**Combo of all sets**

hyperorality

The need to taste, chew, and put everything in one's mouth.

hypermetamorphosis

The need to touch everything in sight.

Pt: " I hear my mom's voice saying terrible things about me. She says she regrets that I was born and the world would be better without me." Nurse: "That must be very upsetting, Tom. Are you feeling upset?" (Nurse waits for response) WHY is this the right response by the nurse? (pg. 314) Pt. "Yes, I feel bad." Nurse: "Let's go over here and play poker. I hear you're a very good poker player."

The nurse started the conversation with acknowledging the feelings of the patient. In an attempt to distract the pt. the nurse encourages something that the patient can do well. Ok. So that's the rationale. It threw me off initially cuz it's reminiscent of entering a pt's room who is crying and saying "It's a nice day, let's open the window." BUT, in the context of the conversation, it's beneficial to reinforce the good in the patient. So acknowledging his feelings but not entertaining them and bringing him back to reality by engaging him in something he is good at is the best route of action.

Finding the evidence for the practice

The science of nursing

Anergia

The subjective feeling of lack of energy and sense of increased effort required to carry out tasks. Associated with depressive illness.

Freud's psychoanalytic theory

Theory that believed experiences during the early stages of life determine an individual's lifetime adjustment patterns and personality traits

Biological theory

Theory that believes neuro chemical imbalances are corrected through medication and talk therapy

Erikson's eight stages of development

Theory that believes personality continues to develop through old age and failures in one stage can be rectified at another stage

Sullivan's interpersonal theory

Theory that believes the purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety

Maslow's hierarchy of needs

Theory that emphasizes human potential and the patients strengths; prioritized nursing actions in the nurse-client relationship

Behavioral theory (Pavlov, Watson-skinner)

Theory where behavioral modification addresses maladaptive behaviors by rewarding adaptive behaviors

Cognitive theory (Beck)

Theory where cognitive behavioral therapists assist in identifying negative thoughts patterns and replacing them with rational ones

Humanistic theory

Theory where they sought a psychological science concerned with the human potential for development, knowledge, attainment, motivation, and understanding

Lithium (lithobid) blood levels

Therapeutic blood level: 0.8 to 1.4 mEq/L Maintenance blood level: 0.4 to 1.3 mEq/L Toxic blood level: 1.5 to 2.0 mEq/L

Expression through artwork, capturing thoughts, feelings, and tensions that children may be unable to express

Therapeutic drawing

Ideal for children who may have difficulty talking about their feelings and problems while developing rapport with HCW

Therapeutic games

Therapeutic and non-therapeutic communication techniques: examples

Therapeutic: use of silence, active listening, clarifying, restating, exploring Non-Therapeutic: asking excessive questions, giving approval or dissaproval, changing the subject

Why's it important to assess for anticholinergic effects?

They're commulative; increase with exposure to the drugs.

I know that beta blockers are blood pressure medications, but why are they used to help treat anxiety?

Think the symptoms of anxiety; increased BP, HR, sweaty palms, arrhythmias... -betablockers treat the physical symptoms

Schizophrenia is potentially a devastating brain disorder that affects:

Thinking Language Emotions Social behavior Ability to perceive reality accurately

suicidal ideation

Thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones.

Concrete Thinking

Thinking in simple, tangible, real, non-idealized terms without drawing relations between objects and concepts.A stage in development of the cognitive thought processes in the child. -In this stage thoughts become increasingly logical & coherent. Child is able to: Classify, sort, order, & organized facts. Incapable of generalizing or dealing with abstraction.

Designated so staff can be consistent in interventions

Time out

Older adults and alcohol/substance abuse

Tolerance for alcohol is decreased. Changes in the response to alcohol include headaches, reduction in mental abilities, memory losses or lapses, and feelings of malaise versus well-being. Body is less resilient. Healing from injury or infection is slower. Stress causes a loss of physiologic equilibrium. Increased time is available for the body to eliminate drugs, resulting in a high blood alcohol level (BAL).

Substandard institutional policies do not absolve the individual nurse of responsibility to practice on the basis of professional standards of nursing care

Tort law

Most serious tic disorder

Tourette's disorder;

Person unconsciously and inappropriately displaces those emotional reactions that originated from significant figures in childhood onto another individual

Tranference

Drugs that have low toxicity in overdose

Trazodone and venlafaxine

Quanfacine HCl (ADHD)

Treats aggression and insomnia

Imipramine (Tofranil) class and use

Tricyclic Antidepressant (TCA) used for depression, bipolar disorder, fibromyalgia disorder, neuropathic pain, chronic insomnia, ADHD, OCD

Antidepressants that increase norepinephrine; side effects include anti cholinergic effects

Tricyclics: amitriptyline (Elavil), imipramine (Trofranil)

True or False? All individuals who have experienced sexual violence suffer severe, deep, emotional scars?

True

Therapeutic communication strategies with someone who has auditory hallucinations

Try to understand what the voices are telling the pt., non-threatening non-judgmental, maintain eye contact, speak simply and louder, distract pt. to something he can do well.

Stress intolerance disorder

Unable to tolerate stressful situations

What do brain scans reveal about kids with ADHD?

Underdeveloped/ inactive frontal lobes

Are kids with behavorial or developemental problems at increase for abuse?

Unfortunately, yes :/

Perceived loss

Uniquely defined by the person experiencing the loss and are less obvious to other people, such as rejection by a friend.

Mini-Mental State Examination (MMSE): what is it used for

Used for assessment of dementia

Potential benefits of guided imagery as a CAM therapy

Uses images or symbols to train the mind to create a definitive physiological or psychological effect; relieves stress and anxiety and reduces pain

PTSD

Usually occurs after a traumatic event outside the range of usual human experience. -Hypothalamus-pituitary-adrenal (HPA) system is abnormal. -Major depression frequently occurs. If left untreated or undertreated, painful repercussions can result.

Medication compliance and alternative treatment strategies. For example, the use of injectable medications.

Vagus nerve stimulation [adjunct treatment (resistant)], ECT for depression, Light therapy for SAD

PCP intoxication symptoms

Vertical/horizontal nystagmus increased BP, P, T Ataxia, muscle rigidity seizures blank stare chronic jerking, impulsiveness (beligerent, assaultiveness)

SEVERE PCP affects

Violent/bizarre behavior (barking, chanting) hallucinations, paranoia

With 2nd gen. antipsychotics, what are some general precautions

Watch for glucose dysregulation Increases cholesterol weighgain in pts.

Good pt. education with 2nd gen antipsychotics?

Watch for hypertension, increasesed risk for cardiovascular disease r/t increased cholesterol Watch for signs of diabetes r/t glucose dysregulation Beware of weight gain

WTF is metabolic syndrome?

Weight gain, altered glucose, dyslipidemia Risk of diabetes, hypertension, atherosclerosis, and increase in heart diseases

Alzheimer's dementia on the long term care unit: essential nursing interventions

When caring for a patient with AD or teaching family members: (a) communication; talk to pt. about familiar things, Do not argue or refute delusions (b) health maintenance; diet, wondering precautions (c) safe environment, group activity, no driving, remove throw rugs.

When's ADHD identified?

When kid has trouble adjusting to elementary school

When are meds used in the therapy process of anxiety?

When psychotherapy is unsuccessful or anxiety is incapacitating

PTSD [Hypothalamus-pituitary-adrenal system]

When stress is prolonged, chemicals produced by the stress response [cortisol, adrenaline, and other catecholamines] can have damaging effects on the body.

Old; Suicide

White men, 65 years of age and older, are at risk five times higher than the general population.

What is the estimated lifetime prevalence rate for developing anorexia nervosa?

Women 1% Men 0.3%

topiramate (Topamax)

Works to decrease alcohol cravings

A formal written order to free the person

Writ of habeas corpus

Can abrupt ETOH/benzo withdrawal lead to death?

Yeah

Are SSRIs used?(Autism)

Yeah, but with caution

Can acute grief exacerbate people with history of other mental illnesses?

Yes

Is hypokalemia a complication of anorexia & bulimia nervosa?

Yes

Is it important to educate pt. family on seizure precautions if there's a history of seizures?

Yes

Should a nurse always assess for suicide?

Yes, always

When talking to someone who is dying or that person's family, is it important to choose your words carefully?

Yes, true

Should the nurse anticipate grief with the loss of things besides loved ones? Like what?

Yes- Losing limbs and other losses can result in grief too

Does dementia take a long time to develop?

Yes- years

Are the antipsychotics considered dangerous with dementia/AD?

Yes-- Dr's weigh the risks

So if someone had ADHD and tourrete's, could there be a contraindication with a CNS stimulant?

Yes. Needs monitoring

What age does schizophrenia target?

Young people in their teens and early twenties

What is Adderall?

a combination of dextroamphetamine and amphetamine that also calms; it comes in an extended-release form.

Illusion

a false idea; something that one seems to see or to be aware that really does not exist

Actual loss

can be identified by others and can arise either in response to or in anticipation of a situation

taking ibuprofen (NSAID) for joint pain with lisinopril(ACE inhibitor)

can decrease the antihypertensive effect of lisinopril.

Primary care

care promotes mental health and reduces mental illness to decrease the incidence of crisis

narcissistic personality

characterized by a grandiose sense of self-importance, a preoccupation with fantasies of success or power, and a need for constant attention or admiration

To minimize the anticholinergic side effects of 1st gens, what teaching points would you provide to the cleint?

chew sugarless gum (dry mouth), eat foods high in fiber (constipation), and drink 2 to 3 L of fluids

Depression is second only to:

chronic htn

For inpatient treatment of eating disorders, what can the nurse do to prevent purging?

closely monitor the client during and after meals, may necessitate accompanying the client to the bathroom

Drugs that produce fewer EPS effects and target negative and positive symptoms of schizophrenia

clozapine (Clozaril) risperadone (Risperdal) quetiapine (Seroquel) olanzapine (Zyprexa) iloperidone (Fanapt) lurasidone HCl (Latuda) ziprasidone HCl (Geodon) aripiprazole (Abilify) paliperidone (Invega)

Glasgow Come Scale: 3

comatose state

interpersonal communication

communication among a small group (2 or more people) where information is exchanged

transpersonal communication

communication that addresses an individual's spiritual needs

public communication

communication within a large group (e.g. community teaching)

intrapersonal communication

communication within one's self; "self-talk" allows the RN to: - assess a patient/situation - critically think about it before verbalizing

The client may make up stories when questioned about events or things she does not remember. This may seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion.

confabulation

The client with an eating disorder may demonstrate a high interest in __________ and ___________ food, but not eating.

cooking, preparing

case management

coordinating holistic care to include medical, mental health, and social services

A nurse feels defensive and angry with a client fro no apparent reason if the client reminds her of a friend who often elicited those feelings. What is this an example of?

countertransference

occurs when a nurse displaces characteristics of people in his/her past onto the client

countertransference

rationalization

creating acceptable explanations for unacceptable behavior

DSM-IV-TR: the client has at least 2 years of repeated hypomanic alternating with minor depressive episodes

cyclothymia

withdrawal s/s of alcohol/CNS depressants (9)

abdominal cramping, vomiting, tremors, restlessness, inability to sleep, increased HR, increased BP, increased RR, increased temperature, and tonic-clonic seizures

taking exernatide to treat DM should withhold if

abdominal pain

prescription for colchicine to treat gouty arthritis, adverse effect of this medication

abdominal pain. indicate cellular damage to the GI tract.

alert

able to fully respond by opening eyes, attend to normal tone of voice and speech, and answer questions spontaneously and appropriately

lethargy

able to open eyes and respond, but is drowsy and falls asleep readily

Helps pt abstain from alcohol

acamprosate (Campral)

toxic effects from amphetamines

acute cardiovascular effects (tachycardia, increased BP) which could cause death

DSM-IV-TR: exposure to a traumatic event causes numbing, detachment, and amnesia about the event for not more than 4 weeks following the event

acute stress disorder

What does behavior modification accomplish(ADHD)

address inattention and hyperactive and impulsive behaviors

Risk factors for Alzheimer's: (4)

advanced age, female gender, prior head trauma, family history of Alzheimer's or trisomy 21

acute asthma attack should administer first

albuterol (short acting beta 2 agonist with a rapid onset)

________________ ________________ ______________ may occur 2-3 days after cessation of alcohol and may last 2-3 days. This is considered a medical emergency.

alcohol withdrawal delirium

symptoms include severe orientation, psychotic symptoms (hallucinations), cardiac dysrhythmias, severe hypertension and occurs 2-3 days after last drink. *medical emergency"

alcohol withdrawal delirium

Axis I

all mental health diagnoses except personality

Axis I of the DSM-IV

all mental health dx except those found in Axis II

using an ipatropium inhaler to treat exercise included bronchospasm. Nurse should alert

allergic to peanut

Benzodiazepines commonly given to treat anxiety disorders

alprazolam (Xanax) diazepam (Valium) lorazepam (Ativan) oxazepam (Serax) chlordiazepoxide (Librium) clorazepate (Tranxene)

Toxic effects of alcohol/CNS depressants (3)

altered judgement, decreased motor skills, decreased LOC

ego defense: dealing with anxiety by reaching out to others (A nurse who has lost a family member in a fire becomes a volunteer firefighter) *HEALTHY*

altruism

Healthy ego defense mechanisms include ____________, _____________, ______________, and ______________.

altruism, humor, sublimation, and suppression.

TCA med list

amitriptyline (Elavil) desipramine (Norpramin) doxepin (Sinequan) imipramine (Trofranil) clomipramine (Anafranil) maprotiline (Ludiomil) nortriptyline (Pamelor) trimipramine (Surmontil) amoxapine (Asendin)

Treatment for PCP OD

ammonium choride acidifies urine to help excrete drug from bod(10-14 days) Speak slowly and in low voice, rm with minimum stimuli Diazepam, haloperidol

DSM IV-TR: different from Alzheimer's, typically there is no personality change or impairment in abstract thinking/inability to recall previously learned information/inability to learn new information despite normal attention

amnestic disorder

The withdrawal symptoms from ___________________ are similar to those from cocaine.

amphetamines

Maturational crisis

an experience, such as puberty, adolescence, young adulthood, marriage, or the aging process, in which one's lifestyle is continually subject to change

Displacement

an unconscious defense mechanism for avoiding emotional conflict and anxiety by transferring emotions, ideas, or wishes from one object to a substitute that is less anxiety producing

_________________, _______________ , and ___________________ _______________ can reduce the therapeutic effects of donepezil.

antihistamines, TCA's, and conventional antipsychotics

withdrawal s/s from benzodiazepines (5)

anxiety, insomnia, diaphoresis, hypertension, possible psychotic reactions

Axis III of the DSM-IV

any general medical dx (e.g. asthma)

adverse effects of chlorpromazine which a client who has history of psychosis

apply sunblock before go outside (chlorpromazin increase skin sensitivity to ultraviolet light and risk of sunburn)

example of tort: making a threat to a client, such as approaching the client in a threatening manner with a syringe in hand

assault

Role of psychiatric nurse:

assessment, careplan, maintain safe environment, assess for suicide ideation, observes behaviors

The cholinesterase inhibitors (Anti-Dementia) should be used with caution in clients with pre-existing ____________ or other obstructive pulmonary disorders.

asthma

summarizing

at the end of dialogue, emphasizes important points and reviews what has been discussed

Drugs that help with psychotic features

atypical antipsychotics

refers to the client's right to make their own decisions (Ex: Rather than giving advice to a client who has difficulty making decisions, the nurse helps the client explore all alternatives)

autonomy

type of behavioral therapy: a maladaptive behavior is paired with a punishment or unpleasant stimuli to change the behavior

aversion therapy

Self-Care for nurses

avoid compassion fatigue and burnout

helicobacter pylori and take tetracyline

avoid prolonged exposure to sunlight

If you discern guilt— say:

"Are you feeling guilty? This is a common reaction many people have. What are some of your thoughts about this?"

What is the best intervention when a pt is responding to an auditory hallucination?

"Can you tell me what you are hearing?" Knowing what the patient is hearing is important. A command hallucination could result in injury to self or others. For example: the voice could be telling the pt to self mutilate

What is the DSM-5

"Diagnostic and statistical manual of mental disorders" is the current official guidebook for categorizing and diagnosing psychiatric mental health disorders in the US

What is the DSM-5?

"Diagnostic and statistical manual of mental disorders" is the current official guidebook for categorizing and diagnosing psychiatric mental health disorders in the US

When you hear anger in the bereaved person's voice— say:

"I hear anger in your voice. Most people go through periods of anger when their loved one dies. Are you feeling angry now?"

What's the philosophy when using medications for AD/ dementia with elderly people?

"Start low and go slow" is the philosophy

When you sense an overwhelming sorrow— say:

"This must hurt terribly."

