on the differentiation levels of their members. The more intense the interdependence, the less the group's capacity to adapt to potentially stressful events without a marked escalation of chronic anxiety. Everyone is subject to problems in his work and personal life, but less differentiated people and families are vulnerable to periods of heightened chronic anxiety which contributes to their having a disproportionate share of society's most serious problems.
List the neurotransmitters associated with Bipolar I mania.
Dopamine
When is the patient, with diurnal variation, more likely to respond to a nursing intervention?
During peak times
Discuss which of the following nursing interventions is the MOST appropriate for a patient who is severely manic:
Encourage the patient act out his feelingsmood" all day long. Explain why the supervisor told the student, you don't appear to understand mania." Explain what the supervisor meant by that statement.
Define piloerection.
Erection or bristling of hairs due to involuntary contraction of small muscles at the base of the hair follicle that occurs as a reflexive response of the sympathetic nervous system
Define cachexia.
Extreme weight and muscle loss. Weakness and wasting of the body due to severe chronic illness
What are the symptoms associated with tardive dyskinesia?
Face: protruding or writhing tongue, blowing, smacking, licking, facial distortion Chorea: rapid, purposeless, and irregular movements Antheoid: slow, complex, and serpentine movements Trunk: neck and shoulders movements, hip jerks and rocking, or twisting pelvic thrust.
Which classification of antipsychotic medications are LEAST likely to cause obesity?
First generation antipsychotic medications Low: loxapine(loxitane), perphenazine, fluphenazine, pimozide(orap), trifluoperazine
Which classification of drugs are high-risk for pseudo-Parkinsonism?
First generation antipsychotics Haldol, Fluphenazine (very high risk) Orap, Navane, Trifluoperazine ( High risk)
What causes akathisia?
First generation antipsychotics( Very high:Fluphenazine,haloperidol) (high:pimozide(orap),thiothixene(navane),trifluoperazine.)
Which classification of drugs are high-risk for tardive dyskinesia?
First generation antipsychotics... trifluoperazine (stelazine)
What would be a priority outcome for a patient who is severely manic, and has lost 20 pounds in 5 days. Give the definition of cachexia.
High-calorie, high-protein food supplements will provide the additional calories needed to offset the patient's extreme hyperactivity. Cachexia is a condition that causes extreme weight loss and muscle wasting
What is a key indicator medications for ADHD are effective in controlling symptoms?
Improved concentration and focus.
2. What are the characteristics of a family with healthy boundaries?
In a balanced system, each person takes full responsibility for what belongs to them in order to make that relationship work properly. A balanced boundary system can be visualized by a line the separates two people. For a healthy relationship to occur, both have to take responsibility to come up to the line and do what they are both responsible for in that relationship. • If they step over the line to do what the other person should do, it is enmeshment. • If they remain distant from the line and default on what is theirs, it is disengagement. The hard part in assessing family boundaries is deciding what belongs to each person in the family. How this is resolved will determine how the parent(s) choose(s) to communicate and what he/she/they attend to. A balanced family boundary system incorporates a healthy mix of engagement and autonomy for the individuals in that family. For example, parents need to keep some information away from their children (conflict they need to work out between themselves) but overtly communicate other information to their children that they need to know (e.g., that they are loved). Children need to be allowed to have age-appropriate autonomy but not too much so they feel neglected. It is challenging to find where that boundary line should be, especially when it has not been drawn in a healthy way. But, with open communication about what the family boundaries need to be, unhealthy family boundaries, along with lots of practice, can facilitate the development of healthier relationships that are respectful, safe and meaningful.
Define apraxia.
Inability to perform particular purposive actions as a result of brain damage (head trauma, stroke or brain tumor) It can affect speech and motor function
What is the DSM-V criteria for Autism?
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history: 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to total lack of facial expressions or nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to an absence of interest in peers. Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior. B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following, currently or by history : 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, excessive adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route or eat food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or movement). C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms together limit and impair everyday functioning. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.
