Mental Health Exam #2

Fetal Alcohol syndrome

* Alcohol use during pregnancy inhibits intrauterine growth and postnasal development. * - Low nasal bridge - Thin upper lip - Minor ear abnormalities - microcephaly - short in stature

First generation antipsychotics

* These drugs treat hallucinations - Haloperidol (Haldol) - Chlorpromazine (Thorazine) - Paliperidone (contraindicated with Heart rate) MAIN SIDE EFFECT: Weight gain

Second generation antipsychotics

* Treat both positive and negative symptoms * Minimal to no EPS or tardive dyskinesia - Aripiprazole --> best drug for over weight individuals - Clazopine - Quetiapine - Olanzapine - Ziprasidone --> requires an additonal amount of calories (roughly 500 for absorption) MAIN SIDE EFFECTS: Significant weight gain; at risk for metabolic syndrome (obesity, hyperlipidemia, HTN, hyperglycemia, risk for heart disease)

Word Salad

- A part of associative looseness. - nothing makes sense, the words are not connected whatsoever. EX: sky, green, pasta, stomach

What is dissociative fugue?

- A subtype of dissociative amnesia - Forgetful and individual travels somewhere Characterized by sudden, unexpected travel away from the customary locale and inability to recall one's identity and to recall one's identity and information about some or all of the past.

What interventions would you take if a patient is experiencing disturbed thoughts? What is the main priority?

- ALWAYS ask questions and bring them back to reality. - The main priority is SAFETY

Extra-pyramidal symptoms (EPSs)

- Akathisia (inability to sit still) - Acute dystonia (sudden sustained muscle contractions) - Pseudoparkinsonism (exhibit symptoms like a parkinsons pt: gait shuffling, slow movement) - Tardive dyskinesia (twitching of the face and oral muscles --> tongue is sticking out) -

Negative S/S of schizphrenia:

- Anhedonia (inability to enjoy life) - Avolition (loss of motivation) - Depression - Alogia (poverty of speech or thought) - Affective blunting - Apathy (decrease interest in activity) - Asociality (decrease or desire for comfort/social interactions)

What is an adverse effect of imipramine?

- Anticholinergic effects * (urinary retention is VERY serious, dry mouth, blurred vision, etc)

Interventions with a patient who has anxiety:

- Assess what level of anxiety they have first - Never ask WHY questions - Teach them how to identify their triggers - Utilize therapeutic communication

Benzodiazepines and its Adverse Reactions

- Benzos have a fast onset of action. - Benzos can cause dependency, therefor they should be used only for a short period of time. - Not recommended for an individual who has a substance abuse disorder. - Buspirone is an alternative antianxiety medication that doesn't cause dependence (usually takes 2-4 weeks to go into effect)

Tobacco use

- Can be inhaled or chewed - Long term effects include: HTN, stroke, emphysema, lung cancer or mucosal and mouth cancer) - Lesions can be present

Anticonvulsants (for bipolar)

- Carbamazepine - Valproate - Lamotrigine * Valproic acid cannot be used for patients who have liver disorders. * Carbamazepine cannot be used on patients with bone marrow suppression or bleeding disorders. * These medications can cause birth defects, so pregnant patients will be at risk.

Cocaine

- Cocaine is a stimulant - If patient goes through withdrawals, they will be at risk for suicidal ideation

Re-feeding syndrome

- Eating too much which causes deficiencies and electrolytes: can cause muscle weakness, respiratory depression, heart problems (dysrhythmias) - Nutrients are re-introduced slowly in order to avoid this syndrome.

Lanugo

- Fine downy hair - Associated with anorexia

Manic phase

- Hyperactive - No sleeping - Must be provided with finger foods - Pacing - They are manic for about a week, then they crash and go into a depressive state, where they cannot make decisions

Teachings about SSRIs:

- If taken with a second serotonin enhancing agent, patient can be at risk for serotonin syndrome - Patient should discontinue SSRIs for 2-5 weeks before starting an MAOI - Pregnant patients should avoid using paroxetine (not safe for the baby)

S/S of depression

- Individuals can sleep too much or too little (insomnia or hypersomnia) - Worthlessness or guilt - lack or inability to concentrate - suicidal ideation - weight loss and appetite changes - Low self esteem (KNOW ALL THE A'S) •Affect •Anergia •Anhedonia

S/S of Marijuana withdrawal

- Irritability - Aggression - anxiety - Abdominal pain - Fever - Headache - Depressed mood - Tremors - Diaphoresis (sweating) - Lack of appetite - insomnia

Lithium

- Narrow therapeutic range (0.8-1.1) - Inverse relationship with sodium

Naltrexone

- Opioid antagonist - Is used to take patients off opioid addictions slowly; helps client in the reduction of self harm (can also be used for alcohol abuse).