What to say to demonstrate comfort to a family suffering from the death of a family member

"This must hurt terribly..." (Table 25-4)

How should the nurse prioritize nursing diagnoses on plan of care? [AD]

"start low and go slow", treat underlaying conditions like depression with SSRIs, avoid agents with anticholinergic side effects.

What are 9 essential areas of end of life care for psychiatric nurses?

(1) Defining and determining the goals of communication (2) Understanding the importance of listening (3) Recognizing the barriers to communication (4) Delivering bad news and truth telling (5) Recognizing family dynamics in communication (6) Developing a sensitivity to culture, ethnicity, values, and religion (7) Discussing options and decisions with the patient and family members (8) Communicating and collaborating within the interdisciplinary team (9) Responding to requests for assisted suicide

Bulimia nervosa: Priority nursing intervention

(First) Interrupt binge/purge cycle, psychotherapy, self-care skills, treat underlying depression, substance abuse, and/or personality disorder.

Buspirone (Buspar) class and use

(NON-Benzo) Used to treat anxiety

What is Confabulation?

(psychiatry) a plausible but imagined memory that fills in gaps in what is remembered

For a nurse working in crisis intervention, which belief would be least helpful? **a. A person in crisis is incapable of making decisions. b.The crisis counseling relationship is one between partners. c.Crisis counseling helps the patient refocus to gain new perspectives on the situation. d.Anxiety reduction techniques are used to enable the patient's inner resources to be accessed.

* a) A person in crisis is incapable of making decisions.

Nursing staff that care for patients who are cognitively impaired can develop burnout. Strategies to avoid the development of burnout include: **a.Setting realistic patient goals. b.Insulating self from emotional involvement with patients. c.Sedating patients to promote rest and minimize catastrophic episodes. d.Encouraging the family to permit the use of restraints to promote patient safety.

* a. Setting realistic patient goals.

Which statement about crisis theory provides a basis for nursing intervention? *a.A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable. b.A person in crisis usually has had adjustment problems and has inadequately coped in his or her usual life situations. c.Crisis is precipitated by an event that enhances the person's self-concept and self-esteem. e.Nursing intervention in crisis situations rarely has the effect of ameliorating the crisis.

**a. A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable.

Grief is best described as a: *A. Normal response to a significant loss. B. Mild to moderately severe mood disorder. C. Display of feelings associated with death. D. Denial of the reality of the loss of a significant person, object, or state of being.

*A. Normal response to a significant loss.

The nurse who is working in the emergency department usually assesses adult patients, but tonight she is responsible for assessing the suicidal potential of a 13-year-old adolescent. In this assessment, which topic must be explored that is different from such an assessment in the adult? **a.Presence of distorted perceptions about suicide and death b.Presence of ideas about seriously hurting self or causing death c.Circumstances at the time suicidal thoughts are experienced d.Identification of feelings such as depression, anger, guilt, and rejection

*A. Presence of distorted perceptions about suicide and death Adolescents conceptualize finality (e.g., death) differently than adults. They have a sense of "immortality."

In caring for a patient with late AD, which nursing diagnosis demands the nurse's highest priority? A. Risk for injury B. Self-care deficit C. Chronic low self- esteem D. Impaired verbal communication

*A. Risk for injury  The patient is bed bound; therefore a risk for falls is not so great. A risk for decubiti exists, but this is addressed as a need related to self-care deficit.

Which statement indicates that a patient has successfully mourned a loss in his or her life? A. "She was so strong after her husband died. She never cried the whole time. She kept a stiff upper lip." **B. "She was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest." C. "You know, he still talks about his mother as if she were alive today, and she's been dead for 4 years." D. "He never talked about his wife after she died. He just picked up and went on life's way."

*B. "She was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest."

A method of modifying the disruptive behavior of a child that will be perceived by the child as punishment is: a.Therapeutic holding b.Planned ignoring c.Restructuring ** d.Seclusion

*D) Seclusion

Situational crisis

*unexpected events -job loss or death- that disrupt the biopsychosocial balance

Anorexia nervosa: associated medical conditions

- Depressive symptoms common, hypokalemia, bradycardia, orthostatic hypotension, electrolyte imbalance

Time frame for alcohol withdrawal (ACUTE)

- Early signs develop within a few hours. Signs peak in 24 to 48 hours. -Grand mal seizures occur in 7 to 48 hours after cessation. - Illusions are experienced.Irritability and "shaking inside" are common.

psychobiological interventions

- administering prescribed medications - providing teaching to patient/family - monitoring for side effects and effectiveness of therapy

health promotion and maintenance

- assisting patient with smoking cessation - monitoring other health conditions

panic-level anxiety

- inability to process the environment - may lose touch with reality - speech dysfunction, inability to sleep, delusions, hallucinations, extreme fright/horror

mild anxiety

- increases reality perception - an identifiable cause of the anxiety - a vague feeling of mild discomfort, impatience, and apprehension

orientation phase

- introduce self and purpose of relationship - set contract with patient - discuss confidentiality - set goals with patient

working phase

- maintain relationship according to contract - perform ongoing assessment - promote problem solving, positive behavioral change, self-esteem - handle/explore resistance and defense mechanisms

cognitive and behavioral therapies

- modeling - operant conditioning - systematic desensitization

promotion of self-care activities

- offering assistance - allowing time for patient to complete self-care task - setting incentives to promote patient self-care

milieu therapy

- orienting patient to physical setting - identifying rules and boundaries of setting - ensuring a safe environment for patient - assisting patient to participate in appropriate activities

severe anxiety

- perception is greatly reduced and distorted - no learning or problem solving - confusion, feelings of impending doom, and aimless activity - patient is unable to take direction from others

termination phase

- provide opportunity for patient to discuss thoughts/feelings about termination - explore the meaning of the therapeutic relationship - summarize goals and achievements - discuss ways for patient to incorporate new healthy behaviors into life - maintain limits of termination

Neuroleptic malignant syndrome and anti-psychotics

- rapid onset of motor, mental, and autonomic symptoms including muscle rigidity, tachycardia, hyperthermia, and altered consciousness - Adverse effect of antipsychotic meds

moderate anxiety

- reality perception is slightly reduced - thinking is hampered, but learning and problem solving may still occur - difficulty concentrating, tiredness, pacing, and increased HR and RR - patient benefits from receiving direction

RN intervention for severe to panic-level anxiety

- remain with patient in safe, quiet environment - use medications and restraints if necessary - encourage gross motor activities - set limits with short, firm statements - direct patient to focus on reality and the present

RN intervention for mild to moderate anxiety

- use active listening - provide a calm presence, recognizing their distress - evaluate past coping mechanisms - explore alternatives to problem situations - encourage participation in activities that may temporarily relieve feelings of inner tension

counseling

- using therapeutic communication skills - assisting with problem solving - crisis intervention - stress management

perseveration

-A persistent focus on a previous topic or behavior after a new topic or behavior has been introduced

Assessing Complicated grief

-Assess for History of depression, substance abuse, or post-traumatic stress disorder (PTSD) -Complicated grieving; grief work unresolved -Prolonged depression; the most common response

Implementations of a nursing plan for ADHD

-Assess the parent or caregiver's knowledge (teaching). -Explore the effects of behaviors on family life. -Discuss the family or caregiver's support system. -Discuss realistic behavioral goals. -Plan activities that are geared to abilities for success. -Offer positive recognition and feedback when a child succeeds. -Provide educational information about medications. -Refer the parent or caregiver to the appropriate support group.

Vascular dementia and agnosia: appropriate nursing intervention

-Caused by atrophy and death of brain cells due to decreased blood flow - Identify self, speak slowly, face to face contact, two arms length away, one piece of info at a time, talk about meaningful things, reminising about happy times, aknowledge pts. feelings then move to reality, pt. to wear glasses/hearing aid, room well lit, clocks/calendars (x's).

Barriers of psychiatric treatment with kids

-Clarity about the why, when, and how of screening -Coordination of funding and eligibility systems -Resources -Mental health providers -Adequate reimbursement

When assessing older patient;

-Conduct the interview in a private area. -Ask the patient the name he or she would like to be called. -Sit or stand at the same level. -Ensure that the lighting is adequate and the noise level is low. -Respect the comfort level with a personal touch. -Summarize the interaction, and invite feedback.

Milieu Therapy

-Creating a social climate, or milieu, that promotes productive activity, self-respect, and individual responsibility -Use of total environment to treat mental disorders. Enforces community rules and boundaries.

Diazepam versus buspirone for Anxiety disorder

-Diazepam [Valium] works faster than buspirone [Buspar] -Diazepam is can cause physical dependence, and more side-effects; buspirone takes >3 weeks for full effect.

What symptoms are associated with alcoholism *and* dementia? What test is used to assess alcohol problems?

-Distinguish the underlying cause of these symptoms. -Michigan Alcohol Screening Test- Geriatric Version is used (MAST-G) CAGE test

Assessing for suicide:

-Examine previous suicidal behavior -seriousness of intent -presence of active plans -availability of means -lethality of method -specific details of the plan.

Separation anxiety

-Experience extreme anxiety when separated or anticipating separation from familial surroundings. -Panic is overwhelming and excessive.

Focus of Tourette's disorder therapy

-Focus of the treatment is helping the child, family, and school understand and cope with tic behaviors. -Is managed on an outpatient basis unless tics severely impair the child's ability to function at home or school. -Inpatient and day hospitalization is needed for a complete evaluation and pharmacologic intervention.

Questions to ask that can identify pt's perception of crisis:

-Has anything particularly upsetting happened to you within the past few days or weeks? -What was happening in your life before you started to feel this way? -What leads you to seek help now? -Describe how you are feeling right now. -How does this situation affect your life? -How do you see this event as affecting your future?

Questions to asses pt's coping skills

-Have you thought of killing yourself or someone else? ---If yes, have you thought about how you would do this? -What do you usually do to feel better? -Did you try it this time? If so, what was different? -What helped you through difficult times in the past? -What do you think might happen now?

Causes of developemental disorders

-Heredity (Tay-Sachs disease, fragile X syndrome) -Alterations in early embryonic development (Down syndrome, fetal alcohol syndrome) -Pregnancy or perinatal problems (fetal malnutrition, prematurity, hypoxia, infections) -Other factors such as trauma or poisoning

Interventions for ODD and ODD

-Immediate nonthreatening feedback for unacceptable behavior -Immediate positive feedback for good behavior

Meds for PTSD Helps patient gain emotional control.

-Intrusive experiences [Flashbacks, avoidance, numbness]: SSRI antidepressants, 2nd gen antipsychotics. -Treatment-resistant PTSD: 2nd Gen antipsychotics, anticonvulsants. -Panic attacks: Antidepressants, MAOIs, high potent benzodiazepines. Antidepressants, benzodiazepines, anticonvulsants. -Nightmares: Prazosin (minipress)

Obsessive Complusive Disorder [OCD]

-Obsessions: Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause significant anxiety or distress. -Compulsions: Unwanted, repetitive behavior patterns or mental acts intended to reduce anxiety but not to provide pleasure or gratification

HIV and AIDS; growing problem with older adults

-Older adults who are sexually active often fail to practice safe sex. -Pregnancy is not a threat; the use of condoms is uncommon

These disorders are known to be disruptive

-Oppositional Defiant Disorder -Conduct disorder

Anorexia nervosa: criteria for hospital admission (Box 14-3)

-Physical: weight loss >30% over 6 months, rapid decline in weight, inability to gain weight, severe hypothermia (little subQ/dehydration), HR <40 Bpm, systolic <70, hypokalemia <3 mEq/L, dysrhythmias. -Psyciatric: suicidal, self-multilating, uncontrollable laxative use, emetic, diuretics, street drugs use; severe depression, pyschosis, family crisis/dysfunction

Positive and negative symptoms of psychosis

-Positive (Extra): Hallucinations, delusions, disorganized speech, bizarre behaviors [easier to treat; typical or 1st gen antipsychotic]. -Negative (Missing/absent): inexpressive faces [flat affect], monotone and monosyllabic speech, few gestures, seeming lack of interest in other people, inability to feel pleasure or act spontaneously.

Positive and negative symptoms of psychosis:

-Positive (Extra): Hallucinations, delusions, disorganized speech, bizarre behaviors [easier to treat; typical or 1st gen antipsychotic]. -Negative (Missing/absent): inexpressive faces [flat affect], monotone and monosyllabic speech, few gestures, seeming lack of interest in other people, inability to feel pleasure or act spontaneously.

Assessing for ODD Note the;

-Quality of child-parent/caregiver relationship: ---Bonding, anxiety, tension, and difficulty-of-fit between the parent and child's temperaments can contribute to these problems. -Parent or caregiver's understanding of growth and development and parenting skills: ---Lack of knowledge contributes to the development of these problems.

Techniques to collect data **Star/know/ research more**

-Questions answered about life at home and school -Free to describe current problems -Games, drawings, puppets, and free play used for children unable to respond to a direct approach -Observe interactions between kids and parents/siblings

When assessing, what should be focused on?

-Seriousness of disruptive behavior -Possible hospitalization or residential placement -Levels of anxiety, aggression, hostility, and impulse control -moral development

What's CISD used to debrief?

-Staff members on an inpatient unit after the suicide of a patient -Staff members after incidents of patient violence -Crisis hotline volunteers -School children and school personnel after shootings have occurred in a school -Rescue and health care workers who have responded to a natural disaster or terrorist attack

Empathy

-Temporary living in the others life -Identification with and understanding of another's situation, feelings, and motives

apraxia

-The inability to carry out specific motor tasks in the absence of sensory or motor impairment

Questions to assess for suicidality

-What kinds of thoughts do you have about a person's right to take his or her own life? -What advantage does ending one's life offer? -What is the most important thing you have to live for? -Have you thought of taking your life?

Freud's Psychoanalytic theory

-attempts to explain personality, motivation, nd psychological disorders by focusing on the influence of early childhood experiences, on unconscious motives, and conflicts, and on the methods peopl use to cope with their sexual and aggressive urges.

Alzheimer's disease and medication management

-donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne) [ACh inhibitor] -resperidone (Risperdal), olanzepine (Zyprexa), quetiapine fumarate (Seroqel) [Antipsychotic; behavior] **dementia + depression: -bupropion (Wellbutrin) [Atypical Antidepressant] -venlafaxine (Effexor) [SNRI] -mirtazapine (Remeron)

Introjection

-unconsciously incorporating the values, attitudes, or qualities of another person into the one's own personality or behavior to make up for a perceived inadequacy or weaknes

Lithium Levels

0.8 to 1.4 mEq/L [Therapeutic] 0.4 to 1.3 mEq/L [Maintenance] 1.5 to 2.0 mEq/L [Toxic blood Level] > 2.5 =cardiac, peripheral shut down, death

Three (3) nursing actions following ECT:

1 Provide frequent orientation 2 Provide a safe environment to prevent injury 3 Assist with personal hygiene as needed

Characteristic withdrawal syndrome from COCAINE occurs within __ hour to __________ days of cessation of drug use

1 hour to several days

Antidepressants take ______________ for therapeutic effects for initial response with up to ______________ for maximal response

1-3 weeks; 2 months

During a nursing assessment, which of the following is a " red flag" for suspecting that a patient has been a victim of physical violence? 1. Patient's explanation does not match the injury. 2. Patient has no history of stress- related physical problems. 3. Patient mentions having a concerned, supportive spouse. 4. Patient is anxious but open and direct in explaining the complaint or injury.

1.

What are the 4 main things that mourning accomplishes?

1. Accept the reality of the loss. 2. Process the pain of grief while caring for the self. 3. Adjust to a world without the deceased. 4. Find an enduring connection with the deceased in the midst of embarking on a new life.

Components of active listening

1. Listen for message content 2. Listen for feelings 3. Respond to feelings 4. Note all cues 5. Paraphrase and restate

parts of nonverbal communication

1. appearance 2. posture 3. gait 4. facial expressions 5. eye contact 6. gestures 7. sounds 8. territoriality 9. personal space 10. silence

communication with children

1. be at their eye level 2. use simple, straightforward language 3. be aware of your own nonverbal messages 4. incorporate play

What are some mental health nursing interventions?

1. counseling 2. milieu therapy 3. promotion of self-care activities 4. psychobiological interventions 5. cognitive and behavioral therapies 6. health teaching 7. health promotion and maintenance 8. case management

There are three (3) types of involuntary (civil) commitments:

1. emergency 2. observational or temporary 3. Long term or formal

What do you assess for during a Mental Status Exam (MSE)?

1. level of consciousness 2. physical appearance 3. behavior 4. cognitive and intellectual abilities

communication with older adults

1. may have to amplify voice 2. minimize distractions 3. allow time for response 4. if communication is impaired, ask family/caregivers for advice

What do you assess for during a Mini-Mental State Exam?

