Psych test 3 (anxiety, personality disorders, & substance abuse)
A nurse uses the CAGE screening test for alcoholism to determine an individual's potential for a drinking problem. What is one of the four questions included on this test? "Do you feel that you are a normal drinker?" "Have you ever felt bad or guilty about your drinking?" "Are you always able to stop drinking when you want to?" "How often did you have a drink containing alcohol in the past year?"
"Have you ever felt bad or guilty about your drinking?"
Antihistamines used for anxiety
"Yzine" Atarax Vistaril Benadryl
A client is found to have generalized anxiety disorder. For what behavior should the nurse assess the client to determine the effectiveness of therapy?
Recognizing when anxiety is developing
A client with a conversion disorder is experiencing paralysis of a leg. What should the nurse expect this client to do?
Recover use of the affected leg but, under stress, to again experience these symptoms
Interventions for patient in crisis
-Assess for suicidal ideation -Focus on here and now -Remain with patient -Limit setting for inappropriate behavior -Acknowledge patients feelings -Evaluation and follow up
Treat OCD
-Clear & structured communication -Exerces -Stress management -SSRIs (tine & pram) -TCAs (Pam Dox, Imi, Ami)
Treatment for PTSD
-Cognitive behavior therapy -SSRIs -MAO -Benzo -Minipress (for nightmares) -Beta-blockers
Treatment for Munchausen Disorder
-Empathy -Cognitive behavioral Therapy -Engage & educate family -Psychotherapy -Medications if mental disorder
According to Aguilera, these factors determine if a crisis will occur:
-Individual perception of event -Availability of situational supports -Availability of adequate coping mechanisms
Treatment for Somatic Disorders
-Outpatient -Develop effective coping strategies -SSRIs -Short term anti-anxiety
Treatment for body dimorphic disorder
-SSRIs (tine & pram) -Cognitive behavioral therapy -Sometimes second degree anti-psychotics (Zyprexa, seroquel)
Alcohol withdrawal delirium
1-5 days duration increased symptoms of early withdrawal paranoia & disorientation frightening visual/tactile hallucinations increased TPR Aggressive
A nurse working on a detoxification unit has clients who are in active withdrawal from alcohol, opiates, benzodiazepines, cocaine, and marijuana. Place these clients in order, from the one with the highest risk for life-threatening physiologic withdrawal to the one with the lowest risk: 1. An adolescent who is withdrawing from cocaine 2. A young adult who is withdrawing from a long-acting benzodiazepine 3. An older adult who is withdrawing from alcohol 4.A middle-aged adult who is withdrawing from marijuana
1. An older adult who is withdrawing from alcohol 2. A young adult who is withdrawing from a long-acting benzodiazepine 3. An adolescent who is withdrawing from cocaine 4. A middle-aged adult who is withdrawing from marijuana
Place these crisis interventions in the order the nurse would implement them for a client experiencing escalating levels of anxiety. 1. Provide firm but kind directions. Incorrect 2. Attempt to identify the source of the anxiety. Incorrect 3. Encourage deep breathing and relaxation techniques. 4. Place the client in restraints if deemed dangerous
1. Attempt to identify the source of the anxiety. Incorrect 2. Encourage deep breathing and relaxation techniques. 3. Provide firm but kind directions. Incorrect 4. Place the client in restraints if deemed dangerous
Phases of crisis development
1. Individual is exposed to precipitating stressor 2. Anxiety increases 3. Use of all internal and external resources 4. Anxiety continues to increase
A client with a history of alcohol abuse was admitted 2 days ago for treatment of a gastrointestinal bleed. The client has remained in bed; pulse rate and blood pressure has gradually increased. The client now has a low-grade fever. Place the following nursing interventions in the appropriate order to best minimize the client's risk for injury. 1. Notify the primary healthcare provider of the report findings 2. Initiate seizure precautions 3.Attempt to determine when the client last consumed alcohol 4.Turn off the client's television and dim the room's lights
1. Initiate seizure precautions 2. Turn off the client's television and dim the room's lights 3. Attempt to determine when the client last consumed alcohol 4. Notify the primary healthcare provider of the report findings
Phases of Progression of Alcoholism
1. Prealcoholic Phase 2. Early Alcoholic phase 3. Crucial phase 4. Chronic phase
PD Symptoms -Doesn't learn from mistakes -Instable -Emotional liable -Easily insulted -Mood swings -Impulsive -Depression, anxiety, hopeless -B&W thinking
Borderline PD
Nonbenzodiazepine antianxiety med
Buspar (long term) Takes a few weeks to work Take 3-4x/day
Overdose of narcotics
Pinpoint pupils respiratory depression coma Treatment: Narcan
Age of onset of Generalized anxiety disorder
19-60
What type of problem is very common with Borderline PD
Self Mutilation
Alchohol withdrawal detox signs
3-5 days duration Increased BP & P Tremors Hallucinations/Illusions anorexia Insomnia irritability diaphoresis headaches seizures
Intoxication with inhalants
lethargy psychomotor retardation weakness can have respiratory or cardiac depression
Phases of Progression of Alcoholism: Preoccupied, don't tell, denial
Early alcoholic phase
Intoxication with marijuana
reddened conjunctiva euphoria increased appetite time distortion dry mouth sensory perception changes
Secondary gains of anxiety
A patient is allowed to miss work and gets financial compensation as the result of a medical condition.