Define Polysomnography.
Is the most common sleep test and is used to diagnose and evaluate patients with sleep related breathing disorders and nocturnal seizure disorders. It usually involves one or two nights of sleep in lab with electrodes and monitors placed on the head, chest and legs. Technicians record brain wave activities eye movement muscle tone heart rhythm and breathing
Why does gaining insight into their maladaptive behavior help children?
It helps to prevent relapse, provide social support, improve coping skills in interpersonal relationships, improve adherence to medication regimen, reduce functional morbidity, and decrease the need for hospitalization.
Why is journaling an intervention that is effective for adolescents as well as adults? (What does journaling accomplish?)
Journaling helps to deal with stress and stressful events, and in healing both physically and emotionally. In adolescents and adults, it helps to to express emotions and can help begin a dialogue with other.
What does resilience enable a child to do?
Adapt to changes in the environment Form nurturing relationships with other adults when the parent is not available Distance self from emotional chaos Develop social intelligence Develop good problem-solving skills Perceive a long-term future
Does the person with Narcolepsy sleep at night?
Additional symptoms of narcolepsy include disturbed night time sleep with multiple middle of the night awakenings which can cause memory lapses.
What is the treatment for pseudoParkinsonism?
Administer antiparkinsonian agent such as Trihexyphenidyl (artane) or Benztropine (cogentin)
Discuss the priority nursing intervention(s) for a patient that is exhibiting symptoms associated with pseudo-Parkinsonism?
Administer antiparkinsonian agent such as trihexyphenidyl (atrane) or benztropine (cogentin) if intolerable, consult prescriber regarding dose reduction or medication change. Provide towel or handkerchief to wipe excess saliva. Teach how to reduce fall risk.
What type of behavior does the person with CD engage in?
Aggression, destruction of property, stealing, deceitfulness, and criminal behavior.
What baseline assessment is most important before starting ADHD medications in children?
Cardiac examination, Heart rate, Respiratory rate, Blood pressure, Lung sounds
What are the symptoms of cirrhosis of the liver?
Jaundice Easy bleeding or bruising Pruritus Leg edema Testicular atrophy Gastrointestinal bleeding Abdominal swelling (ascitis) Confusion Fatigue weakness and weight loss
What is the difference between renewal of hope and self-esteem?
Renewal of hope= Demonstrates a positive future orientation and identifies concrete goals · Renewal of self-esteem= Describes feelings of self-worth
8. What are the risks associated with ECT?
Modern electroconvulsive therapy (ECT) is generally considered a safe and effective treatment for severe, chronic depression and treatment-resistant depression, although it may occasionally be used to treat other conditions as well. Despite its general safety and efficacy, like psychiatric medications, it carries with it a number of side effects. a. Memory Loss Memory loss is the primary side effect associated with ECT treatment. Most people experience what's called retrograde amnesia, which is a loss of memory of events leading up to and including the treatment itself. Some people's memory loss is longer and greater with ECT. Some have trouble recalling events that occurred during the weeks leading up to treatment, or the weeks after treatment. Others lose memories of events and experiences in their past. Memory loss generally improves within a few weeks after ECT treatment. As with psychiatric medications, no professional or doctor can tell you for certain what kind of memory loss you will experience, but virtually all patients experience some memory loss. Sometimes the memory loss in some patients is permanent. b. Concentration and Attention Problems Some people with have ECT treatments complain of ongoing problems with concentration and attention, much like a person with attention deficit disorder. While in most people this clears up within a few weeks of treatment, you may find it harder to concentrate on tasks or reading that you could previously do before ECT treatment began. 3. General Confusion Many people who undergo the electroconvulsive therapy find that they experience a period of confusion after the procedure has been completed. You may forget why you're in the hospital, or even what hospital you're in. For most people, this confusion fades after a few hours, but can last as long as a few days after the ECT treatment. Older adults tend to have a greater problem with confusion than middle-aged or younger adults. c. Other Side Effects Similar to some psychiatric medications, some people undergoing ECT may experience physical side effects such as nausea, headaches, muscle aches or spasms, and vomiting. These are temporary side effects that nearly always go away within a few hours or days after treatment. d. Other Risks ECT is a medical procedure that can only be performed by a qualified physician or psychiatrist. Because general anesthesia is administered, electroconvulsive therapy carries with it similar risks that any medical procedure using anesthesia does. Hospital staff and an anesthesiologist monitor your vital signs during the procedure — including heart rate and blood pressure — to watch for any signs that you may be having difficulty with the treatment. Patients with a history of heart problems generally should not undergo ECT treatment, because the risk associated with receiving the electrical stimulation is greater.
