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1. Which data gathering technique is employed during the assessment phase of the nursing process? A. Asking the client to rate mood after administering an antidepressant B. Asking the client to verbalize understanding of previously explained unit rules C. Asking the client to describe any thoughts of self-harm D. Asking the client if the group on assertiveness skills was helpful

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ANS: C The nurse should ask the client to describe any thoughts of self-harm during the assessment phase of the nursing process. Assessment involves collecting and analyzing data about the client that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. The other three options are employed during the evaluation phase of the nursing process. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

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2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? A. Medical history is of little significance and can be eliminated from the nursing assessment. B. Assessment provides a holistic view of the client including biopsychosocial aspects. C. Comprehensive assessments can be performed only by advanced practice nurses. D. Psychosocial evaluations are gained by subjective reports rather than objective observations.

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ANS: B The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

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3. Which nursing diagnosis should a nurse identify as being correctly formulated? A. Schizophrenia R/T biochemical alterations AEB altered thought B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance C. Depressed mood R/T multiple life stressors D. Developmental disability R/T early-onset schizophrenia AEB hallucinations

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ANS: B The nurse should determine that the correctly written diagnosis would be Self-care deficit: hygiene R/T altered thought AEB disheveled appearance. The nursing diagnosis should describe the client's condition, facilitating the choice of interventions. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

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4. Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge. B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days.

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ANS: D The statement "Client will initiate interaction with one peer during free time within 2 days." is an example of a correctly formulated expected outcome. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

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5. Which statement regarding nursing interventions should a nurse identify as accurate? A. Nursing interventions are independent from the treatment team's goals. B. Nursing interventions are solely directed by written physician orders. C. Nursing interventions occur independently but in concert with overall treatment team goals. D. Nursing interventions are standardized by policies and procedures.

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ANS: C The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved in the client's care. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

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6. Within the nurse's scope of practice, which function is exclusive to the advance practice psychiatric nurse? A. Teaching about the side effects of neuroleptic medications B. Using psychotherapy to improve mental health status C. Using milieu therapy to structure a therapeutic environment D. Providing case management to coordinate continuity of health services

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ANS: B The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. It is within the scope of practice of a registered psychiatric mental health nurse generalist to provide education, case management, and milieu therapy. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

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7. A nurse charts "Verbalizes understanding of the side effects of Prozac." This is an example of which category of focused charting? A. Data B. Problem C. Action D. Response

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ANS: D "Verbalizes understanding of the side effects of Prozac." is an example of the response category of focused charting. The response is a description of the client's reaction to any part of medical or nursing care. PTS: 1 REF: 182 KEY: Cognitive Level: Application | Integrated Process: Implementation

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9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? A. CIWA scale B. GGT C. MMSE D. CAPS scale

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ANS: C The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdrawal from substances such as alcohol. The CAPS refers to the clinician-administered PTSD scale and would be used to assess signs and symptoms of PTSD. The GGT test is used to assess gamma-glutamyl transferase levels which may be an indication of alcoholism. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Assessment

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10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? A. Mood B. Perception C. Orientation D. Affect

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ANS: C The nurse should ask the client to identify name, date, residential address, and situation to assess the client's orientation. Assessment of the client's orientation to reality is part of a mental status evaluation. PTS: 1 REF: 172 KEY: Cognitive Level: Comprehension | Integrated Process: Assessment

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11. What is the purpose when a nurse gathers client information? A. It enables the nurse to modify client behaviors related to personality disorders. B. It enables the nurse to make sound clinical judgments and plan appropriate client care. C. It enables the nurse to prescribe the appropriate medications. D. It enables the nurse to assign the appropriate Axis I diagnosis.

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ANS: B The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client including information collected from the client, significant others, and health-care providers. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

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13. The following outcome was developed for a client: "Client will list five personal strengths by the end of day 1." Which correctly written nursing diagnostic statement most likely generated the development of this outcome? A. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements B. Self-care deficit R/T altered thought processes C. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 D. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

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ANS: A The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day 1. Self-care deficit, disturbed body image, and risk for disturbed self-concept would generate specific outcomes in accordance with specific needs and goals. The self-care deficit and risk for disturbed self-concept nursing diagnoses are incorrectly written. PTS: 1 REF: 172 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

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14. How should a nurse prioritize nursing diagnoses? A. By the established goal of care B. By the life-threatening potential C. By the physician's priority of care D. By the client's preference

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ANS: B The nurse should prioritize nursing diagnoses related to life-threatening potential. Safety is always the nurse's first priority. PTS: 1 REF: 178 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

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15. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping. Which is a correctly written and appropriate outcome for this client's problem? A. The client will avoid daytime napping and attend all groups. B. The client will exercise, as needed, before bedtime. C. The client will sleep 7 uninterrupted hours by day four of hospitalization. D. The client's sleep habits will improve during hospitalization.

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ANS: C The outcome "The client will sleep 7 uninterrupted hours by day four of hospitalization." is accurately written and an appropriate outcome to address the client problem of insomnia. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. PTS: 1 REF: 173 KEY: Cognitive Level: Analysis | Integrated Process: Planning

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16. The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement? A. The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism. B. The client has a history of four suicide attempts in adolescence. C. The client expresses hopelessness and helplessness and isolates self. D. The client has disorganized thought processes and delusional thinking.

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ANS: A The nurse should identify that a client receiving ECT and who is diagnosed with Parkinsonism is at risk for injury due to confusion and potential for falls. History of suicide and hopelessness would lead to the development of a risk for suicide nursing diagnosis. Disorganized thoughts and delusional thinking would lead to the development of an altered thought process nursing diagnosis. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

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17. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which reply by the instructor most accurately answers the student's question? A. "Use the Nursing Interventions Classification (NIC) as a reference for nursing outcomes." B. "Look at your client's problems and set a realistic, achievable goal." C. "Use the Nursing Outcomes Classification (NOC) as a reference for nursing outcomes." D. "Copy your standard outcomes from a nursing care plan textbook."

