Mental Illness Unit Two Test Blue Print
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| Bipolar disorders or manic depressive disorders exhibit sudden | shifts of emotional extremes from depression to mania
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| During the manic phase the nurses interventions need to be focused on | the clients nonstop physical activity and poor nutritional intake
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| Someone that comes in saying that they are the presidnet, they are pacing, they become angry when you try to ask them questions, they are dresed in multi colored clothes they are experiencing a | manic episode
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| An individual in the depressed phase of bipolar disorder will manifest the same SS as an individual with | depression
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| If you are suggesting activities that would be appropriate for the bipolar individual you may need to suggest something they can do alone, such as | writing
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| The drug of choice for treatment of bipolar disorder is | lithium
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| Lithium is referred to as a | "mood stabilizer"
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| Lithium has a very narrow range of therapeutic effectiveness | 0.8-1.2
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| toxic level of lithium is | 1.5 or above
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| periodic blood levels must be done to monitor | the pt is on the correct amount of lithium
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| Depression. Many feelings underlie or contribute to depression especially | learned helplessness, hopelessness, and worthlessness. Other feelings that may cause depression include anger, despair, guilt, resentment, hostility, dependency, negativity, inferiority, low self esteem, feelings of inadequacy, a poor self-image,
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| Depression can also be a sympotom of certain diseases: | diabetes, thyroid disease, systemic, lupus, stroke, cardiac disease and neurotransmitter dysregulation
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| Elavil is an antidepressant and you should monitor | cautiously for urinary retention
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| Elavil S/e | dry mouth, blurred vision, constipation, postural hypotension, monitor BP, due to reduced diaphoreseis caution against strenusous exercise. if this med is given to a pt that has prostatic hypertrophy this can cause an increase of urinary retention
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| ECT Special precautions | Causes Headache, Memory loss, make sure the family knows about everything!
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| Haldol is an antipsychoticand can cause anticholinergic effects such as | dry mouth, blurred vision, constipation, postural hypotension, parkinsonia effects, rigidity, resting tremor, shuffling gait
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| Another SE of Haldol is Dystonia: | bizarre movements of the face and neck, torticollis, culogyric crisis
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| Zoloft and Prozac are Selective Serotonin Reuptake injibitors (SSRIs) and are used to treat depression. Side effects: | dry mouth, blurred vision, constipation, urinary retention, postural hypotension, appetite loss, fatigue, weight loss, diarrhea or constipation, diaphoresis, anxiety, sexual dysfunction, tachycardia and tinnitus. Avoid booze.
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| Special tip for SSRIs (Prozac, Zoloft) | Take early in the morning because they have a tendency to keep people awake!
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| Is one of the top five leading causes of death in the general population. It is the 2nd leading cause of death for ages 15-24 | Suicide.
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| It is always appropriate to ask the pt very directyl if he or she is | suicidal or has ever thoguht about hurting or killing themselves. directly asking doesnot increase the risk of suicide.
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| S/S of Suicide | Previous attempts, giving away stuff, stating "i won't be around much longer" chronic illness, isolation, bereavement or loss, financial stress, severe depression or psychosis, drug abuse, chronic use of hypnotics or sedatives, family history,
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| The S/S of possible suicide is of the highest priority and also when the SS are noted you must privide indiviuals with a safe environment: | remove articles that could be used for suicide, belts, shoelaces, sheets, anything with sharp edges, hair brushes/combs, remove any furniture that can be used for self injury. Check Q15minutes at least. Keep track of utensils
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| Somatoform disorders are characterized by | recurrent, multiple, physical complaints and symptoms for which there is no organic cause
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| Somatoform diagnosis is by | ruling out any possible physical causes of the dysfunction, any drug or other toxic substance reactiuon, or mental health probs that may be related to the symptoms. these pts have innefective coping skills.
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| Motifvators influence the coarse of the somatoform disorder, the individual does not control the symptom. Any pt that is suffering from a somatoform disorder c/o | physical symptoms you must do a physical assessment and monitor their vital signs.
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| Somatoform nursing action is best to assist the pt to | focus on their abilities and strengths
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| Conversion disorder is where the | individual can suffer from deafness, blindness or paralysis due to a stressful situation
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| body dysmorphic disorder is when an | individual sees parts of their body as flawed.
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| Munchausens syndrome a | individual makes themselves ill just to seek medical attention
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| munchausens tends to affect | women more than men
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| Parmate is an MAOI se includes | orthostatic hypotension, HA, abnormal heart rate, blurred vision, dry mouth. You must also caution the pt from consuming any foods or beverages containing tyramine.
