Psych test 3 (anxiety, personality disorders, & substance abuse)

A nurse uses the CAGE screening test for alcoholism to determine an individual's potential for a drinking problem. What is one of the four questions included on this test? "Do you feel that you are a normal drinker?" "Have you ever felt bad or guilty about your drinking?" "Are you always able to stop drinking when you want to?" "How often did you have a drink containing alcohol in the past year?"

"Have you ever felt bad or guilty about your drinking?"

Antihistamines used for anxiety

"Yzine" Atarax Vistaril Benadryl

A client is found to have generalized anxiety disorder. For what behavior should the nurse assess the client to determine the effectiveness of therapy?

Recognizing when anxiety is developing

A client with a conversion disorder is experiencing paralysis of a leg. What should the nurse expect this client to do?

Recover use of the affected leg but, under stress, to again experience these symptoms

Interventions for patient in crisis

-Assess for suicidal ideation -Focus on here and now -Remain with patient -Limit setting for inappropriate behavior -Acknowledge patients feelings -Evaluation and follow up

Treat OCD

-Clear & structured communication -Exerces -Stress management -SSRIs (tine & pram) -TCAs (Pam Dox, Imi, Ami)

Treatment for PTSD

-Cognitive behavior therapy -SSRIs -MAO -Benzo -Minipress (for nightmares) -Beta-blockers

Treatment for Munchausen Disorder

-Empathy -Cognitive behavioral Therapy -Engage & educate family -Psychotherapy -Medications if mental disorder

According to Aguilera, these factors determine if a crisis will occur:

-Individual perception of event -Availability of situational supports -Availability of adequate coping mechanisms

Treatment for Somatic Disorders

-Outpatient -Develop effective coping strategies -SSRIs -Short term anti-anxiety

Treatment for body dimorphic disorder

-SSRIs (tine & pram) -Cognitive behavioral therapy -Sometimes second degree anti-psychotics (Zyprexa, seroquel)

Alcohol withdrawal delirium

1-5 days duration increased symptoms of early withdrawal paranoia & disorientation frightening visual/tactile hallucinations increased TPR Aggressive

A nurse working on a detoxification unit has clients who are in active withdrawal from alcohol, opiates, benzodiazepines, cocaine, and marijuana. Place these clients in order, from the one with the highest risk for life-threatening physiologic withdrawal to the one with the lowest risk: 1. An adolescent who is withdrawing from cocaine 2. A young adult who is withdrawing from a long-acting benzodiazepine 3. An older adult who is withdrawing from alcohol 4.A middle-aged adult who is withdrawing from marijuana

1. An older adult who is withdrawing from alcohol 2. A young adult who is withdrawing from a long-acting benzodiazepine 3. An adolescent who is withdrawing from cocaine 4. A middle-aged adult who is withdrawing from marijuana

Place these crisis interventions in the order the nurse would implement them for a client experiencing escalating levels of anxiety. 1. Provide firm but kind directions. Incorrect 2. Attempt to identify the source of the anxiety. Incorrect 3. Encourage deep breathing and relaxation techniques. 4. Place the client in restraints if deemed dangerous

1. Attempt to identify the source of the anxiety. Incorrect 2. Encourage deep breathing and relaxation techniques. 3. Provide firm but kind directions. Incorrect 4. Place the client in restraints if deemed dangerous

Phases of crisis development

1. Individual is exposed to precipitating stressor 2. Anxiety increases 3. Use of all internal and external resources 4. Anxiety continues to increase

A client with a history of alcohol abuse was admitted 2 days ago for treatment of a gastrointestinal bleed. The client has remained in bed; pulse rate and blood pressure has gradually increased. The client now has a low-grade fever. Place the following nursing interventions in the appropriate order to best minimize the client's risk for injury. 1. Notify the primary healthcare provider of the report findings 2. Initiate seizure precautions 3.Attempt to determine when the client last consumed alcohol 4.Turn off the client's television and dim the room's lights

1. Initiate seizure precautions 2. Turn off the client's television and dim the room's lights 3. Attempt to determine when the client last consumed alcohol 4. Notify the primary healthcare provider of the report findings

Phases of Progression of Alcoholism

1. Prealcoholic Phase 2. Early Alcoholic phase 3. Crucial phase 4. Chronic phase

PD Symptoms -Doesn't learn from mistakes -Instable -Emotional liable -Easily insulted -Mood swings -Impulsive -Depression, anxiety, hopeless -B&W thinking

