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Psychiatric N Final

PT's who have (MCI) should improve sleeping habits, treat any underlying psychiatric disorder, eat well, reduce alcohol use, use, get treatment for physical illness, increase socialization and do cognitively stimulating activities,Challenge the brain with mental exercises
signs of delirium fluctuating levels of consciousness, slurred speech, nonsensical thoughts, day-night sleep reversal, hallucinations
what is the difference between visual hallucinations and tactile? visual-see; tactile-feel
physical illnesses can be associated with delirium such as myocardial infarction, urinary tract infection, pneumonia
medicinal toxicity can be associated with delirium drugs with anticholinergeric properties: Benadryl, some tricyclic antidepressants and benztropine
In initial medical assessment ask about OTC and prescribed medication; specifically cough syrups, dietary supplements and medications for allergies, pain and sedation
A person may have dementia and delirium, However which one is priority? delirium
delirium is characterized by 1.disturbances of conciousness 2. Changes in cognition 3. develops over a short period of time (usually hours to days) and with a tendency to fluctuate during the course of the day
difference between delirium & Demntia CTD Delirium: matches level of consciousness, logical alternating with illogical, depending on the level of conciousness, may have slurred speech; hallucinations: visual, tactile, andxiety, fear, bewildered frightened longterm memory fails slowly, sleep patterns are consistent day-night reversal; thought process may be
_____ Dementia cannot be reversed Alcoholic
What two dementias can be reversed Normal pressure Hydrocephalus (NPH) and Vitamin B12
Before any dementia can be diagnosed physical disturbances and neoplasms should be ruled out
NPH usually present these S&S Symptoms: unsteady gait, urinary urgency or incontinence and demtia enlarged large and third verntricles
NPH cause impaired return of cerebrospinal fluid throufh the subarachnoid space of the venous system it can be revered via neurospinal surgery
Vitamin B12 common in older adults but not common period; given intranasal or instramuscular; has to be given continuously.
Alzhemier's Disease -rule out other disorders before diagnosing this disease. Risk factors include age, , presence of aloprotien E4 allele on chromosome 19, poor educational status, female, history of head injury and hormone replacement of estrogen with or without progesterone.
re-feeding side effects it must be done slowly; it can cause cardiovascular,neurologic and hematologic complications and even death neurologic, and hematologic complications, even death
Causes of alzheimers Genetics, hormones, beta amyloid plaques,neurofibrillary tangles and neuronal loss
DSM IV Criteria for Anorexia Nervosa A.Refusal to maintain body weight at or above a minimum normal weight. B. Intense fear of gaining
DSM Criteria for Anorexia Nervosa A.Refusal to maintain body weight at or a minimum body weight or age and height B. Intense fear o gaining weight or becoming fat, although significantly underweght. C.Disturbance in the way in which one's body weight or shape is D.In women and female adolescents the absence of at least 3 consecutive menstual cycles
S&S of anorectics Hypotension, bradycardia, and hypothermia are common. Skin is often dry and lanugo may appear;renal damage, cardiovascular,neurologic and hematologic complications, death.
Subjective symptoms of anorexia ear that they me lose control over what is being eaten; of becoming fat; Concerned about gaining, or losing weight. May be triggered by a comment or a traumatic event. They may exhibit depression irritability, social withdrawal,less sex.
Anorexia(Biologic Eitiology) increased serotonin levels, increased cerbrospinal fluid. Even though SSRI's may be used to treat depressed bullims it doesnt really work for depressed anorectics. If they are used for treatment it should be used after weight restoration
Cognitive & Behavioral Factors Positive attention from others may be as a result of refusing food
DSM for Bulimia A. Reccurent episodes of binge eating in a short period of time, with intake much greater than average. B. Feeling a lack of control over eating behaviors during eating binges. C.Binge eating and inappropriate compensatory behavior to prevent weight gain D.Binge eating and inappropriate compensatory behaviors both occuring on average at least twice a week for 3months. E.Self-Evaluation unduly influenced by body shape and weight.
