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RN program - Psych

RN Program test 2 - Psych

QuestionAnswer
personal space 18 inches - 3 feet
intimate space 10-18 inches
social space 3-5 feet
3 Phases of the Nurse-Patient Therapeutic Relationship orientation, working, termination - some have 4th-pre-orientation
what are some things a nurse discusses in the orientation period establish contact define roles and rules confidentiality ID pt. needs ID goals ID strengths/weaknesses establish trust rapport
describe the working phase r/t a threapeutic relationship put plan into action work together to solve problems and meet goals evaluate and revise plan
skills to use during the working phase of a therapeutic relationship clarification validation confrontation empathy respect genuineness advocacy
what are the goals for the working phase of a therapeutic relationship? id support systems positive coping behaviors positive self concept promote independence
what are three things you do during the termination phase of a relationship D/C plans, summerize experiences, say good-byes
Behaviors that diminish the Therapeutic Relationship Boundary violation Sympathy Encouraging dependency Non-acceptance Avoidance Not being genuine
when you ask someone to do something and they don't want to resistance
congruent appearance and internal mood match; crying and feeling sad.
incongruent someone's appearance and mood do not match. Being at a funeral and laughing and saying everything is great when you're really sad inside
what are some factors r/t non-verbal communication? personal appearance, facial expressions ,posture and gait, gestures, proxemics, touch, eye contact
when in the 1900's did psychotropics become available? 1950's - Lithium Thorazine
what year did the Community Mental Health Act pass and become effective 1963 - deinstitutionalization of state mental hospitals: release from state hosp develop community services…..problems
during direct care, what are some of the roles and responsibilities promotes self care, assist w/ADLs communication, interpersonal relations examine behaviors, test alternatives teach meds/ tx’s
Primary level of care altering risk factors to hinder the development of MI
secondary level of care reduce the effect of Mental Illness: screening crisis intervention suicide prevention counseling short term hospitalization
tertiary level of care minimizing long term effects of MI; rehab vocational training aftercare programs IOP partial hospitalization/ day tx
look at chart on page 324 in HESI book Denial, Displacement, Intellectualization, passive-aggression, projection, reaction formation, regression, repression, suppression, undoing
impairment in functioning due to a social, psychologic, genetic, physical, chemical, or biologic disturbance mental illness
lying on a couch and talking to therapist Psychodynamic treatment
Behavioral framework learned behavior:shaped by environment reward and punishment change environment, change behavior
Cognitive framework Changing expectations, beliefs, memory, thinking - treatment: changes in thinking = changes in behavior
Neuro-Biomedical Model neurotransmitters and receptors serotonin norepinephrine dopamine GABA psychotropics
milieu therapy planned use of people, resources, and activities in the environment to assist in improving interpersonal skills, social functioning & ADLs. Here and now. Realities of today, limit setting, client makes decisions ~ healthcare.
family therapy goal is to decrease family confilct and anxiety and to develope appropriate role relationships.
Patients interact within group: roles, rules established. Act out conflicts and solutions Types: education, supportive, psychotherapy, self-help group therapy
the stages of group therapy forming, storming, norming, conforming, adjourning
r/t group therapy: forming
r/t group therapy: review pg 325
r/t group therapy:
r/t group therapy:
r/t group therapy:
this type of tx induces tonic-clonic seizure and is usually 3-12 tx ECT
event that overwhelms previously useful coping behaviors crisis
what are the phases of a crisis problem-solving, trial and error, relief behaviors, severe disorginization
5 steps of crisis intervention ID the problem, list alternatives, choose an alternate, implement the plan, evaluate
what you are feeling on the INSIDE mood
your outward display of emotions affect
R/T DSM-IV: Axis I clinical d/o, substance abuse (major depression)
R/T DSM-IV: Axis II personality d/o, mental retardation (borderline personality d/o)
R/T DSM-IV: Axis III medical conditions (HTN, DM)
R/T DSM-IV: Axis IV Psychosocial stressors (Severe r/t chronic financial stress, loss of job)
R/T DSM-IV: Axis V Global Assessment of Functioning (Current GAF 30, past year GAF 70)
review slides for drug information - 74-82 DANG DRUGS!!