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ANS: C NOC is a comprehensive, standardized classification of client outcomes developed to evaluate the effects of nursing interventions. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

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18. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this client's problem? A. Altered thought processes B. Altered sensory perception C. Anxiety D. Chronic confusion

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ANS: B The nursing diagnosis altered sensory perception accurately reflects the client's symptoms of hearing things that others do not. A nursing diagnosis describes a client's condition and facilitates the prescription of interventions. Delusional thinking, confusion, and disorientation are problems associated with the nursing diagnosis of altered thought processes. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

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19. A nurse is evaluating the effectiveness of teaching after instructing a group of clients on joint replacement. In the evaluation step of the nursing process, which learning domain is the most difficult to measure? A. Normative domain B. Affective domain C. Cognitive domain D. Psychomotor domain

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ANS: B Affective knowledge is the most difficult to evaluate because of differences in values, cultures, and attitudes. PTS: 1 REF: 174 KEY: Cognitive Level: Application | Integrated Process: Evaluation

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20. A client is recovering from abdominal surgery. In order to maximize the learning process prior to discharge teaching, which assessment should be performed by the nurse? A. Assessing the client's level of pain B. Assessing and documenting the client's vital signs C. Assessing skin turgor and hydration status D. Assessing incisional site for serosanguineous drainage

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ANS: A Pain will distract the client and interfere with the learning process. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

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21. During the implementation phase of the nursing process, a nurse is teaching an adult with a cochlear implant about medications. Which modification in the teaching plan would be the most appropriate for this client? A. Using repetition B. Speaking directly face-to-face C. Employing the use of sign language D. Providing large-print materials

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ANS: B Speaking face-to-face is an appropriate way to teach individuals with alterations in hearing. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

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22. A client who has slept 6 hours the previous night reports this to the assigned psychiatric nurse. What should be the initial nursing action to address this situation? A. Provide warm milk and a backrub. B. Give a sleep medication. C. Hold a relaxation group before bedtime. D. Review the client's normal sleep pattern.

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ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. In this situation, the nurse must initially determine the client's normal sleep patterns in order to evaluate if a true problem exists. PTS: 1 REF: 165 KEY: Cognitive Level: Analysis | Integrated Process: Assessment

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23. An instructor overhears a student say, "That family seems to disagree more than agree. The family seems to be dysfunctional." To further assess the family's situation, which would be an appropriate instructor reply? A. "Families who disagree can be a challenge to the treatment team." B. "You seem very critical of the family. Do you believe that you are unable to help them?" C. "Let's bring the family in for an educational session to improve their communication." D. "What appears to trigger family disagreements?"

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ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. In this situation, prior to intervening with this family, the nurse needs further information about the cause of family conflicts. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

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24. Which nursing response would be appropriately used in the evaluation phase of the nursing process? A. "If I were in your situation, I would not repeat a behavior that has caused problems." B. "What do you think needs changing, and what do you want to do differently?" C. "What exactly will it take to carry out your plan, and what else do you need to do?" D. "This new approach seems to work for you."

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ANS: D In the evaluation phase of the nursing process, the nurse evaluates progress toward attainment of the expected outcomes. PTS: 1 REF: 174 KEY: Cognitive Level: Application | Integrated Process: Evaluation

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25. A client diagnosed with major depressive disorder states, "Why should I keep trying to get a job? I mess up everything I do." Which correctly written nursing diagnosis best reflects the content and mood themes in this client's statement? A. Hopelessness R/T poor job performance B. Risk for impaired adjustment R/T inadequate social skills AEB isolation C. Altered role performance R/T the fear of failure AEB not seeking employment D. Chronic low self-esteem R/T major depressive disorder AEB self-hatred

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ANS: C An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem, it doesn't as of yet exist. The client's statement indicates that role performance is altered due to the fact that fear of failure prevents seeking employment. PTS: 1 REF: 172 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

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26. During an intake interview, which question would assist the nurse in gathering data about the client's judgment? A. "What brought you to the hospital? Do you know what day and season it is now?" B. "On a scale of 1 to 10, how would you rate your stress level?" C. "What does the phrase 'a rolling stone gathers no moss' mean to you?" D. "If you found a stamped, addressed envelope in the street, what would you do?"

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ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. The nurse presents a situation that requires the client to make a judgment call and can assess appropriate judgment based on the client's action choice. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

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27. An adolescent client has problems expressing anger appropriately. Which nursing statement would encourage the client to set realistic goals? A. "What do you think needs to change about how you express anger?" B. "How did you feel after attending the anger management session?" C. "On a scale of 1 to 10, please rate your current level of anger." D. "What bothers you about the actions of others when you get angry?"

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ANS: A In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client or to the situation. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

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28. The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and rarely made eye contact. Which is the most complete documentation of baseline data obtained during the interview? A. "Appears uncooperative. Exhibits characteristics of depression." B. "Maintains poor eye contact throughout interview process. Unable to answer interview questions due to depression." C. "States, 'I don't need to be here.' when discussing admission status. Maintains minimal eye contact and offers little data related to triggers for admission." D. "Unwilling to respond openly during interview."

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ANS: C Documentation occurs in the implementation phase of the nursing process. All charting entries to the client's legal record should be objective and based on assessed data. Implications and generalizations should be avoided. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

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29. A client is assigned the nursing diagnosis of impaired social interaction R/T socio-cultural differences AEB client stating, "Although I'd like to, I don't join in because I don't speak the language so good." Which correctly written outcome addresses this client's problem? A. The client will collaborate with nursing staff to set specific goals by day 3. B. The client will participate in one group activity of choice by day 2. C. The client will express a desire to interact with others. D. The client will become increasingly independent by discharge.

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ANS: B In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client need or to the situation. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

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30. The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. The triage nurse should expect which client to be admitted? A. The client who is experiencing tremors and has a need for medication adjustment B. The client who is experiencing anxiety and a sad mood after separation from spouse C. The client who is a single parent and hears voices stating, "Kill your infant son" D. The client who argued with her boyfriend and inflicted a superficial cut on her arm

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ANS: C In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. These data are prioritized to meet client needs with an emphasis on safety. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

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31. Which of the following nursing interventions fall within the standards of psychiatric-mental health clinical nursing practice for a nurse generalist? (Select all that apply.) A. Assist clients to perform activities of daily living. B. Consult with other clinicians to provide services for clients and effect system change. C. Encourage clients to discuss triggers for relapse. D. Use prescriptive authority in accordance with state and federal laws. E. Educate families about signs and symptoms of alcohol dependence and withdrawal.

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ANS: A, C, E Assisting clients to perform daily living activities, encouraging clients to discuss triggers, and educating families are nursing interventions that fall within the standards of psychiatric clinical nursing practice for a nurse generalist. Psychiatric-mental health advanced practice registered nurses can consult with other clinicians and use prescriptive authority. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

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32. Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.) A. Client outcomes are specifically formulated by nurses. B. Client outcomes are not restricted by time frames. C. Client outcomes are specific and measurable. D. Client outcomes are realistically based on client capability. E. Client outcomes are formally approved by the psychiatrist.