PD Symptoms No remorse, calloused, Lies, Impulsive, Cheats, Irresponsible
Antisocial PD
What other disorders are associated with anxiety
COPD, depression, PTSD, substance abuse
Fear of being in places or situations where help may not be available and escape might be difficult or embarrassing.
Agoraphobia
2 types of phobias
Agoraphobia Social Phobia
What is the #1 health problem in US
Alcholism
What can not be used with Benzos?
Alcohol & Opiates
This medication is for alcohol abstinence
Campral (stay abstenent at camp)
Crisis: catastrophic (Tornadoes, hurricanes, earthquakes, and tsunamis)
Adventitious
Other symptoms with marijuana
Amotivational syndrome Trigger psychotic symptoms
Types of stimulants
Amphetamine Cocain (powder & crack)
Ways people with personality disorder manipulate
Assuming instant intimacy Flattery Entitlement Splitting Sexually provocative
PD Symptoms Low self esteem Sensitive to rejection Anxiety impedes ability to enjoy social situations
Avoidant PD
Encompasses cluster C
Avoidant PD Dependent PD OCD
Treatment for Social anxiety
Behavioral Therapy Cognitive Therapy SSRIs (tine & pram) Propranolol (beta blocker) MAOIs (No Popular Meds, Nardil, Parnate, Marplan) Social Skill training
Short term meds for anxiety
Benzodiazepines (Xanax, Librium, klonopin, Valium, serax, Ativan)
Treatment of alcohol withdrawal (detox)
Benzodiazepines (lam & pam) Beta Blockers (lol) Antipsychotics Vitamins (vit b, magnesium, folic acid, vit k) Hydration vital signs & mental status reality orientation quiet environment restraints as needed
Effects of alcohol on body
Blocks absorption of Thiamine & Folic Acid, leads to Wernicke-Korsakoff syndrome
Exaggerated belief the body is deformed or defective in some way
Body dimorphic disorder
Medications for detoxification (Narcotics)
Catapres (BP) Methadone (synthetic morphine, legalized version of Heroin)
Phases of Progression of Alcoholism: Drunk, need alcohol to live, tremors without a drink
Chronic phase
Atypical antipsychotics
Clozaril (Clozapine) Risperdal Zyprexa Seroquel Geodon Ability Saphris Fanapt Latuda Invega Rexulti
Odd and Eccentric Personality Group
Cluster A
Dramatic and Erratic Personality Group
Cluster B
Anxious and Fearful personality group
Cluster C
Treatment for Agoraphobia
Cognitive behavioral Behavioral Therapy therapy SSRIs (tine & pram)
Intoxication with narcotics
Constricted pupils Euphoria Nodding
1 or more symptoms of impaired motor or sensory function. Develop abruptly, and onset can be linked to a stressful event.
Conversion Disorder (somatic)
Withdrawal with stimulants
Crash Cocaine Blues
Withdrawal with marijuana
Cravings & irribility
Phases of Progression of Alcoholism: Focused, no cares
Crucial phase
What is cage screening?
Cut down Annoyed Gulity Eye opener (edge off)
PD Symptoms Need to be taken care of Clingy Submissive Fear of seperation
Dependent PD
GHB Rohypnol Ketamine Ecstasy are examples of what
Designer or rave drugs
Cautions for benzodiazepines
Don't take with caffeine, opiates, alcohol, glaucoma, pregnant women
What neurotransmitter is associated with Substance Abuse
Dopamine
What is Wernicke-Korsakoff syndrome?
