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68WM6 Phs 2 Test 18
68WM6 Phase 2 Test 18 Mental Health
| Question | Answer |
|---|---|
| The last test for Phase II.... | SWEET!!...kinda...there is gonna be a lot of slides... sucks. |
| Outward manifestation of a person's feeling or emotions | affect |
| Feeling of apprehension | anxiety |
| Manner of conducting oneself; one's actions | behavior |
| Thoughts blocked; usually sudden & unexpected. May stop and stare in middle of conversation | blocking |
| Distressing recurring behavior that must be performed to reduce anxiety | Compulsion |
| Used to reduce anxiety of stress | coping response |
| A time of change or turning point in life | crisis |
| Behavioral patterns that protect the individual against a real or perceived threat | defense mechanism |
| Release of institutionalized psychiatric patients & treated in the community setting | Deinstitutionalization |
| Change in consciousness that occurs over a short period of time | delirium |
| False beliefs that are resistant to reasoning or change | Delusion |
| Loss of multiple abilities, including long and short memory loss, language, and the ability to understand (conceptualize) | Dementia |
| Disconnection from full awareness of self, time, or external circumstances | Dissociation |
| Exposure of one's genitals to an unsuspecting person followed by sexual arousal | Exhibitionism |
| Use of objects (e.g., underwear, leather, rubber sheeting) for the purpose of sexual arousal | Fetishism |
| Abrupt change of topic in a rapid flow of speech | Flight of Ideas |
| A false belief in which one's own importance is greatly exaggerated | Grandiosity or Delusions of Grandeur |
| False sensory input with no external stimulus, usually in the form of smells, sounds, tastes, sight, touch | Hallucination |
| State of homeostatic imbalance | Illness |
| Dramatic changes in mood, often can be rapid in occurrence | Labile |
| Ability to adjust to changing life situations using various strategies | Adaptation |
| Thought disturbances in which the speaker rapidly shifts topics from one unrelated area to another | Loose Association |
| Extreme emotional state characterized by excitement, great elation, over-talkativeness, increased motor activity, fleeting grandiose ideas, and agitated behaviors | Mania |
| Ability to cope and adjust to recurrent stressors of everyday life | Mental Health |
| A pattern of behavior that is noticeable, threatening, and disruptive of relationships or deviates significantly from behavior that is considered socially and culturally acceptable | Mental Illness |
| Persistent, recurring, inappropriate, and distressing thoughts | Obsession |
| Awareness of who you are, who others are around you, your surroundings and awareness of time | Orientation (reality) |
| Consistent sort of attitudes and behaviors particular to an individual | Personality |
| Unnatural fear of people, animals, objects, situations, or occurrences | Phobia |
| Any large number of related methods of treating mental-emotional disorders by psychological techniques rather than physical means | Psychotherapy |
| State of being psychotic | Psychosis |
| Anxiety produced when separated from source of security | Separation Anxiety |
| Frame of reference individuals use for all they know and experience | Self-Concept |
| Nonspecific response of the body to any demand made on it | stress |
| Situation, activity or event that produces stress | stressor |
| Treatment of an emotionally ill or incapacitated client by physiological means | Somatic Therapy |
| What is meant by ‘flight of ideas’? | Abrupt change of topic in a rapid flow of speech |
| examples of manifestation of dysfunction | Behavioral, Psychological, Biological |
| mental illness characteristics | Poor self-concept Feelings of inadequacy Dependent behavior Pessimism (constant) Poor judgment Inability to cope Irresponsibility |
| mental illness characteristics | inability to: accept responsibility for actions, recognize talents, recognize limitations, perceive reality, establish meaningful relationships. Maladaptive behavior Seeks immediate gratification |
| 3 Basic factors affecting mental health | Inherited characteristics Childhood nurturing Life's circumstances |
| what is the GOAL of emotional growth process | deal with stress in an adaptive & corrective manner |