what is hardiness? how the event is perceived: commitment, challenge, control
Process of learning how to live with the inevitable life stressors people encounter by learning how to cope effectively and positively stress management
Vague feeling of apprehension, terror, or dread arising from identified or unidentified stressors anxiety
unpredictable, recurrent attacks of intense anxiety/fear that interfere with daily living. panic d/o - more common in women
unrealistic, excessive, persistent anxiety about 2 or more life events. Coping is inadequate. anxiety d/o
common physiologic responses to anxiety increased HR & BP, rapid, shallow respirations, dry mouth, tight feeling in throat, tremors, muscle tension, anorexia, urinary frequency, and palmar sweating
persistent, intrusive thought, emotion or urge, unable to ignore obsessions
performance of repetitious, uncontrollable purposeful act to prevent some future event compulsions
r/t OCD, what are some interventions allow time for rituals (initially): then set limits, gradually dec. time Explore meaning of the ritual encourage socially acceptable outlets non confrontational
interventions r/t panic stay with patient/ protect remain calm short simple sentences quiet environment physical activity may release tension meds
Somatoform Disorders Conversion Hypochondriasis Somatization Pain Disorder Body Dysmorphic
Dissociative Disorders Amnesia Fugue Dissociative Identity Depersonalization
pattern of behavior relating to self or others personality
personality d/o are when traits become what? inflexibility, inaffective relationships, maladaptive coping
4 areas that deviate r/t maladaptive coping
when do people with a personality d/o seek tx? in a CRISIS: depression, bipolar crisis, other axis 1
Personality d/o is an Axis ___ problem II
always be on alert for _____ manipulation
r/t personality d/o, avoid ____ power struggles
r/t personality d/o help the pt identify ___ ___ maladaptive coping
r/t PD, the RN should do what? be consistent, set standards/limits
4 reasons why you would not tx PD in an outpatient setting Safety issues Psychotic Axis 1 Crisis
Axis II is grouped into three clusters. What is in Cluster A? BEHAVIOR: ODD OR ECCENTRIC 1. Paranoid 2. Schizoid 3. Schizotypal
characteristics of a paranoid pt: SUSPICIOUS MISTRUSTS OTHERS, HYPERSENSITIVE LACK SENSE OF HUMOR, SECRETIVE, ARGUMENTATIVE AFFECT COLD, SARCASTIC, ALOOF CONTROLLING
interventions r/t a paranoid pt formal approach, straightforward, on time, involve in care plans, validate ideas before taking action
characteristics of a schizoid INTROVERT, LONER, SHY, INDIFFERENT TO PRAISE / CRITICISM. ALOOF INABILITY TO FORM SOCIAL. REL. FOCUS ON OBJECTS RATHER THAN PEOPLE RICH FANTASY LIFE
interventions r/t a schizoid Improve community functioning Referrals Case management: 1 person
characteristics r/t a SCHIZOTYPAL ODDITY OF THOUGHT, PERCEPTION, SPEECH, AFFECT ECCENTRIC MAGICAL THINKING HIGHLY ANXIOUS
interventions r/t schizotypal develope self care & social skills, improve community functioning, role play, teach to be "normal"
what d/o are in cluster B? antisocial, borderline, narcissistic, Histrionic
characters of an antisocial pt DISREGARDS RIGHTS OF OTHERS AGGRESSIVE / VIOLENT ILLEGAL ACTIVITIES NO GUILT MANIPULATIVE DISREGARDS AUTHORITY IMPULSIVE EXPLOIT OTHERS
interventions r/t antisocial pts limit setting, matter of fact, anger management, time outs/leave the situation, positive feedback
characters of boderline personality d/o prob w/identity & mood, unstable interpersonal relationships, "splitting" , "pits" staff, manipulation, abandonment issues, self mutilization, suicidal
interventions r/t borderline pts maintain safety, coping strageties, reshape thinking, structured time
characters of a NARCISSISTIC pt GRANDIOSE EGOTISTICAL LIKES ATTENTION EXAGGERATES LACK OF EMPATHY EXPLOITS OTHERS, FEEL DESERVES SPECIAL TX SUPERIOR ATTITUDE
interventions r/t narcissistic pt straight forward, consistent, limit setting
characters of a HISTRIONIC HYSTERICAL, DRAMATIC, THEATRICAL EXTROVERTED, SEEKS ATTENTION OUTBURSTS, TANTRUMS, OVERREACTS TO MINOR EVENTS IMMATURE SOMATIC C/O LABILE MOOD
interventions r/t histrionic Appropriate feedback: social skills, dress, communication, non verbal behaviors Role play social situations Assertive communication
Cluster C d/o.... ANXIOUS OR FEARFUL 1. Dependent 2. Avoidant 3. Obsessive-compulsive
characters of dependent d/o LACKS SELF- CONFIDENCE ALLOWS OTHERS TO MAKE DECISIONS SUBMISSIVE, PASSIVE LIKES TO PLEASE OTHERS LOW SELF- ESTEEM ANXIOUS
interventions r/t dependent pts Help verbalize feelings Id strengths Help with daily living/functions Teach p/s and d/m skills