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ANS: C, D The nurse should identify that client outcomes should be specific, measurable, and realistically based on client capability. Outcomes should be derived from the diagnosis and should include a time estimate for attainment. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, client, and significant others. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

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33. After a comprehensive assessment, correctly written nursing diagnoses developed for psychiatric clients may include which of the following components? (Select all that apply.) A. Medical judgments related to the psychiatric disorder B. Unmet client needs present at the moment C. Supporting data that validate the diagnosis D. Outcomes that will be targets for nursing interventions E. Statements of client problems of a functional nature

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ANS: B, C, E A nursing diagnosis is a statement of a client's functional problem. An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem, it does not as yet exist. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

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Attention-Deficit/Hyperactive Disorder

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persistent pattern of inattention and/or hyperactivity impulsivity that interferes with functioning or development

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Diagnostics Criteria for ADHD

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Inattention Hyperactivity and Impulsivity

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Etiology - ADHD

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Sx presents before age 7 Must have 6 or more symptoms persisting at least 6 months Sx present in two or more settings Impairment in social, academic, occupational setting

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Inattention - Characteristics

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Deficit in: 1. Attention 2. Sustaining attention 3. Listening 4. Following through instruction 5. Organizing tasks and activities 6. Interest in activities require mental effort Also: 7. Loses things necessary for tasks/activities 8. Often forgetful

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Hyperactivity - Characteristics

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1. Fidgets hands/feet or squirm in seat 2. Hard to remain seated 3. Runs/climbs excessively 4. Hard to play or engage in activities quietly (loud) 5. "On the go" or "driven by the motor" 6. Talk excessively.

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Impulsivity - Characteristics

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1. Blurts out answer before question finished 2. Difficulty waiting turn 3. Interrupts or intrudes

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ADHD causes

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1. Genetics 2. Body chemistry: dopamine, norepinephrine, serotonin 3. Brain alterations 4. Prenatal, perinatal, postnatal factors: smokers during pregnancy; intrauterine toxicity (alcohol, etc.); prematurity; low birth weight.

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Food substances (dyes, additives, etc.) play role in ADHD?

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NO

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85% comorbidity of ADHD & psych disorders. All can be treated concurrently, except in .......

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Substance abuse Bipolar disorder

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ND r/t ADHD

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1. Risk for injury r/t impulsive, accident-prone, inability to perceive self harm 2. Low self-esteem r/t dysfunctional family system and negative feedback 3. Non-compliance (with task expectations) r/t low frustration tolerance and short attention span

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ND #1 - GOAL Risk for injury r/t impulsive, accident-prone, inability to perceive self-harm

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Free from injury

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ND #1 - INTERVENTIONS Risk for injury

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1. Safe environment ~ Remove hazardous items 2. Identify risk-for-injury behaviors & institute consequences ~ Aversive reinforcement --> modify behavior 3. Provide adequate supervision ~ Safety is priority

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ND #2 - GOALS Low Self-esteem

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1. Independently direct own care/ADLs 2. Increased self-worth (verbalizing positive statements about self; less demanding behavior) 3. Identify factors lead to low self-esteem 4. Verbalize view of self-worth 5. Self-confidence (setting realistic goals & activity, and participate in life situation) 6. Participate in treatment program to promote self-evaluation

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ND #2 - INTERVENTIONS

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1. Realistic goals ~ Unrealistic goals --> set up for failure --> diminishes self-esteem 2. Plan activities for successful opportunities ~ enhances self-esteem 3. Unconditional acceptance & positive regard ~ affirmation of worth-while ct --> increase self-esteem 4. Immediate recognition & positive feedback/reinforcement ~Enhance self-esteem & increased desire behavior

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ND #3 - GOALS Non- compliance

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1. Participate and cooperate in therapeutic activities 2. Able to complete task s willingly and independently/minimum assistance

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ND #3 - INTERVENTIONS Non-compliance

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1. Free distractions environment ~ highly distractible even with minimal stimuli 2. One-to-one assistance for simple and concrete instructions ~ unable assimilate complicated and abstract information 3. Ask to repeat instructions ~ repetition --> identify level of comprehension 4. Establish goals to complete part of task, rewarding each task ~ short term goals --> not overwhelming; reward --> increase self-esteem & incentive 5. Gradually decrease assistance given while assuring assistance available if deemed necessary ~ independent & security

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Meds for ADHD

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Amphetamines: Vyvanse Dexedrine Adderall Should be used cautiously with comorbid condition: Cardiac & drug abuse Black box warning: sudden death

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Meds for ADHD - other

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Buproprion (Wellbutrin) Cautious with comorbid: seizures, bulimia, anorexia

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S/E for ADHD Meds

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Over-stimulation Restlessness Insomnia

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Insomnia r/t ADHD Meds - Interventions

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1. Prevent injury 2. Low stimulation - Quiet environment 3. Administer last dose at least 6 hours before bedtime

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Anorexia/wt loss r/t ADHD Meds - Interventions

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1. Take med immediately after meals 2. Weigh regularly

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Tolerance/withdrawal r/t ADHD Meds

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1. Rapidly developed 2. Drug holiday (at MD advice) to eval effectiveness and necessary continuation 3. No abrupt stop - Withdrawal S/E: N/V, abd cramping, HA, fatigue, weakness, mental depression, suicidal ideation, increased dreaming, psychotic behavior

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CONDUCT DISORDER (CD) - specific

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Violation of the basic rights for others

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Family influences in CD

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1. Parental rejection 2. Inconsistent mgmt/Harsh discipline 3. Early institutional 4. Frequent shifting of parental figures 5. Large family size 6. Absent father 7. Parents with antisocial PD/alcohol dependence 8. Marital conflict or divorce 9. Inadequate communication 10. Parental permissiveness

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Diagnostic Criteria CD

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1. Aggression to People or animals 2. Destruction of Property 3. Deceitful or Theft 4. Serious violations of rules

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Aggression to People or animals

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1. Bullies, threatens/intimidates 2. Initiatives physical fights. 3. Used weapon (bat, brick, knife, etc.) to harm others 4. Physically cruel to people/animals 5. Stole while confronting a victim 6. Sexual forced

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Deceitful/Theft

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1. Broken into other's house/car/etc. 2. Lies to obtain goods/favors or avoid obligations 3. Stole items without confrontation

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Serious violations to the rules

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1. Beginning before 13 of age, stays out despite parental prohibitions 2. Run away from home for long period of time 3. Truant from school before 13

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Etiology CD

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~ The pattern behavior manifested by the presence of three or more of these criteria in the past 12 months with at least one criterion present in the past 6 months. ~ Cause clinically impairment in social, economic and occupational functioning ~ Addtl: tobacco/liquor/non-prescribed drugs use; sexually active (early); low self-esteem; tough guy image; poor frustration tolerance; irritability, frequent temper outbursts; NOT anxiety, depression sx; ADHD is common.

