Holistics 2: unit 1-mind, body, and soul: understanding mental health

physical indicators of depressive disorders

weight loss, weight gain, sleep disturbances, fatigue

a patient reports an overwhelming feeling of worthlessness, difficulty in making decisions and suicidal thoughts. Which of the following would be appropriate for the nurse to ask? 1. Do you have a plan to commit suicide 2. Why do you want to commit suicide 3. Have you considered how your family would feel if you committed suicide 4. What would you accomplish by committing suicide

1

The practical nurse (PN) is taking the blood pressure of a middle-aged male who is involved with his children's sports teams as a coach and referee. While establishing a nurse-client relationship, the client tells the PN that he hires and trains teenagers to work part-time in his restaurant. Which psychosocial developmental stage is the client experiencing? 1. Identity. 2. Generativity. 3. Isolation. 4. Stagnation.

2

What approach is best for the practical nurse (PN) to use when establishing a relationship with a severely socially withdrawn male client diagnosed with schizophrenia? 1. Client autonomy. 2. The therapeutic community. 3. The nurse-client relationship. 4. The multidisciplinary mental health team.

2

A client with schizophrenia approaches the practical nurse (PN) and says, "The voices are bothering me. They're yelling and telling me I'm bad. Can't you hear them?" Which response should the PN provide? 1. "Do you hear the voices often?" 2. "Have you been taking your medication regularly?" 3. "I can't hear the voices, but I can see that you're upset." 4. "Dismiss the voices and ask someone to play cards with you."

3

medications for major depressive disorders

tricyclics (amitriptyline, clomipramine, imipramine): inhibits the reuptake of nuerotransmitters selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine): block reuptake of serotonin Monoamine oxidase inhibitors: prevents breakdown of neurotransmitters

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors

nonbenzodiazepine (buspirone)

less drowsiness and dizziness than benzodiazepine; takes several weeks to get results

What are physical symptoms of anxiety?

increased BP, pulse, respirations, and urinary output, dry mouth, nausea, diarrhea, trembling, restlessness

A client diagnosed with Stage 3 Alzheimer's disease is experiencing difficulty toileting appropriately. What instruction is best for the practical nurse (PN) to provide the family? 1. Label the client's bathroom door. 2. Place the client in disposable diapers. 3. Make sure the client does not eat nonfood items. 4. Question the client often about the urge to void or defecate.

1

SNRIs take how long to work

2-4 weeks

How are anxiety disorders treated?

cognitive behavioral therapy, supportive therapy, self help techniques

interventions for anxiety disorders

decreasing environmental stimuli, relaxation techniques, stress management, medication with anxiolytics

psychological indicators of bipolar disorder

delusions, flat affect, irritability, inability to concentrate

psychological assessment of eating disorders

denial of problem, compulsive dieting, low self-esteem, body dysmorphia

benzodiazepines (alprazolam, diazepam, lorazepam)

depresses the central nervous system: watch for orthostatic hypotension, drowsiness, confusion-do not take with other CNS depressants like alcohol

interventions for suicidal patient

develop trust, remove dangerous objects, talk openly about thoughts

psychological indicators of depressive disorders

feelings of sadness, worthlessness, inability to feel pleasure, difficulty concentrating, thoughts of death or suicide

TCAs adverse effects

- Hypotension - Anticholinergic - Sedation - Diaphoresis - Cardiotoxicity (arrythmias) - Seizures - Hypomania - Yawngasm

Warning signs of suicide

- talking about suicide - wanting to be left alone - engaging in risky behavior such as drug use - giving away possessions - interest in death or violence - saying final goodbyes to friends and loved ones

Bupropion

Antidepressant

Anxiolytics

Drugs that alleviate the symptoms of anxiety.

The practical nurse (PN) is assessing a newly admitted client with paranoid schizophrenia who is hypervigilant and who constantly scans the environment. The client tells the PN, "I saw those two doctors in the hall talking about me." What descriptive terminology should the PN document to describe the client's thought process? 1. Echolalia. 2. Ideas of reference. 3. Delusions of infidelity. 4. Auditory hallucinations.

2

The practical nurse (PN) is inquiring about coping strategies with a male client who is admitted for alcohol abuse. The client tells the PN that his job skills and communication skills are his best assets and support. Which additional information should the PN obtain about maladaptive mechanisms? 1. Family support. 2. Self indulgence. 3. Financial security. 4. Daily stressors.

2

command hallucinations

disturbed auditory sensory perceptions demanding that the client take action, often to harm self or others, and are considered dangerous; often referred to as "voices"

common adverse side affects of SNRIs

drowsiness, nausea, dry mouth, excessive sweating

Dual Action Reuptake Inhibitors (SNRIs)

duloxetine, venlafaxine

adverse side affects to antipsychotic drugs

dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia

Risk factors of suicide

family history of suicide, terminal illness, history of previous suicide attempt, addiction to drugs or alcohol, diagnosis of major depressive disorder or bipolar disorders

bipolar disorder

A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.