characters of a avoident pt TIMID, WITHDRAWN HYPERSENSITIVE TO CRITICISM DESIRES RELATIONSHIPS BUT AFRAID FEARFUL RELUCTANT TO GET INVOLVED LO SELF ESTEEM INHIBITED
interventions with an avoident pt Support and reassurance Positive self talk Cognitive restructuring Social skills Be patient
characters of OBSESSIVE-COMPULSIVE d/o PREOCCUPIED W/ RULES ORGANIZATION, TRIVIA, DETAILS PERFECTIONIST, INFLEXIBLE, FORMAL CONTROLLING, HARSH, UNFORGIVING CAN’T EXPRESS EMOTIONS
interventions with OBSESSIVE-COMPULSIVE d/o Cognitive restructuring Realistic goal setting Take risks Practice negotiation
issues r/t anorexia control, preoccupation, rigid and restrained, hi-achievers, low self-esteem
what is the tx goal for anorexia restore healthy weight, restore healthy eating patterns, correct electrolyte imbalances
long term goals r/t anorexia IMPROVE SELF ESTEEM IMPROVE BODY IMAGE PARTICIPATE IN LONG TERM THERAPY
meds r/t eating d/o SSRI's (Prozac-60-80mg/day), Lithium(lessens the "denial"), TCA(Imiparamine-decrease bing), Elavil(>weight gain), Zyprexa, Avoid antianxiety meds & Wellbrutrin(lowers seizure threshold)
desired outcomes r/t anorexia ideal wt, adeq calories, good turgor, normal menstrual cycle
desired outcome r/t bulemia no binge/purge, normal eating pattern, comfort w/ body
Persistent, pervasive, intense lowering of mood depression
type I bipolar d/o 1 or more acute manic episodes with depression Both: hi income, hi educated, intelligent, creative, artistic
type II bipolar d/o Major depressive episode with hypomania. No acute mania.
flight of ideas: going from one thing to the next, can't stay focused on one thing
psychotic disorder involving difficulty with reality testing and relatedness Schizophrenia
Schizophrenia characterized by Bleuler's 4 A's affect, associations, autism, ambivalence(hard time making decisions)
Features of Schizophrenia (+) Disordered thoughts: loose associations, flight of ideas Language disturbance: tangentiality, neologisms, word salad, incoherence Loss of function: withdrawal, poor ADL’s Delusions Hallucinations
neologisms creating new words
word salad jumbled words that together make no sense
false, fixed belief that cannot be changed by reason delusion
false SENSORY perception hallucination
(-) features of schizophrenia Flat Affect Poverty of speech Apathy Anhedonia Social isolation
when will you see the s/s of alcohol withdrawal? 4-12 hours after last drink
define delirium tremens 12-36 hours after last drink, tachycardia, tachypnea, diaphoresis, marked tremors, hallucinations, paranoia
medication r/t alcohol withdrawal Antabuse - SE-hypotension, weakness, chest pain, Ativan, Valium, Librium, Campral
look at slides 145 - 150 meds
effects of hallucinogens Dilated pupils, ˆ BP / P bizarre behavior, altered perceptions or feelings, insomnia, paranoia
general nursing care r/t drug overdose include ABG’s, blood & UDS O2,intubation,ventilator Cardiac monitor/EKG Restraints Induce vomiting/gastric lavage if drug ingested Activated charcoal
what med can block the effects of opiates Naltrexone
what med can be used for Heroin abstinence Methadone
this modification changes ineffective behavior patterns, focuses on consequences of actions rather than peer pressure behavior modification
unconscious faiulure to acknowledge an event, thought, or feeling that is too painful for conscious awareness denial
"kick the cat" - transference of feelings to another person or object displacement
using reason to avoid emotional conflicts intellectualization
attributing one's own thoughts or impulses to another person projection
a person who dislikes animals does vounteer work at an animal shelter reaction formation
involuntary exclusion of a painful thought or memory from awareness repression
intentional exclusion of feelings and ideas suppression
3 common complaints after and ECT headache, nausea, muscle soreness
day to day stressors, allows for logical thought and problem solving, pt will appear calm and in control = ____ anxiety mild anxiety
client becomes restless, speech rate increases, client becomes wordy = ____ anxiety moderate anxiety
stimulate causes fight or flight response, impairs concentration and problem solving ability = ____ anxiety Severe anxiety
perception of reality is greatly distorted; unable to concentrate, overwhelmed, loss of control = ____ anxiety Panic
what are some common physiologic responses to stress/anxiety >HR, >BP, rapid shallow resp, dry mouth, tight feeling in throat, tremors, muscle tension, anorexia, urinary frequency, palmar sweating
acrophobia fear of heights
agoraphobia fear of crowds or open places
claustrophobia fear of closed in spaces
nyctophobia fear of the dark
thanatophobia fear of death
examples of benzodiazepines valium, xanax, ativan, librium