| Positive influences in response to stress: | Adequate coping ability Mother-child bond at birth Success at school Good health Financial security |
| Negative influences in response to stress: | Cognitive Impairment Profound mental illness Extreme sibling rivalry Parental rejection Deprivation of maternal love Poor physical health Poverty Broken/failed relationships |
| Factors affecting mental health in U.S.: | Geography / access to MH care Changing family structure Relocation stressors Stepfamilies Women Same gender families Living longer |
| when was the Introduction of psychotherapeutic drugs? | 1950 |
| name the two psychotherapeutic drugs that were introduced in 1950 | MAJOR Tranquilizers: Thorazine; Serpsil MINOR Tranquilizers: Imipramine |
| what were the 2 MAJOR forces; changed public attitudes r/t mental health care | National Alliance for Mentally Ill (1973) National Institute on Mental Health |
| When did ‘deinstitutionalization’ occur? | 1950 |
| all willful, self-inflicted, life-threatening attempts that have not led to death | suicide attempt |
| thoughts of harming or killing oneself | Suicidal ideation |
| an action that appears to be a suicide attempt, but is actually committed to manipulate a situation | Suicidal gesture |
| Suicidal threat | verbal threat to commit suicide; may or may not be accompanied by a gesture or attempt |
| Majority of completed suicides are individuals with diagnosable psychiatric conditions such as | Depression Alcohol or substance abuse |
| People with a ___ ___ ___ have a 20 times greater risk for suicide than the general public | major depressive disorder |
| what age group has the highest rate of suicide | 65 |
| T/F: Women attempt suicide three times more often than men and women seek help for depression five time more often | True |
| who has the highest rate of suicide? | white males |
| warning signs of suicide r/t appearance and behavior | Indirect and direct verbalization Giving away possessions Agitation Changes in eating or sleeping patterns Changes in behavior or usual activity Neglect of hygiene or appearance Refusing medications Drawing up a will |
| warning signs of suicide r/t mood and emotions, and Thoughts, beliefs, and perceptions | Be aware of sudden mood changes, Disorganized, chaotic or irrational thinking Death is the only option Persecutory delusions, excessive guilt/self blame Low self esteem Command hallucinations (hearing voices) |
| warning signs of suicide r/t relationships and interactions | Withdrawn, socially isolated, feelings of abandonment Recent loss or change in relationships Termination or interruption of psychiatric treatment |
| warning signs of suicide r/t physical problems | Chronic debilitating illness or terminal illness Unrelieved pain Recent catastrophic loss of physical ability |
| Economic Factors Affecting Health Care | Rising health care cost. Aging population. Advancement in technology. Healthcare insurance. Malpractice insurance |
| Individuals are trained to do a variety of duties depending on the needs. | Cross-training |
| Managed Care Organizations (MCO’s)goals: | Uses resources efficiently. High quality care at reasonable cost. Measure, monitor, and manage fiscal and client outcomes. Prevent illness. Client education. Minimize hospitalizations for chronic patients |
| who plans and supervises the distribution of health care services | Managed Care Organizations (MCO’s) |
| two types of Managed Care Systems | Health Maintenance Organizations (HMO’s). Preferred Provider Organizations (PPO's). |
| describe an HMO | Group insurance plan. Fixed fee for services. Provide ambulatory, hospitalization, and home care services. Utilizes “gate keepers” usually a primary physician who must authorize secondary care. Member is responsible for all cost of unauthorized care |
| describe Preferred Provider Organizations (PPO's) | Network of providers who discount their rates for plan members. Members pay higher rates if treatment is provided outside the network |
| negative effects of Management Care Systems | Decision making power moved from providers to insurance companies. Increased economic pressure on the consumer. Desire for profit conflicts with access to care. Hospital downsizing or closure |
| Demand for evidence that hospitals and other healthcare providers provide quality, cost-effective care comes from: | Quality Improvement |
| Symptoms cannot be fully explained by a known general medical condition or substance abuse, Frequent hospitalizations for diagnostic workups and multiple surgeries. Disorder: | SOMATIZATION DISORDER |