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ND #1 - Conductive Disorder (CD)

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Risk for Other-Directed r/t characteristics of temperament, peer rejection, negative parental role models, dysfunctional family dynamics.

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ND #1 - CD - Goals

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1. Discuss feelings of anger 2. Will not harm others/property

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ND #1 - CD - Intervention

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1. Observe behavior frequently through routine activities ~ aware of agitation --> prevent/interven before violence occur 2. Redirect violent behavior with physical outlets for suppressed anger/frustration ~ Release excess energy/anger --> feeling of relaxation 3. Express anger and act as role model for anger expression ~ create anger --> effective to deal with it 4. Sufficient staff --> show strength ~ evidence of control over situation & security for staff 5. Tranquilizing medications or mechanical restraints/isolation ~ ensure safety

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ND #2 - CD

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Defensive Coping r/t low self-esteem and dysfunctional family system

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ND #2 - CD - Goals

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1. Verbalize personal responsibilities for difficulties experienced in interpersonal relationships 2. Accept responsibility for own behaviors without being defensive

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ND #2 - CD - Interventions

answer

1.

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mood

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Apervasive and sustained emotion that colours one's perception of the world and how one functions. Normal variations in mood: - Sadness - Euphoria - Anxiety Variations occur in response to specific life experiences and are time limited Not normally associated with significant functional impairment

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Major Depressive Disorder (MDD)

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One or more depressive episodes Depressed mood or a loss of interest or pleasure in nearly all activities AND 4 or the following 7 additional symptoms: 1. Disrupted sleep patterns 2. Appetite (weight) changes 3. Poor concentration 4. Loss of energy 5. Psychomotor agitation or retardation 6. Excessive guilt or feelings of worthlessness Suicidal ideation Can include: - psychotic features - melancholic features: - atypical features - catatonic features - Postpartum onset - Seasonal features (seasonal affective disorder [SAD])

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psychotic features

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presence of disorganized thinking, delusions (of guilt or being punished for sins, horrible disease or body rotting, poverty, bankruptcy), or hallucinations (usually auditory)

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atypical features

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includes vegetative symptoms such as overeating and oversleeping

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catatonic features

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unresponsiveness and psychomotor retardation

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seasonal effectiveness disorder

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episodes of depression begin in the fall/winter and remit in the spring there is reduced cerebral metabolic activity this disorder is characterized by anergia, hypersomnia, overeating, weight gain and a craving for carbs; it responds to light therapy

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short-duration depressive episode

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depressive affect with at least four of the eight symptoms of MDD that persists more than four days but less than fourteen days

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diathesis-stress model of depression

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takes into the interplay of biology and life events in the development of depressive disorders early life trauma may result in sensitization of the corticotropin-releasing factor (CRF) circuits to even mild stress in adulthood --> exaggerated stress response

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cognitive theory

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the underlying assumption is that a person's thoughts will result in emotions; if a person looks at his or her life in a positive way, the person will experience positive emotions people may acquire a psychological predisposition due to early life experiences where negative predispositions can be reactivated during times of stress

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Beck's cognitive triad

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1. A negative, self-deprecating view of self 2. A pessimistic view of the world 3. The belief that negative reinforcement (or no validation for the self) will continue in the future *realizing that one has an ability to interpret life events in positive ways provides and element of control over emotions and, therefore, over depression

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Learned helplessness theory of depression

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although anxiety is the initial response to a stressful situation, it is replaced by depression if the person feels no control over the outcome

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Children - depression

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- Similar manifestations to those seen in adults - Less likely to experience psychosis (auditory hallucinations more common than delusions) - More likely to have anxiety and somatic symptoms

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Adolescents - depression

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- mood may be irritable rather than sad - risk for suicide highest in mid-adolescents (15+)

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Older adults - depression

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not a normal part of aging!

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anhedonia

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loss of ability to experience joy or pleasure in living occurs in almost 97% of people living with depression

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psychomotor agitation

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constant pacing or wringing of hands

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psychomotor retardation

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slowed movements and somatic complaints of headaches, malaise, backaches)

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vegetative signs of depression

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alterations in those activities necessary to support physical life and growth e.g. change in BM and eating habits, sleep disturbances, lack of interest in sex

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Nursing Phases of treatment and recovery from MD

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1. acute phase: - 6-12 weeks and directed at reduction of depressive symptoms and restoration of psychosocial/work function 2. continuation phase: - 4-9 months is directed at prevention of relapse through pharmacotherapy, education, and depression-specific psychotherapy 3. maintenance phase: - one year or more is directed at prevention of reoccurrences of depression **keeping the pt. a functional and contributing member of the community after recovery from the acute phase is the goal**

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Selective serotonin reuptake inhibitors (SSRIs)

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recommended as first-line therapy for most types of depression; they block the neuronal uptake of serotonin increasing availability in the synaptic cleft they have relatively low adverse effects (no dry mouth, blurred vision, urinary retention; effective in depression with anxiety features and with psychomotor agitation sometimes used to treat anxiety, OCD and panic disorders

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serotonin syndrome

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a syndrome thought to be related to over activation of the central serotonin receptors, caused by either too high a dose or interaction with other drugs symptoms include abdominal pain, diarrhea, sweating, fever, tachycardia, elevated blood pressure, altered mental state, myoclonus, increased motor activity, irritability, hostility and mood change risk is highest when used in conjunction with MAOIs

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tricyclic antidepressants

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inhibit the reuptake of norepinephrine and serotonin presynaptically have sedative effects likely due to blockage of histamine receptors with a 10-14 day onset with full effects maybe 4-8weeks; choosing is based on what has worked for pt or not; similar to antipsychotic agents, therefore anticholinergic actions are similar - dry mouth, blurred vision, tachycardia, constipation, urinary retention, GERD Administering at night is beneficial because: 1. most TCAs have sedative effects; 2. the minor adverse effects occur while sleeping, increasing drug adherence