what are benzodiazepines used for? reduce anxiety, induce sedation
Side effects of Benzodiazepines drowsiness, ataxia,dizziness, irritability, blood dyscrasias
when is the best time to interact with an OCD pt? right after ritual is finished...anxiety is at lowest point
what are some anxiety-reducing behaviors that can be taught deep breathing, visualization, meditation, exercise and relaxation.
lack of concern over physical illness La belle indifference
decrease in anxiety resulting frfom the ability to deal with a stressful situation primary gain
rewards obtained from the sick role; sympathy, freedom from certain responsibilities secondary gain
name two NON-benzodiazepines BuSpar, Ambien
sudden temporary inablity to recall extensive personal information psychogenic amnesia
when would you expect to see a case of psychogenic amnesia? after a traumatic event, threat of death or injury, natural disaster
psychogenic fugue a person suddenly leaving home or work with the inability to recall his or her identity.
fear of "going crazy", temporary loss of one's reality and ability to feel and express emotions depersonalization
the last developmental task for a person. death
types of death natural, sudden, suicide
stages of preparing for expected death denial, anger, bargaining, depression, acceptance
stages of grief Shock, disbelief, rejection, or denial, 2.Resolution - up to 1 year or more
this PD is socially detaced, shy, and introverted. they avoid interpersonal relationships schizoid personality
this PD has interpersonal deficits, eccentricities and odd beliefs, socially isolated schizotypal personality
this PD is aggressive acting out behavior, clever and manipulative, self centered goals, emotionally immature Antisocial personality
has disturbances r/t self image and sexual, social, and occupational roles. Makes suicidal gestures, overly dependent on others, unable to problem solve. borderline personality
seeks attention by overreacting and exhibiting hyperexcitable emotions, "drama queen" histrionic personality
perceives self as all-powerful and important, is critical of others, arrogant, self-love narcissistic personality
socially inhibited, feels inadequate, hypersensitive to negative criticism avoidant personality
low self-esteem, sees self as stupid, dependent on others to meet needs dependent personality
cold and rigid towards others, attempts to control self by controlling others or environment obsessive-compulsive personality
r/t bulimics, monitor electrolytes, especially ____ potassium
this is a test used for degree of depression. It is positive if post test levels of _____ is greater than 5mg/dl dexamethasone-suppression test (DST), cortisol
decreased ____ and _____ are indicative of depression serotonin and norepinephrine
give examples of anticholinergic effects dry mouth, blurred vision, constipation, urinary retention
examples of tricyclics Elavil, Tofranil, Aventyl, Ludiomil
examples of side effects r/t MAO-inhibitors impotence, tachycardia, dizziness, dry mouth, HTN crisis-severe HTN, headache, chest pain, fever, sweating, N/V
there are certain foods that trigger interactions with MAO-inhibitors. What is in the food and name some of the foods. Tyramine, aged cheese, red wine, beer, beef and chicken liver, yeast, yogurt, sory sauce, chocolate, bananas
examples of SSRI's. Prozac, Paxil, Zoloft, Lexapro
serotonin syndrome has to have 3 symptoms by definition, name some of the symptoms rapid onset of AMS, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, diarrhea
examples of nontypical antidepressants Wellbutrin, Remeron
example of S/NRIs Cymbalta, Effexor
common S/E for antianxiety meds sedation, drowsiness
common S/E for antidepressants anticholinergic effects, postural hypotension
common S/E for MAO's HTN Crisis, diet restrictions (tyramine)
specific concerns/problems r/t Lithium renal function assessment and monitoring
specific concerns/problems r/t Phenothiazines extrapyramidal effects; tardive dyskinesia, photosensitivity
symptoms of mania r/t mood euphoric, grandiose, unstable, self-confident
symptoms of mania r/t thoughts flight of ideas, pressured speech, paranoid, psychotic
symptoms of mania r/t behavior hyperactive, hyperverbal, manipulative, risky behaviors, colorful, poor grooming, wild energy
nursing interventions r/t mania limit stimuli, firm, direct, consistent limits, high protein finger foods(on the go)
name of most common mood stabilizer Lithium
how does Lithium work? balances neurotransmitters in brain, regulates nerve impulses and balances mood swings
early signs of Lithium toxicity D/V, drowsiness, muscle weakness, lack of coordination. Others:slurred speech, confusion, decreased BP.