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| Congentin is an anticholinergic med that | slows down Extrapyramidal symptoms
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| Desyrel is an antidepressant that can be taken with food to | decrease vertigo
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| SE of Desyrel | dry mouth, blurred vision, constipation, urinary retention, postural hypotension and possible vertigo
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| A symptom of COnversion disorder is "la bell eindifference" | when the pt consults the physician with symptoms they give the impression of really not caring about the problem
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| Affect is | verbal and nonverbal behavior that communicates feelings
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| Secondary gain is | love and attention from having an illness
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| Anorexia Nervosa is a sever form of | self-starvation that can lead to death. It occurs predominantly in adolsecent girls of above average intelligence.
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| Bulimia is also know as | gorge-purge syndrme (they alternate binge eating with purging) it is an eating disorder characterized by binge eating. It is most commmon in young women.
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| Unlike anorezia nervosa, bulimia is characterized by | alternating episodes of eating abnormally large quantities of food and calories with induced intestinal purging by means of vomiting or laxatives or both.
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| Anorexia Nervosa Physical S/S | decrease of 25% in body weight; weight is 85% or less of normal; lanugo; alopecia; cold intolerance; amenorrhea; constipation; abdominal pain
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| Anorexia Nervosa Emotional SS | distorted body image; hatred of a particular body part; low self esteem; depression; isolation; perfectionism
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| Anorexia Nervosa Behavorial SS | Restriction of food choices and intakel ritualistic handling of foodl weighing onesef frequently; denial of hunger
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| Bulimia Nervosa Physical SS | Inability to interpret accurately hunger and fullness signals; swelling of parotied glands; frequent weight fluctuations; irregular menses
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| Bulimia Nervosa Emotional SS | Feeling unable to control eating, depressive mood and frequent mood swings; black and white thinking; exaggerated concern about weight
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| Bulimia Nervosa Behavioral SS | Excessive exercise, use of diuretics, and laxatives, secret eating of high-calorie, high carb foods; alternately binging and fasting.
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| Client and family teaching about anorexia nervosa | focus on the person, not the disease; give unconditional love; avoid making them feel guilty; give them power to make decisions; avoid being manipulated by the anorexic; demonstrate support; prepare for rehospitalization if the clietnt becomes unstable.
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| Examples of Mood and Affect: HAPPY | smiling, briskly walking, paying attention to appearance, showing a positive attitude, being cooperative, creative, gregarious
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| Examples of Mood and Affect: DEPRESSED | looking gloomy, being inactive, neglecting appearance, feeling empty, showing no initiative, being insensitve to others feelings or isolated
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| Conditions that Mimic depression | hypothyroidism, brain tumor, alcohol or sedative abuse, stimulant withdrawal, chronic hypoxia, side effects of drug therapy such as corticosteroids, antihypertensives
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| Tricyclic antidepressants such as | amitryptyline *elavil* and imipramine *tofranil* were the first group of drugs to treat depression; they are occasionally prescribed for clients with chronic pain.
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| Cyclic antidepressants block the reuptake of | serotonin and norepinephrine.
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| Nursing interventions for Tricyclic antidepressants (elavil) | inform client that max relief may not cocur for 2-4 weeks or longer, caution client to rise slowinly from sitting or lying, blurred vision and dry mouth will decrease, discuss suicide, discontinue gradually.
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| Nursing Considerations MAOIS (Parnate) | provide diet restriction info, advise client to wear ID bracelet, educate about demerol lethal interaction, explain 2-6 week delay, take last dose earlier than bed time to avoid sleep disturb,
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| Nursing considerations for SSRIs, (prozac, zoloft) | instruct client to avoid caffeeine or cardiac supplements, monitor BP and HR, Allow 14 days before switching to MAOI, Monitor for serotonin syndrome (drugdrug interactions)
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| ECT uses the application of an electric stimulus to one or both temporal regions of the head to produce a brief, generalized seizure. Although the exact mechanism of action is unknown, the belief is that ECT | achieves its effect either by increasing circulating levels of monoamine neurotransmitters or by improving transmission to the receptor site.
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| ECT is usually reserved for those clients who are depressed and | have not responded to drugs, are intolerant of the SE of antidepressant meds, are so seriously suicidial that waiting for antidepressants to become effective jeopardizes their safety.
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| FOOD and beverages to avoid with MAOI therapy | aged, hard cheese, chocolate, pickled herring, overripe bananas, chicken liver, dried fish, fermented meat, yogurt, pepperonie sausage, sour crea, fava beans, monosodium glutamate, beer, soy sauce, red wine, meat tenderizer
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| Drugs affecting serum lithium levels - INCREASE lithium level | tetracycline, thiazide diurteics, loop diuretics, NSAIDS, haloperidol
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| DRugs affecting serum lithium levels - Decrease serum lithium levels | theophylline, aminophylline, carbamazepine, sodium bicarbonate, osmotic diuretics
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| Monitor for ss of lithium toxicity | diarrhea, vomiting, nausea, drowsiness, muscular weakness, twitching, and lack of coordination
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| polyuria can occur with admin of lithium. unless contraindicated because of a disease condition, the client may require an | increase in fluids up to 3000 mL/day to maintain fluid balance.
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