Difference between purging type and non-purging type bullemia? purging: regularly engages in self induced vomitting or the use of laxatives, diuretics or enemas. Nonpurging: strict diet,fasting, vigorous exercise, not regularly purging
Onset of bulimia adolescence or early adulthood, primarily in women; 15-24 yrs old
Objective Signs of bulimia -dehydration, hyponatremia, hypochloremia, hypokalemia,metabolic alkalosis and acidosis, mechanical irriation, irritation to the GI. Reflex constipation because of laxative and diuretic abuse, swallen gland (esp parotis). Russel sign: callous fingers & k
Subjective symptoms shame, guilt, depression, anxiety, fear SSRI's can be used to treat bulimia whether otr not they are also experiencing depression; serotonin levels are lower in bulimics
families of bullemics tend to be disorganized, no structyure, lack nurture etc.
families of anorexics tend to be stricter
Difference between bulemia and anorexia ANOREEXIA: Early onset, very low weight, amenorrhea for some patients, hormonal imbalance, constipation if not using laxatives BULIMIA: Late onset, More normal weight, menstrual irregularities but not ammenorrhea, fluid and electrolyte imabalance, GI problems related to bingeing and purging.
MAnagement of ANorexia (Priority) 1. Increasing weight to at least 90% of average body weight for the patient. 2. helping patients reestablish appropriate eating behavior. 3. increase self esteem
_____ _____is the initial treatment goal of a bulemic pt Medical stabilization
Hospitalization of a Bulimic 1. to treat underlying psychiatric or medical crisis 2.when respite is needed from a chaotic home life so that the bullimic can examine his or her living situation more objectively. 3. if the pt can't receive care in community or home
Nurse-Pt relations ship (eating disorders Because anorectics may be forced to receive treatment they may view nurse as the enemy in wanting to mae them gain weight.It is harder to build trust with an anorexic than bullemic. A bullemic may try to gain help on their own.
anoxiolytics may help pt eat when given right before refeeding. can be used to decrease anxiety that makes pt want to purge. antidepressants are safer and more effective. andtidepressants should be only used only when pt has failed to respond to psychotherapy alon. Long term use of anolytics can cause dependence. Xyprexa is is used to promote weight gain. antidepressants work by affecting serotonin and epinephrine.
when the patient tries to hide or get rid of food respond- in a nonjudgemental confrontation, conveying understanding of weight gain fears.
When pt feels like purging encourage pt to seek a team member speaking about feelings reduces anxiety
If pts do not improve with therapy they can be referred for more intensive form of treatment such as interpersonal psychotherapy, partial or full hospitalization and possibly antidepressant medication
Men and eating disorders -more likely to have a history of obesity before the onset of eating disorder, comorbidity with other psychiatric disorder is higher in men than women. In psychotherapeutic management focus on the excessive sttn boys place on masculine physique, dietary habits to promote health, fitness and muscle mass without using disordered eating patterrns, expression of feelings and the exploration of any gay concrn
Binge eating disorder pts feel guilt just like bulemia but do not comoensate for over eating therefore becoming significantly overweight
alcohol causes the most physical, cognitive and behavorial difficulties when exposed before birth
BPD in children irritability is the most prominent symptom. Can be overlooked because S&S are more likr instability, temper tantrums, impulsivity, and subtle depressive symptoms. They tend to have attention problems. Treatment: elevating a depressed mood of a child with BPD may send them into mania or extreme irritability
Anxiety disorders in children foreshadow anxiety as adults, can be caused by genetic and environmental factors. Types incluse: OCD (recurring thoughts or rituals done to decrease anxiety) Pediatric OCD: associated with behaviors such as conduct disorders , oppositional defiant dis Anxiety disorder CTd. PTSD, separation anxiety, social anxiety disorder, panic disorder.
Anxiety disorders in children come about when children have experienced harsh parenting, stressful events, and a genetic predisposition to anxiety disordrs
ADHD a complex brain disorder that -most common childhood psyychiatric disorder. It involves subtle abnormalities in the CNS
ADHD symptoms and sighns: hyperacyiviy, inattentive, defiant must last 6months appeear before age 7 and cause noteworthy troubles for child academicall, socially or homes
Autism Spectrum disorder Autistic disorder, pervasive development disorder not otherwise specified, Aspeger's Disorder, Rett's disorder, Childhood Disintergrative disorder. (Most to least) have theses 3 in common: Arrested social skills, impaired verbal and nonverbal communication, restrictive, stereotypical behavior, interests and activities: only paying attn to specific toys or items, behaviors such as flapping spin/twist=overstimuli
Bullying. _____ bullying is done more by girls Relational ignoring
___ bullying is the most frequent type of bullying Verbal
Nurse-Patient Relationship for child and adolescent psych Educate patients and families on mental health. Literacy is an important goal to maintain.