Therapuetic level for Lithium 0.5 - 1.5mEq/L
Other nursing implications r/t Lithium Watch Na levels, keeps salt usage consistent, diuretics are contraindicated
examples of anticonvulsant mood stabilizers and what do they do? Depakene, Tegretol, Lamictal. increase GABA in CNS
One noted side effect of Lamictal Rash
what activities are good for a manic pt noncompetitive physical activities that require use of large muscle groups
characterized by a distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days and present for most of the day nearly every day. hypomania
define grief personal, individual experience of a loss
define mourning outward appearance of grief
what are some of things can affect the intensity and duration of grief age, developmental stage, coping ablilities, support systems, culture, spiritual beliefs
true or false: the stages of dying are fluid and can be experienced in any order True
symptoms of uncomplicated grief sadness, anger, anxiety, guilt, shock, crying ect...
what is complicated grief? no resolution of grief; chronic, delayed, exaggerated, masked
risk factors for complicated grief social factors, relationship hx, death of a child, multiple losses, lack of faith system
describe death as seen as a preschooler death is temporary, reversible, magical thinking
describe death as seen as a school-age child irreversible, sad, inevitable, like details ( honesty, avoid cliches, give choices, listen, touch)
describe death as seen as a adolescent child adult like view of death, inevitable, irreversible but distant event (loving confrontation, open communication)
how does a preschooler react to dying? feel punished, angry, labile
how does a school age child react to dying? why me? guilt, fear, vulnerable
how does an adolescent react to dying? adult awareness, sad, bitter, isolated
describe delirium acute process that if tx, is usually reversible. Sudden onset. Tx=correct the causitive d/o (infection, drug reaction, head trauma)
describe dementia cognitive impairments characterized by gradual, progressive onset; irreversible. judgement, memory, abstract thinking and social behavior are affected.
WERNICKES-KORSAKOFF SYNDROME are due to ___ and ___ alcoholism and Vit B deficiency
hallmark signs of dementia and Alzheimers memory impairment, aphasia, apraxia, agnosia(recognizing everyday objects)
there are 3 stages of Alzheimers; stage 1 memory loss, forgets recent events, trouble with words "you know that thingamagig"
there are 3 stages of Alzheimers; stage 2 2-12 years. loss of cognitive, motor skills, past memory is OK-recent memory not good. May start wandering, sleep disturbances(sundowners)
there are 3 stages of Alzheimers; stage 3 profound dementia, complete nursing care, 8 mos - 5 years. death due to UTI, pneumonia, malnutrition
how/what do you need/see for a diagnosis in a child with a d/o? behavior inappropriate for age, deviates from normal and creates a funcitional impairment
what are the three impairments of autism spectrum d/o social impairment, communication impairment, ususual behaviors
characteristics of autism Delayed socialization Stereotypical behaviors Rigid, intolerant to change Communication problems, Limited eye contact Minimal mood expression Min. pretend play
strengths of a child with autism Visual Predictable Patterns Numbers/letters Computers Music Books Special interests
Rett's d/o multiple deficits after a period of normal development
three characteristics of ADHD inattention, impulsiveness, hyperactivity (increase of dopamine)
examples of conduct d/o aggression to animals or people, vandalism, lying, theft, breaking the rules, lack empathy
s/s: mood instability, impulsivity, irritability, hyperactivity, sleep disturbances; r/t children bipolar d/o.
how would a Dr begin to diagnose a child with bipolar d/o daily mood chart, pattern over time. Looks like ADHD.