1. orientation 2. attention span and ability to calculate 3. registration and recall of objects 4. language (e.g. naming objects, following commands, and writing ability)

phases of a therapeutic relationship

1. orientation phase 2. working phase 3. termination phase

parts of verbal communication

1. vocabulary 2. denotative/connotative meaning 3. clarity/brevity 4. timing/relevance 5. pacing 6. intonation

Three questions that are usually enough to reveal intimate partner violence:

1.Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom? 2.Do you feel safe in your current relationship? 3.Is there a partner from a previous relationship who is making you feel unsafe now?

Ages that tourrette's manifests

2 years, with an average onset between 6 and 7 years of age

Describe an inpatient care setting in which psychiatric care is provided

24 hour nursing care Locked units Crisis care Residential treatment programs State acute care systems General hospital psychiatric units Private psychiatric hospital acute care

Orders for restraints must be written every ___________, specifying type of restraint, and frequency

24 hours

Intervention for delusion? 1. "your delusion is only in your head." 2. "It's a nice day, let's go outside" **3. "I don't know about what you're seeing- It's time to eat." 4. "Wanna arm wrestle?"

3 "I don't know about what you're seeing- It's time to eat." [Acknowledge feelings and reinforce reality]

Glasgow Coma Scale - what is the lowest to highest value?

3 (coma) to 15 (awake and responding appropriately)

The client is usually awake and ready for transfer back to the mental health unit or other facility within ___-___ minutes after an ECT.

30-60

How many stages of Alzheimer's?

4

How long does it typically take for alcohol withdrawal symptoms to take place? When do they peak?

4-12 hours after last drink; 24-48 hours

How many kids/adolescents have ADHD?

5-10%

Treatment for long time drinker is more intense and includes

5-7 day detoxification Naltrexone (50mg/day) is often used

Young-old

65-74 y/o

For the client with an eating disorder, implement refeeding over at least _____ days.

7

In most states a person may be admitted to psych and held for how many hours against their will?

72 hours

Mandated psychiatric hold and personal rights

72 hours hold (In most states)

Middle-old

75-84

What GAF score would you give to someone who was at near or normal function?

80-100

Clients with eating disorders with a body weight of less than ____% of expected normal weight are diagnosed with anorexia nervosa.

85%

Old-old

85-94

Elite-old

94 or older

Hypokalemia has to be less than what for hospitalization?

< 3 mEq/L

Chloe is now being seen by the ED physician. Her husband, Chad, is quietly demanding to see his wife. As the triage nurse, what are your best actions? Select all that apply. A. Tell Chad that Chloe "is fine" but no room for visitors is provided. B. Have staff members (e.g., physician, nurse, technician, assistant) make regular contact with Chad in the waiting room. C. Immediately call hospital security. D. Move Chloe to secluded area in the ED so that you can interview her in private. E. Insist that Chloe admit she is being abused by Chad. F. Immediately report the abuse to the police department. G. Advise Chloe of SAFE SHELTERS, and offer brochures.

A B D G

Neologism

A "word" coined by psychotic or delirious patient that is only meaningful to the patient.

Thought Insertion

A belief by some mentally ill pts. that thoughts of other people can be inserted into their own minds.

Alcohol dependence: complications

A chronic disease that includes a strong craving for alcohol, continued use despite repeated physical, psychological, or interpersonal problems, the inability to limit drinking, physical illness when one stops drinking, and the need to drink increasing amounts to feel its effects.

Stigma

A collection of negative attitudes, beliefs, thoughts, and behaviors that influence the individual and general public

Anergia

A condition of lethargy or lack of physical activity. Diminished or absent sensitivity to commonly used test antigens

Projection

A defense mechanism that involves attributing one's own threatening feelings, motives, or impulses to another person or group.

Reaction formation

A defense mechanism that involves unconsciously replacing threatening inner wishes and fantasies with an exaggerated version of their opposite

psychosis

A disorder involving profound disturbances in perception, rational thinking, or affect.

WTF is a delusion?

A false belief or opinion, especially one held in spite of contradictory evidence

Euphoria

A feeling or state of well being. Exaggerated or abnormal sense of physical & emotional well-being not based on REALITY or truth, disproportionate to its cause and inappropriate to the situation

Suppression

A form of emotion regulation that involves inhibiting emotion-expressive behavior

Idea of Reference

A link or connection between or Standard of evaluation for objects, data, or ideas.

Depression

A mental disorder characterized by sadness, hopelessness, pessimism, loss of interest in life, reduced emotional wellbeing, and abnormalities in sleep, appetite, and energy level.

mania

A mood disorder marked by a hyperactive, wildly optimistic state.

What is released once an electrical impulse reaches the end of a neuron

A neurotransmitter

What is released once an electrical impulse reaches the end of a neuron?

A neurotransmitter

inpatient

A patient who has been formally admitted to a hospital for diagnostic tests, medical care and treatment, or a surgical procedure, typically staying overnight.

outpatient

A patient who has not officially been admitted but receives diagnostic test or treatment in a facility.

Grief

A period of deep sorrow- can be prolonged

compulsive personality

A preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.

Reuptake

A process in which neurotransmitters are sponged up from the synaptic cleft by the presynaptic membrane.

Regression

A retreat or backward movement in conditions, signs, or symptoms

Disenfranchised grief

A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions. • A loss that is not able to be socially expressed. May be more difficult to resolve.

Dementia

A slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes -Gradual onset

antisocial personality

A type of personality disorder marked by impulsive, callous, manipulative, aggressive, and irresponsible behavior that reflects a failure to accept social norms.

Nonverbal behaviors

A wide range of human activities from body movements to responses to the messages from others

The withdrawal signs and symptoms of ________________ are the same as those seen in alcohol withdrawal.

barbituates

example of tort: actually TOUCHING the client in a harmful or offensive way, such as threatening and then GIVING an unconsented injection

battery

nitroglycerin transdermal patch

be careful when rising from the chair (nitroglycerin can cause orthostatic hypotension, which cause dizziness)

this related to the quality of doing good and can be described as charity (Ex: A nurse helps a newly admitted client with psychosis feel safe on the unit)

beneficience

Empathy

Ability to understand others; identification with the feelings of others.

What is delirium?

Abnormal mental state characterized by disorientation, inattention, confusion usually related to a metabolic condition Secondary to another condition

Delirium

Abnormal mental state characterized by disorientation, inattention, confusion usually related to a metabolic condition -Acute onset

WTF is dyslipidemia?

Abnormalities with one or more of the blood fats (lipids)

Maintenance phase of one suffering from bipolar disorder and medication regimen

About 6 months, meds for bipolar maintenance: Lamotrigine, lithium, olanzapine, aripiprazole, risperidone Consta, and quetiapine or ziprasidone (either one in combination with lithium or valproate) are the only drugs that have been approved by the FDA specifically for maintenance therapy for bipolar disorder.

aphasia

Absence or impairment of communication through speech

Cholinergic neurotransmitter that increase: depression; decrease: Alzheimer's disease, Huntington chorea, Parkinson's disease

Acetylcholine

Age discrimination

Act that prohibits discrimination in employment for persons age 40 and over except where age is a bona fide occupational qualification.

beneficence

Action of helping others and performing actions that would result in benefit to another person.

Alcohol overdose and hallucinations: therapeutic medication to treat

Activated charcoal to aid in absorption of alcohol. flumazenil (Romazicon), also for benzo OD too

What is terrorism?

Acts of violence designed to promote a specific ideology or agenda by creating panic among an enemy population

What factors help determine which setting is more appropriate for patient?

Acuity, stability, and patient interventions necessary

Antipsychotic medications are effective in:

Acute exacerbations or schizophrenia Preventing or mitigating a relapse Symptoms return with noncompliance, does not cure underlying psychotic processes

Assessment for delirium

Acute onset & fluctuating course Inattention Disorganized thinking Disturbance of consciousness

Four cardinal features of delirium?

Acute onset/fluctuation course Inattention Disorganized thinking Disturbed consciousness

Ms. T., a single mother of four, comes to the crisis center 24 hours after an apartment fire in which all the family's household goods and clothing were lost. Ms. T. has no family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. The nurse assesses the situation as which of the following types of crisis? Maturational crisis Situational crisis **Adventitious crisis Evidence of an inadequate personality

Adventitious crisis

Crisis state following a disaster:

Adventitious crisis = natural disaster focus on current feelings, what their perception of problem is.

Situations where a patient may require a referral

Affects Cardiovascular, neurology

Alzheimer's disease and neurotransmitters

Affects the process that keeps the neurons healthy -communication, metabolism & repair of neurons "tau protein" = stability of microtubules is change by AD resulting in "Senile Plaques" (SN) and "Neurofibrillary Tangles" (NFT) which affects memory in hippocampus.

Most important risk factor for Alzheimer's Disease?

Age

Why's Sertraline (Zoloft) a good choice for depression in older adults?

Age does not appear to affect its pharmacokinetic actions.

Action or behavior that results in a verbal or physical attack

Aggression

Loss of sensory ability to recognize objects

Agnosia

Intense excessive anxiety or fear about being in places or situations from which help might not be available, and escape might be either difficult or embarrassing

Agoraphobia

Varieties of anxiety

Agoraphobia, generalized anxiety disorder, panic disorder, specific phobia, and a social phobia may develop through adulthood.

EPS symptoms:

Akathisia Acute dystonia Pseudoparkinsonism Tardive dyskinesia

disulfiram (Antabuse)

Alcohol-disulfiram reaction causes unpleasant physical effects.

Sertraline [SSRI] (Selective Serotonin Reuptake Inhibitor)

Also known as ZOLOFT - Antidepressant Rx - Causes elevated mood due to more serotonin - must TITRATE dose for optimum effects - may cause: insomnia, HA, nausea, dry mouth - DO NOT combine w/ MAOIs = serotonin syndrome

This disorder has its own pattern of perceiving, affect, cognition, behavior, and memories

Alternate personality disorder or subpersonality

Gamma-amino butyric acid (GABA)

Amino acid neurotransmitter that -decrease (too little): anxiety disorders, schizophrenia, mania, Huntington chorea; -increase of GABA: reduction of anxiety, schizophrenia, mania

Glutamate

Amino acid neurotransmitter that is the major mediator of excitatory signals in the CNS and is involved in most aspects of normal brain function

Four A's of Alzheimer's

Amnesia (memory impairment) Aphasia (loss of language ability) Apraxia (loss of purposeful movement in the absence of motor or sensory impairment) Agnosia (loss of sensory ability to recognize objects)

Cardinal symptoms of Alzheimer's

Amnesia or memory impairment Aphasia Apraxia Agnosia Disturbances in executive functioning

type of eating disorder behavior: the individual eats large quantities of food and self-induces vomiting or other aids of elimination to rid the body of excess calories

binge-eating/purging type

Projection

An unconscious defense mechanism by which an individual attributes his or her own unacceptable traits, ideas, and impulses to another.

Denial

An unconscious defense mechanism in which emotional conflict & anxiety are avoided by refusal to acknowledge the thoughts, feelings, desires, impulses, or facts that are consciously tolerable.

An emotional response to a frustration of desires, treat to one's needs or a challenge

Anger

Characteristics of ODD?

Angry mood Defiant and headstrong behaviors

Diagnosis of ODD

Angry mood Defiant and headstrong behaviors persistant and frequent

Phenytoin (Dilantin)

Anticonvulsant used to treat/prevent tonic/clonic (grand mal) seizures and complex partial seizures

What category of medications should not be taken with St. John's wort?

Antidepressants

Other Antidepressants: bupropion (Wellbutrin, Zyban) trazodone (Desyrel)

Antidepressants that are NOT the first choice but helps with insomnia

Tricyclics: amitriptyline (Elavil), imipramine (Trofranil)

Antidepressants that increase norepinephrine; side effects include anti cholinergic effects

SNDIs: mirtazapine (Remeron)

Antidepressants that increase serotonin and norepinephrine; has anti anxiety, antidepressant, and antiemetic effects; side effects include sedation and weight gain

SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta)

Antidepressants that increase serotonin and norepinephrine; side effects include fewer anti cholinergic effects then tricyclics & N/V

SSRIs: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)

Antidepressants that increases serotonin; side effects include fewer anti cholinergic effects than tricyclics & N/V

What other classes of drugs are added to antipsychotic drug therapy?term-58

Antidepressants, mood stabilizers, benzos

The affects of what drugs are increased by alcohol?

Antidepressants, tranquilizers Acetaminophen is enhanced by alcohol

Chlorpromazine (Thorazine) class and use

Antiemetic, antipsychotic used for psychotic disorders, mania, schizophrenia, anxiety, intractable hiccups, N/V, behavioral problems children, Tourette's syndrome.

Lithium (lithobid) class and use

Antimanic used for bipolar disorders [MANIC phase], prevent bipolar manic-depressive psychosis. Mood stabilizer

A feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized

Anxiety

What is the most basic emotion?

Anxiety

Schizophrenia and unrealistic thoughts: Nursing diagnosis

Anxiety Disabled family coping Disturbed personal identity Disturbed sensory perception (auditory, visual, Kinesthetics) Disturbed sleep pattern Disturbed thought processes Fear

Eating disorders are connected to the underlying emotions of:

Anxiety Dysphoria Low self-esteem Feelings of lack of control

Most common disorders ** ANXIETY DISORDERS!!**

Anxiety! --13% of 9-17 y/o Genetic vulnerability

Who provides psychiatric home health?

Any mental health professional but typically nurses with inpatient experience

Goals for delirium:

Are the vital signs stable? Have the patient's skin turgor and urine-specific gravity remained normal?

Identify the 5 A's in the simple multistep process of evidence-based practice

Ask a question Acquire the literature Appraise the literature Apply the evidence Assess the performance

How do you assess judgment?

Ask patient a hypothetical question to see how they would answer (i.e. is it logical).

How do you assess ability to calculate?

Ask patient to count backward from 100 in serials of 7.

How do you assess level of knowledge?

Ask patient what they know about their illness or hospitalization.

autonomy

Asserts that individuals have the right to determine their own actions and the freedom to make their own decisions

Assess these specific for separation anxiety disorder

Assess child's previous and current ability to separate from parent or caregiver: --Separation and individuation process may not be completed, or the child may have regressed Assess for the presence of anxiety problems in the parent or caregiver: --In addition to genetic issues, anxiety and depression can be "contagious." Assess parental response to child's anxiety: --Increased attention reinforces behavior.

Assessment priority in crisis

Assess for suicidal and homicidal ideation or plans Make pt feel safe Listen carefully Assess support systems

Priority of interventions with delirium?

Assess risk for injury Assess need for comfort measures Assess availability of immediate medical interventions to prevent brain damage

Personality disorder and making demands: nursing interventions

Assess your own reaction towards pt. and pt. interactions, set limits on manipulative behaviors (demands), intervention includes all staff adhering to "limits", provide clear boundaries/consequences, enforce consequences, avoid discussing yourself w/ pt., avoid promises of secrets.

Alcoholic client and family members: nursing assessment and intervention

Assessment: date of first, #, last time of use, get patient history on alcohol use/family hx/hx of blackouts. Intervention: (19-5) Rehearse with counselor before carried out, evidence r/t substance abuse, genuine but firm concern shown, substance abuse is a disease, Tx alternatives, goal; get the affected person to treatment.

Symptoms of Panic Disorder with Agoraphobia

At least 4 of these symptoms [panic attack]: feelings of danger, need to flee, heart palpitations, sweating or chills, trembling or tingling, shortness of breath, a choking or tightening sensation in the throat, chest pain, nausia or stomach discomfort, dizziness, feeling of unreality, fear you are losing your mind, fear of losing control or dying

ADHD

Attention deficit hyperactivity disorder (ADHD) is a mental disorder that causes above-normal levels of hyperactive and disruptive behaviors.

DSM-IV-TR: the client has at least one episode of mania alternating with major depression

bipolar I disorder

DSM-IV-TR: the client has one or more hypomanic episodes alternating with major depressive episodes

bipolar II disorder

Traits of narcissistic personality disorder:

Attention seeking Antagonism Grandiosity Expectation of special treatment Arrogant and haughty Lack of empathy Exploit, blame, and envy others Shallow, superficial, and tantrums Manipulation Splitting

Characteristics that define narcissistic PDs

Attention seeking Antagonism Grandiosity Splitting

Clozapine class and use

Atypical 2nd Gen Antipsychotic [positive or negative symptoms] used for schizophrenia unresponsive to intolerant standard therapy with other antipsychotics; reduce suicidal behavior in schizophrenic pts.

Symptoms of dilerium?