Due to brain damage caused by a lack of vitamin B1. Confusion and loss of mental activity that can progress to coma and death Loss of muscle coordination (ataxia) that can cause leg tremor Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping Alcohol withdrawal, Inability to form new memories Loss of memory, can be severe Making up stories (confabulation) Seeing or hearing things that are not really there (hallucinations) IS reversible with vit B treatments
Intoxication with stimulants
Euphoria paranoia increased energy hyperalertness overconfidence
NICs for Antisocial
Expected outcomes realistic: Explore consequences, no striking out Consistent approach/set limits Assign one nurse Do not focus on feelings Mobilize anxiety Be aware of your feelings
What is not helped with Narcan?
Fentenyl
What other symptoms are possible with hallucinogens
Flashbacks Psychosis Death Brain-damage Trigger schizophrenia
A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) does the nurse anticipate that the primary healthcare provider may prescribe?
Fluvoxamine
Alcohol rehabilitation
Formal interventions Group & family therapy Meds: Antabuse, ReVia & Vivitrol, Camparal, Topamax
Symptoms are: restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbances, dread, feeling on edge, seeks reassurance, difficulty with decision making
Generalized Anxiety Disorder
What is known as the "Worry Disease"?
Generalized anxiety disorder
Detoxification
Getting substance out of body
Which body parts are most often involved in Body dimorphic disorder?
Head or face
Benzodiazepines mechanism of action
Helps gaba do its job
Illegal Narcotics (Opiates)
Heroin
PD Symptoms -Excessive tears -Dramatic attention seeking -Manipulative -Charming but shallow
Histrionic PD
High level of anxiety lasting 6 months. Alarm about their health excessively check for problems and avoid medical care
Hypochondriasis
A college student is brought to the mental health clinic by parents with a diagnosis of borderline personality disorder. Which factors in the client's history support this diagnosis? Select all that apply. Impulsiveness Lability of mood Ritualistic behavior Psychomotor retardation Self-destructive behavior
Impulsiveness Lability of mood Self-destructive behavior
Traits of personality disorders
Inflexible Interpersonal problems Irritation/Irritating Insensitive Indifferent
A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience?
Increased alertness
For what clinical manifestations should the nurse assess a client during the first few hours of the alcohol withdrawal?
Irritability Tachycardia Increasing anxiety
NIC for alcohol overdose
Keep pt awake & airway patent
This medication is an animal tranquilizer
Ketamine
Hallucinogens
LSD PCP Mescaline Magic Mushrooms
If your unbothered by symptoms, happy they get you out of things
LaBelle Indifference
Benzodiazepines
Last name: Lam & Pam
Nursing assessment for Alcoholism
Last time you drank? How much? How often? Cage screening
A nurse is assessing a client with a history of marijuana use. Which long-term effects are associated with marijuana?
Lung cancer Emphysema Heart disease
Purposeful behavior aimed at meeting ones needs without concern for others
Manipulation
Alternatives to anxiety meds
Massage Acupunture herbs valarian root kavakava
Crisis: Normal changes in life (college, marriage, baby)
Maturational or Developmental
Fastest growing drug threat in US. Illegal labs in US or Mexico, very addictive
Methamphetamine
Consciously and intentionally fabricate symptoms for emotional gain
Munchausen Disorder
What is the factitious disorder?
Munchausen Disorder
PD Symptoms -Attention seeking -Grandiose sense of personal achievements -Arrogant -Lack empathy -Look to others for self esteem -Relationships are superficial
Narcissistic PD
Encompasses Cluster B
Narcissistic PD Histrionic PD Borderline PD Antisocial PD
Assessment for Alcohol Withdrawal
Nausea & Vomiting Tremor Paroxysmal sweats Anxiety Agitation Tactile disturbances Auditory disturbances Visual disturbances Headache, fullness in head Orientation and clouding of sensorium Maximum score is 67
Thiamine (vitamin B1) and niacin (vitamin B3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan?
Neuronal activity (Thiamine and niacin help convert glucose for energy, and therefore influence nerve activity.)
Do phobias occur unexpectedly?
No
Treatment for Stressor Disorder
No meds Help with coping
Which neurotransmitters are associated with anxiety?