Name all the signs and symptoms of opioid withdrawal.
Mood dysphoria Nausea Vomiting Diarrhea Muscle aches Fever Insomnia Lacrimation (watery eyes) Pupillary dilation Piloreaction ,Yawning
Which symptoms are associated with akathisia?
Motor restlessness: pacing, unable to stand still or stay in one location, rocking while seated or shifting from one foot to the other while standing
What drugs are used to treat an overdose of opioids?
Naloxon (narcan) or Evzio is a prefilled autoinjector device that is used to inject naloxone in inner thigh
Are there medications that will relieve suicidal intent?
No, there are currently no medications available to specifically relieve suicidal intent alone. Other medications are used to treat other psych illnesses that may attribute to suicidal intent though.
Describe nursing responsibilities when care for suicidal adolescent.
One on one nursing observation and interaction 24 hours a day · Chart patients whereabouts and record mood, verbatim statements, and behavior q15 · Make sure meal trays contain no glass or metal silverware · During observation when patient appears to be sleeping hands should be in view at all times · Observe patient swallow each dose of medication · Explaining to the patient what you will be doing and why, and documenting this in the chart
What are the characteristics of Narcolepsy?
Patient with narcolepsy generally feel refreshed upon awakening but within 2 to 3 hours begin to feel sleepy again. People with narcolepsy have an uncontrollable urge to sleep. It occurs in men more than in women
Explain why one-on-one supervision is an appropriate nursing intervention for a patient, who is severely manic, and insists that he does not want to wear any clothes.
Patients must be protected from the embarrassing consequences of their poor judgment whenever possible. One on one supervision may provide the necessary structure.
What physiological changes happen to an alcoholic? (Chronic abuse)
Peripheral neuropathy Alcoholic myopathy (weakened muscles, decrease in muscle mass, muscle wasting) Alcoholic cardiomyopathy Esophagitis (inflammation of esophagus) Gastritis (stomach inflammation) Cirrhosis of the liver Leukopenia ( low level of WBC) Thrombocytopenia ( low platelet level) Cancer Pancreatitis Alcoholic hepatitis Memory reducing problem called Wernicke encephalopathy an acute and reversible condition (treated with B1 Thiamine) Korsakoff syndrome is more severe and chronic problem of Wernicke encephalopathy
Define tunnel vision.
Phenomenon that occurs in times of acute stress and pain in suicidal individuals in which problem solving skills are poor, and suicidal individuals have difficulty preforming flexible cognitive operations. Teaching the patient or reinforcing the patient's own effective problem solving skills and helping them reframe life difficulties as events that can be controlled.
Discuss priority nursing interventions for a patient who exhibits waxy flexibility.
Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Higher level needs are of lesser concern.
What behavioral interventions can help children gain insight into maladaptive behavior?