| Most common Somatoform Disorder likely to be encountered in combat. Impaired coordination or balance. Weakness or paralysis. Loss of sensation. Spontaneously resolves fairly rapidly | CONVERSION DISORDER |
| A preoccupation with bodily functions and fears of acquiring or having a serious disease based on misinterpretation of physical symptoms | HYPOCHONDRIASIS |
| Characteristics of HYPOCHONDRIASIS | Social / occupational impairment. 6+ month duration of disturbances. Reassurance by physician not comforting. Abdominal complaints most common |
| Preoccupation with a perceived defect in appearance. Patient believes that even a slight defect is of great concern | BODY DYSMORPHIC DISORDER |
| Pain is present in one or more anatomic sites and is exclusively or predominantly caused by psychological factors | PAIN DISORDER |
| name some plans/interventions r/t Somatoform disorders | Facilitate a single care provider approach. Refrain from focusing on the symptoms. Focus client on other activities. Supervise client at a distance, Refrain from allowing special privileges responsibility for own health Give positive feedback |
| Emaciated. Clothing to hide appearance. Avoids being weighed and/or manipulates weight. High achiever. Ritualistic behavior surrounding food | anorexia |
| Three nursing diagnoses will apply in all eating disorder cases | Alteration in nutrition. Ineffective individual coping. Body image disturbance |
| Why is it important to limit meal times? | Because lengthy meals might increase anxiety and result in acting out behaviors. |
| an uncomfortable feeling of apprehension or dread that occurs in response to internal or external stimuli and can result in physical, emotional, cognitive, and behavioral symptoms | anxiety |
| describe abnormal anxiety | Intensity of anxiety higher, more pervasive, Particular cluster of symptoms to include physiological symptoms |
| what are the 4 levels of anxiety? | mile, moderate, severe, panic |
| describe mild anxiety | Fully aware of both the environment and their own feelings. Alert, Perceptual field is increased, Motivates learning--produces creativity |
| describe moderate anxiety | Focuses on immediate concerns and blocks the periphery, Alert. Perceptual field is decreased. Selective inattentiveness, selective learning. Pacing, tremors, increased rate of speech, verbalizes some danger |
| describe severe anxiety | Focuses on a specific detail, and nothing else. Hyper alert (full-blown): “Flight/Fight Response”. Perceptual field is greatly reduced. Behavior: aimed at getting relief. Need guidance |
| describe panic anxiety | Details are out of focus. Loss of control. Unable to follow direction. Details blown out of proportion, loss of rational thought. Disorganization of personality, Increased HR,BP, sweating, faint, choking. |
| As anxiety increases/escalates there is a decrease in? | Perceptual ability, ability to comprehend a situation correctly, ability to report a situation correctly, ability to interpret the environment, and ability to modify behavior to meet one's needs |
| Which nursing intervention would be given priority for a person experiencing panic? | Direct what’s said towards changing physiological response, such as taking deep breaths |
| MAJOR ANXIETY DISORDERS | Generalized Anxiety Disorder Panic Disorder Agoraphobia Phobia Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder |
| One of the most common mental illnesses, surpassed only by phobias and alcohol abuse | Generalized Anxiety Disorder |
| Inaccurate assessment of perceived environmental dangers. Excessive worry occurring more days than not over 6 month period of time. Restlessness, poor concentration, irritable; all these describe what? | generalized anxiety disorder |
| Loss of control or fear of loosing control. Attacks last 10-30 min with gradual return to normal functioning. Physiological symptoms: Palpitations, CP, choking, n/v, sweating | Panic Disorder |
| Persistent irrational fear of specific object or situation | Phobias |
| Agoraphobia | Acute anxiety in crowds. Fear of being in a place you can not escape |
| Obsessive-Compulsive Disorder Con’t | The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. |
| obsession = | thoughts |
| compulsions = | behaviors |
| Anyone involved in a life threatening event. Responses to an intense traumatic experience | PTSD |