Borderline PD

Nonbenzodiazepine antianxiety med

Buspar (long term) Takes a few weeks to work Take 3-4x/day

Overdose of narcotics

Pinpoint pupils respiratory depression coma Treatment: Narcan

Age of onset of Generalized anxiety disorder

19-60

What type of problem is very common with Borderline PD

Self Mutilation

Alchohol withdrawal detox signs

3-5 days duration Increased BP & P Tremors Hallucinations/Illusions anorexia Insomnia irritability diaphoresis headaches seizures

Intoxication with inhalants

lethargy psychomotor retardation weakness can have respiratory or cardiac depression

Phases of Progression of Alcoholism: Preoccupied, don't tell, denial

Early alcoholic phase

Intoxication with marijuana

reddened conjunctiva euphoria increased appetite time distortion dry mouth sensory perception changes

Secondary gains of anxiety

A patient is allowed to miss work and gets financial compensation as the result of a medical condition.

PD Symptoms No remorse, calloused, Lies, Impulsive, Cheats, Irresponsible

Antisocial PD

What other disorders are associated with anxiety

COPD, depression, PTSD, substance abuse

Fear of being in places or situations where help may not be available and escape might be difficult or embarrassing.

Agoraphobia

2 types of phobias

Agoraphobia Social Phobia

What is the #1 health problem in US

Alcholism

What can not be used with Benzos?

Alcohol & Opiates

This medication is for alcohol abstinence

Campral (stay abstenent at camp)

Crisis: catastrophic (Tornadoes, hurricanes, earthquakes, and tsunamis)

Adventitious

Other symptoms with marijuana

Amotivational syndrome Trigger psychotic symptoms

Types of stimulants

Amphetamine Cocain (powder & crack)

Ways people with personality disorder manipulate

Assuming instant intimacy Flattery Entitlement Splitting Sexually provocative

PD Symptoms Low self esteem Sensitive to rejection Anxiety impedes ability to enjoy social situations

Avoidant PD

Encompasses cluster C

Avoidant PD Dependent PD OCD

Treatment for Social anxiety

Behavioral Therapy Cognitive Therapy SSRIs (tine & pram) Propranolol (beta blocker) MAOIs (No Popular Meds, Nardil, Parnate, Marplan) Social Skill training

Short term meds for anxiety

Benzodiazepines (Xanax, Librium, klonopin, Valium, serax, Ativan)

Treatment of alcohol withdrawal (detox)

Benzodiazepines (lam & pam) Beta Blockers (lol) Antipsychotics Vitamins (vit b, magnesium, folic acid, vit k) Hydration vital signs & mental status reality orientation quiet environment restraints as needed

Effects of alcohol on body

Blocks absorption of Thiamine & Folic Acid, leads to Wernicke-Korsakoff syndrome

Exaggerated belief the body is deformed or defective in some way

Body dimorphic disorder

Medications for detoxification (Narcotics)

Catapres (BP) Methadone (synthetic morphine, legalized version of Heroin)

Phases of Progression of Alcoholism: Drunk, need alcohol to live, tremors without a drink

Chronic phase

Atypical antipsychotics

Clozaril (Clozapine) Risperdal Zyprexa Seroquel Geodon Ability Saphris Fanapt Latuda Invega Rexulti

Odd and Eccentric Personality Group

Cluster A

Dramatic and Erratic Personality Group

Cluster B

Anxious and Fearful personality group

Cluster C

Treatment for Agoraphobia

Cognitive behavioral Behavioral Therapy therapy SSRIs (tine & pram)

Intoxication with narcotics

Constricted pupils Euphoria Nodding

1 or more symptoms of impaired motor or sensory function. Develop abruptly, and onset can be linked to a stressful event.

Conversion Disorder (somatic)

Withdrawal with stimulants

Crash Cocaine Blues

Withdrawal with marijuana

Cravings & irribility

Phases of Progression of Alcoholism: Focused, no cares

Crucial phase

What is cage screening?

Cut down Annoyed Gulity Eye opener (edge off)

PD Symptoms Need to be taken care of Clingy Submissive Fear of seperation

Dependent PD

GHB Rohypnol Ketamine Ecstasy are examples of what

Designer or rave drugs

Cautions for benzodiazepines

Don't take with caffeine, opiates, alcohol, glaucoma, pregnant women

What neurotransmitter is associated with Substance Abuse

Dopamine

What is Wernicke-Korsakoff syndrome?