True/False: Assault on a patient can be a nurse forcing a pt to take a medication. (without touching the pt-verbally) TRUE - assault is a mental or physical threat
True/False: An example of battery can be if you perform CPR on an DNR pt. TRUE. touching, with or without the intent to do harm.
After death, a client has the right to be unobserved, exluded from unwarranted operations, and protected from unathorized touching of the body. This is an example of what? Falls under invasion of privacy.
6 rights of a hospitalied pt are discussed in the HESI book. What are they? Right to: 1.wear own clothes and have money on them. 2.own storage space for use. 3. see visitors daily. 4.access to phone, ability for private calls. 5. get and send mail. 6. refuse shock/lobotomy tx.
how long can a pt be required to stay at a facility if someone applied for an emergency addmission? A medical or judicial approval is required to detain anyone over 24 hours
according to the HESI book, there are 5 things that a person cannot do if they are delared incompetent. vote, make contracts or wills, drive a care, sue or be sued, hold a professional license.
who is responsible to explain a surgical procedure to the pt? the provider
psychiatric d/o characterized by thought disturbance, altered affect, withdrawal from reality, regressive behavior, difficulty w/communication, impaired interpersonal relationships. schizophrenia - TOO MUCH DOPAMINE=TOO many signals
which type of schiophrenia is characteried by stupor, rigidity, posturing(waxy flexibility), negativism, potential for violence catatonic
type of schiophrenia characterized by incoherence, flat affect, disorganied, unusual mannerisms, no delusions Disorganized
type of schiophrenia characterized by delusions, hallucinations r/t a single theme or both, potential for violence if delusions are acted on. Paranoid
type of schiophrenia characterized by being socially withdrawn, inappropriate affect, eccentric or peculiar behavior, no current psychotic behavior exhibited. Residual
type of schiophrenia characterized by prominent delusions and hallucinations, incoherence and grossly disorganized behaviors. failure to meet other criteria for other types undifferentiated
belief that conversations or actions of others have reference to the client Ideas of reference
lack of clear connection from one thought to the next looseness of association
echolalia constantly repeating what is heard
neologism creating new words
thinking based on facts vs abstract and intellectual points concrete thinking
false sensory perception usually visual or auditory hallucinations
misinterpretations of external environment Illusions
false, fixed beliefs that cannot be changed by reason. delusions
feelings or mood affect
repeating another persons movements echopraxia
nursing interventions r/t a schizophrenic stress reality, avoid agreeing with inaccurate communications, assist w/ ADLs, nonjudgemental, set limits, avoid stressful situations,structure time for activities.
nursing interventions r/t delusions encourage recognition of distorted reality, divert attention to reality based object, avoid arguing, no touching, meds(antipsychotics, antiparkisonians)
nursing inverventions r/t hallucinations protect from injury, pay attn to content of hallucin, avoid arguing, "you appear to be listening to something", make frequent but brief remarks to break up hallucn, antipsychotics, antiparkisonians.
use Bleuler's four A's to help remember the important characteristics of schizophrenia, what are the four A's? Autism(preoccupied w/self), Affect(flat), Associations(loose), Ambivalence(diff. making decisions)
what is a sign of increased command hallucinations? increased motor activity and/or erratic responses to staff and other clients. -increased potential for aggressive behavior.
what meds are used to control hallucinations and delusions, and bizzare behavior? antipsychotics - block excess dopamine
side effects for traditional antipsychotics (Phenothiazines) orthostatic hypotension, weight gain, anticholinergic effects, extrapyramidal effects(pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia) Photosensitivity
nursing implications r/t phenothiazines 2-3 weeks for therapeutic effects, supine for 1 hour after administration, avoid alcohol, sedatives and antacids.
what are some side effects of Haldol? severe extrapyramidal reactions, leukocytosis, blurred vision, dry mouth, urinary retention
Prolixin Decanoate is a long lasting nonphenothiazine, how often would a pt get this medication? Prolixin can be given every 7-28 days and can take up to several months to get steady-state drug levels.