| A client with a social phobia should be observed for which symptom? | Avoidance of social situations |
| A client with a generalized anxiety disorder also may have which concurrent diagnosis? | panic disorder |
| Insight-based treatment includes | Identify level of anxiety. Identify causes of anxiety. Explore effects of anxiety on self and health. |
| Cognitive-behavior therapy includes | Help client assess threats as realistic or distorted. Teach positive “self-talk”. |
| List the common side effects of anti-anxiety medication. | Drowsiness, sedation, fatigue, ataxia, dizziness |
| Which behavior modification technique is useful in the treatment of phobias? | Systemic desensitization |
| nursing diagnosis r/t anxiety d/o | Increased anxiety. Ineffective coping. Altered thought process. Powerlessness. Self-esteem disturbance. Altered role performance |
| Withdrawal side effects r/t anxiety meds | anxiety, tremor, irritability, & insomnia. |
| Use of Benzodiazepines (Valium,Xanax) should be restricted to ?? | short term therapy due to dependence and tolerance developing quickly |
| Diphenylmethane antihistamines (Atarax) can be used how? | longer term since no dependence is developed |
| Azaspirodecanedione (Buspar) requires up to __ weeks to become effecive | 3 weeks to become effective; may be uncomfortable to wait until effectiveness. |
| A client suspected of having PTSD should be assessed for which problem? | suicide |
| Which intervention is appropriate for a client with a panic disorder? | Suicide prevention |
| r/t antianxiety meds; Intermittent or short-term meds | benzodiazepines |
| r/t antianxiety meds; long term meds | buspirone, paroxetine, venlafaxine |
| Anti-Anxiety Agents Action | Exert a tranquilizing effect by potentiating the effects of gamma-aminobutyric acid (GABA), an inhibitory transmitter, generalized CNS depression |
| Benzodiazepines (examples): | alprazolam (Xanax). chlordiazepoxide (Librium). diazepam (Valium). lorazepam (Ativan). midazolam (Versed). oxazepam (Serax). |
| Miscellaneous (examples)of anti-anxiety agents | buspirone (BuSpar); doxepin (Sinequan, Zonalon); hydroxyzine (Atarax, Hydroxine-50, Vistaril): Sedative/hypnotics meprobrate (Equanil, Miltown): Carbamates paroxetine (Paxeva, Paxil, Paxil CR):(SSRI) venlafaxine (Effexor, Effexor XR): Antidepressant |
| Anti-Anxiety Agents Contraindications | Hypersensitivity. Comatose patients. Pre-existing CNS depression. Uncontrolled severe pain. Pregnancy. Lactation |
| Anti-Anxiety Agents Precautions | Hepatic dysfunction. Severe renal impairment. Severe pulmonary disease: benzodiazepines only. Suicidal patients. Previous drug addictions. Sensitivity to CNS depressants: dosage reduction may be required. |
| lab tests r/t Anti-Anxiety Agents | hepatic and renal studies (AST, ALT, bilirubin, creatinine, LDH, alk phos). |
| Changing to ____ from other anti-anxiety agents should receive gradual decreasing dosages, will not prevent withdrawal symptoms. | buspirone; Administer with food or milk for GI symptoms; May be crushed if patient is unable to swallow whole |
| A patient with a history of anxiety attacks is given a medication for these episodes. Which medication is appropriate for this problem? | buspirone (BuSpar) |
| Alcohol used concurrently with a benzodiazepine or azaspirone could result in which effects on the patient? | Overdepression of the CNS |
| The pattern in which we perceive, relate to, and think about ourselves, those around us, and our overall environment | personality |
| Behavior that continually creates and perpetuates upset, confusion, chaos, or conflict for themselves and those around them | personality disorder |
| Criteria for personality disorder | pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment |
| Personality Disorder Cluster A: | odd and eccentric individals; Paranoid Personality Disorder, Schizotypal Personality Disorder, Schizoid Personality Disorder |
| Personality Disorder Cluster B: | dramatic, emotional, erratic, intense individuals; Antisocial Personality Disorder, Narcissistic Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder |
| Personality Disorder Cluster C: | anxious and fearful individuals; Avoidant Personality Disorder, Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder |
| Describe what the Patient Self-Determination Act requires | Healthcare institutions inquire of patients whether or not an advanced directive has been written |