Play Therapy- Play is often described as the work of childhood. Through play children develop their physical, intellectual, emotional, social, and moral capacities. Bibliotherapy- Involves using literature to help the child express feelings in a supportive environment, gain insight into feelings and behavior, and learn new ways to cope with difficult situations. When children listen to or read a story, they unconsciously identify with the characters and experience a catharsis of feelings. Expressive Arts Therapy-The therapeutic use of art provides a nonverbal means of expressing difficult or confusing emotions. Drawing, painting, and sculpting are a few of the commonly used mediums. Creating something may help young people express the thoughts, feelings, and tensions that they cannot express verbally, are unaware of, or are denying. Journaling - Writing in a journal (journaling) is an extremely useful and simple method of identifying stressors.This is effective when working with younger people, particularly teenagers. The use of a daily journal is also effective in setting goals and evaluating progress. Music Therapy - Music can be used to improve physical, psychological, cognitive, behavioral, and social functioning. It is a nonthreatening approach that engages multiple senses. Children and adolescents can be involved in music by listening, singing, playing, moving, and other creative activities
Give the rationale why limit setting would not be appropriate for a patient who is severely manic.
Psychiatric emergency: because they feel so important and powerful, they take horrific chances and engage in hazardous activities. We must keep watching the patient at all times.
What are the most common side effects associated with ADHD medications?
Psychostimulant drugs- Agitation, exacerbation of psychotic thought processes, hypertension, and growth suppression, as well as their potential for abuse.
Explain why it is important for a baseline assessment of height and weight is needed before starting a child on methylphenidate hydrochloride therapy
Psycostimulant like methylphenidate can cause hypertension, and growth suppression, decreased appetite and weight loss.
List the adverse effects associated with ECT. (Note: be sure and distinguish between side effects and adverse effects. If these two terms are not clear, learning the difference.
Pt's wake about 15 minutes after procedure confused and disoriented for several hours. Retrograde Amnesia, which is a loss of memory of events leading up to and including the treatment itself.
Compare and contrast the following symptoms: referential delusion, delusion of grandeur, and delusion of paranoia.
Referential Delusion: a belief that events or circumstances that have no connection to you are somehow related to you. example : barbara believes that the birds sing songs to cheer her up. Andrea believes songs on the radio are chosen to send her a message. Grandeur Delusion: Believing that one is a very powerful or important person. Example: brianna believes she is a famous playwright. Paranoia Delusion: An irrational fear , ranging from mild(wary, guarded) to profound (believing irrationally that another person intends to kill you.
Define resilience. Construct a sentence which describes resilience.
Resilience is the ability and capacity for people to secure the resources they need to support their wellbeing. The phenomenon of resilience is the relationship between a person's inborn strengths and success in handling stressful environmental factors. "I try to remember not to take other people's bad moods personally." "I've learned to calm down before trying to defend my opinions." "I know that discussing issues with my boss would help me get my point across."
What symptom of opioid withdrawal is a key feature? (Think nasal.)
Rhinorhea (runny nose)
What are areas of assessment for the adolescent population where suicide is more likely?
Risk factors and warning signs
What is savant syndrome associated with Autism? (Remember intellectual disability is not universally applicable to all autistic persons.)
Savant syndrome is a condition in some individuals with autism spectrum disorder who may have low IQs yet are brilliant in specific areas. These areas include musical, visual-spatial, or intellectual abilities such as the ability to complete complex mathematical calculations or photographic memory recall.
What are environmental risk factors associated with child psychiatric disorders?
Severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. Trauma in childhood is strongly associated with adult dysfunction
A patient is being discharged with an SSRI that rarely causes anticholinergic side effects. What should the patient be taught before discharge?
Side effects: agitation, insomnia, headache, nausea, and vomiting, sexual dysfunction, and hyponatremia. Warnings: Discontinuation syndrome- dizziness, insomnia, nervousness, irritability, nausea, and agitation may occur with abrupt withdrawal (depending on half-life) taper slowly.
What are the key features of suicidal ideation?
Suicidal ideation= thoughts of harming self · High degree of hopelessness, helplessness, and anhedonia · Has a plan to kill self
What are the signs and symptoms of delirium tremens (DTs)?