Autonomic hyperactivity (increased vital signs) Hypervigilance (constantly alert or scanning room) Labile mood swings Agitation and/or anger Hallucinatio Delusion

non-maleficence

Avoidance of harm or hurt; choosing the least harmful intervention that will provide the most benefit

A nurse assessing a patient with suspected delirium will expect to find that the patient's symptoms developed: a Over a period of hours to days **b. Over a period of weeks to months c With no relationship to another condition d During middle age

B Happens quick!

projection

blaming others for unacceptable thoughts/feelings

Mematine (Namenda) works to treat cognitive disorders by ______________________________ into nerve cells, thus slowing brain-cell death.

blocking the entry of calcium

Drugs used when dementia coincides with depression?

bupropion (Wellbutrin) venlafaxine (Effexor) mirtazapine (Remeron)

Interventions (ADHD)

Behavior modification Meds Special education Psychotherapy/ play therapy

Rewarded behavior is more likely to be repeated. Appropriate behaviors are rewarded by a significant adult in the child's life. If the behavior is disruptive it's either ignored or consequences are set on it.

Behavior modification therapy

Theory where behavioral modification addresses maladaptive behaviors by rewarding adaptive behaviors

Behavioral theory (Pavlov, Watson-skinner)

justice

Being fair to all and giving equal treatment, including distributing benefits, risks, and costs equally.

Lorazepam (Ativan) Class and use

Benzodiazepine used to treat anxiety disorders, pre-op sedation and amnesia, status elipticus

Diazepam (valium) class and use

Benzodiazepine; long acting antianxiety, muscle relaxant, anticonvulsant. -Indicated for anxiety, acute ETOH withdrawal, seizure disorder, pre-op muscle relaxant.

Medication that are short term treatment of anxiety

Benzodiazepines

Medications for pts going through alcohol withdrawal include:

Benzodiazepines Anticonvulsants Beta-blockers Magnesium sulfate, thiamine (vitB1), folic acid, and multivitamins

What meds are especially associated with adverse events?

Benzodiazepines, anticholinergic

Using children's literature to help express feelings a supportive environment, gain insight to feelings and behavior, and learn new ways to cope with difficult situations

Bibliotherapy

Theory that believes neuro chemical imbalances are corrected through medication and talk therapy

Biological theory

Bipolar disorder (mania and depression)

Bipolar is characterized by severe mood changes, ranging from extreme highs "mania" and equally extreme lows. -This disorder is also known as manic depressive illness.

Tardive dyskinesia

Bizarre movements of the jaw, lips, & tongue

buprenorphine (Subutex)

Blocks the signs and symptoms of opioid withdrawal.

Negative symptoms of schizophrenia:

Blunted affect Poverty of thought Loss of motivation Inability to experience pleasure or joy

__________________ may be caused by an increase of acetylcholine.

Bronchoconstriction

This screening tool asks questions of the client to determine how the client perceives his current substance abuse

CAGE-AID

Aims at changing distorted and maladaptive thoughts and feelings toward more realistic/adaptive experiences

CBT

Chronic anxiety is associated with an increased risk for:

CV morbidity and mortality

Why is psychiatric home health beneficial?

Can reduce the need for costly and disruptive hospitalizations Comfortable & safe alternative

Successful outcomes of grief counseling

Can tolerate intense emotions. Reports a decreased preoccupation with the loss. Demonstrates increased periods of stability. Tends to previous responsibilities. Takes on new roles and responsibilities. Has the energy to invest in new endeavors. Expresses positive expectations about the future. Remembers positive and negative aspects of the deceased.

What can a nurse NOT do with advanced directives?

Can't help patient write advanced directives; nurse ONLY informs patient of their options

Co-occurring medical conditions to anxiety

Cancer Heart disease HTN IBS Renal or liver dysfunction Reduced immunity

Drug that targets impulsivity and self harm

Carbamazepine

____________ ____________ should be monitored and treated before the ECT procedure

Cardiac conditions

What are 3 areas important in a nurse-patient relationship?

Caring Attending Patient advocacy

Ch 25

Caring for those dying and grieving

Cause of Panic Disorder with Agoraphobia

Causes: Genetics & stress (death of loved one, divorced, loss of job)

Phenelzine (Nardil) caution

Caution: Lots of interaction with other drugs, hypertensive crisis with tyramine rich foods

Severe symptoms of OCD

Center on dirtiness, contamination, and germs and occur with corresponding compulsions such as cleaning and washing hands Most severe include: persistent thoughts of sexuality, violence, illness, and death

Scale used to assess for suicidality

Chapter 23, SAD PERSONS Scale

Examples of traumatic events:

Childhood abuse Torture/kidnapping Military combat Sexual assault Natural disasters Human disasters Crime related events Diagnosis of life-threatening disease

Ch. 26

Children and Adolescents

At what age are children most vulnerable for child abuse?

Children younger than 4

Acetylcholine

Cholinergic neurotransmitter that -increase (too much): depression; -decrease (too little): Alzheimer's disease, Huntington chorea, Parkinson's disease

Psychobiologic agents showing promise for the treatment of cognitive impairment associated with AD include:

Cholinesterase inhibitors Herbals, including ginkgo biloba SSRIs and trazodone Benzodiazepines and buspirone

Assessment guidelines of alcohol and drugs

Clarify presenting signs Assess for withdrawal Assess for overdose Assess for self harm potential Evaluate physiological response Explore individual's interest in taking action Assess knowledge of community resources History of substance abuse Medical history Psychiatric history Psychosocial issues

What is Clinical Depression?

Clinical depression is regarded as the most severe form of depression. It is characterized by persistent feelings of sadness, hopelessness, and worthlessness that do not go away on their own.

Catatonic Schizophrenia

Clinical features: disturbances in a person's movement. - Exhibits a dramatic REDUCTION in activity, to the point that voluntary movement stops, as in catatonic stupor. -Or, activity can dramatically increase, a state known as catatonic excitement.

Reality orientation techniques

Clocks, calenders, same staff if possible, encourage family

Most effective drugs (tourette's)

Clonidine HCl and guanfacine HCl are the most effective drugs.

Withdrawal symptoms include depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating, and chills. What drugs?

Cocaine and crack

Mild anxiety and agoraphobia: appropriate treatment plan

Cognitive Behavioral Therapy & SSRI medications; reduce anxiety and treat depression

These should come to mind when thinking about psychotherapeutic treatment strategies

Cognitive behavorial therapy (CBT) SSRIs Group therapy w/ others who have gone through similar traumatic experiences Family therapy

The idea that our mental representations of the world depend on the cognitive stage we have reached

Cognitive development (Piaget)

Results from processing errors in the brain in pts with eating disorders

Cognitive distortion

Theory where cognitive behavioral therapists assist in identifying negative thoughts patterns and replacing them with rational ones

Cognitive theory (Beck)

What are some harmful physiological effects of chronic stress?

Colds and flu Asthma Stomach ulcers Eczema and other skin disorders Heart disease Cancer Depression PTSD

Acute mania: Nursing interventions

Comm: Use firm calm approach, short concise explanations, remain neutral, be consistent in approach & expectations (limits), hear & act on legit complaints, firmly redirect energy Safe Milieu: maintain low level stimuli, freq. high calorie fluids, rest periods, admin antipsychotics PRN per MD, observe for lithium toxicity.

Unwanted, repetitive behavior patterns or mental acts intended to reduce anxiety but not to provide pleasure or gratification

Compulsions

What are the 4 C's of addiction?

Compulsive behavior Cravings Chronic, relapsing brain disorder Cognitive impairment

addiction

Compulsive drug craving and use, despite adverse consequences.

What other disorder is associated with ODD?

Conduct disorder

When assessing, what can indicate Alzheimer's or dementia?

Confabulation Perseveration

If a patient threatens himself of others, what is done and how is it documented?

Contact authorities/follow facility protocol. Document who was contacted/notified and when.

PHASE 2 Stabilization phase. What is the priority?

Continual recovery, improvement in functioning and enhancement of pt's quality of life

Diazepam (valium) Contraindications

Contraindications: Pregnancy (D), hypersensitivity to benzodiazepines, closed-angle glaucoma, coma, myasthenia gravis, ethanol intoxication, hepatic disease, sleep apnea

Lorazepam (Ativan) contraindications

Contraindications: closed angle glaucoma, Hx of drug abuse, COPD, <12 years old, geriatric pts., suicidal pts.

Drug classes that treat schizophrenia

Conventional (first gen) antipsychotics Atypical (Second gen) antipsychotics

Nursing interventions for pts with Alzheimer's

Counseling and communication techniques Health teaching and health promotion Referral to community sports Pharmacologic interventions

Tendency of the nurse to displace feelings related to people in his or her past onto a patient

Countertransference

Plan of care tactics for one who is suicidal

Create a safe environment per institution [take away potential weapons]. Keep accurate records of what the client says and does. Put the client on suicide prevention watch [one on one or every 15 minutes], No suicide contract, Encourage client to talk about their feelings and problem solve alternatives

Presents both danger to personality organization and an opportunity for growth; represents a struggle for equilibrium and an adjustment when problems seem unsolvable

Crisis

Chapter 20

Crisis and Mass Murder

Crisis and response before and after

Crisis is a struggle for emotional balance. - It offers opportunity for emotional growth but can also lead to personality disorganization -Resolution of crisis: person emerges at higher level, pre-crisis level or lower functioning level.

Adventitious crisis

Crisis resulting from a natural disaster such as a tsunami.

Tertiary intervention directed toward a group that has experienced a crisis:

Critical incident stress debriefing (CISD)

This assessment influence health and illness while helping decrease stereotyping, stigmatizing, and labeling

Cultural and/or social assessment

Of the following outcomes, which one is most appropriate for a patient with cognitive impairment related to delirium? The patient will: Participate fully in self-care from admission on. Have stable vital signs 6 hours after admission. Participate in simple activities that bring enjoyment. Return to the premorbid level of functioning

D

Medication administration calculation

D/H x Qty. = Amount to give

Reasons for hospitalization for one with mental illness

Danger/unsafe to self and/or others, assist in ADLs

As anxiety decreases, dysfunctional behavior will frequently what?

Decrease

Ways to note therapy is effective

Decrease in symptoms, reach pt. goals

Alcohol/ medication interaction in older person

Decreased liver enzymes to break down alcohol results in higher blood alcohol level (BAL)

Repression

Defense mechanism by which anxiety-provoking thoughts and feelings are forced to the unconscious.

Sublimation

Defense mechanism by which people redirect socially unacceptable impulses toward acceptable goals.

Rationalization

Defense mechanism that offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one's actions.

Impaired cognitive function by slowly deteriorating social and occupational functioning, although the levels or alertness are generally not disturbed

Dementia

How to note if treatment plan for acute mania has been effective

Demonstration of self-control, No injury to self.

Models are used to identify stages of grief:

Denial and shock, anger and guilt, emotional turmoil, disorganization, panic, depression, loneliness, and acceptance common during bereavement

Screening test developed for kids up to 6 y/o

Denver II Developmental Screening Test

S&S of grieving

Depressed mood Insomnia Anxiety Poor appetite Loss of interest Guilt Dreams about the deceased Poor concentration

What is the most common psychiatric disorder in older adults?

Depression (Biggest risk factor for suicide especially when combined with chronic illness, loneliness, or loss of independence)

Two Catergories of Depression

Depression has two main categories: clinical depression (also known as major depressive disorder) and dysthymia (chronic depression).

Depression

Depression is classified as a mood disorder, and may be described as feelings of sadness, loss, or anger that interfere with a person's everyday activities.

What's contained within psychiatric history?

Depression? Schizophrenia? etc

Symptoms of ADHD

Difficulty concentrating, sitting still, paying attention, staying organized, following instructions, remembering details, and/or controlling impulses.

Agnosia

Difficulty processing sensory information (pt. doesn't "NO" know)

Common signs of stimulant abuse

Dilation of the pupils Dryness of the oronasal cavity Excessive motor activity

Ageism

Discrimination against adults or age

mental illness

Disease of the mind, affects thoughts, feelings, behaviors.

Positive regard

Displays respect; has the ability to view another person as worthy

Formally known as multiple personality disorder, which is the presence of 2 or more personality states that control behavior

Dissociative identity disorder (DID)

One with major depression and personal outlook on life.

Does not enjoy life, nothing going right.

Medical professionals and acceptance of gifts

Don't do it! Maintain professional nurse-patient boundaries.

Ineffective reaction towards a patient uncontrollable response to a trauma

Don't provide false reassurance "Everything will be alright"

Monoamine Neurotransmitter that decrease: Parkinson's disease, depression; increase: schizophrenia, mania

Dopamine

Dramatic techniques to act out emotional problems, examine subjective experiences, develop new perspectives, and try new behaviors

Dramatic play

Intoxication of LSD symptoms

EVERYTHING GETS FAST tachycardia, tremors, incoordination, elevated temp/pulse, anxidty/depression, Hearling colors, seeing sounds feeling immortal

At what age to disorders in kids usually take affect?

Early childhood- early adulthood MOST likely in early childhood- early adolescence 9-17 yrs/old

What age group does anorexia nervosa begin to appear

Early to middle adolescence

Components of psychotherapy

Educational Encouragement Attempt to help bereaved person come to new relationship with deceasd

______ delivers an electrical current that produces a grand mal seizure.

Electroconvulsive therapy (ECT)

What kinds of biological changes are associated with depression?

Electrolyte disturbance, nervous system alterations, faulty regulation of the autonomic nervous system (ANS)

Stress reduction techniques

Eliciting the relaxation response Physical activity Social supports

Involuntary hold and personal rights

Emergency Involuntary Hold or "civil commitment" - 1 to 10 days prevent dangerous behaviors to self or others. Patient's Rights: to treatment, to refuse treatment, to informed consent, advance directives, restraints and seclusion, choose or refuse visitors, least restrictive means of treatment, participate in religious worship...

characteristic that define borderline personality disorder

Emotional instability Separation anxiety Depression Splitting

Traits of borderline personality disorder:

Emotional instability Separation insecurity Depression (chronic) Fear feelings of abandonment Excessive demands, impulsive behavior, uncontrolled anger Stormy relationships Idealization and devaluation Self-mutilation and prone to suicide Splitting

Temporary living in the others life

Empathy

Theory that believes personality continues to develop through old age and failures in one stage can be rectified at another stage

Erikson's eight stages of development

_______________ _____________ for women may prevent Alzheimer's disease, but is nto useful in decreasing the effects of pre-existing dementia

Estrogen therapy

Legal and ethical concepts

Ethics Bioethics Beneficence Autonomy Justice Fidelity Veracity

-Attempting to control someone else's drug use -Covering up for the person's substance use -Often bailing the addicted person out of financial or legal problems

Examples of overresponsible behaviors

Nurse's role in the patient's advanced directives decision making process

Explains the ethics and legal policies of advance directives. Serves as an advocate and knowledgeable resource person. Supports a surrogate who can act on the patient's behalf. Prepares (studies) to manage the legal, ethical, and moral issues involved in advance directives.

distress

Extreme anxiety, sorrow, or pain

Examples of nonverbal communication

Eye contact and visual tracking (gaze) of others, Proximity to others, Dress and hygiene, Body posture, Touching, Facial expressions, Movement, Dynamic speech properties (e.g., volume, tone, prosody), Imitation, Sharing and turn taking

Long term goals for autism pts.

Facilitate: -Appropriate expression of emotions -Development of cognitive skills -Foster the development of: -Social skills -Self-concepts (e.g., identity, self-awareness, body image, self-esteem) -Self-control, including impulse control

Hallucinations

False sensory experiences, such as seeing something in the absence of an external visual stimulus

WTF is a hallucination?

False sensory experiences, such as seeing something in the absence of an external visual stimulus

______________ and ________________ are the most significant risk factors for depression.

Family history and previous personal history

When assessing a pt. after a major life event, what's the first thing that is assessed?

Family's perception of the problem

Some nursing diagnoses for intellectual developmental disorders:

Fear Personal identity disturbed Defensive and ineffective coping Delayed growth and development—self-care deficit Impaired verbal communication and social interaction deficits **Risk for: Impaired parent or child attachment Injury Self-mutilation Self- or other-directed violence

Mourning

Feeling sorrow for the death of a loved one

Risk factors of suicide:

Feelings of hopelessness, uselessness, and despair Financial need, medical illness, and functional disability family history, chronic sleep problems, alcoholism, depression, and losses (see Chapter 23).

Histrionic personality disorder and narcissistic personality disorder: Appropriate nursing intervention

Firm boundaries Avoid entering a close personal relationship that may be misinterpreted as sexual.

SSRIs for older adults' depression

First Line meds: -few side effects, low toxicity -May double risk of BONE fractures**

Peplau's Interpersonal relationship Theory

First to describe the nurse patient relationship as doing "with" the patient rather than "to" the patient

Pt. has history of cardiac issues and is about to take a TCA for depression. What's the nurse's priority?

First, get baseline cardiovascular labs. **TCAs are hard on the heart

SSRIs : fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), escitalopram (Lexapro), and citaprolam (Celexa)

First-line therapy Indications: Major depression, OCD, panic disorder Adverse reactions: Nausea, insomnia, sexual dysfunction [decreased libido, impotence, delayed ejaculation, absent orgasm], hyponatremia, increased risk of GI bleeding, bruxism [clinching/grinding of teeth], serotonin syndrome. Potential toxic effects: TOO MUCH serotonin. increased heart rate, sweating, dilated pupils, tremors, twitching, hyperthermia, agitation, confusion, disorientation, hallucinations

How do you fix delirium?