| Durable Power of Attorney | legal document that gives individuals authority to make healthcare decisions on behalf of persons that become incapacitated |
| Goals of hospice address the following | Controlling or alleviating symptoms Allowing the patient and care to make care decisions Maintain patient and family confidences for goal achievement Education and supporting the primary caregiver |
| What is the difference between a living will and a durable power of attorney? | A living will prescribes treatment upon incapacitation. Durable power of attorney gives others the decision-making power. |
| what are the Kubler-Ross stages of grieving/dying? | Denial and isolation, Anger, Bargaining, Depression, Acceptance |
| What are the parts of the Martocchio - Survivor's Reaction? | shock and disbelief, Yearning and Protest, Anguish/disorginization and dispair, Identification and bereavement, Reorginization and restitution |
| Plan nursing interventions to do what? | meet physical, emotional, developmental and spiritual needs |
| Give two examples of nursing diagnoses appropriate for dying patient/family | Spiritual distress and anticipatory grieving. |
| what aspects of human functioning does the nurse assess? | Physical Emotional Intellectual Sociocultural Spiritual |
| physical assessment includes what? | Observe behaviors Discuss sleeping patterns Assess Body image Assess Activities of daily living (ADL) Assess Mobility Review Medications Assess level Pain issues |
| portions of the emotional assesment | Assess patient and family’s level of anxiety Assess level of Guilt Assess level of anger or acceptance |
| portions of the intellectual assessment | Evaluate patient’s and family’s educational level Assess level of knowledge and abilities Assess patient’s and family’s expectations about dying process |
| portions of the social assessment | family’s desire to assist w/ patient’s care family members & assist in working w/ the dying person home care vs. hospital care; arrange hospice services whom the patient considers “significant” others, Encourage social support people to become involved |
| portion of spiritual assessment | Assess your feelings r/t death and dying Do not judge, interpret patient’s spiritual concerns Support the patient and family’s belief system and values |
| clinical manifestations of impending death | diminished sensory and motor functions in extremities, changes in VS(slow pulse, low BP, rapid/shallow RR), fixed and dialated Pupils, Cheyne - Stokes respirations; decrease peripheral pulses Skin cold and clammy; profuse sweating |
| nursing interventions r/t pt near death | suction resp. tract, skin care, ROM exercises, change position q2h, maintain hygiene esp. oral, clear, slow verbal communication in view of pt, evaluate for pain/anxiety and tx accordingly, touch gently and frequently as appropriate, |
| special care r/t pediatric death | Usually aware they are going to die Often try to protect patients Be truthful in a way they can understand Need reassurance they will not suffer or be abandoned |
| special care r/t suicide | Usually not considered socially acceptable; victims lack support Survivors suffer profound grief, guilt and shame Survivors fear rejection and lack social support Families don’t reach out for help |
| special care r/t Gerontologic Death | No always true that older adults accept death and dying process Treat older patients the same as any patient facing terminal illness Provide intensive nursing interventions and pain control |
| special care r/t Sudden or Unexpected Death | Accidents, homicides or sudden illness Preoccupation in final hours or minutes Involvement of law authorities |
| How is it best to communicate verbally with a dying patient? | Use clear, slow verbal communication |
| What are some aspects of grief work that the family may go through? | Develop new relationships, adjust to changed environment, live comfortably with memories |
| describe Euthanasia “ Greek for “ easy death” | Passive- with holding treatment that may extend life such as medication or life-support Active – an action taken deliberately to shorten life |
| describe DNR = Do Not Resuscitate | No CPR performed for a patient Joint decision of patient, family and healthcare providers DNR must be written to be valid |
| Organ Donations are recovered after when? | person pronounced clinically and brain dead |