What can help treat depression?

- SSRIs - St. John's Wort (herbal supplement) - It takes 4-6 weeks for antidepressants to work

Info on First generation antipsychotics

- Take 6 weeks to work - If they don't work effectively, clozapine will be tried - Has anticholinergic side effects (most concerning will be urinary retention) - Other effects: sexual dysfunction, agranulocytosis (puts client at risk for infection), NMS (Neuroleptic malignant syndrome —> severe muscle rigidity, temp of 103*F, BP and HR is increased)

Dissociative Identity disorder

- The essential feature is the presence of two or more distinct personality states that recurrently take control of behavior. - Main intervention: Making sure the client is safe

Bulimia Nervosa

- Uncontrollable action of eating and then purging (binging) - Innapropriate compensatory behaviors: diuretics, laxatives, excessive exercise, vomiting. - They are likely to have eroded teeth and enlarged parotid gland

Opioid withdrawal

- Very unpleasant, but not life-threatening - Occurs after a reduction or cessation of heavy opioid use, or after opioid antagonist is administered. - Individual will experience Tachycardia, pupil dilation, nausea and vomiting, diarrhea, fever, muscle spasms, pain in the muscle and bones, insomnia, sweating and runny nose.

S/S of too much caffiene

- tachycardia - insomnia - headache - restlessness - GI disturbances

Binge Eating

- they initially start off with a normal weight, they become obese (therefor, self esteem and body image will be at risk) - Bariatric surgery is common in individuals who binge eat

Referential (Type of delusion)

A belief that an event or circumstance that has no connection to you, is somehow related to you. EX: Seeing 222 means I am going to win the lottery.

Withdrawal

A set of psychological symptoms that occur when a person stops using a substance.

What is your best intervention when you assess that a patient is responding to an auditory hallucination? A.Ask the patient, "Can you tell me what you are hearing?" B.Ask the patient, "Are you afraid of the voice you are hearing?" C.Tell the patient, "Try to ignore the voices you hear." D.Tell the patient, "The voices you hear are not real."

A.Ask the patient, "Can you tell me what you are hearing?"

Which of the following should be established first in working with a child with PTSD? A.Provide safety and stabilization B.Reduce symptoms C.Develop a value system D.Provide support for catching up on developmental and social skills

A.Provide safety and stabilization

Loose associations in a person with schizophrenia indicate A.paranoia. B.mood instability. C.depersonalization. D.poorly organized thinking.

A.paranoia.

What interventions would you take if a PTSD patient informs you that they are tired of not sleeping and having flash backs?

Ask them about coping mechanisms and inform them that these are normal S/S of their disease.

A nurse assesses a patient diagnosed with dissociative identity disorder. Which finding would likely be part of the patient's history? A.Travel to a foreign country B.Physical or sexual abuse C.Thyroid dysfunction D.Eating disorder

B.Physical or sexual abuse

A person has recently abused morphine. The person's pupils would most likely be A.dilated. B.constricted. C.asymmetrical. D.unresponsive to light.

B.constricted.

Erotomanic (Type of delusion)

Believing that another person desires you romantically

Control (Type of delusion)

Believing that another person, group or external force controls your thoughts, feelings, impulses and behaviors.

Persecutory (Type of delusion)

Believing that one is being singled out for harm or prevented from making progress by others. EX: Shannon believes that her co workers are plotting to prevent her promotion.

Grandiose (Type of delusion)

Believing that one is powerful or an important person. EX: Karen believes that she is a famous singer.

Somatic (Type of delusion)

Believing that the body is changing in unusual ways

Shortly before treatment, after crying and begging him to get help, Ahmed's girlfriend stayed home from a planned night out with her friends to pour all the alcohol in his apartment down the drain. What type of behavior is evident? A.Enabling B.Tolerance C.Codependence D.Use of defense mechanisms

C. Codependence

Associative looseness

Concepts that are loosely connected. EX: I don't trust the french, therefore I won't eat french fries.

Generalized anxiety disorder

Constant and persistent worrying.