Fix the underlying condition

S&S of PTSD

Flashbacks Avoidance of stimuli associated with trauma Experience of persistent numbing of responses Persistent symptoms of increased arousal

Inappropriate nutrition diagnosis: Appropriate outcome

For Acute Mania: Monitor I&O, vitals, offer high calorie protein shake, and finger food, frequently remind pt. to eat. -Adequate nutrition

Expression of depression:

Forgetfulness Agitation and combativeness Constant complaining Irritability Chronic aches and pains that do not respond to treatment Fatigue Rumination Easily angered Paranoia and suspiciousness Apprehension and anxiety without any cause Low self-esteem (feelings of insignificance or pessimism)

Theory that believed experiences during the early stages of life determine an individual's lifetime adjustment patterns and personality traits

Freud's psychoanalytic theory

Test used to assess dementia?

Functional Dementia Scale

DSM-IV-TR: the client experiences uncontrollable, excessive worry for more than 6 months

GAD

Axis V

GAF

Amino acid neurotransmitter that decrease: anxiety disorders, schizophrenia, mania, Huntington chorea; increase: reduction of anxiety, schizophrenia, mania

Gamma-amino butyric acid (GABA)

Self-awareness of ones feelings occurs; develops the ability to communicate when appropriate

Genuineness

What if a woman is getting abused but doesn't want to press charges?

Give her references to local resources: Hotlines, shelters, battered women's groups Battered women's advocates Aid to Families with Dependent Children (AFDC)

used to obtain a baseline assessment of the clients LOC and for ongoing assessment

Glasgow Come Scale

Amino acid neurotransmitter that is the major mediator of excitatory signals in the CNS and is involved in most aspects of normal brain function

Glutamate

Nursing diagnoses for grief:

Grieving Complicated grieving Risk for complicated grieving Ineffective coping Compromised family coping Disturbed sleep pattern Risk for spiritual distress Disturbed thought processes Chronic sorrow Social isolation

Schizophrenia spectrum disorders are a:

Group of psychotic disorders

Therapy for children; takes the form of play combining playing and talking about the activity. For adolescents it involves talking and peer relationships. Used to deal with issues such as bereavement, physical and sexual abuse, substance abuse, sexuality and dating, teen pregnancy, chronic illness, depression, suicidal ideation

Group therapy

Things not associated with normal mourning (complicated grief)

Guilt about things other than actions taken or not taken by the survivor at the time of death -Thoughts of death other than the survivor feeling he or she would be better off dead without the deceased person: -Morbid preoccupation with worthlessness -Significant psychomotor retardation -Prolonged functional impairment Hallucinations other than thinking he or she hears the voice or transiently sees images of the deceased.

Positive symptoms of schizophrenia:

Hallucinations Delusions Disorganized speech Bizarre behavior

PCP and LCD are both

Hallucinogens

Examples of primary prevention for domestic violence intervention

Have a safety plan in place; referrals, phone numbers for safe house, support groups, legal counselling.

Common problems with dementia

Have difficulty finding the right words. Use familiar words repeatedly. Invent new words to describe things (neologisms) . Lose their train of thought. Rely on nonverbal gestures.

Why are TCAs not primarily used?

Have more anticholinergic effects than SSRIs. HEART.

How do you assess recent memory?

Have patient recall a series of number or list of objects.

How do you assess remote memory?

Have patient state a verifiable fact (e.g. birthdate).

During the interview, in case hostility escalates, what are good precautions to take?

Have support available in case hostility escalates. Position self in a safe spot.

Clinical manifestations of alcohol withdrawal

Heavy use: N/V, Tachycardia, Diaphoresis, Anxiety or irritability, Tremors; hands, fingers, eyelids, insomnia, Grand mal seizures. -5 to 15 yrs of heavy use: Delirium (Immediate medical attention needed)

Family members of dying patient: nursing care plan

Help families maintain hope; hope that the loved one knows how important he or she was to them.

Nursing interventions for pts who are grieving

Help pts learn what to expect and how to normalize their confusing feelings and behaviors Encourage full expression of emotions and affect Attempt to help bereaved come to peace with a new relationship to the deceased

Education component of psychotherapy:

Helping to know what to expect and to normalize confusing feelings

What are the common elements in the traumatic experiences?

Helplessness & powerlessness

acamprosate (Campral)

Helps patient abstain from alcohol

Conventional antipsychotics that target positive symptoms:

High potency: trifluoperazine, thiothixene (Navane), fluphenzine (Prolixin), haloperidol (Haldol), pirozide (Orap) Low potency: chlorpromazine (Thorazine), thioriadizine (Mellaril) Medium potency: loxine (Loxitane), molidone (Moban), perphenazine (Trilafon)

Those at highest risk of suicide

Highest rate in 14 to 24 year old age (p.449)

Monoamine Neurotransmitter that has high levels associated with anxiety and depression

Histamine

Overly theatrical or melodramatic in character style

Histrionic

More Schizo Nursing Diagnoses...

Hopelessness Impaired social interaction Impaired verbal communication Ineffective coping Ineffective role performance Powerlessness Risk for injury Risk for other-directed violence Risk for self-directed violence Social isolation

Suicidal assessment: lethality of the plan (no risk, low level, moderate level, and high level)

How detailed is the plan? How lethal is the purposed method? Guns, hanging, carbon monoxide, and staging a car crash (extremely lethal). Slashing wrist, inhaling natural gases, ingesting pills (lower lethal methods). Access to means of plan? Has gun....

Theory where they sought a psychological science concerned with the human potential for development, knowledge, attainment, motivation, and understanding

Humanistic theory

Assessment modalities to assess for substance abuse

Hx of substance abuse Medical history Psychiatric history Psychosocial issues

Occurs if patient ingests tyramine found in some OTC medications, beer, wine, aged cheese, organ meets, avocados, and other foods while taking MAOI's

Hypertensive crisis

Total and excessive preoccupation with their belief that they have a devastating sickness or disease

Hypocondriasis

In what ways does PCP mess up the body?

IV: HIV, AIDS, Hepatitis, Bacterial endocarditis, renal failure, cardiac arrest, coma, seizures, respiratory arrest, dermatitis, pulmonary emboli, tetanus, abscesses-- osteomyelitis, septicemia Ingested: Respiratory Arrest

Delusions of being poisoned: appropriate interventions

Identify patients feelings, do not argue with patients beliefs or try to correct, do not touch patient, If patient thinks that food is poisoned offer food and drinks in closed containers, After understanding patients underlying feelings, engage in reality based activities.

First thing to do when talking to person with dementia

Identify self

What's the basic stuff that's assessed during crisis assessment?

Identify whether the patient needs psychiatric treatment or hospitalization. -Can the patient identify the precipitating event? -Does the patient understand situation supports? -Identify the patient's usual coping skills. -Determine the religious and cultural beliefs that need to be considered as you intervene in the crisis. -Assess whether the patient needs primary, secondary, or tertiary intervention.

After a catastrophic loss when should a patient call the doctor?

If not feeling better within a few weeks for a few hours each day

Crisis Phase 4

If the problem is not solved and new coping skills are ineffective, then anxiety can overwhelm the person and lead to serious illness; assess for suicidal thoughts.

Crisis Phase 3

If the trial-and-error attempts fail, then anxiety can escalate to severe and panic levels.

Crisis Phase 2

If the usual defensive response fails and if threat persists, then anxiety escalates. Trial-and-error begins.

Auditory hallucinations: therapeutic communication

Illusions, unlike delusions or hallucinations, can be explained and clarified for the individual. - "What are voices telling you?", try to understand what the voices are telling pt., speak simply, distract pt. to something he can do well.

If a clinician approaches the patient with meds in hand and the patient indicates a willingness to receive the medication, this is called:

Implied consent

Clonidine hydrochloride (ADHD)

Improved symptoms in children 6 to 17 years of age. -Catapres, Nexiclon XR (antihypertensive)

agraphia

Inability to write

ADHD symptoms

Inattention Hyperactivity Impulsivity

Symptoms of neurloeptic malignant syndrome

Increased Temp HR, BP Muscle rigidity, Altered level of consciousness Possible CVA

What are Erikson's 8 stages of development

Infant- trust vs mistrust Toddler- autonomy vs shame/doubt Preschooler- initiative vs guilt School-age: industry vs inferiority Adolescent- identity vs role confusion Young adult- intimacy vs isolation Middle-aged: generativity vs stagnation Older adult: integrity vs despair

What are Erikson's 8 stages of development?

Infant- trust vs mistrust Toddler- autonomy vs shame/doubt Preschooler- initiative vs guilt School-age: industry vs inferiority Adolescent- identity vs role confusion Young adult- intimacy vs isolation Middle-aged: generativity vs stagnation Older adult: integrity vs despair

Developmental assessment

Info. about the child's current maturational level compared to chronological age as well as identifying developmental deficits

Components of tyramine-restricted diet

Interact with MAOIs -Avacados, fermented bean curd, sauerkraut, figs, cured/fermented/smoked meats, liver, bologna, sausages, pickled fish, aged cheese, beer, wine (chianti), shrimp patse, soy sauce, chocolate.

methadone (Dolophine)

Is a synthetic opiate that blocks the craving for and effects of heroin.

l-α-acetylmethadol (LAAM)

Is an alternative to methadone.

naltrexone (ReVia)

Is an antagonist that blocks the euphoric effects of opioids.

clonidine (Catapres)

Is an effective somatic treatment when combined with naltrexone.

Questions to ask when evaluating pt. progress after therapy (4-8 wks after first interview)

Is the patient safe? Has the patient developed more adaptive ways to cope with stress and anxiety? Does the patient have a stronger existing support system? Has the patient maintained an optimal level of functioning? Has the patient returned to the pre-crisis level of functioning?

Communication with pt. with delerium

Keep distractions to a minimum. Always identify yourself. Speak slowly with short, simple words. Focus on one piece of information at a time. Talk with the patient about familiar things in life. Reinforce reality when the patient is delusional. Have the patient wear eyeglasses or hearing aids. Use reality-orientation tools such as clocks, calendars, a well-lit room, and family pictures

Factors associated with lithium toxicity

Kidney and thyroid problems

Tardive dyskinesia (TD)

Late, onset irreversible neurologic side effect of antipsychotic medication. Abnormal movements, lip smacking, tongue protrusion, chewing, grimacing, choreiform movements of limbs. Side effect of anti-psychotic drugs.

Stage 4 AD

Late- End stage

Mandates that the least drastic means be taken to achieve a specific purpose

Least restrictive alternative doctrine

Why are 2nd usually preferred over 1st gen antipsychotics?

Less EPS symptoms, Less anticholinergic effects,

Outpatient

Less acuity

Chlorpromazine (Thorazine)

Lesser potent drug for less serious cases of schizophrenia

What can be included with Encouragement of full expression of emotions and affect?

Letter writing to the deceased, role-playing, and looking at pictures

NEVER combine 2nd gen antipsychotics with..... WHY?

Levodopa, dementia Levodopa is an anti parkinson's medication; will cancel each other out.

Drugs that minimize aggression

Lithium, anticonvulsants, SSRIs

Examples of situational crisis

Loss of a job Death of a loved one Unwanted pregnancy A move Change of job Change in financial status Divorce Severe physical or mental illness

Phenelzine (Nardil) class and use

MAOI used to treat neurotic or atypical depression (ONLY USED when all other modes of therapy are ineffective)

What is a mass casualty incident?

MCI is an emergency involving three or more people

quetiapine (Seroquel) risperdone (Risperdal) clozapine (Clozaril)

Main 2nd gen antipsychotics

histrionic personality

Marked by emotional ATTENTION-SEEKING behavior in which the person needs to be the center of attention. The person with histrionic personality disorder is impulsive and melodramatic and may act flirtatious or provocative

Theory that emphasizes human potential and the patients strengths; prioritized nursing actions in the nurse-client relationship

Maslow's hierarchy of needs

Types of crisis

Maturational Situational Adventitious

Signs of drug withdrawal

Medical emergency Possible death Peaks 2-3 days after cessation and reduction Autonomic hyperactivity Sensorial and perceptual disturbances Fluctuating loss of consciousness Delusions Agitated behavior Body temp >100 F

Interventions for dilerium

Medical management is directed toward identifying and treating any underlying cause. Nursing implementations are directed toward patient safety. Communicate in simple and concrete phrases. Use reality-orientation aids (clocks, calendars). Maintain the same staff, if possible. Encourage family members to be supportive.

Disadvantages of 2nd gen antipsychotics

Metabolic syndrome More expensive

Anxiety level that occurs in the normal experience of everyday living; the individual is able to bring their perception of reality into sharp focus

Mild anxiety

What are the levels of anxiety?

Mild anxiety Moderate anxiety Severe anxiety Panic level of anxiety

Stage 1 AD

Mild forgetfulness

Levels of anxiety: signs from mild to severe

Mild— high degree of alertness, mild uneasiness Moderate— heart pounds, skin cold and clammy, poor comprehension. Severe— symptoms of moderate anxiety plus hallucinations, delusions. Panic— symptoms of severe anxiety plus inability to see and hear, inability to function; may regress to less appropriate behaviors

Signs of Anxiety: Mild, Moderate, Severe, and Panic [Levels of anxiety]

Mild— high degree of alertness, mild uneasiness Moderate— heart pounds, skin cold and clammy, poor comprehension. Severe— symptoms of moderate anxiety plus hallucinations, delusions. Panic— symptoms of severe anxiety plus inability to see and hear, inability to function; may regress to less appropriate behaviors

Provides a safe, comfortable place to live, play, and learn with areas for group activity as well as private time

Miley therapy

Best treatment plan for one suffering from an acutely manic patient

Milieu Therapy- seclusion

____________ _____________ creates an environment that is supportive, therapeutic, and safe.

Milieu therapy

Basics of safe environment

Minimize sensory stimulation If verbally upset, give support and change the topic Label rooms, drawers, and often-used objects. Install safety bars in the bathroom. Remove throw rugs and other objects

Nursing interventions for LSD

Minimize stimuli, One to one care, speak with slow clear voice

Stage 2 AD

Moderate Confusion

Anxiety level where the individual sees, hears, and grasps less information than someone who is not in that state

Moderate anxiety

Stage 3 AD

Moderate-severe; Unable to recognize familiar objects/people

Nursing guidelines with antipsychotics

Monitor glucose and liver labs

Norepinephrine

Monoamine Neurotransmitter that -Too little NorEpi: depression -Too much NorEpi: anxiety states

Serotonin & norepinephrine

Monoamine Neurotransmitter that -decrease (too little): depression; -increase (too much): anxiety states

Histamine

Monoamine Neurotransmitter that has high levels associated with anxiety and depression

Dopamine

Monoamine Neurotransmitter that: Decrease (Too little): Parkinson's disease, depression; -"Feel Good" transmitter, deficient in parkinson's disease Increase in Dopamine (Too much): schizophrenia, mania

Factors that help with resilience

More available resources than nonadapting children Average or better-than-average intellectual skills Good parenting or mentoring figure Less vulnerable to stress

Paranoid schizophrenia and medication management: non-compliance patient and alternative interventions/considerations

Most common type of schizophrenia -Characterized by: relatively stable, often paranoid, delusions, hallucinations; auditory variety, and perceptual disturbances. Typical: Haldol, chlorpromazine for +symptoms (EPS?) Atypical: clozapine, resperidone for +/- symptoms (seizures?)

Paranoid Schizophrenia

Most common type of schizophrenia -Characterized by: relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. -Disturbances of affect, volition, and speech, and catatonic symptoms, are not prominent.

Direct expression of the self that helps the youth become more aware of feelings, thoughts, tensions, improvement of a distorted body image, improve coordination, and increase social interaction

Movement and dance therapy

Neuroleptic malignant syndrome

Muscle rigidity, altered mental status, Tachycardia, seizures, hyperpyrexia, dyspnea, diaphoresis, increased/decreased B/P (Notify provider immediately)

Instigates changes in both the physiology of the nervous system and in social interactions

Music therapy

What's it take to diagnose someone with an Autism spectrum disorder?

Must demonstrate 2 or more of the following: -Stereotyped or repetitive speech, motor movements, and echolalia, and the repetitive use of objects -Excessive adherence to routines, rituals, or excessive resistance to change -Fixated interests that are abnormal in intensity -Hyporeactive or hyperreactive to the sense of joy or unusual interest in sensory aspects of the environment (e.g., indifference to pain, heat, cold)

Withdrawal symptoms of ETOH, Benzodiazepines

N/V, tachycardia, diaphoresis, anxiety/irritability, TREMORS in hands fingers, eyelids GRAND MAL seizures

Is AD affected by ethnicity?