| what organs can be harvested? | Vital Organs – kidney, heart, lung, liver, pancreas Non vital –cornea, long bones, skin, middle ear bones |
| list the Dying Person’s Bill of Rights | Right to: be tx as a human being, maintain a sense of hopefulness, be cared for by hopeful, express feelings about death, participate in planning care, not to die alone, free from pain, die in peace w/ dignity, retain individuality, enlarge religious exp. |
| what are some Fraudulent Methods of Treatment? | Special diets Experimental drugs, enemas Special regimens Machines or strange devices,Treatments for the purposes of inducing another to use products without disclosure of facts Treatment that does not offer informed consent |
| Signed documents specifying instructions for healthcare treatment in the event someone is no longer able to make decisions due to illness or incapacity. Each state regulates the use of advance directives differently | advanced directive |
| written document that states your wishes about medical treatment should you be unable to communicate at the end of life. The right to accept or refuse treatment is protected by constitutional and common law | living will |
| requires healthcare institutions to inquire whether patients have an advance directive | Patient Self-Determination Act |
| substance dependence which is serious enough to call a disease | addiction |
| what are the 4 elements of an addiction? | Excessive use or abuse. Display of psychological disturbance. Decline of social and economic function. Uncontrollable consumption indicating dependence |
| primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations | alcoholism |
| physiological state of adaptation to the specific psychoactive substance | dependence |
| characteristic of drug addiction that refers to a progressive need for more of the abused substance to achieve the desired effect | tolerance |
| r/t alcohol, what does CAGE stand for? | Cut, Annoyed, Guilty, Eye Opener |
| what are the most commonly abused drugs? | Alcohol. Benzodiazepines: Vitamin V (valium). Barbiturates: Reds, Blues, Yellow jackets. Chloral Hydrate: Mickey Finn. Cocaine: coke, blow. GHB: soap, Liquid X |
| more of the most commonly abused drugs: | Heroin: H, smack, junk. Ketamine: special K, vitamin K. LSD: acid. Marijuana, Methamphetamine: speed, crystal, ice. MDMA: ecstasy, E, X, oxide: nitrous, whippets. PCP: angel dust. Psilocybin:: shrooms, Rohypnol: roofies, Inha |
| AKA - affective disorders | mood disorders |
| daily moderate depression that lasts more than 2 years. This disorder often ends up as a lifestyle in which the individual can function but does not enjoy life | Dysthymic disorder |
| a pattern that involves repeated mood swings of hypomania and depression but are less intense. There are no periods of normal function with this condition | Cyclothymic disorder |
| the early phase of a manic episode when symptoms are not severe. | Hypomanic episode |
| repeating, severe depressive episodes lasting more than 2 years. | Major depressive disorder |
| AKA manic-depressive disorder) exhibit sudden shifts of emotional extremes from depression to mania | Bipolar disorder |
| what is the criteria for a diagnosis of major diagnosis disorder? | indicates at least five of the nine major symptoms (including one of the first two) must be present most of the day, almost every day, for at least 2 weeks. |
| Major Depressive Disorder (MDD) Nine Major Symptoms are: | depressed mood, Anhedonism -(Must have one of these two major sysmptoms),Unintentional weight change of 5% or more in a month,Change in sleep pattern, Psychomotor agitation or retardation, Fatigue or loss of energy, Feelings of worthlessness or guilt... |
| The other two of the nine major symptoms of MDD | Difficulty thinking, focusing, or making decisions, Hopelessness, helplessness, and/or suicidal ideation |
| Depression that comes with shortened daylight in winter and fall and disappears during spring and summer | Seasonal affective disorder (SAD) |
| symptoms of Seasonal affective disorder (SAD) | hypersomnia, lethargy and fatigue, increased anxiety, irritability, increased appetite with carbohydrate craving, and often weight gain |
| Postpartum mood symptoms are divided into three categories based on severity; what are they? | Postpartum blues, Postpartum depression, Postpartum psychosis |