Clozaril is an atypical antipsychotic drug. What unique side effects do this med have and you should watch for? agranulocytosis. Also: drowsiness and dizziness, GI symptoms, neuroleptic malignant syndrome. Monitor WBC for 1st 6 months then biweekly
what are characteristics of agranulocytosis in psychotropic drugs? sore throat, fever, chills: gargle, use lozenges, and analgesics
characteristics of Parkisonism (1-4 wks after initiation of meds) rigidity, shuffling gait, pill rolling, hand movements, tremors, dyskinesia, mask-like face.
characteristics of Akathisia (1-6 wks after initiation of meds) Restlessness, agitation, and pacing. Sudden difficulty sitting still. (rule out anxiety: ask pt, "are you having trouble sitting still?"
Characteristics of dystonia (1-2 days after initiation of tx) Limb and neck spasms, uncoordinated, jerky movements, difficulty speaking and swallowing, rigidity and muscle spasms.
characteristics of tardive dyskinesia (develops late in tx) involuntary tongue and lip movements, blinking, choreiform movements of limbs and trunk.
characteristics of neuroleptic malignant syndrome? high fever, tachycardia, stupor, ^ Respirations, severe muscle rigidity - Emergency situation!
characteristics of serotonin syndrome? confusion, disorientation, autonomic dysfunction.
examples of anticholinergic effects dry mouth, blurred vision, tachycardia,nasal congestion, constipation, urinary retention, orthostatic hypotension
cogentin is an antiparkinsonian drug, what are some side effects of these meds? antihcolinergic effects, drowsiness, headaches, urinary hesitancy, memory impairment
benzodiazapines have 2 types of dosing strategies, what are they? fixed dose; example q6hrs. 2: symptom triggered; dose r/t scale & s/s
how early can s/s of alcohol withdrawal present? s/s such as anxiety, nausea, iinsomnia, tremors, hyperalertness, restlessness, and sudden or gradual increase of VS 4-6 hours
delirium tremors (DTs) may appear ___ to ___ hours after the last drink. 12-36
what are delirium tremors? tachycardia, tachypnea, diaphoresis, marked tremors, hallucinations, paranoia, (possible grand mal seizures)
_____ syndrome is irreversible and usually follows delirium tremens associated w/alcoholism. Korsakoff
a severe d/o occuring in chronic alcoholics that is probably due to lack of Vit B (thiamine). It may escalate Korsakoff syndrome and tx w/ thiamine chloride Wernicke syndrome
what is the preferred tx medication for alcoholics? Antabuse - severe side effects if alcohol is consumed while taking this med. Also:librium or Antivan(antianxiety meds)
what are the side effects of drinking alcohol while taking Disulfiram(antabuse)? N/V, Hypotension, headaches, rapid pulse and respirations, flushed face and blood-shot eyes, confusion, chest pain, weakness, dizziness
what kind of diet and Vitamins would you want to give to an alcoholic pt? high protein diet, limit caffeine, and Vit B1 and B complex
what are some examples of antianxiety drugs? Benzodiazepines: valium, serax, ativan
what kind of defense mechanisims are used by chemically dependent clients? denial and rationalization are the two most common coping styles used
what is the basic priority for a chemically dependent pt? nutrition
what are the three phases of intimate-partner violence? I:tension, II: episode/explosion, III:Honeymoon
describe the Tension stage of r/t abuse. the woman tries to avoid the stressful triggers
describe the Explosion stage r/t abuse. this is the actual account; the abuse; shock and denial
describe the "honeymoon" stage of abuse the abuser is very apologetic, promises change, brings gifts
the basic difference between delirium and dementia is that delirium is ___ and ___, whereas dementia is ____ and ____. acute and reversible, gradual and permanent
what are some causes of delirium? infection, drug reaction, sustance abuse, electrolyte imbalance, head trauma, sleep deprivation
nursing interventions for confused elderly patients should be what? maintaining pt's health and safety, encouraging self care, reinforce reality("good Monday morning mr smith), engage in simple tasks and activities to build self-esteem
what are some things you need to consider r/t a child w/possible ADHD? how many friends do they have?, normal behaviors/developmental tasks, feelings? watch for change.
what are some notable side effects r/t stimulants for an ADHD pt? Tourette's syndrome, tachycardia, palpations, angina, anorexia, weight loss, nausea, abd pain
there are three basic levels to manage ADHD. Briefly what are they? Primary: Headstart, Secondary: Screening, Therapy: family/individual
Created by: jrstrader