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monamine oxidase

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the enzyme responsible for breaking down norepinephrine, serotonin, dopamine and tyramine in the brain

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Monoamine oxidase inhibitors (MAOIs)

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anti-depressants that prevents the amines from becoming activated that breakdown NE, serotonin, dopamine and tyramine resulting in mood elevation tyramine is of concern, as increased levels can cause high BP, hypertensive crisis and eventually cerebrovascular accident particularly effective for atypical depression, panic disorder, social phobia, generalized anxiety, OCD, PTSD and bulimia

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ECT

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- Mechanism of action unknown - Effective treatment for severe depression Treatment-resistant depression or so severely ill that rapid treatment is required - Several contraindications - Appears to be more effecitve in older adults RNs role: patient education and monitoring

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Bipolar I

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at least one episode of mania alternates with major depression; psychosis may accompany the manic episode

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Bipolar II

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hypomanic episode(s) alternate with major depression; psychosis is not present hypomania tends to be euphoric; depression tends to put people at higher than average risk for suicide more common in women

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unipolar depression

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depression without episodes of mania

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Mania

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characterized by: 1. mood; 2. behaviour; 3. thought processes and speech patterns; and 4. cognitive function has three phases, which guide panning of care: 1. acute 2. continuation (4-9mos) 3. maintenance

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Hypomania

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mild to moderate state in which people have voracious appetites for social engagement, spending, activity, and even indiscriminate sex; constant activity and a reduced need for sleep

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flight of ideas

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a nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations or plays on words

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grandiosity

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inflated self regard, is apparent in both the ideas expressed and behaviour

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clang associations

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the stringing together of words because of their rhyming sounds, without regard to their meaning

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Lithium carbonate

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effective in the treatment of bipolar I acute and recurrent manic and depressive episodes and inhibits about 80% of acute manic and hypomanic episodes within 10-21 days Indicated for reducing: - elation, grandiosity, and expansiveness - flight of ideas - irritability and manipulation - anxiety To a lesser extent, this drug controls: - insomnia - psychomotor agitation - threatening behaviour - distractibility - hyper sexuality - paranoia Often supplemented with olanzapine to prevent exhaustion/cardiac collapse and has a narrow therapeutic level 0.4-1.0 (toxic) therefore fluid levels and sodium levels are watched 2 longterm affects: - hypothyroidism - impairment of the kidneys' ability to concentrate urine

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Anticonvulsant drugs: Bi-polar treatment

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Do not support the Kindling Theory, but are thought to be: - superior for continuously cycling patients - more effective when no family hx of bipolar - effective at dampening affective swings in schizoaffective pts - effective at diminishing impulsive and aggressive behaviour in some non psychotic pts - helpful in cases of alcohol and benzo withdrawal - beneficial in controlling mania (within 2 weeks) and depression (within 3 weeks or longer) 3 drugs are generally used: 1. Divalproex sodium 2. Carbamazepine 3. Lamotrigine

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Divalproex sodium

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an anticonvulsant chemically related to valproic acid; useful in treating lithium non responders in acute mania, rapid cycles, in dysphoric mania or have not responded to carbamazepine and preventing future mania Liver fun and platelet count must be monitored; can cause drowsiness/dizziness and increase SI normal dose: 50-100mcg

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Carbamazepine

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an anticonvulsant used with treatment-resistant bipolar for rapid cycling and severely paranoid, angry pts experiencing mania (dysphoric) can cause bone marrow suppression and liver inflammation, therefore liver fxn and platelet count should be monitored weekly for up to 8 weeks

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Clonazepam and lorazepam

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anti-anxiety drugs useful in the treatment of acute mania in some pts who are resistant to other treatments effective in managing psychomotor agitation seen in mania AVOID: substance abusers

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Olanzapine, risperidone, and quetiapine

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atypical anti-psychotics that have sedative properties and seem to have mood-stabilizing properties and may be better tolerated and prevents mania relapse more effectively than lithium

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suicide

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the act of taking one's own life

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suicidal behaviour

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used to describe potentially self-injurious actions with a nonfatal outcome for which there is evidence that a person intended to kill him/herself e.g. self harm, SI, desire to hasten death, risky behaviour, suicide threats

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suicidal ideation

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suicidal thoughts

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Personality

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- complex pattern of characteristics, largely outside of the person's awareness - distinctive patterns of perceiving, feeling, thinking, coping and behaving - emerges within bio-psychosocial framework

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Personality disorder

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- an enduring pattern of deviant inner experiences and behaviours - differ from cultural expectations; pervasive, inflexible and stable - leeds to distress or impairment

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Cluster A

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1. Paranoid personality disorder 2. Schizoid personality disorder 3. Schizotypal personality disorder

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Paranoid personality disorder (suspicious pattern)

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Features: - Mistrustful, avoid relationships that cannot control. Incidents are often misinterpreted as having sinister or hidden meaning. - These people are blind to their own behaviours; they are often hypercritical and attribute these traits to others (projection) Management: - Nurse-client relationship may be difficult to establish (mistrust) - Need to use therapeutic communication technique such as acceptance, confrontation, and reflection, etc. - Goal is to examine problematic area and gain another view of the situation. - Associated anxiety may be treated with psychotropics --> May be treated with anti-anxiety meds or a low dose Seroquel

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Schizotypal personality disorder (eccentric pattern)

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Features: - eccentric (unconventional ; slightly strange) - pattern of social and interpersonal deficits, no close friends - odd beliefs, ideas of reference - when psychotic, symptoms mimic schizophrenia Nursing interventions: - similar to that with schizo - provide social skills training - reinforcing and modelling socially appropriate behaviour

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Cluster B

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1. Borderline personality disorder 2. Antisocial personality disorder 3. Histrionic personality disorder 4. Narcissistic personality disorder

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Borderline personality disorder (BPD)

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Features: - pervasive patterns of instability of interpersonal relationships, self-image, and affects, as well as marked impulsivity that begins by early adulthood and is present in a variety of contexts - they appear more competent then they really are - when personal expectations are not met, they experience various emotions such as intense shame, self-hate, self directed anger, etc. - live from crisis to crisis (soap opera) Affective instability: - rapid and extreme shifts in mood Identity disturbance: - personality is poorly developed Unstable interpersonal relationships: - fear of abandonment, insecure attachments Cognitive dysfunction: - dichotomous thinking; dissociation