Cyclothymia

A relatively mild form of bipolar disorder

interventions for patients in manic phase

high calorie diet, maintaining patient safety, antimanic medications, rest and sleep

Physical indicators of bipolar disorder

hypersomnia, insomnia, appetite change, bowel changes

bulimia nervosa

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

What are the four levels of anxiety?

mild, moderate, severe, and panic

anorexia nervosa

an eating disorder in which an irrational fear of weight gain leads people to starve themselves

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

antidepressant act by reuptake of serotonin and norepinephrine and dopamine and therefore prolong the action of the neurotransmitter

How is schizophrenia treated?

antipsychotic drugs

MAOIs adverse effects

Few adverse effects—orthostatic hypotension most common Tachycardia Dizziness Insomnia Anorexia Blurred vision Palpitations Drowsiness Headache Nausea Impotence

medications for bipolar disorder

Mood Stabilizer : lithium- this drug has a narrow theraputic range so not used as much anymore anticonvulsants- divalproex sodium, carbamazepine, quetiapine other meds: risperidone, aripiprazole, ziprasidone

Labile mood

Oscillations in mood between euphoria and depression or anxiety.

Anxiety

The condition of feeling uneasy or worried about what may happen

electroconvulsive therapy (ECT)

a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

theraputic alliance

a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client's problem

Lithium Carbonate

a chemical used to counteract mood swings of bipolar disorder

at what age is schizophrenia normally diagnosed

ages 15-25 years old

negative symptoms of schizophrenia

the absence of appropriate behaviors (expressionless faces, rigid bodies, social withdrawal, apathy)

How are anxiety disorders diagnosed?

through the diagnostic and statistic manual of mental disorders-fifth addition

A patient is not interested in daily activities such as bathing or hygiene. They report an overwhelming feeling of sadness and loss of energy. Which of the following nursing interventions would be appropriate for this patient? Select all that apply- one, some or all may be correct 1. explain the importance of hygiene to the patient 2. inform the patient they need to "look good" to "feel good" 3. plan extra time to help the patient complete hygiene activities 4. encourage some patient participation in hygiene activities 5. assign the same caregiver to assist every day if possible

3

During the admission interview to an inpatient psychiatric unit, the practical nurse (PN) asks a male client who is admitted with depression about recent life events that precipitated his admission. The client remains silent, looks at the floor, and does not answer any of the PN's questions. Which intervention is best for the PN to implement? 1. Initiate a conversation about the client's suicidal ideations and plans. 2. Describe diagnostic laboratory results to the client. 3. Ask the client if he would like to talk to another nurse. 4. Record these findings in the medical record under the DSM IV Axis IV.

3

The nurse is discussing with the patient the effects of the antipsychotic medication. Which patient statement indicates a need for further teaching? 1. the medication helps me to think more logically 2. the medication makes my mouth dry 3. the medication improves my mood 4. the medication helps to stop the voices

3

When the mother of a young child is diagnosed with HIV, she asks the practical nurse (PN), "Who will take care of my children if I die soon?" What response is best for the PN to provide? 1. "Surely you have a friend or family member who can help you in this time of need." 2. "Where is the father of your children? Surely he will want to help with the care of his children." 3. "This is an important consideration, but you may live until they are grown up or even longer." 4. "I can see that you are very concerned. Would you like me to call the chaplain to talk to you?"

3

A practical nurse (PN) is interacting with a female client who is discussing her divorce as a stressor. What areas should be explored with the client to gather the most relevant information? 1. Affective responses. 2. Social responses. 3. Physiological responses. 4. Biopsychosocial responses.

4

During a routine prenatal clinic visit, the practical nurse (PN) is assessing a pregnant female client who expresses fears of spousal abuse. Which information should the PN provide to facilitate client disclosure? 1. Provide her with a reflection of her apparent unhappiness and uncertainty about pregnancy. 2. Tell her that spousal abuse can be supported by evidence of old fractures seen on x-rays. 3. Encourage her to share incidents of past abuse so her personal safety can be addressed. 4. Share with client that her situation is not unique and abuse often increases with pregnancy.

4

When implementing the plan of care for a client who is recovering from an overdose of clomipramine (Anafranil), the practical nurse (PN) recognizes that it is essential to monitor the client for which side effects? 1. Excess salivation and drooling. 2. Muscle rigidity and restlessness. 3. Polyuria and extreme hand tremors. 4. Orthostatic hypotension and constipation.