Norepinephrine serotonin gaba
Withdrawal with narcotics
Not medically dangerous (flu like symptoms)
PD Symptoms Sense of self comes from productivity Lake empathy Details and organization Perfectionist (also applied to others)
OCD
Experiences impulse or image that is unbidden, disruptive & persistent. Perform ritualistic behavior which temporarily reduces anxiety caused by the thought
Obsessive Compulsive Disorder
These medications block effects of alcohol and opiates
ReVia & Vivitrol (watch closely for overdose of substances)
Actual or threatened death or serious injury leading to intense dread, horror or fear
PTSD
Symptoms: intrusive reexperiencing trauma, avoidance, persistent negative alterations in cognition and mood, alteration in arousal and activity
PTSD
Persistent in nature, pain lasting longer than 6 months, specified as mild, moderate, severe
Pain Disorder
Patient is overwhelmed, palpitations, chest pain, diaphoresis, hyperventilation, nausea, choking, no pathological event, time limited
Panic Attack
PD Symptoms Mistrustful, controlling, hostile, irritable, jealous, Business like, they create fear and conflict through sarcasm, reads meaning into benign remarks
Paranoid PD
Encompasses Cluster A
Paranoid PD Schizoid PD Schizotypal PD
Goal for panic attacks
resolve immediate crisis, return to previous level of functioning, preserve self-esteem, assess for suicidality & anxiety
Inflexible and maladaptive traits that impair functioning and relationships
Personality Disorder
Withdraw indicates what type of dependence
Physical
Phases of Progression of Alcoholism: Episodes of blacking out
Prealcoholic phase
Primary gains of anxiety
Primary gain example: A patient feels guilty about not being able to perform a task, but if there is a medical condition justifying this inability, the guilt diminishes.
Beta blockers used for anxiety
Propranolol (Inderal)
Best medication for social phobias
Propranolol (inderal)
Which nursing intervention is most important for a client who has the diagnosis of antisocial personality disorder?
Providing clear boundaries and consequences
Nursing Interventions: Forms of cognitive behavioral interventions for Anxiety
Relaxation Modeling Systemic desensitization Flooding Thought stopping Changing faulty thinking
What should be the nurse's first intervention in the care of a client with a generalized anxiety disorder?
Removing as many stimuli from the client's environment as possible
Preferred medical treatment for generalized anxiety disorder
SSRIs
NICs for Borderline
Safety Consistency and limit setting Matter of fact approach Assign one nurse Be aware of your own feelings Allow client as much control as possible Teach assertiveness
PD Symptoms -Shy, detached, Isolated from social relationships -Restricted emotional range in interpersonal settings -Better with "things" rather than people (math, astronomy) -Might develop into schizophrenia
Schizoid PD
PD Symptoms -Oddities of thought -Socially isolative -Magical thinking -Unrealistic life goals -NOT psychotic -Closely related to schizophrenia
Schizotypal PD
Intoxication with hallucinogens
Sensory-perceptual changes, intense emotional experiences, heightened awareness. Colors are heard, sounds are seen. No withdrawals
Crisis: Unanticipated (divorce, death of loved one, loss of job)
Situational
Fear of being evaluated our rejected by others
Social Anxiety
Psychological stress causes physical symptoms
Somatic Disorder or Psychophysiological Disorder
Multiple physical/medical symptoms, considerable distress, impaired function of daily life, describe symptoms in exaggerated & dramatic ways
Somatization disorder
Maladaptive reaction to a stressor leading to emotional and or behavioral symptoms. Short duration.
Stressor Disorder
Anticonvulsants used for anxiety
Tegretol (Carbamazepine) Depakote (Valproate acid) Neurontin (Gabapentin)
This is an anti seizure medication used in alcohol rehabilitation
Topamax
Narcotic Rehabilitation
Trexan Methadone Subutex Suboxone (under tongue)
Is patient aware that beliefs are exaggerated in Body dimorphic disorder?
Yes
Side effects of Tegretol (carbamazepine)
agranulocytosis Monitor CBC & Liver Therapeutic range 4-12
Difference between fear and anxiety
fear is present, anxiety is future.
Ego-syntonic
the individual perceives her behavior as correct, normal, or in harmony with her goals
Ego dystonic
the individual sees the illness as something thrust upon her that is intrusive and bothersome
SSRIs
tine & pram