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Splitting

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the primary defence or coping style used by people with BPD; the inability to incorporate positive and negative aspects of oneself or others into a whole image e.g. individual may tend to idealize another person (friend, lover, nurse) at the start of a new relationship, hoping that this person will meet all of his or her needs; but the first disappointment, the individual quickly shifts to devaluation, despising the other

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Interventions for BPD

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1. Dialectical Behavioural Therapy (DBT) 2. Sleep enhancement 3. Prevention and treatment of self-injury 4. Establishing boundaries and limitations 5. Management of dissociative states 6. Behavioural Interventions 7. Pharmacological

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Antisocial personality disorder

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Features: - pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence - behaviourally impulsive and interpersonally irresponsible - fail to adapt to the ethical and social community standards - interpersonally engaging, but in reality lack empathy; lack of remorse - easily irritated, often aggressive directed at others Interventions: - Milieu interventions - establish clear boundaries

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Histrionic personality disorder

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Features: - attention seeking, life of the party, uncomfortable w/single relationship - women: dress seductively - men: dress "macho" - become depressed when not centre of attn Interventions: - help develop a sense of self w/out validation of others - ensure that the pt does not become dependant on the mental health system - reinforce personal strengths - encourage the pt to act autonomously

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Narcissistic personality disorder

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Features: - grandiose, inexhaustible need for admiration and lack of empathy - believe that they are superior, unique, special - they define the world through their own self-centred view

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Cluster C

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1. Avoidant personality disorder 2. Dependent personality disorder 3. Obsessive-compulsive personality disorder

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Avoidant personality disorder

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Features: - avoiding interpersonal contacts and social situations - perceiving themselves as socially inept Interventions: - focus on refraining negative criticism; explore previous achievements of success

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Dependent personality disorder

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Features: - submissive pattern - cling to others to be taken care of Intervention: - support these individuals to make their own decisions

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Obsessive-compulsive personality disorder

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**different than OCD** Features: - not as many obsessions or compulsions - described as "not fun" - rigidity, perfectionism, and control are part of the clinical picture

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Selye's Three Phases of Stress Response

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Alarm reaction stage, resistance stage, exhaustion stage

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Alarm Reaction Stage

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Fright or flight

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Resistance Stage

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Attempt to adapt to stressor

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Exhaustion Stage

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Prolonged exposure, adaptation no longer possible; diseases of adaptation occur

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Two major responses to stress

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Anxiety and grief

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Anxiety

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Apprehension that is vague in nature; characterized by uncertainty and helplessness

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Peplau's four stages of anxiety

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Mild, moderate, severe, panic

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Grief

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Emotional, physical, and social responses to loss

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Kubler-Ross -- Five Stages of Grief

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Denial, anger, bargaining, depression, acceptance

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Delayed/Inhibited Grief

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Keeping a "stiff upper lip"; stuck in denial stage of grief; ambivalent feelings about lost one, outside pressure to continue life, perceived lack of coping mechanisms

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Distorted/Exaggerated Grief

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Dysfunctional in management of daily living; fixed in anger stage of grief; anger turned inwards, can lead to depression

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Chronic/Prolonged Grief

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Maintaining personal possessions aimed at keeping lost one alive, unable to perform ADLs, refusing to participate in family gatherings, setting place at table for loved one long after death

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Grief resolution

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Can only occur when person is able to remember both the good and bad qualities of partner

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Anna Freud's Ego Defense Mechanisms

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Mild to moderate states of anxiety; adaptive or maladaptive

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Compensation

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Covering up real or perceived weakness by emphasizing a trait one considers more desirable; physically handicapped boy cannot play football, compensates by becoming a great scholar

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Denial

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Refusing to acknowledge existence of/feelings about situation; woman drinks alcohol every day but doesn't realize that she has a problem

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Displacement

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Transfer of feelings from target to another; client is angry with doctor, does not express it, then becomes verbally abusive towards nurse

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Rationalization

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Making excuses or formulating logical reasons to justify unacceptable feelings/behaviors; man tells rehab nurse "I drink because it's the only way to deal with my bad marriage and worse job"

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Reaction Formation

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Preventing unacceptable/undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts/behaviors; girl hates nursing and only went to school to please parents, but speaks to prospective students about excellence of nursing as a career

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Regression

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Responding to stress by retreating to earlier level of development for comfort measures; 2-year-old boy is hospitalized for tonsillitis and will only drink from bottle even though he has been drinking from cup for 6 months

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Identification

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Attempt to increase self-worth by acquiring characteristics of an individual one admires; teenaged boy who went through lengthy rehabilitation after accident decides to become physical therapist

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Intellectualization

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Attempt to avoid expressing actual emotions about situation by using logic, reasoning, and analysis; woman's husband is being transferred with his job to a city far away from woman's parents, and she explains to her parents the advantages of moving

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Introjection

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Integrating beliefs and values of another person into one's own ego structure; child integrates parents' value system by saying to another kid, "Don't cheat, it's wrong."

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Isolation

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Separating thought or memory from the feeling tone or emotion associated with it; a young woman describes being attacked and raped without showing any emotion

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Projection

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Attributing feelings/impulses unacceptable to one's self to another person; girl feels strong sexual attraction to her track coach and tells her friend, "He's coming on to me!"

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Repression

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Involuntary blocking unpleasant feelings and experiences from one's awareness; an accident victim can remember nothing about the accident

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Sublimination

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Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive; a mother whose son was killed by a drunk driver channels anger and energy into being president of local chapter of MADD

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Suppression

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Voluntary blocking of unpleasant feelings and experiences from one's awareness; Scarlett O'Hara says, "I don't want to think about that now. I'll think about that tomorrow."

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Undoing

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Symbolically negating or canceling out an experience that one finds intolerable; Man in nervous about new job and yells at wife, then stops and buys her flowers on the way home

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Freud's Personality Theory

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Stages of development; birth to 5 years is the most important in the formation of basic character

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Freud's Three Components of Personality

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Id, ego, superego

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Id

answer

Instinct driven, "pleasure principle"; "I found this wallet, I will keep the money", "Mom and Dad are gone, let's party!", "I'll have sex with whomever I please, whenever I please."

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Ego

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Rational self, "reality principle"; "I already have money. Maybe the person who owns this needs it", "Mom and Dad said no friends over while they are away. Too risky", "Promiscuity can be very dangerous."