NO

Is characteristic withdrawal syndrome from COCAINE life-threatening?

NO, but there is a risk for suicidal ideation

GI bleeding may result from concurrent use of cholinersterase inhibitors with _____________s.

NSAIDS

Organization for Hospice

National Hospice and Palliative Care Organizations NHPCO

Ch. 18

Neurocognitive disorders :Alzheimer's and Dementia

What is NFT?

Neurofibrillary tangles

ADVERSE reaction to 1st gen antipsychotics

Neuroleptic Malignant syndrome LIFETHREATENING

Peptide-neuro modulator neurotransmitter that decrease levels in spinal fluid of patients with schizophrenia

Neurotensin

What drugs are associated with reduced brain function and early death in older people?

Nifedipine, codeine, chlorpromazine, certain tranquilizers, antihistamines, antidepressants, and others. ---Anticholinergic effects

Are there meds to help treat autism?

No

Should ethical guidelines override laws?

No

Are the meds for personality disorders?

No man. Not specifically. BUT, there are meds used to treat the symptoms. You don't treat the borderline personality disorder, but you do treat the depression an/or anxiety associated with it.

Are Intelectual impairments/ asocial behaviors only associated with dementia?

No, depression is another reason someone might become forgetful

Is end of life hope a denial of reality?

No. At this stage of care, the hope has changed from surviving to hope that the loved one knows that he is loved and will be missed

A wide range of human activities from body movements to responses to the messages from others

Nonverbal behaviors

Are IQ (intelligence quitient) used to define level of impairment?

Nope

Is normal aging characterized by mental/cognitive disorders?

Nope

Older Adults; Depression Is it a normal part of aging?

Nope

Monoamine Neurotransmitter that decrease: depression; increase: anxiety states

Norepinephrine

What is NANDA?

North American Nursing Diagnosis Association international: describes a nursing diagnosis as a clinical judgement about responses to health problems

What is NANDA?

North American nursing diagnosis association international describes a nursing diagnosis as a clinical judgement about responses to health problems

Physician-assisted suicide for the terminally ill law established in 2009 states that the pt must:

Not have any neuromedical and/or psychiatric conditions that impair his or her capacity to reason Be diagnosed with < 3 months to live Make a request orally and in writing and have agreement for PAS approved by 2 different physicians Make the request again after a 15 day waiting period

Clozapine Nursing considerations

Nursing Considerations: Assess for hypotension; BP [take pulse and respiration prior to admin. Of drug] report drop of 30mm Hg, stay cool; heat stroke, Avoid abrupt discontinuation of med →EPS

Clozapine: patient teaching

Nursing Considerations: Assess for hypotension; BP [take pulse and respiration prior to admin. of drug] report drop of 30mm Hg -Pt. to stay cool; heat stroke, Avoid abrupt discontinuation of med →EPS

Nursing considerations of Diazepam (valium)

Nursing Considerations: CNS depressant, Use-anxiety, sedation, alcohol withdrawal, seizures, May result in toxic build-up in the elderly, Potential for physiological addiction/overdose, Can develop tolerance and cross-tolerance, Cigarette smoking increases clearance of drug, Alcohol increases CNS depression, Increased sedation, fall risk, and confusion in older adults, No grapefruit

Phenytoin (Dilantin) Nursing considerations

Nursing Considerations: Check hepatic and renal function, Medic-Alert band, Do not abruptly stop med, Take meds with meal.

Imipramine (Tofranil) Nursing considerations

Nursing Considerations: Take at bedtime to minimize problems with sedation, pt. to stop smoking and ETOH, therapy last about 6 months, taper of med, suicide watch.

Buspirone (Buspar) Nursing Considerations

Nursing consideration: Little sedation, Requires ≥3 weeks to be effective, Cannot be given as a PRN medication, Particularly useful for generalized anxiety disorder (GAD), No abuse potential, Used for clients with previous addiction, Avoid alcohol and grapefruit juice, Monitor for worsening depression or suicidal tendencies

Lithium (lithobid) Nursing considerations

Nursing considerations: Lots of drug interactions [NSAIDs, Hypertensive meds, thyroid, antidepressants, antipsychotic meds], high sodium foods, monitor ECG, administer after meals

Phenelzine (Nardil) Nursing consideration

Nursing considerations: NO OTC drugs (cold remedies), evaluate for suicidal tendencies, AVOID TYRAMINE rich foods [fermented meats, cured fish, all cheeses, Chianti (red) wine, soy sauce, ripe avocados]. Pt. should AVOID chocolate and caffeine too.

Citalopram (Celexa) Nursing considerations

Nursing considerations: Pt. increased risk for suicide [monitor moods], taper off drugs, bleeding problems if used with anticoagulants, NSAIDs, avoid ETOH, may take 4 to 6 weeks.

Fluoxetine (Prozac) Nursing considerations

Nursing considerations: Pt. increased risk for suicide [monitor moods], taper off drugs, bleeding problems if used with anticoagulants, NSAIDs.

Lorazepam (Ativan) Nursing considerations

Nursing considerations: Taper drug, avoid ETOH, assist with ambulation, Treatment for OD is flumazenil (Romazicon)

What disorder sometimes accompanies tourette's during cognitive therapy?

OCD

Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause significant anxiety or distress

Obsessions

Hypertensive crisis

Occurs if patient ingests tyramine found in some OTC medications, beer, wine, aged cheese, organ meets, avocados, and other foods while taking MAOI's

Generalized Anxiety Disorder

Occurs when you feel worried about everyday events and activities (small & unimportant stuff). These worries disrupt daily life.

Best foods to offer a patient with depression and refusing to eat

Offer high calorie, high protein snacks frequently throughout the day.

Ch28

Older Adults

Patients with mental health illness are to be placed in less restrictive community settings rather than in institutions

Olmsted v. L. C. (1999): US Supreme Court

OBRA

Omnibus Budget Reconciliation Act -declares that each nursing home resident has the right to be free from unnecessary drugs and physical restraints.

What is ODD?

Oppositional Defiant Disorder

3 phases of the nurse-patient relationship are:

Orientation Working Termination

Appropriate nursing actions for the termination phase of the nurse-client relationship

Orientation, Working, Termination - Termination phase is the final, integral phase of relationship; summary of goals & objectives achieved, exchange memories and facilitate closure of relationship.

Universal precaution for antipsychotics

Orthostatic precautions

Antidepressants that are not the first choice but help with insomnia

Other: bupropion (Wellbutrin, Zyban) trazodone (Desyrel)

Usually occurs after a traumatic event outside the range of usual human experience; major depression frequently occurs; painful repercussions can result if left untreated/undertreated

PTSD (post traumatic stress disorder)

Anxiety level that is the most extreme level and results in markedly disturbed behavior; individual not able to process events in the environment and may lose touch with reality

Panic level of anxiety

Desired outcomes of dilerium

Patient will return to premorbid level of functioning. Patient will remain safe and free from injury while in the hospital. Patient will be oriented to time, place, and person. Patient will be free from falls and injury.

Elderly with delirium: therapeutic responses

Patient will return to premormid level of functioning, patient will remain safe and free from injury, patient will be oriented to place, time, and person.

What are the behavioral theories?

Pavlov's classical conditioning Watson's behaviorism Skinner's operant conditioning Implications for nursing

Panic Disorder with Agoraphobia

People who have a panic disorder (also known as anxiety attacks) suffer from sudden attacks of intense and overwhelming fear that something awful is about to happen. -Agoraphobia usually involves a fear of being caught in a place where "escape" would not be easy.

Somatostatin

Peptide-neuro modulator neurotransmitter that -decrease: Alzheimer's disease; -increase: Huntington disease

Neurotensin

Peptide-neuro modulator neurotransmitter that decrease levels in spinal fluid of patients with schizophrenia

Substance P

Peptide-neuromodulator neurotransmitter that regulates mood & anxiety; role in pain management

Crisis phase 1

Person confronted by conflict that threatens self-concept responds with increased anxiety.

Tranference

Person unconsciously and inappropriately displaces those emotional reactions that originated from significant figures in childhood onto another individual

Components of a psychiatric nursing assessment

Personal info Appearance Behavior Speech Affect and mood Thought Perceptual disturbances Cognition

Disorder where personality traits are exaggerated and rigid to the point that they cause dysfunction in their relationships

Personality disorder

DSM-IV-TR: the client fears a specific object or situations to an unreasonable level

Phobia

Erikson's 8 Stages of development

Physcosocial. proposes that life is a sequence of developmental stages or levels of achievement. Each stage signals a task that must be accomplished. The resolution of the task can be complete, partial, or unsuccessful. The more success an ind. has at each stage, the healthier the personality of the individual.

Maslow's Hierarchy of Needs

Physical Needs (food, water), Safety Needs (shelter, clothes), Belonging Needs (teams, friends), Self-esteem (respect), self-actualization, Self-trancendence

What are the 4 different types of abuse that most states recognize?

Physical abuse Neglect Sexual abuse Emotional or psychologic abuse

What might help a person relax?

Physical activity, social supports

What can chronic stress cause?

Physiologic harm & emotional dificulties

What are Maslow's hierarchy of needs?

Physiological Safety Love and belonging Esteem Self-actualization Self-transcendent

What are Maslow's hierarchy of needs?

Physiological (most basic needs vital to survival), Safety (security needs offering protection), Social (need for companionship, acceptance), Self-esteem (need for personal worth, recognition), and Self-actualization (highest level, needs appealing to one's potential), Self-transcendent

Provide opportunities to act out conflicts, stressful situations, work through feelings, and develop ways of coping

Play therapy

Points are awarded for desired behavior and increasing levels or privileges can be earned

Point and level system

Risk factors associated with Alzheimer's **star**

Poor diet, obesity, and insulin resistance History of head injury First-degree relative of a person with AD Family history Vascular factors Inflammatory markers Hypertension Down syndrome

What's contained within psychosocial issues?

Poor work record has substance abuse affected relationships Criminal record?

What symptoms to 2nd gen antipsychotics treat?

Positive or negative

Displays respect; has the ability to view another person as worthy

Positive regard

What do first generation meds target for schizophrenic

Positive symptoms

Parkes, Caplan, Engel, Kübler-Ross

Postulated phases of bereavement that proceed in orderly sequences (models)

Diazepam (valium) Precautions

Precautions: Breastfeeding, children < 6 mo, geriatric patients, debilitation, renal disease, asthma, bipolar disorder, COPD, CNS depression, labor, Parkinson's disease, neutropenia, psychosis, seizures, substance abuse, smoking

Identify 3 advanced practice psychiatric nursing interventions

Prescriptive authority and treatment Psychotherapy Consultation

Nursing interventions for pts with delirium

Prevent physical harm caused by confusion, aggression, or fluid and electrolyte imbalance Perform a comprehensive nursing assessment to aid in identifying the cause Assist with proper health management to eradicate the underlying cause Use supportive measures to relieve stress

Levels of nursing care in crisis intervention

Primary Secondary Tertiary Care

Level of nursing care in crisis intervention that promotes mental health and reduces mental illness to decrease the incidence of crisis

Primary care

What is preferred to Risperidone?(Autism)

Propanolol- Less side affects

Cognitive behavioral therapy

Provides education, address cognitive distortions, and present behavioral approaches to attempt to decrease symptoms. Restructure their thinking and examine problem...see problem in a more positive light [challenges distress].

A series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one's hands, uncontrolled tongue movement, pulling off clothing and putting it back on and other similar actions.

Psychomotor agitation

Alleviate psychiatric symptoms, increase ability to make decisions and function more independently

Psychotherapy

For people at risk for complicated grief reactions, what kind of therapy might be indicated?

Psychotherapy

How is PTSD treated?

Psychotherapy in conjunction with medications (Zoloft & Paxil)

Treatment for PTSD [Therapy]

Psychotherapy is the treatment of choice for individuals with PTSD.

What are the requirements for a pt to qualify for reimbursement for psychiatric home care?

Pt cannot safely leave home Under the care of PCP Home bound

So if a pt. has potential to hurt self or others, initial pt. outcomes should reflect that. Ex:

Pt. consistently refrains from hurting self or others Pt. consistently refrains acting on delusions or halucinations

Maslow's hierarchy of needs and how they relate to the patient's current state such as with catatonic schizophrenia

Pt. does not move or eat so Maslow hierarchy of needs...Physiological Need; food.

What is therapy planning geared toward with Alzheimer's/dementia?

Pt.'s immediate needs Identify the level of functioning. Assess the caregivers' needs. Plan and identify appropriate community resources.

Sexual assault/violence include:

Rape Date rape Acquaintance rape Gang rape Marital or partner rape Sexual molestation Incest Statutory rape Sexual assault of older adults

Re-socialize regressed and apathetic pts; reawaken interest in the environment.

Re-motivation therapy

Activities center around game that teaches psychomotor and social skills. Gives children the opportunity to act like other children and to act appropriately

Recreational therapy

Indicators for family violence

Recurrent ED visits from being "accident prone" Present signs of high anxiety and chronic stress

naltrexone (ReVia)

Reduces or eliminates alcohol craving

Effects of not taking Lithium and priority nursing concerns

Relapse of acute mania and depressive episodes with sudden stop of Lithium [taper down gradually] -Monitor lithium level -Monitor kidney and thyroid functions

Share memories of the past, increase self-esteem, increase socialization, increase awareness of the uniqueness of each participant

Reminiscence therapy

Dangerous, controversial treatment for children; perceives seclusion as punishment with the experience of being overpowered by adults is terrifying, especially for a child that has been abused. Should only be used in extreme emergency. Quiet rooms (unlocked) may be used instead of seclusion, when the child needs to be removed from the situation either self-control or control by the staff

Removal and restraint

Conduct disorder: related behaviors

Repetitive and persistent pattern of behavior in which the basic rights of others, or societal norms or rules, are violated: aggression toward people or animals, destruction of property, deceitfulness or theft and serious violations of rules.

After interacting with a post synaptic receptor, the neurotransmitter is released and taken back to the presynaptic cell

Reuptake

Personal (patient) rights

Right to privacy, personal items, habeas corpus, to enter into legal contracts, right to informed consent, right to refuse treatment, etc

Patient's rights under law are

Right to treatment Right to refuse treatment Right to informed consent

Patient's rights under law are:

Right to treatment Right to refuse treatment Right to informed consent

What's a nursing diagnosis to watch out for?

Risk for caregiver role strain

Nuring diagnoses for delerium? *Star this one and know it*

Risk for injury Acute confusion Deficient fluid volume Insomnia and sleep deprivation Impaired verbal communication Fear Self-care deficit Disturbed thought process

Delirium nursing dx

Risk for injury Acute confusion Deficient fluid volume Insomnia and sleep deprivation Impaired verbal communication Fear Self-care deficit Disturbed thought process

Nursing diagnoses for Alzheimer's

Risk for injury Impaired verbal communication Impaired environmental interpretation syndrome Impaired memory Confusion Caregiver role strain

Alzheimer nursing dx

Risk for injury Impaired verbal communication Impaired environmental interpretation syndrome Impaired memory Confusion Caregiver role strain

Nursing Diagnoses: Crisis

Risk for self-directed violence Chronic low self-esteem Spiritual distress Hopelessness Powerlessness Anxiety (moderate, severe, panic) Acute confusion Disturbed thought processes Sleep deprivation Risk for loneliness Impaired social interaction Ineffective coping Interrupted family processes Caregiver role strain Risk for post-trauma syndrome Rape-trauma syndrome Dysfunctional grieving Chronic sorrow

** Patient with PTSD with history of violence: Relevant nursing diagnoses relevant to event:

Risk for violence

Risk of combining SSRIs and MAOIs

Risk greatest when SSRI is administered in combination with monoamine oxidase inhibitor (MAOI) = Serotonin Syndrome

Side effects of atypical antipsychotics

Risk of metabolic syndrome: increased weight, blood glucose, triglycerides, and insulin resistance

PTSD and a history of violence: Priority nursing diagnosis

Risk of violence, Risk for self harm, Risk of harm- other.

What is concerta?

Ritalin, but extended release [ER] tablet for once a day dosing

Antidepressants that increase serotonin and norepinephrine; has anti anxiety, antidepressant, and antiemetic effects; side effects include sedation and weight gain

SNDIs: mirtazapine (Remeron)

Antidepressants that increase serotonin and norepinephrine; side effects include fewer anti cholinergic effects then tricyclics & N/V

SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta)

Citalopram (Celexa) class and use

SSRI used for major depression, OCD, panic disorders

Fluoxetine (Prozac) class and use

SSRI used for major depression, OCD, panic disorders

Drugs that treat comorbid depression and panic attacks

SSRIs

What class of drugs are most effective with anxiety?