| psychotic episode developing within 3 weeks of delivery and beginning with fatigue, sadness, emotional lability, poor memory, and confusion and progressing to delusions, hallucinations, poor insight and judgment, and loss of contact with reality. | Postpartum psychosis |
| meets all the criteria for a major depressive episode, with onset within 4 weeks of delivery | Postpartum depression |
| Characterized by labile mood and affect, crying spells, sadness, insomnia, and anxiety. Symptoms begin approximately 1 day after delivery, usually peak in 3 to 7 days, and disappear rapidly with no medical treatment | Postpartum blues |
| risk factors r/t depression | family hx, prior episodes, hx of suicide attemps or success, females, under 40 y/o, postpartum period, medical illness, abscence of social support, negative life events, alcohol/substance abuse, hx of sexual abuse |
| NURSING DIAGNOSES COMMONLY ESTABLISHED FOR PATIENTS WITH DEPRESSION? | risk for suicide, Self-care deficit (bathing/hygiene, dressing/grooming), Imbalanced nutrition: less than body requirements, Disturbed sleep pattern, Constipation, and Sexual dysfunction |
| Primary Considerations for Choosing Antidepressants | Side effect profile, Ease of administration, Past response, Safety and medical considerations, Specific depressive symptoms, Medical considerations |
| Secondary Considerations for Choosing Antidepressants | Neurotransmitter specificity. Family history of response. Cost |
| The most serious effects of TCAs are cardiovascular issues such as: | Dysrhythmias Tachycardia Myocardial infarction Heart block Considered a risk in patients with cardiac disease and in older adults |
| Inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS | Tricyclic Antidepressants (TCAs) |
| Common Adverse Reactions of Tricyclic Antidepressants (TCAs) | Dry mouth Blurred vision Tachycardia Constipation Urinary retention Esophageal reflux |
| Contraindications of Tricyclic Antidepressants (TCAs) | Patients who have recently had a myocardial infarction or other cardiovascular problem. Patients with narrow-angle glaucoma. Patients with a history of seizures. Patients who are pregnant |
| how long do TCAs typically take to work? | 6-8 weeks |
| r/t PCAs; If the patient forgets the bedtime dose (or the once-a-day dose), the next dose should be taken when? | within 3 hours; otherwise the patient should wait until the usual medication time the next day. The patient should not double the dose |
| name some examples of TCAs | Amitriptyline (Elavil), Doxepin (Sinequan), Imipramine (Tofranil), Desipramine (Norpramine), Nortriptyline (Pamelor), |
| Prevent the breakdown of norepinephrine, serotonin, and dopamine in the brain, thereby increasing the levels of these brain amines and resulting in increased mood | Monoamine Oxidase Inhibitors (MAOIs) |
| Useful in treating other disorders such as panic disorder, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and bulimia | Monoamine Oxidase Inhibitors (MAOIs) |
| Increased levels of ____ can lead to high blood pressure, hypertensive crisis, and eventually cerebrovascular accident and death | tyramine |
| UNSAFE foods that can Interact with MAOIs | Fermented bean curd. Fermented soybean. Soybean paste. Figs, especially if overripe. Bananas, in large amounts. Meats that are fermented, smoked, or otherwise aged. Avocados |
| UNSAFE foods that can Interact with MAOIs...more | Bologna, pepperoni, salami. Practically all cheeses. Yeast extract (e.g., Marmite, Bovril) Some imported beers, Chianti Protein dietary supplements. Soy sauce. |
| Foods that can Interact with MAOIs -safe foods | Most vegetables Most fruits. Fresh meats. Fresh or vacuum packed fish. Milk, yogurt, cottage cheese, and cream cheese. Baked goods that contain yeast. Major domestic brands of beer and most wines |
| qualities of Bipolar I d/o | At least one episode of mania alternating with major depression. Psychosis may accompany the manic episode |
| qualities of Bipolar II d/o | Hypomanic episode(s) alternating with major depression Psychosis is not present in bipolar II. The hypomania of bipolar II tends to be euphoric. The depression tends to put people at particular risk for suicide. |
| qualities of Cyclothymia d/o | Hypomanic episodes alternating with minor depressive episodes (at least 2 years in duration). Individuals with cyclothymia tend to have irritable hypomanic episodes |
| Bipolar Disorders Diagnostic Criteria | A distinct period of abnormality and persistenly elevated, expansive, or irritable mood for at least: 4 days for hypomania. 1 week for mania |