Conservative approach to drug prescription Important when working with children and should be the first step: prescription hygeine. Removal of selected meds to distinguish efects, interactions etc. it fascilitates the management of sude effects and adverse effects.
TCA's Older and cheap. They have a narrow therapeutic index. They cause dry mouth , fatigue, dizziness, sweating, weight gain urinary retention, tremor, tachycardia, agitation. They affect cardiac conduction so get baselines of cardiograms. eg. Imipramine, clomipramine, and desipramine.
SSRI Increase Intrasynaptic serotonin effect, antidepressant effect. Black Box warning to inducing suicidal thoughts or behavior. OCD in children: Prozac, Zoloft, Paxil, Luvox, cilatopram and Lexapro; Depression: fluoxetine
BPD Drugs First line medication will typically include either an atypical antipsych or mood stablilizer. 1. Risperidone for 10-17; 2. aripipzole: 11-17; Lithiu 12 and older; Dosage ies weight based. Medication goals:1. Intervene to stablilze moods and sleep and then seek tp manage comorbid symptoms like anxiety abd hyperactivity.
Anxiety Disorder Drugs antidepressants are good. Buspar & knlonopin can reduce anxiety;
Causes of Alzheimer's Neuronal Loss,Neurofibrillary Tangles, Beta Amylois plaques, Brain Atrophy, Genetics, Hormones. Hormones: lack of estrogen or if used as therapy with progesterone Genetics: EarlOnset: (50's or earlier). Chromosome 1: presenilin 2 gene; Chromosome 14L presenilin 1 gene; chromosom21: makes amyloid prescursor protein; Late:apolioprotein is inherited from parents or even if not, if parents have it they most likely will
Alzheimer's 4 A's & interventions Agnosia: Inability to recognize or identify familiar objects and people in the absence of visual or hearing impairment: Assess for impairment, Intrduce self dont expect pt to remember you, cover mirrors and pics that bring distess, name objects they use. Aphasia: Expressive: Can't express self' Receptive can't understand what you are saying; Intv: USe gestures, tone and facial expression,help them find word use simple words,allow time for response, listen carefully and encourage nonverbal cues use pics Amnesia:Inability to learn new info or recall previously learned. Intv: Do not test memory unnecessarily, operate here and now, provide orientation cues,compensate for patients lost judgement or reasoning. Apracia: Inability to carry out motor activity, despite intact motor function. Intv: Assess for motor weakness, swallowing difficulties, Give simple tasks and give step by step instructions. Initiate motion for patient with gentle touch and guidance.
Vascular Dementia 2nd most prevalent; Brain has many vascular lesions in the cortex and subcortical areas. Memory loss is most common complaint. THey however don;t lose ability in finding words risk factors are HPTN, cardiac arrythmias, coronary artery disease, tobacco use, and alcohol or substance abuse.
Frontotemporal Lobe Dementia atrophy of the frontal and anterior temporal lobes of the brain. Pick's disease is a type of FLD. It features pick celss and bodies int e brain (swollen neurons); diagnosed betweeen 40 -50 yeats olf can beassymetical or symmetric; affects part of brain responsible for judgement, decision making, imulse contol and abiding by social norms; later in illness, speech, memory and attenyion may decline with repetitive behavipr and motor problems.