Due to brain damage caused by a lack of vitamin B1. Confusion and loss of mental activity that can progress to coma and death Loss of muscle coordination (ataxia) that can cause leg tremor Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping Alcohol withdrawal, Inability to form new memories Loss of memory, can be severe Making up stories (confabulation) Seeing or hearing things that are not really there (hallucinations) IS reversible with vit B treatments

Intoxication with stimulants

Euphoria paranoia increased energy hyperalertness overconfidence

NICs for Antisocial

Expected outcomes realistic: Explore consequences, no striking out Consistent approach/set limits Assign one nurse Do not focus on feelings Mobilize anxiety Be aware of your feelings

What is not helped with Narcan?

Fentenyl

What other symptoms are possible with hallucinogens

Flashbacks Psychosis Death Brain-damage Trigger schizophrenia

A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) does the nurse anticipate that the primary healthcare provider may prescribe?

Fluvoxamine

Alcohol rehabilitation

Formal interventions Group & family therapy Meds: Antabuse, ReVia & Vivitrol, Camparal, Topamax

Symptoms are: restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbances, dread, feeling on edge, seeks reassurance, difficulty with decision making

Generalized Anxiety Disorder

What is known as the "Worry Disease"?

Generalized anxiety disorder

Detoxification

Getting substance out of body

Which body parts are most often involved in Body dimorphic disorder?

Head or face

Benzodiazepines mechanism of action

Helps gaba do its job

Illegal Narcotics (Opiates)

Heroin

PD Symptoms -Excessive tears -Dramatic attention seeking -Manipulative -Charming but shallow

Histrionic PD

High level of anxiety lasting 6 months. Alarm about their health excessively check for problems and avoid medical care

Hypochondriasis

A college student is brought to the mental health clinic by parents with a diagnosis of borderline personality disorder. Which factors in the client's history support this diagnosis? Select all that apply. Impulsiveness Lability of mood Ritualistic behavior Psychomotor retardation Self-destructive behavior

Impulsiveness Lability of mood Self-destructive behavior

Traits of personality disorders

Inflexible Interpersonal problems Irritation/Irritating Insensitive Indifferent

A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience?

Increased alertness

For what clinical manifestations should the nurse assess a client during the first few hours of the alcohol withdrawal?

Irritability Tachycardia Increasing anxiety

NIC for alcohol overdose

Keep pt awake & airway patent

This medication is an animal tranquilizer

Ketamine

Hallucinogens

LSD PCP Mescaline Magic Mushrooms

If your unbothered by symptoms, happy they get you out of things

LaBelle Indifference

Benzodiazepines

Last name: Lam & Pam

Nursing assessment for Alcoholism

Last time you drank? How much? How often? Cage screening

A nurse is assessing a client with a history of marijuana use. Which long-term effects are associated with marijuana?

Lung cancer Emphysema Heart disease

Purposeful behavior aimed at meeting ones needs without concern for others

Manipulation

Alternatives to anxiety meds

Massage Acupunture herbs valarian root kavakava

Crisis: Normal changes in life (college, marriage, baby)

Maturational or Developmental

Fastest growing drug threat in US. Illegal labs in US or Mexico, very addictive

Methamphetamine

Consciously and intentionally fabricate symptoms for emotional gain

Munchausen Disorder

What is the factitious disorder?

Munchausen Disorder

PD Symptoms -Attention seeking -Grandiose sense of personal achievements -Arrogant -Lack empathy -Look to others for self esteem -Relationships are superficial

Narcissistic PD

Encompasses Cluster B

Narcissistic PD Histrionic PD Borderline PD Antisocial PD

Assessment for Alcohol Withdrawal

Nausea & Vomiting Tremor Paroxysmal sweats Anxiety Agitation Tactile disturbances Auditory disturbances Visual disturbances Headache, fullness in head Orientation and clouding of sensorium Maximum score is 67

Thiamine (vitamin B1) and niacin (vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan?

Neuronal activity (Thiamine and niacin help convert glucose for energy, and therefore influence nerve activity.)

Do phobias occur unexpectedly?

No

Treatment for Stressor Disorder

No meds Help with coping

Which neurotransmitters are associated with anxiety?