Tachycardia, diaphoresis, fever, anxiety, insomnia, and hypertension. · Delusions and visual and tactile hallucinations may also occur
Which of the following adverse effects is the Abnormal Involuntary Scale (AMIS) use to assess: tardive dyskinesia, pseudo-parkinsonism, Tourette's Syndrome, and ECT?
Tardive Dyskinesia
Define temperament.
Temperament refers to the usual attitude, mood, or behavior that a child habitually uses to cope with the demands and expectations of the environment.
What is diurnal variation?
The peak and low
What makes the adolescent population at a greater risk for suicide?
Their immature prefrontal cortex, the portion of the brain that controls the executive functions involving judgement, frustration, tolerance, and impulse control
Define parent management training.
This treatment targets the parents rather than the child and focuses attention on reinforcement of positive and prosocial behavior, and on brief, negative consequences of bad behavior. This evidence-based treatment is for children aged 2 to 14 with mild to severe behavioral problems.
Describe the difference between punishing a child and giving a time-out. Provide examples.
Time-out may involve going to a designated room or sitting on the periphery of an activity until self-control is regained. It is a less restrictive alternative to seclusion and restraint. E.g. Asking or directing a child or adolescent to take a time-out from an activity to promote self-reflection and encourage self-control. Punishment is an unpleasant consequence. E.g. Driving too fast may result in a speeding ticket, which—in mature and healthy individuals—decreases the chances that speeding will occur again.
Define petechiae.
Tiny round brown purple spots due to bleeding under the skin, maybe a small area due to minor trauma or wide spread due to blood clotting disorder ( low level of platelets)
What is/are the treatments for tardive dyskinesia?
Valbenazine capsules( ingrezza) in adults (FDA approved) Tetrabenazine- for abnormal movements at least every 3 months
Describe verbal and non-verbal cues of suicide intent.
Verbal · Overt Statements: "I can't 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 work out." "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?" Non verbal: · Sudden brightening of mood with more energy · Giving away possessions · Organizing financial affairs
Describe verbal and non-verbal communication in those with Autism.
Verbal: Continuous repetition of words—a condition called echolalia. Speaking in a high-pitched or sing-song voice or use robot-like speech Use stock phrases to start a conversation Non-verbal: Often avoid eye contact, abnormalities in eye body language or deficits in understanding and use of gestures, total lack of facial expressions or nonverbal communication
What are the main goals of care for alcoholic during hospitalization? (Think medical management...not addiction management)
Vital signs stabilization and safety from injury and detox, prevention of sei Patient will remain free from injury while intoxicated after overdosing and while withdrawing from the substance.
What vitamin deficiency does the alcoholic have?
Vitamin B 1 (Thiamine) B 3 (niacin) B 12, folic acid, zinc, magnesium
Is suicidal ideation always a high nursing priority? (Yes!!)
Yes, the potential for suicide is always the first area of nursing concern. PATIENT SAFETY IS ALWAYS #1 PRIORITY.
Explain which of the following hypnotics would be appropriate to treat a patient experiencing insomnia associated to a recent stressful event.
Zolpidem Fluoxetine Flurazepam (for treatment of insomnia with hypnotic effect but also an antianxiety agent) Risperidone
What cognitive distortion is common in children and adolescents with suicidal ideation?
· Helplessness
Why is the psychotic alcoholic going through DTs at a greater risk of mortality?
· Patient is at a higher risk for experiencing unconsciousness, seizures, and delirium
Why is it important to identify short-term goals for the future with suicidal patients?
· Renewing realistic dreams and hopes can give promise to the future and meaning to life.
What role does sleep play in a patient experiencing anxiety?
· Sleep disturbances are very common, most have difficulty falling asleep. Patients may perform rituals to the exclusion of resting and sleeping and physical exhaustion may occur.
During antidepressant therapy, what is the best rationale for closely monitoring a severely depressed patient for suicide intent?
· When antidepressants take effect and decrease symptoms of depression a patient is more likely to carry out a suicide attempt because they are no longer too depressed to do so.