SSRIs

Depression: First line medication treatment

SSRIs, TCAs (sertraline, fluoxetine, citalepram)

Main classes of drugs used for anxiety:

SSRIs- first line SNRIs- first line TCAs- Second/third line Benzodiapines Atypical benzodiazepines Beta blockers

Antidepressants that increases serotonin; side effects include fewer anti cholinergic effects than tricyclics & N/V

SSRIs: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)

PT. edu with first gen antipsychotics

STOP smoking Take with food if GI upset and dry mouth occurs

comorbidities associated with bipolar disorder (4):

SUBSTANCE ABUSE, anxiety disorders, eating disorders, and ADHD

Client with dementia and depression: problems/needs to address

Safety Needs; make sure patient is safe and free of injury (don't leave pt. alone) and address nutrition and dehydration.

Overall goal for pt. in the acute phase of schizophrenia PHASE 1

Safety and medical stabilization

Assessment of anxiety disorders

Same as other disorders; -Assess quality of relationships, pt/parent education of disorders -Physical/behavioral/ cognitive symptoms of anxiety RECENT STRESSORS

Level of nursing care in crisis intervention that establishes the intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization

Secondary care

WTF is SLUDGE?`

Sedative, Lethargy, Energy Loss Anticholinergic ( Urine retention, Dry mouth, GI upset)

How do you assess ability to think abstractly?

See if patient can interpret an idiom/saying.

What is conduct disorder?

Seen as early as 2 years of age. ---Is physically aggressive, has poor peer relationships, shows little concern for others, and lacks guilt and remorse. -Adolescent-onset conduct disorder results in less aggression. ---Acts out misconduct with peer group (e.g., truancy, early-onset sexual behaviors, drinking, substance abuse, risk-taking behaviors).

Genuineness

Self-awareness of ones feelings occurs; develops the ability to communicate when appropriate

Elderly victims:

Self-neglect, self-abuse, institutional abuse, domestic abuse

Monoamine Neurotransmitter that decrease: depression; increase: anxiety states

Serotonin & norepinephrine

What is serotonin syndrome?

Serotonin syndrome: increased heart rate, sweating, dilated pupils, tremors, twitching, hyperthermia, agitation, confusion, disorientation, hallucinations Rare and life-threatening event

Ch. 5

Settings for psychiatric care

Dysthymia

Several depressive disorder merge to low grade chronic depressive state. > 2 years for dysthymic disorder (chronic depression)

Dysthymia [Chronic Depression]

Several depressive disorder merge to low grade chronic depressive state. > 2 years for dysthymic disorder (chronic depression)

Anxiety level where the individuals perceptual field is greatly reduced; the individual may focus on one particular detail or many scattered details

Severe anxiety

______-_______ ___________ ________, _______________, and ____________ may occur immediately following ECT procedures.

Short-term memory loss, confusion, and disorientation

Diazepam (valium) Side effects

Side Effects: Dizzy, drowsy, confusion, HA, tremors, insomnia, hallucinations, orthostatic HTN, ECG changes, tachycardia, blurred vision, tinnitus, constipation, dry mouth, anorexia, N/V/D, neutropenia, rash, respiratory depression, physical dependence

Chlorpromazine (Thorazine) side effects

Side Effects: EPS, seizures, neuroleptic malignant syndrome, orthostatic hypotension, hypertension, cardiac arrests, blurred vision, tachycardia, dry mouth, N/V/D, constipation, rash, anemia, leukopenia, agranulocytosis.

Lithium (lithobid) side effects

Side effects: Ataxia, coma, confusion, depression, dizziness, drowsiness, headache, lethargy, seizures, syncope, tremor (in hands), vertigo, Arrhythmias (including bradycardia and tachycardia), ECG changes, edema, Dental caries, dry mouth, exophthalmos, Diabetes insipidus, euthyroid goiter, hypothyroidism, myxedema, Abdominal distention and pain, anorexia, diarrhea, nausea, thirst, Stress incontinence, urinary frequency, Leukocytosis, Muscle twitching and weakness, Dyspnea, Acne; alopecia; dry, thin hair; pruritus; rash, Cold sensitivity, weight gain or loss

Phenelzine (Nardil) side effects

Side effects: CNS STIM; anxiety, agitation, hypomania, mania, ORTHOSTATIC hypotension, H/A, dry mouth, lethargy

Buspirone (Buspar) Common side effects

Side effects: Light-headedness, Confusion, Hypotension, palpitations

Clozapine side effects

Side effects: NEUROLEPTIC MALIGNANT SYNDROME, sedation, salivation, dizzy, H/A, tremors, sleep problems, akinesia, fever, seizures, confusion, insomnia, slurred speech, dystonia, tachycardia, hypo/hypertension, blurred vision, drooling, constipation, abd pain, N/V/D weight gain, dry mouth, urinary abnormalities, leukopenia, agranulocytosis, rigidity, diaphoresis, death (demented geriatrics)

Citalopram (Celexa) side effects

Side effects: Nausea, insomnia, sexual dysfunction [decreased libido, impotence, delayed ejaculation, absent orgasm], hyponatremia, increased risk of GI bleeding, bruxism [clinching/grinding of teeth], serotonin syndrome

Fluoxetine (Prozac) side effects

Side effects: Nausea, insomnia, sexual dysfunction [decreased libido, impotence, delayed ejaculation, absent orgasm], hyponatremia, increased risk of GI bleeding, bruxism [clinching/grinding of teeth], serotonin syndrome

Phenytoin (Dilantin) side effects

Side effects: cardiac dysrhythmias, hypotension, gingival hyperplasia, rash, ataxia, cognitive impairment

Lorazepam (Ativan) Common side effects

Side effects: dizzy, drowsy, H/A, confusion, slurred speech, mental depression, hangover, blurred vision, respiratory depression, constipation, N/V/D, rashes, PHYSICAL DEPENDENCE.

Imipramine (Tofranil) side effects

Side effects: sedation, orthostatic hypotension, anticholinergic effects (dries everything, h/a, urinary retention, blurry vision, tachycardia), cardiac toxicity, dysrhythmias

Signs of alcohol withdrawal

Similar to all CNS depressant drugs Early signs develop within a few hours Signs peak in 24-48 hours Grand mal seizures occur in 7-48 hours after cessation Illusions are experienced Irritability and "shaking inside" are common

Crisis that arises from an external rather than an internal source

Situational crisis

When individual's feel stressed out, they may have trouble:

Sleeping & eating Or may: experience headache or back pain, lose interest in favorite activities, feel tense and become irritable, feel powerless

Therapeutic communication when one has irrational thoughts

Slow and calm approach, ask if they have thoughts of suicide

What's SAD?

Social Anxiety Disorders -- fear of public speaking (most common), eating in front of others

This disorder is characterized by the presence of physical symptoms in the absence of a pathophysiologic cause

Somatic symptom disorder

Peptide-neuro modulator neurotransmitter that decrease: Alzheimer's disease; increase: Huntington disease

Somatostatin

Stage of Alzheimer's: no memory problems, no memory problems evident to provider

Stage 1

Stage of Alzheimer's: forgetfulness, especially of everyday objects (such as eyeglasses, wallet)/no memory problems evident to provider, friends or coworkers

Stage 2

Stage of Alzheimer's: mild cognitive deficits, including losing or misplacing important objects, decreased attention span, difficulty remembering words or names

Stage 3

Stage of Alzheimer's: personality change, appearing withdrawn or subdued esp. in social situations/obvious memory loss/difficulty performing tasks that require planning and organizing (paying bills, managing $$)

Stage 4

Stage of Alzheimer's: inability to recall important details, such as addresses and telephone number, but ability to remember information about self and family/disorientation and confusion as to time and place

Stage 5

Stage of Alzheimer's: loss of awareness of recent events and surroundings/ability to recall own name but not personal history/evidence of significant personality changes (delusions, hallucinations, compulsive behaviors)/wandering

Stage 6

Stage of Alzheimer's: loss of ability to respond to the environment, to speak, and to control movement/unrecognizable speech, general urinary incontinence, inability to eat without assistance, and impaired swallowing

Stage 7

What is an algorithm?

Step-by-step guidelines in a flow chart

A collection of negative attitudes, beliefs, thoughts, and behaviors that influence the individual and general public

Stigma

What do psychostimulants do for ADHD?

Stimulate the frontal lobe

Interventions for neuroleptic malignant syndrome

Stop the med and cool the patient

Ch. 10 box 10.1

Stress reduction

Crises are acute, time-limited occurences experiences as overwhelming emotional reactions to a:

Stressful situational event Developmental event Societal event Cultural event Perception of an event

Peptide-neuromodulator neurotransmitter that regulates mood & anxiety; role in pain management

Substance P

Common co-occcurences with personality disorders

Substance abuse, somatic symptom disorders, eating disorders, PTSD, depression, anxiet, general medical condiions

Major Depression: Priority of care

Suicide watch, and if refusing to eat offer high calorie, high protein snacks frequently throughout the day

Theory that believes the purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety

Sullivan's interpersonal theory

What are possible causes of delirium?

Surgery Drugs UTIs Pneumonia Cerebrovascular disease CHF

Risperidone is used for what? (Autism)

Symptoms of aggression, deliberate self-injury, and temper tantrums

Generalized Anxiety Disorder Symptoms

Symptoms: nervous, anxious, H/A, muscle aches, feeling shaky, sweating, lightheaded, sick to stomach, out of breath or hard time sleeping and tired all the time

Mematine (Namenda) may be used concurrently with a cholinesterase inhibitor. T/F

T

Memory loss following ECT is typically short term. (T/F)

T

Acronyms to help with symptoms of antipsychotics

TAAP, SLUDGE

Inhibit reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS

TCAs

What category of antidepressants can be used for a frail older adult?

TCAs- low doses

Toolkit for Nursing Excellence at End-of-Life Transition

TNEEL http://www.tneel.uic.edu/

Manic behaviors

Talkative, grandiosity, sexual behavior may be impulsive, can go for days without sleep, buying sprees, creative company or out of control and be danger to self or others, may lose touch with reality, become psychotic, paranoid, agitated, delusional or suffer hallucinations.

WTF is TAAP?

Tardive dyskinesia Akathesia Acute Dystonia Pseudo-parkinsonism

Mental status assessment

Technique used to determine cognitive functioning-- [Developmental level is considered]

Countertransference

Tendency of the nurse to displace feelings related to people in his or her past onto a patient

Level of nursing care in crisis intervention that provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state

Tertiary care

Developing the skills for the practice

The art of nursing

Common elements of PTSD

The common element in these experiences (traumatic events) is extraordinary helplessness or powerlessness.

Complicated grief

The grieving person has a prolonged or significantly difficult time moving forward after a loss.

Cognitive development (Piaget)

The idea that our mental representations of the world depend on the cognitive stage we have reached

Anhedonia

The inability to feel pleasure or happiness in response to experiences that are usually pleasurable. -Characteristics of major depression or schizophrenia

Why is it important to assess the Family's perception of the problem?

The more clearly the problem can be defined, the better the chance that an effective solution will be found.

Rationalization

The most COMMON defense mechanism in which an individual justifies ideas, actions, or feelings with seemingly acceptable reasons or explanations. Used to preserve self-respect or reduce guilt.

offering self

demonstrates a willingness to spend time with patient

splitting

demonstrating an inability to reconcile positive and negative attributes of self or others

The defense mechanism of ___________ is commonly used by clients who have problems with drug abuse or dependency.

denial

Defense mechanisms may be used by the client to preserve self-esteem when cognitive changes are progressive. What are they? (3)

denial, confabulation, perseveration

Characteristic withdrawal syndrome from COCAINE: (6)

depression, fatigue, craving, excessive sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation or agitation

type of behavioral therapy: the planned, progressive exposure to anxiety-provoking stimuli

desensitization

What do psychotherapy and play therapy accomplish? (ADHD)

determine emotional problems that develop as a result of the disorder

somatization

developing a physical symptom in place of anxiety

theophylline should expect the outcome

dialects bronchioles

Drugs to give for LSD overdose to treat anxiety or tension?

diazepam/ chloral hydrate

take oxycodone for pain management should avoid

diphenhydramine (both can cause CNS depression, risk for sedation, respiratory depression and injury)

What drugs are usually prescribed with antipsychotics to reduce Parkinsonian symptoms?

diphenhydramine hydrochloride (Benadryl) -9/10 times benztropine mesylate (Cogentin) trihexyphenidyl (Artane)- least often

reflecting

directing focus back to patient to examine their feelings

Its reaction with alcohol causes unpleasant physical effects

disulfiram (Antabuse)

MILD toxic effects of cocaine/CNS stimulants: (4)

dizziness, irritability, tremors, blurred vision

undoing

doing something to make up for prior behavior

reaction formation

doing the opposite behavior of what is felt

ciprofloxacin should include teaching

drink 8 full glasses of water per day (keep hydrate and prevent crystalluria of the urine)

Risperidone side effects

drowsiness; tardive dyskinesia; dizziness; constipation; hypersensitivity; NMS; hyperglycemia; dysphagia; priapism

adverse effect of enalapril

dry cough

involuntary commitment: client is hospitalized to prevent harm to self or others (May be up to 10 days)

emergency

offering general leads

encourages patient to continue talking

Secondary care

establishes the intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization.

Treatment of late life drinker (person who starts drinking late in life) isn't too intense. Prognosis for tx is

excellent

idealization

expressing extremely positve thoughts of self or others

devaluation

expressing negative thoughts of self or others

What is evaluated in the Glasgow Coma Scale?

eye, verbal, and motor response

example of tort: confining a client to a specific area, such as a seclusion room as a convenience to the staff

false imprisonment

receive a tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) booster immunization the previous day, potentially serious adverse effects is

feeling dazed and confuse

this relates to loyalty and faithfulness to the client and one's duty (Ex: A client askes a nurse to be present when she talks to her mother for the first time in several years and the nurse stays)

fidelity

decorticate rigidity

flexion and internal rotation of upper extremity joints and legs (arms toward midline)

An antidote ___________________, is available for IV yse for benzodiazepine toxicity

flumazenil (Romazicon)

Because 2nd gens can cause weight gain, what teaching would you provide to the client?

follow a healthy, low-calorie diet, engage in regular exercise, monitor weight gain

client has history of Stevens Johnson syndrome when taking sulfamethoxazole trimethoprim, what medication should withhold to prevent allergic reaction

furosemide

medication administration errors

furosemide 10.0 mg PO daily

varicella vaccine should withhold if allergic to

gelatin

______________ ____________, an herbal product is used by some clients to improve memory. Instruct clients to inform the provider due to potential interactions.

gingko biloba

Axis V of the DSM-V

global assessment of functioning (GAF)

take metformin for DM should include teaching that medication will be decrease

glucose production in the liver (metformin lower blood sugar by improving insulin sensitivity. Decrease production glucose production in the liver)

client is guided through a series of images to promote relaxation

guided imagery

SEVERE toxic effects of cocaine/CNS stimulants: (6)

hallucinations, seizures, extreme fever, tachycardia, cardiovascular collapse

Name the 1st gen (conventional) antipsychotics used to treat mainly positive symptoms of psychotic disorders (4)

haloperidol (Haldol) loxapine (Loxitane) cholopromazine (Thorazine) fluphenazine (Prolixin)

cocaine intoxication

have tachycardia, elevated blood pressure and dilated pupils

client's current INR is 5.0, what question

have you noticed any brusing

presenting reality

helps patient focus on what is actually happening; dispels delusions, hallucinations, and faulty beliefs

Tricyclic antidepressants (TCAs) or bupropion HCl (ADHD)

helps with ADHD too.