Dimentia Related to Parkinsons neurologic disorder that affects that the extrapyrimidal system. Diagnosed in 50's or sixties; Experience hallucinations, delusions, flat affect, apathy, memory problems, visuo-spatial skolls and executive functioning
Defuse Lewy Body Disease has cognitive impairment andextrapyrimidial signs. Classic tetrad: Alzheimer's like demtia, parkinsons symptoms, prominent psychotic symptoms, and extreme sensitivity to antipsychotic agents
CJD Human form of madcow disease, contacted through blood or bodily fluids of infected person or ingested meats containing bovine.Neuronal tissue is extremely contagipus s let people handling dead body know Dementia is inevitable, they may experience personality changes, seizures, myoclnic movements; patients die within6 -12 months Nurse should focus on anticipatory greif of the family;
Dementia associated with Alcoholism Winerke's encephalopathy: confusion, ataxia, abnoral extraocular movement (nystagmus). Thyamine replacement is critical.Korsaoff syndomr: antegrade amnesia. The patient wont be able to remember anything since he developed these problems. they may try to fill in the blanks by making up something without knowing (confabulation) Treatment is thiamine relacement and abstinence form alcohol. Weenicke-korsaoff may be called for symptoms
Dementia related to Hutington's DIsease Transmitted only through sutosomal dominant gene that either parent may provide. travels on chromosome 4. Once transmitted you have 50% chance of getting it. It does not skip generations. Only can get it if the person has chromosome 4. Personality changes are the first signs to appear. mild temper - moodswings; begins with facial twitches to abnormal involuntary limb of all extremities that progress to myoclonous (jerking movements) makes pt suceptible to falling out of bed. it is rare. only treatment for symptoms nt disease.
Communication W/ dementia If interaction is going poorly, stop walk away, and come back in a few mins;ake eye contact; do not use sarcasm or jokes,use short simple sentences,do not finish sentences, give time to finish thoughts, approach pts from the front, lst of chatter may throw them off
Schedules with dementia Develp schedule that has day to day structure and that has a predictable routine. focus on pt centered activites; Develop singular activities not more than one at once, and group meetings should have one subject
Nutrition and dementia Give finer foods if wont stay at table, use fav foods, beverage supplements can help when eat less serve less portions more throughout the day. If swallowing difficulties then consult speech pathologis
TOileting Dementia MAke sure the patient does not have an illness that affects toileting, provide sufficient hygeine, take to the bathroom every 2 hours to promote continence.
Drugs used for alzheimer's Cognex (not really used anymore);Donepril, Exelon, galantamine,Namenda. ACH inhibitors :Done, rivast or galantm is usually used first. Cognex causes hepatic toxic effects. AcHe inhibitors boost acetychline in the brain; Stopping meds may cause a drop in cognitive status. Namenda works on behavior
Cognex (Tacrine) reverseible inhibit chiolingterase Ache and BchE. Rarely prescribes because it has to be taken 4 times daily because of its half life, and hepatoxicity,
Donzepril (Aricept) Reversible inhibitor of AchE and BchE; has few peripheral side effects, no hepatoxicity, oce a day dosing, cna be taken with or without fod. Side effects include GI problems, Bradycardia suggesting that ACHE is not complete
Rivastigmine (Exelon) inhibits CHW but is irreversibly short plasma life but inhibiting time is long 10 hrs. Better than DOn and Cognex. has still peripheral side effects.
Galantamine (Razadyne) Inhibits CHE too but prefers ACHE over BCHE, and can stimulatee presynaptic muscarinic receptors to release more ACH; oroduces a cholinergeric effects like GI symptoms, readily absorbes, half life of 6 hrs; metabolized by cytochrome 450. Can interact with drugs catalyzed by cytochrome P450 system.
Neuronal DEath neuronal Excitatory: rapid firing of the neuron. To prevent this give a drug that prevents this to block NDMA receptors
Memantine (NAmenda) is and NMDA antagonist. It blocks its receptors.prevents glutamate from overstimulating it and tries to slow down neuronal degeneration. Too much stimulation leads to dementia too little stimulation leads to behavorial problems and psychotic behavior.
seacretase inhibitors block seacreatase which are enzymes thay cut of pieces of amyloid precurspr [roteins and keep the peices.
Drugs that prevent alzheimers disease NSAIDS, Statins ( lowere cholesterol and in turn preventing AD), Estrogen (getting it after menopause), Vitamin B and E
Mood difference in Delirium and Dementia Delirium: anxiety or fear Dementia: grandiose, paranoid, pathologic jealousy, wide range of feelings
difference between Delirium & Dementia Delirium: Occurs quickly, obvious, result of other physical reasons, short-term memory is impaired when assessed during an interim lucid or clear moment; fluctuating level of consciousness; sleep is erratic,no pattern Dementia:Slow unnoticeable at first, slow development over years with a progressive deterioration spanning 3 to 10 years until death; usually the primary disorder, but may be related to other illnesses, short term memory is lost initially; If an atypical drug is used in treatment then they should be warned of the black box
Created by: bunny6108