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Superego

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"Perfection principle"; "It is never right to take something that doesn't belong to you", "Never disobey your parents", "Sex outside of marriage is always wrong"

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Freud's Three Mental Concepts and Operations

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The conscious mind, the preconscious mind, and the unconscious mind

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The conscious mind

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Memories within awareness

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The preconscious

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Forgotten memories that can be recalled

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The unconscious mind

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Memories you are unable to bring to memory

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Freud's Stages of Personality Development: Birth to 18 months

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Oral Stage - relief of anxiety through oral gratification

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Freud's Stages of Personality Development: 18 months to 3 years

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Anal stage - independence and control, focus on excretory function (potty training)

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Freud's Stages of Personality Development: 3-6 years

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Phallic Stage - identification with parent of same gender, sexual identity, focus on genital organs

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Freud's Stages of Personality Development: 6 - 12 years

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Latency - sexuality repressed, relationships with same gender peers

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Freud's Stages of Personality Development: 13- 20 years

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Genital - libido reawakened as genital organs mature, relationships with opposite gender

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Sullivan's Personality Theory

answer

Individual behavior and personality development are the result of interpersonal relationships

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Sullivan's major personality concepts: Anxiety

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Emotional discomfort we all try to avoid; develops when we can not satisfy our needs of achieve interpersonal security

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Sullivan's major personality concepts: Satisfaction of needs

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All needs (water, food, warmth, tenderness, rest, sexual expression) must be met for an individual to have interpersonal security

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Sullivan's major personality concepts: Interpersonal security

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A state where needs are met and the person has a sense of total well being

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Sullivan's major personality concepts: Self-system

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Security measures to prevent anxiety e.g. "good me" or our response to positive feedback; "Bad me" or our response to negative feedback, increases our anxiety; "Not me", a denial of situations that cause intense anxiety, horror, dread

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Sullivan's Stages of Development: Birth to 18 months

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Infancy - relief of anxiety through oral gratification

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Sullivan's Stages of Development: 18 months to 6 years

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Childhood - learning to delay personal gratification without undue anxiety

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Sullivan's Stages of Development: 6-9 years

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Juvenile - learning to form satisfactory peer relationships

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Sullivan's Stages of Development: 9-12 years

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Preadolescene - learning to form satisfactory relationships with persons of same gender

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Sullivan's Stages of Development: 12-14 years

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Early adolescene - learning to form satisfactory relationships with persons of opposite gender; sense of identity

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Sullivan's Stages of Development: 12-21 years

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Late adolescence - Establishing self-identity, intimate opposite-gender relationship

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Erikson's 8 Stages of Life

answer

Focuses on social processes on the development of personality; when person struggles with developmental tasks

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Erikson's 8 Stages of Life: Infancy (Birth - 18 months)

answer

Trust vs. Mistrust - develop basic trust in mothering figure, learn to generalize it to others

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Erikson's 8 Stages of Life: Early childhood (18 months - 2 years)

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Autonomy vs. Shame and Doubt - gain some self-control and independence within environment

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Erikson's 8 Stages of Life: Late childhood (3-6 years)

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Initiative vs. Guilt - develop a sense of purpose, ability to initiate and direct own activities

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Erikson's 8 Stages of Life: School age (6-12 years)

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Industry vs. Inferiority - self-confidence by learning, competing, performing successfully, and receiving recognition from family and peers

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Erikson's 8 Stages of Life: Adolescence (12-20 years)

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Identity vs. Role Confusion - integrate tasks mastered in previous stages into secure sense of self

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Erikson's 8 Stages of Life: Young adulthood (20 to 30 years)

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Intimacy vs. Isolation - form intense, lasting relationship to another person, cause, institution

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Erikson's 8 Stages of Life: Adulthood (30-65 years)

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Generativity vs. Stagnation - achieve life goals while considering welfare of future generations

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Erikson's 8 Stages of Life: Old age (65+)

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Ego Integrity vs. Despair - review one's life, derive meaning from positive and negative events, achieving positive sense of self-worth

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Anorexia Nervosa

answer

individuals who refuse to maintain weight for their height; fear of gaining weight some restrict food intake, where others binge eat and purge

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Bulimia Nervosa

answer

individuals who binge eat and then compensate with behaviours such as self-induced vomiting, fasting, excessive exercise and using medications such as laxatives and diuretics

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Binge Eating Disorder

answer

individuals who engage in repeated episodes of binge eating but do not regularly use compensatory behaviours

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Eating Disorder NOS

answer

includes disorders that do not meet the criteria for either anorexia, bulimia or binge eating, which are all characterized by a significant disturbance in the perception of body shape and weight

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Eating Disorders - epidemiology

answer

Most eating disorders begin in early teens to mid-20s Incidence: Women - Anorexia nervosa—0.9% - Bulimia nervosa—1.5% - Binge eating disorder—3.5% Incidence: Men - Anorexia nervosa—0.3% - Bulimia nervosa—0.5% - Binge eating disorder—2% Many people with disordered eating patterns do not present for help Statistics do not reflect the magnitude of the problem

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Eating disorders Co-morbitities

answer

Depression and anxiety disorders (particularly social phobias) are common co-morbidities Incidence of OCD is as high as 25% in individuals with anorexia nervosa Personality disorders may occur in 42-75% of individuals with eating disorders Link exists between trauma and eating disorders

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Anorexia - Nursing Assessment

answer

General: - Physical: Electrolytes, weight, hair, skin, pulse, temperature - Perception of the problem - Eating habits - History of dieting - Methods to achieve weight loss/control - Value attached to weight - Social functioning - Mental status Self assessment

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Anorexia Nervosa - thoughts and behaviours

answer

- terror of gaining weight - preoccupation w/food - view of self as fat even when emaciated - peculiar handling of food --> cutting food into small bits / pushing pieces of food around plate - possible development of rigorous exercise regimen - possible self-induced vomiting, use of laxatives and diuretics - cognition so disturbed that individual judges self-worth by weight

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Anorexia Nervosa - signs / symptoms

answer

- low weight - amenorrhea - yellow skin - lanugo - cold extremities - peripheral edema - muscle weakness - constipation - abnormal lab values - abnormal CT/EEG - cardiovascular abnormalities - impaired renal function - hypokalemia - anemic pancytopenia - decreased bone density

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Criteria for hospital admission - eating disorders

answer

Physical: - weight loss, ;85% below ideal - rapid decline in weight w/food refusal - inability to gain weight w/outpatient treatment - temperature ;36 - HR ;40 bpm - BP ;90/60 - severe dehydration - hypokalemia - glucose ;60mg/dL - hepatic, renal or cardio organ compromise Psychiatric: - risk for suicide - failure to comply w/treatment contract - severe depression or other disorder - family crisis or dysfunction