What does naltrexone do?

helps with decrease cravings

receiving epoetin alfa for 2 weeks, therapeutic effect

hemoglobin rises 0.5 g/dL

For the client with an eating disorder, provide a diet high in __________ and low in __________ to control constipation and fluid retention.

high in fiber, low in sodium

Inpatient care is for patients who have

higher acuity level, medical stabilization level, higher psychiatric instability 24 hr. nursing care, locked units for safety, residential tx programs

Glasgow Coma Scale: 15

highest possible score, awake and responding appropriately

Where do NFTs form?

hippocampus

celecoxib for treatment of joint pain is a contraindication to

history of myocardial infraction

What other conditions can betablockers be used to treat?

hypertension, glaucoma, migraine headaches

administer in error of an additional dose of captopril, adverse effect

hypotension

client has schizophrenia and take risperidone treatment is effective if

improve social interaction (who has schizophrenia difficulty interacting with other and maintaining relationship)

who has rheumatoid and take methotrexate should teaching

increase fluid intake

taking phenylephrine monitor for

increase heart rate

What do CNS stimulants do with tourette's?

increase tics

toxic effects of benzodiazepines (6)

increased drowsiness, agitation, disorientation, nausea, vomiting, respiratory depression

taking ferrous sulfate orally, medication is achieving its desire outcome

increased tolerance to exercise (to treat iron deficiency anemia. Anemia experience fatigue and shortness of breath)

Anti-dementia medications [donepezil (Aricept), rivastigmine (Exelon) amd galantamine (Razadyne) work by increasing or decreasing acetylcholine?

increasing, by inhibiting its breakdown

passive aggression

indirectly being aggressive but appearing to be compliant

The greatest risk to a client going through withdrawal is __________ from seizures and fallS.

injury

HIPAA: nursing responsibility

is a federal regulation that requires health care professionals to protect the privacy and confidentiality of patient's health information.

regular insulin

is clear appearance and prior to draw up

regular insulin and NPH insulin

keep the open vial of insulin at room temperature

Vital signs to expect for a client with an eating disorder: ________ BP with possible _____________ _____________, __________ pulse, ______________ temperature

low BP with possible orthostatic hypotension, decreased pulse, decreased temperature

Haloperidol (Haldol)

main first gen. antipsychotics for SERIOUS schizophrenia

should include in the teaching for client who has bipolar disorder and a new prescription for lithium

maintain a consistent sodium intake

acting-out behaviors

managing emotional conflicts through actions rather than self-reflection

Neurofibrillary tangles

masses of neurofibrils that form dense mats inside cell body and axon

___________________ is the only medication approved for moderate to severe stages of Alzheimer's disease.

mematine (Namenda)

Most widely used med for ADHD?

methylphenidate (Ritalin) -PO/Transdermal patch

level of anxiety: occurs in normal experience of everyday living/ increases focus and perception

mild

Within acute, normal, and chronic anxiety, what are the levels?

mild, moderate, severe, panic Tabl 11-1

type of behavioral therapy: therapist or others serve as role models for the client, who learns improved behavior by imitation

modeling

has heart failure and take digoxin and hydrochlorothiazide

muscle weakness

An antidote, __________________ is available IV to releive symptoms of opioid overdose

naloxone (Narcan)

Reduces or eliminates alcohol craving

naltrexone (ReVia)

Examples of complementary therapies

natural medicines, bodywork, supplements, yoga ad tai chi, meditation, acupuncture.

What side effects would you teach to a client taking anti-dementia medications? (3)

nausea, diarrhea, bradycardia

decerebrate rigidity

neck and elbow extension, wrist and finger flexion (arms away from midline)

obtundation

needs to be lightly shaken to elicit a response; may be confused and slow to respond

coma

no response from repeated painful stimuli

bulimia nervosa behavior most often seen in males; compensates for bingeing through other means such as excessive exercise or misuse of laxatives/diuretics

nonpurging type

Do these kids show many signs of remorse for being mean?

nope

Most clients with bulimia maintain a weight within a _____________ range or _____________ ______________.

normal; slightly higher

Treatment modalities for eating disorders focus on _____________ ____________ ____________ and beginning to address the issues raised by the illness.

normalizing eating patterns

affect

objective data about expression of mood

What is coprolalia?

obscenities, is present in less than 10% of cases.

involuntary commitment: client is in need of observation, a diagnosis and a treatment plan

observational or temporary

tobramycin should immediately report if

oliguria

A client has just arrived onto the unit folllowing an ECT procedure. What position should the nurse make sure he is in during the initial postoperative period?

on his side

type of behavioral therapy: positive rewards are given for positive behavior (reinforcement)

operant conditioning

Withdrawal from ______________ is very unpleasant, but not life-threatening, and is self-limiting to 7-10 days

opiods

Because confusion and short-term memory loss are common during the recovery phase following an ECT, what should the nurse know to do?

orient the client frequently

phase of the nurse-client relationship: set the contract, setting goals with client/exploring client's ideas, needs, strengths and weaknesses

orientation

If not treated, extreme anxiety can persist and lead to:

panic disorder with agoraphobia later in life.

level of anxiety: characterized by markedly disturbed behavior/ client not able to process what is occurring in the environment/ client experiences extreme fright and horror, possible hallucinations, inability to sleep

panic-level

transference

patient views healthcare provider as someone from their personal life

goal of milieu therapy

patient will learn coping skills, interact more effectively/appropriately, and strengthen relationship skills

The client avoids answering questions by repeating phrases or behavior. This is an unconscious attempt to maintain self-esteem when memory has failed.

perseveration

Axis II of the DSM-IV

personality disorder dx, mental retardation

Axis IV

pertinent psychosocial problems

repression

placing unacceptable thoughts/emotions/ideas in the unconscious

Anorexia labs: there is a direct loss of _________________ due to purging.

potassium

spironolactone should report if serum lab result is

potassium 5.3 mEq/L

denial

pretending the truth is not reality to manage the anxiety of acknowledging what is real

What is a triage?

process of evaluating the urgency of medical need and prioritizing treatment. -order of importance when provinding treatment

ego defense: blaming others for unacceptable thoughts and feelings

projection

Tertiary care

provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state.

Axis IV of the DSM-IV

psychosocial problems, problems that may affect dx/treatment/prognosis of mental disorders

There are two types of eating disorder behaviors with bulimia nervosa:

purging and non-purging

Tthere are two types of anorexia nervosa behaviors: restricting type and ______________ ________

purging type

ego defense: creating reasonable and acceptable explanations for unacceptable behavior (A young adultexplainshe had to drive home from a arty after drinking alcohol because he has to feed his dog)

rationalization

altruism

reaching out to others

What's the hippocampus responsible for?

recent, short-term memory

take vancomycin should monitor for

red neck

_____________ ______________ is the circulatory collapse that occurs when a client's completely compromised cardiac system is overwhelmed by a replenished vascular system after normal fluid intake resumes.

refeeding syndrome

ego defense: putting unacceptable ideas, thoughts, and emotions out of conscious awareness (A person who has a fear of the dentist's drill continually "forgets" his appts)

repression

stupor

requires painful stimuli (e.g. pinch a tendon, rub sternum) to elicit a brief response; may not be able to respond verbally

prescribed disulfiram and consumed alcohol within 12 hours, the priority reaction is

respiratory depression

paraphrasing

restating patient's thoughts and feelings to confirm what was said

type of eating disorder behavior: the individual drastically limits food intake and does not binge or purge

restricting type

aspirin is contraindicated for children because

reye's syndrome

Pseudo-parkinsonism

rigidity, tremors, pill rolling, shuffling gait

Drugs used with dementia coincides with psychosis?

risperidone (Risperda) olanzapine (Zyprexa) quetiapine fumarate (Seroquel)

Name the 2nd gen atypical antipsychotics used for psychotic disorders (6)

risperidone (Risperidal) olanzapine (Zyprexa) quetapine (Seroquel) ziprasidone (Geodon) aripiprazole (Abilify) clozapine (Clozaril)

What is the focus of nursing care during the ACUTE PHASE of bipolar disorder?

safety

So we know that as people get older they are at higher risk for intoxication than when they were younger; what medication related adverse events are increased?

sedation, delirium, confusion, and falls resulting in hip fractures.

The nurse must ________-__________ his own feelings regarding abuses as those feelings may be transferred to the client through body language and the terminology the nurse may use. An _____________, _____-___________ approach is imperative.

self-assess; objective, non-judgemental

Alzheimer's Disease- physical symptoms

senile plaques NFTs

prescription for sumatriptan and client take fluoxetine at risk for

serotonin syndrome: experience tremors, confusion, hallucination.

displacement

shifting feelings from one person/thing to another

teaching about nicotine polacrilex gum

should chew the gum for a full 30 minute before discarding (full dose of nicotine from the gum occurs within 15 to 30 minute)

For the client with an eating disorder, provide _________, ___________ meals, which are better tolerated and will help prevent the client from feeling overwhelmed.

small, frequent

ego defense: developing a physical symptom in place of anxiety

somatization

ego defense: demonstrating an inability to reconcile negative and positive attributes of self or others (A client tells a nurse that she is the only one who cares about her, yet the following day the same client refuses to talk to the nurse)

splitting

With cholinesterase inhibitors, dosage should ____________________________ until side effects are no longer tolerable or medication is no longer beneficial.

start low and gradually be increased

mood

subjective data about emotions that are felt

ego defense: dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression (like going to work out when you are having a bad day) *HEALTHY*

sublimation

DSM IV-TR: characterized by the presence of tolerance

substance dependence

ego defense: voluntarily denying unpleasant thoughts and feelings (A person who lost his job states he will worry about paying his bills next week.)

supression

taking levodopa/carbidopa, what is priority finding should be monitor

syncope

theophylline for treatment of bronchial asthma

tachycardia nausea headache

cocaine intoxication

tachycardia, elevated blood pressure, dilate pupil.

Drugs that are used to treat Alzheimer's and dementia

tacrine (Cognex) donepezil (Aricept) rivastigmine (Exelon) galantamine (Razadyne) memantine (Namenda) ergoloid mesylates (Hydergine), an ergot alkaloid, has been approved for use in AD and stroke.

health teaching

teaching social and coping skills

dissociation

temporarily blocking memories and perceptions from consciousness

phase of the nurse-client relationship: summarize goals and achievements/discuss palns to continue new behaviors/make plans for the future

termination

safety immunization during pregnancy

tetanus and diphtheria (td)

Tort law

that division of law that covers acts that result in harm to another; covers wrongful acts

indicate that levodopa/carbidopa is effective

the client is able to wash his face (levodopa active dopamine receptor, restoring nerve transmission for client who have Parkinson's disease. Carbidopa enhances these effects by inhibiting the breakdown of levodopa in the intestine and periphery, allow to move freely)

National incident management system (NIMS)

the management system used by federal, state, and local governments to manage emergencies in the United States

The care of the client with bipolar disorder will be based on ______________________________.

the phase of mania the client is experiencing

Reproductive status: Anorexia is accompanied by amenorrhea for at least ____________ consecutive cycles

three

The typical course of ECT treatment is _______ times per week for a total of ___ -___ treatments.

three; 6-12

What is Perservation?

to fixate on a task or behavior

Goal of crisis intervention

to return the individual to the pre-crisis level of functioning.

Works to decrease alcohol cravings

topiramate (Topamax)

sublimation

unconsciously substituting acceptable forms of expression

ego defense: performing an act to make up for prior behavior

undoing

What common use do the following medications have: disulfuram (Antabuse), naltrexone (Revia), acamprosate (Campral)

used for alcohol ABSTINENCE

What common use do the following medications have: diazepam (Valium), lorazepam (Ativan), carbemazepine (Tegretol), clonidine (catapres)

used for alcohol withdrawal

What common use do the following medications have: bupropion (Zyban), nicotine gum (Nicorette) and nicotine patch (Nicotrol)

used for nicotine (cigarette) withdrawal

What common use do the following medications have: methadone (Dolophine), clonidine (Catapres), buprenorphine (Subutex), buprenorphine combined with naloxone (Subuxone)

used for opioid withdrawal

restating

using exact words

suppression

voluntarily denying unpleasant thoughts/feelings

clients of this type of commitment are there by choice or per a family member or other; have the right to apply for release at any time and refuse medication and treatment

voluntary

manifestation digoxin toxicity

vomiting

methylprenisolone sodium succinate should monitor

white blood cell count (risk for infection) serum potassium (cause hypokalemia along with fluid and sodium retention) blood glucose (cause increase blood glucose level)

instill antibiotic ear drops for a client who has otitis extema, what action

wiggle the earlobe after instilling the ear drops (help the ear drop move down to external auditory canal)

phase of the nurse-client relationship: performing ongoing assessment to plan and evaluate therapeutic measures/recognize transference and countertransference issues/client describes major conflicts and/or defenses

working

Are care plans for Alzheimer's and dementia similar?

yeah, so they'll be used interchangeably

Hallucinations and illusions w/ delirium?

yes

Higher rates of diabetes and hypertension are found in those with AD than found in those who do not develop AD?

yes

counter-transference

you (healthcare provider) view patient as someone from your personal life

metronidazole for a urinary tract infection should include in teaching

your urine may become reddish brown

expressing extremely positive thoughts of self or others (A boy boasts about his older brother and his accomplishments)

idealization

ego defense: indirectly behaving aggressively but appearing to be compliant

passive aggression

Axis II

personality disorders and mental retardation

ego defense: overcompensating or demonstrating the opposite behavior of what is felt (A boy who has a crush on a girl actually teases and humiliates her instead)

reaction formation

Thirty minutes prior to the beginning of the ECT procedure, an IM injection of _________________ is given to decrease secretions and counteract any vagal stimulation

robinul (Glycopyrrolate)

level of anxiety: perceptual field is greatly reduced/ learning and problem solving do not occur/ feelings of impending doom and confusion/usually NOT able to take direction from others

severe

________ ___________, ______________, and _______ __________ ___________ are indications for ECT (*remember that it is only done after all other treatment options have been unsuccessful)

severe depression, schitzophrenia, and acute manic episodes

What is important to tell a patient taking MAOIs or lithium that is to undergo ECT?

should be discontinued 2 weeks before ECT procedure

type of behavioral therapy: teaching a cleint, when negative thoughts or compulsive behaviors arise to say or shout "STOP" and substitute a positive thought

thought stopping

Why is robinul (Glycopyrrolate) given 30 minutes before an ECT procedure?

to decrease secretions and therefore reduce the risk for aspiration

a wrongful act of injury committed by a person against another person or another person's property

tort

A client sees the nurse as being like his mother, and demonstrates some of the same behaviors with the nurse as he did with his mother. What is this an example of?

transference

occurs when the client views the nurse as having characteristics of another person who has been significant to the client in their personal life

transference

____________________ and ____________________ are potential boundaries to the therapeutic relationship

transference and countertransference

this refers to being honest when dealing with this client (Ex: a client states "You and that other staff member were talking about me, huh?" The nurse should reply truthfully)

veracity

type of behavioral therapy: assists the cleint to change irrational or unrealistic thoughts to thoughts that are more realistic

cognitive therapy

ECT is used for cleints who have bipolar disorder with rapid cycling (_______ or more episodes of acute mania within ____________) and very destructive behavior.

4; 1 year

What GAF score would you give to someone who shows serious mental disability and/or functioning impairments?

40 and below

DSM-IV-TR: exposure to a traumatic event causes intense fear, horror, flashbacks, feelings of detachment, and foreboding, restricted affect, and impairment for longer than 1 month after the event/symptoms may last for years

PTSD

DSM-IV-TR: the client experiences recurrent panic attacks

Panic disorder

There are conditions that the nurse must be aware of that place a client at higher risk if ECT is used. What are they?

MI, CVA

used to objectively assess the client's cognitive status

Mini-Mental Status Examination

DSM-IV-TR: the cleint has intrusive thoughts of unrealistic obsessions and tries to control these thoughts with compulsive behaviors (repetitive cleaning or washing of hands)

OCD

What are the contraindications to electroconvulsive therapy (ECT)?

THERE ARE NONE if it is deemed necessary to save a client's life.

ego defense: managing emotional conflicts through actions, rather than self-reflection (A preschool child is told she has to share her toys, and then throws the toys across the room)

acting-out behaviors

Why would you advise a client taking SSRIs to follow a healthy diet?

Weight gain can occur

A nurse or other healthcare professional trained in this method can assist the cleint to gain voluntary control of such autonomic functions as HR and BP

biofeedback

Which type of schizophrenia is less responsive to neuroleptics, and therefore are more likely to indicate ECT?

catatonic schizophrenia

A client thinking he is" a terrible father to my daughter" being helped to change this thinking into "I've made some mistakes as a parent, but I've learned from them and have improved my parenting skills" This is an example of ______________ ________________.

cognitive reframing

Posturing: neck and elbow extension. wrist and finger flexion

decerebrate rigidity

Posturing: flexion and internal rotation of upper extremity-joints and legs

decorticate rigidity

ego defense: pretending the truth is not reality to manage the anxiety of acknowledging what is real

denial

ego defense: expressing negative thoughts of self or others (A person who is passed up for a promotion states that the job isn't any better than the one he currently has)

devaluation

ego defense: shifting feelings related to an object, person or situation to another that is less threatening (A person hwo is angry about losing his job comes home and kicks his dog)

displacement

ego defense: temporarily blocking out memories and perceptions from consciousness (An adolescent who witnesses a shooting is unable to recall any details of the event)

dissociation

DSM-IV-TR: a milder form of depression that usually has an early onset such as in childhood or adolescence and lasts at least 2 years in length

dysthymic disorder

ECT is administered _____________________ after the client has fasted for ___-___ hours.

early in the morning; 8-12

anergia =

lack of energy

anhedonia =

lack of pleasure in normal activities

first-line treatment for seasonal affective disorder (SAD)/inhibits nocturnal secretion of melatonin

light therapy

involuntary commitment: similar to observational or temporary, but it must be imposed by the courts (usually 60-180 days)

long-term or formal

DSM-IV-TR: a single episode or recurrent episodes of unipolar depression that occur almost every day for a minimum of 2 weeks and last most of the day

major depressive disorder (MDD)

Axis III

medical diagnoses

level of anxiety: reduced perception/ ability to think clearly is hampered but learning and problem solving can still occur/usually benefits from direction from others

moderate