| Hypomania | The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic |
| mania | Severe inough to cause marked impairment in occupational activities, usual social activities, or relationships |
| what d/o is associated with the highest lifetime rate of suicide of any psychiatric illness. | Bipolar D/O |
| Individuals with bipolar disorder often require multiple medication. Antianxiolytics, antipsychotics, or even antidepressants may be used for a limited time, but ___ ___ are considered lifetime maintenance therapy | mood stabilizers |
| Most treatment guidelines advocate what two drugs for first-line mood-stabilizing agents. | lithium and divalproex (Depakote) |
| therapeutic level for Lithium | 0.4 to 1 mEq/L |
| Early signs of Lithium toxicity <1.5 mEq/L | Nausea Vomiting Diarrhea Thirst Polyuria Slurred speech Muscle weakness |
| Advanced signs of Lithium toxicity (1.5 to 2 mEq/L): | Course hand tremor. Persistent gastrointestinal upset. Mental confusion. Muscle hyperirritability. Electroencephalographic (ECG) changes. Incoordination |
| signs od severe toxicity of Lithium (2 to 2.5 mEq/L) | Ataxia Serious ECG changes Blurred vision Clonic movements Large output of dilute urine Tinnitus Seizures Stupor A severe hypotension Coma Death |
| A rapid change in consciousness that occurs over a short time | delirium |
| symptoms of delirium | Disorientation Tremors Florid (elaborate/flamboyant) delusions Illusions and/or hallucinations Disturbed psychomotor activity Sleep-wake cycles Incoherence |
| Displays increased disorientation and agitation only during the evening or nighttime | Nocturnal Delirium Also known as Sun-downing syndrome |
| s/s of dementia | Memory loss Inappropriate behaviors Impaired judgment Anxiety Paranoia Personality change Lack of initiative Difficulty with task |
| What is the most common form of dementia? | Alzheimer’s disease |
| A fixed, false belief that cannot be corrected by feedback and is not accepted as true by others in the culture | delusion |
| A perceptual sensory experience without an actual sensory stimulus. | hallucinations |
| False interpretation of stimuli | illusion |
| What is the evidence to support the genetic basis of schizophrenia? | First degree relatives are 10 times more likely to develop schizophrenia than the general population |
| Structural Brain Abnormalities r/t schizophrenia | Enlarged lateral and third ventricles Enlarged sulci Brain atrophy Hypofrontality |
| types of schizophrenia | Paranoid Catatonic Disorganized Undifferentiated Residual |
| stages of schizophrenia | Prodromal Phase Prepsychotic Phase Acute Phase Residual Phase |
| examples of Antipsychotic (neuroleptic) drugs | Clozapine Risperidone Olanzapine Sertindol Ziprasidone Quetiapine |
| describe Wernicke’s Encephalopathy | Thiamine deficiency results in temporal lobe brain damage |
| SE of Antipsychotic Drugs | Cardiovascular Anticholinergic Weight gain Sexual dysfunction Blood Disorders Photosensitivity Pigment changes Seizure Neuroleptic Malignant Syndrome |
| what is Extrapyramidal Syndrome | condition involving involuntary muscle spasms in the face and neck |
| Dystonia | facial grimacing and twisting of the neck into unnatural positions |
| Akathesia | extreme restlessness and increased motor activity |
| what are portions of extrapyramidal syndrome? | Dystonia Pseudoparkinsonism Akathesia |
| what are some medications that can be given for extrapyramidal syndrome? | Cogentin Artane Symmetril |
| What is the evidence to support the genetic basis of schizophrenia? | First degree relatives are 10 times more likely to develop schizophrenia than the general population. |
| The first nursing intervention with a client with a thought disorder is to? | Establish a therapeutic nurse/client relationship |
| Side effects of anti-psychotic drugs | EENT: blurred vision, dry eyes. CV: hypotension. GI: constipation, dry mouth. GU: urinary retention. Derm: photosensitivity. Hemat: agranulocytosis |
| What are our areas to assess when looking at emotional status? | General appearance, general behavior, speech pattern, mood and affect. |
| This "stack" of questions is not comprehensive of all powerpoints and information. | A lot of this information is general knowledge. Good luck on the test.... |
Created by:
jrstrader
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