4

atypical antipsychotics

Antipsychotics that do not have significant side effects common to older antipsychotics

nursing management of patients with personality disorders

build trust, set limits, teach coping skills, preventing self harm, encouraging insight to behavior

what does treatment of anxiety disorders normally entail?

combination of pharmacologic and nonpharmacologic therapies

physical assessments in Eating Disorders

electrolyte imbalances, dry skin, constipation, facial puffiness, hypotension, hypothermia, dental caries

subjective data of anxiety

fear, apprehension, ability to concentrate, restlessness, hypertension, dyspnea, and dizziness

psychological symptoms of anxiety

fear, guilt, anger, irritability, low self-esteem

What is the goal of eating disorders?

for the patient to develop a sense of self-worth and self-acceptance that is not based on appearance

interventions for patients with eating disorders

monitoring nutritional intake, weight, behaviors, and assisting to rebuild self-esteem

MAOIs

monoamine oxidase inhibitors, antidepressant drugs that inhibit MAO

Risks of ECT

mortality, permanent memory loss, brain damage

Akathisia

motor restlessness

dystonic reaction

muscle spasms of any muscles of the body

major depressive disorder

patient diagnosed when at 5 symptoms of depression and have been present for at least 2 weeks.

how do you asses a person with a personality disorder?

patients view of self and others, expression of feelings, and behaviors that interfere with life and relationships

phobic disorder

persistent and irrational fear of an object or situation that presents no realistic danger ex: social anxiety disorders

positive symptoms include of schizophrenia

presence of hallucinations, delusions, disordered thinking

thought disorders

presence of psychotic symptoms which include hallucinations, delusions, and disorganzied speech and/or behavior

medications to treat anxiety disorders

benzodiazepines, nonbenzodiazepine, dual action reuptake inhibitors, selective serotonin reuptake inhibitors

tricyclic antidepressants

block reuptake of serotonin and norepinephrine; elevate mood, increase alertness, improve appetite

what is the most prevalent personality disorder?

borderline personality disorder

obsessive-compulsive disorder

An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions).

how is major depressive order treated

psychotherapy and antidepressants

most common thought disorder

schizophrenia

symptoms of major depressive disorder

sleep disturbances, feelings of worthlessness, suicidal thoughts

The nurse who is leading a group therapy session is called to manage a unit emergency and assigns the practical nurse (PN) as the leader of the group. During the therapeutic session, a client challenges the PN as the leader. Which response should the practical nurse (PN) communicate? 1. You are saying that I should not be the leader? 2. Let's vote and see who should be the leader. 3. So, you do not like me or my leadership style? 4. You will not be the group leader ever.

1

The practical nurse (PN) is caring for a male client with schizophrenia who is exhibiting forgetfulness, disinterest in activities, and difficulty completing tasks. Which intervention should the PN implement? 1. Provide a structured schedule of activities on the unit. 2. Direct the client to pay his own household bills. 3. Encourage the client to go to the day room to work a puzzle. 4. Enroll the client in three therapeutic group sessions each day.

1

A client who is admitted for surgery seems to focus only on his immediate concerns and asks the practical nurse (PN) to repeat everything that is said over again. The client seems to follow directions but asks for assistance when filling out admission forms and checklists. He apologizes to the PN often and says he did not hear all of the instructions. This client is experiencing which level of anxiety? 1. Mild. 2. Panic. 3. Severe. 4. Moderate.

3

A male client with dementia who lives in an extended care facility is placed in a wheelchair each day and positioned in the hall where he kicks people who walk past him. Which intervention should the practical nurse (PN) implement? 1. Move him to a busier hall with more people. 2. Ask the client every half hour what he needs. 3. Call him by name until he focuses his attention. 4. Approach the client from behind to apply a restraint

3

A patient is diagnosed with generalized anxiety disorder. Which behavior is most likely to be displayed with the diagnosis? 1. runs out of the room when they notice a spider in the corner 2. continuously checks to see if the doors are shut and locked 3. has difficulty concentrating and excessively worries about their family 4. wakes up at night screaming because of recurrent nightmares

3

A patient is irritable, pacing, crying, and becoming increasingly agitated. Which of the following nursing interventions would be appropriate? 1. initiate a contract stating suicide wont be attempted 2. administer ordered antidepressant medication 3. stay with the patient and make the surroundings less stimulating 4. offer small meals and finger foods to sustain nutrition

3

oculogyric crisis

fixation of the eyeballs in an upward position

generalized anxiety disorder

a person who experiences persistent, unrealistic and/or excessive worry about two or more life circumstances for 6 months or longer

interventions for depressive disorders

active listening, tending to physical needs, antidepressants

first generation antipsychotics

a group of medications originally developed to combat psychotic symptoms by reducing dopamine levels in the brain; also called conventional or typical antipsychotics

Schizophrenia

a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions, most common thought disorder

post-traumatic stress disorder

an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience

TCAs

tricyclic antidepressants, have sedative effects, good for patients with insomnia; meds with 3 ring (tricyclic) chem structure that keeps norepinephrine and serotonin at nerve terminals and helps electrical impulses to cross synapse

dysthymia (mood disorder)

a disturbance in mood that may be either depression or elation (mania)