Norepinephrine serotonin gaba

Withdrawal with narcotics

Not medically dangerous (flu like symptoms)

PD Symptoms Sense of self comes from productivity Lake empathy Details and organization Perfectionist (also applied to others)

OCD

Experiences impulse or image that is unbidden, disruptive & persistent. Perform ritualistic behavior which temporarily reduces anxiety caused by the thought

Obsessive Compulsive Disorder

These medications block effects of alcohol and opiates

ReVia & Vivitrol (watch closely for overdose of substances)

Actual or threatened death or serious injury leading to intense dread, horror or fear

PTSD

Symptoms: intrusive reexperiencing trauma, avoidance, persistent negative alterations in cognition and mood, alteration in arousal and activity

PTSD

Persistent in nature, pain lasting longer than 6 months, specified as mild, moderate, severe

Pain Disorder

Patient is overwhelmed, palpitations, chest pain, diaphoresis, hyperventilation, nausea, choking, no pathological event, time limited

Panic Attack

PD Symptoms Mistrustful, controlling, hostile, irritable, jealous, Business like, they create fear and conflict through sarcasm, reads meaning into benign remarks

Paranoid PD

Encompasses Cluster A

Paranoid PD Schizoid PD Schizotypal PD

Goal for panic attacks

resolve immediate crisis, return to previous level of functioning, preserve self-esteem, assess for suicidality & anxiety

Inflexible and maladaptive traits that impair functioning and relationships

Personality Disorder

Withdraw indicates what type of dependence

Physical

Phases of Progression of Alcoholism: Episodes of blacking out

Prealcoholic phase

Primary gains of anxiety

Primary gain example: A patient feels guilty about not being able to perform a task, but if there is a medical condition justifying this inability, the guilt diminishes.

Beta blockers used for anxiety

Propranolol (Inderal)

Best medication for social phobias

Propranolol (inderal)

Which nursing intervention is most important for a client who has the diagnosis of antisocial personality disorder?

Providing clear boundaries and consequences

Nursing Interventions: Forms of cognitive behavioral interventions for Anxiety

Relaxation Modeling Systemic desensitization Flooding Thought stopping Changing faulty thinking

What should be the nurse's first intervention in the care of a client with a generalized anxiety disorder?

Removing as many stimuli from the client's environment as possible

Preferred medical treatment for generalized anxiety disorder

SSRIs

NICs for Borderline

Safety Consistency and limit setting Matter of fact approach Assign one nurse Be aware of your own feelings Allow client as much control as possible Teach assertiveness

PD Symptoms -Shy, detached, Isolated from social relationships -Restricted emotional range in interpersonal settings -Better with "things" rather than people (math, astronomy) -Might develop into schizophrenia

Schizoid PD

PD Symptoms -Oddities of thought -Socially isolative -Magical thinking -Unrealistic life goals -NOT psychotic -Closely related to schizophrenia

Schizotypal PD

Intoxication with hallucinogens

Sensory-perceptual changes, intense emotional experiences, heightened awareness. Colors are heard, sounds are seen. No withdrawals

Crisis: Unanticipated (divorce, death of loved one, loss of job)

Situational

Fear of being evaluated our rejected by others

Social Anxiety

Psychological stress causes physical symptoms

Somatic Disorder or Psychophysiological Disorder

Multiple physical/medical symptoms, considerable distress, impaired function of daily life, describe symptoms in exaggerated & dramatic ways

Somatization disorder

Maladaptive reaction to a stressor leading to emotional and or behavioral symptoms. Short duration.

Stressor Disorder

Anticonvulsants used for anxiety

Tegretol (Carbamazepine) Depakote (Valproate acid) Neurontin (Gabapentin)

This is an anti seizure medication used in alcohol rehabilitation

Topamax

Narcotic Rehabilitation

Trexan Methadone Subutex Suboxone (under tongue)

Is patient aware that beliefs are exaggerated in Body dimorphic disorder?

Yes

Side effects of Tegretol (carbamazepine)

agranulocytosis Monitor CBC & Liver Therapeutic range 4-12

Difference between fear and anxiety

fear is present, anxiety is future.

Ego-syntonic

the individual perceives her behavior as correct, normal, or in harmony with her goals

Ego dystonic

the individual sees the illness as something thrust upon her that is intrusive and bothersome

SSRIs

tine & pram