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68WM6 Phs 2 Test 18

68WM6 Phase 2 Test 18 Mental Health

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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