A nurse is assigned the care of four patients who are detoxifying from alcohol. The patient with which symptom would be the nurse's highest priority? A.Fine motor tremors B.Diaphoresis C.Diarrhea D.Hallucinations and delusions

D.Hallucinations and delusions

A patient complains of frustration with his impulse to use tissues "to touch or grab anything and everything around me. I just feel clean and safe doing it that way, but sometimes if I don't have a tissue, I can barely stand to open a door." This patient appears to have which anxiety problem? A.Panic disorder B.Generalized anxiety disorder C.Posttraumatic stress disorder D.Obsessive-compulsive disorder

D.Obsessive-compulsive disorder

Anita, 34, is shopping with her 5-year-old daughter in a large, busy urban mall when she suddenly realizes the child is missing. Which level of anxiety would likely result? A.Mild B.Moderate C.Severe D.Panic

D.Panic

Hypoalbuminemia in a patient with an eating disorder would produce which assessment finding? A.Lanugo B.Jaundice C.Amenorrhea D.Peripheral edema

D.Peripheral edema

Mr. Anderson is found to be eating laundry powdered detergent on more than one occasion. This is most likely a sign of which feeding problem? A.Binge eating B.Rumination C.Bulimia D.Pica

D.Pica

Pica

Eating non-food items EX: paper, hair, grass, dirt, etc.,

Main S/S of PTSD is..

Flash backs

What medication would be the first line of treatment of an individual who suffers from substance abuse who is severely aggressive?

Haloperidol

Interventions for hallucinations:

If someone is saying they see a monster, bring them back to reality; allow them to tell you more what they're experiencing.

Addiction

Inability to abstain from a substance.

What is dissociative amnesia?

Inability to recall personal information, usually stemmed from a traumatic event. The lack of memory is not near ordinary forgetfulness. The amnesia may also be localized or selective.

Insomnia

Inability to sleep

Sevre anxiety

Individual may focus on one particular detail or on many scattered details and have difficulty noticing what is going on in the environment. - Learning and problem solving are not possible at this level (person may be dazed or confused) - Person may experience impending doom or dread, pounding heart rate, and hyperventilation

Moderate Anxiety

Individual sees, hears, and grasps less information and may demonstrate selective inattention. The ability to think clearly is hindered. - Sympathetic nervous system kicks in at this level.

Separation Anxiety

Individuals who experience this exhibit developmentally inappropriate levels of concern over being away from a significant other.

What would you tell a patient who is getting sick from their bipolar medications?

Inform them to take their medications with food.

Mild Anxiety

Occurs in the normal experience of everyday living and allows individuals to perceive reality in sharp focus.

What is a withdrawal symptom from amphetamine use?

Paranoia

First line of treatment for PTSD is..

SSRIs (paroxetine and sertraline)

Clients with depression are at risk for what?

Suicidal ideation and suicide

Nihillistic (Type of delusion)

The conviction that a major catastrophe will occur. EX: The world is going to end soon.

Panic Anxiety

The most extreme level of anxiety and is marked by dysregulated behavior. - Individual is unable to process what is going on in the enviroment and may lose touch with reality. - Behavior: pacing, running, shouting, screaming or withdrawal. - Physical behavior may become erratic, uncoordinated, and impulsive.

Disturbed dreams

Usually occurs in the use of hallucinogens.

Risperidone side effects

Weight gain can lead to.. - insulin resistance - diabetes - dyslipidemia - cardiovascular impairment

Intoxication

When an individual is in the process of using a substance to excess.

Tolerance

When an individual no longer responds to the drug in the way that the person initially responded. Usually takes higher doses of the drug to achieve the same effects.

Around what time of a hospital stay would an individual suffer from alcohol withdrawal?

Within 72 hours, symptoms of withdrawal will start kicking in.

Two months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement? a. "Depression often begins after a major loss. Losing dad was a major loss." b. "Bereavement and depression are the same problem." c. "Mourning is pathological and not normal behavior." d. "Antidepressant medications will not help this type of depression."

a. "Depression often begins after a major loss. Losing dad was a major loss."

When a nurse uses therapeutic communication with a withdrawn patient who has major depression, an effective method of managing the silence is to: a. Meditate in the quiet environment b. Ask simple questions even if the patient will not answer. c. Use the technique of making observations d. Simply sit quietly and leave when the patient falls asleep.

c. Use the technique of making observations

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? a. "I'm so restless. I can't seem to sit still." b. "I spend most of my time studying. I have to get into a good college." c. "I'm not trying to diet, but I've lost about 5 pounds in the past 5 months." d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

Disulfiram

is used on patients who suffer from alcoholism. This is a type of aversion therapy, which will make the patient sick enough to turn around the effects of alcoholism.

•A 25-year-old man is admitted to the psychiatric unit after being found by the police walking naked down the middle of the street at 3:00 AM. In conducting the health history, the nurse identifies some of the following social risk factors as possible predictors of a diagnosis of schizophrenia. (Select all that apply): •a. Urban residence. •B. Recent immigration •C. Impaired physical or mental health. •D. Older paternal age. •E. First-degree relative diagnosed with schizophrenia. •F. Ethnic and racial discrimination

•a. Urban residence. •B. Recent immigration •F. Ethnic and racial discrimination