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Anorexia Nervosa - Nursing Interventions

answer

Acute: - medical stabilization including electrolyte imbalances/ideal body weight Psychosocial: - weight-restoration program - milieu therapy --> cognitive distortion recognition Pharmacological: - SSRIs are helpful in reducing OC behaviour - Antipsychotics (chlorpromazine) helpful for delusional or overactive pts - Atypical antipsychotics (olanzapine) help in improving mood and decreasing obsessive behaviour

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Bulimia Nervosa - Nursing Assessment

answer

General: - Often at or slightly below or above ideal body weight - Physical: Enlargement of parotid glands, dental erosion, electrolytes, dehydration - Social functioning - Mental status Self assessment

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Bulimia Nervosa - Nursing Interventions

answer

Acute: - CBT used to normalize eating habits is the gold standard Pharmacological: - Antidepressants Milieu management: - stopping the cycle of binging and purging Counselling Health teaching/promotion Pharmacological: - SSRIs helpful in short-term, but clients often regain weight once med is d/c Interpersonal therapy

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Which female patient should the nurse recognize as having the highest risk to have or develop bulimia nervosa? The one who: a. grew up in an underserved area b. lives in a society influenced by Eastern cultural beliefs c. is 20 years old d. is Asian Canadian

answer

c. is 20 years old; Bulimia nervosa is rarely seen in children younger than 12, whereas anorexia nervosa may start as early as 7-12. The degree of public services has not been linked as a predisposing factor for bulimia nervosa. Women living in industrialized nations influenced by Western culture are more predisposed to eating disorders than those influenced more strongly by Eastern cultural beliefs. There has not been much research that has focused on eating disorders and ethnicity; however, there is some evidence that Canadian Jewish women and Aboriginal women are at greater risk for developing an eating disorder than their non-Jewish and non-Aboriginal counterparts.

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The nurse is caring for a 16 year old female patient with anorexia nervosa. What should the initial nursing intervention be upon the patient's admission to the unit? a. build a therapeutic relationship b. increase the patient's caloric consumption c. involve the patient in group therapy to build a support group d. self-assess to decrease tendencies toward authoritarianism

answer

d. self-assess to decrease tendencies toward authoritarianism; Without self-assessing, the nurse may inadvertently blame the patient for her health problems and assume a parental role rather than a therapeutic one. The nurse must first self-assess to become aware of personal feelings about the patient's condition and then proceed to act in a therapeutic manner. For the duration of the patient's stay, building a therapeutic relationship will be important, but it is not the initial nursing intervention. For the duration of the patient's stay, having a plan to increase the patient's caloric consumption will be important, but it is not the initial nursing intervention. For the duration of the patient's stay, involving the patient in group therapy to build a support network will be important, but it is not the initial nursing intervention.

question

The nurse is caring for a patient with bulimia. Which nursing intervention is appropriate? a. monitor patient on bathroom trips after eating b. allow patient extensive private time with family members c. provide meals whenever the patient requests them d. encourage patient to select foods that she or he likes

answer

a. monitor patient on bathroom trips after eating; Close observation of patients includes monitoring all trips to the bathroom after eating to prevent self-induced vomiting. Although family contact is important, extensive family time would interfere with the patient participating in the therapeutic activities on the unit. The milieu of an eating-disorder unit is purposefully organized to assist the patient in establishing more adaptive behavioural patterns, including normalization of eating. Providing meals whenever the patient requests them is not consistent with the normalization of eating. The highly structured milieu includes precise mealtimes, adherence to the selected menu, observation during and after meals, and regularly scheduled weigh-ins. Encouraging the patient to select foods that she likes does not support the normalization of eating and may not meet all the patient's daily nutritional requirements.

question

The nurse is admitting a pt who weights 45kg, is 167 cm tall, and is below ideal weight. The pts BP is 130/80, pulse is 72, potassium is 2.5mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands are visibly shaking, and her partied gland is enlarged. The pt states, "I am really worked up about coming to this unit." What is the priority nursing diagnosis? a. Powerlessness b. Risk for injury c. Imbalanced nutrition: less than body requirements d. Anxiety

answer

b. Risk for injury; Although all diagnoses listed are appropriate to consider within the plan of care, the priority is Risk for injury related to the low potassium value, mildly elevated blood pressure, and abnormal ECG, which indicates hypokalemia. If left untreated, multiple complications— including cardiac arrhythmias and eventual respiratory depression—can occur. Although Powerlessness is an appropriate nursing diagnosis, it is not the priority diagnosis. Although Imbalanced nutrition: Less than body requirements is an appropriate nursing diagnosis, it is not the priority diagnosis. Although Anxiety is an appropriate nursing diagnosis, it is not the priority diagnosis.

question

The nurse is planning care for a patient with an eating disorder. What outcomes are appropriate? Select all that apply. a. the patient will experience a decrease in depression b. the patient will identify four methods to control anxiety c. the patient will collect different kinds of cookbooks. d. the patient will identify two people to contact if suicidal thoughts occur

answer

a, b, d. Patients with eating disorders are very likely to have depression, anxiety, higher suicide rates, and problems with substance abuse. Therefore, decreasing depression, controlling anxiety, and having a support system in place are reasonable outcomes for planning care. Patients with eating disorders are very likely to have depression, anxiety, higher suicide rates, and problems with substance abuse. Therefore, decreasing depression, controlling anxiety, and having a support system in place are reasonable outcomes for planning care.

question

4 C's of substance use disorder

answer

Compulsive Use Cravings Continued Use - despite serious consequences Can't Stop

question

ABCDE - substance use disorder

answer

- Inability to consistently ABSTAIN - Impairment in BEHAVIOURAL control - CRAVING or hunger for drugs or rewarding experiences - DIMINISHED recognition of significant problems with one's behaviours and interpersonal relationships - A dysfunctional EMOTIONAL response

question

The nurse is caring for a patient with an addictive disorder who is currently drug-free. The patient is experiencing repeated occurrences of vivid, frightening images and thoughts. Which term would the nurse use to document this finding? a. tolerance b. flashbacks c. withdrawal d. synergistic effect

answer

c. flashbacks; Flashbacks occur in a drug-free state and involve visual distortions, time expansion, loss of ego boundaries, and intense emotions. Often flashbacks are mild and perhaps pleasant, but at other times, individuals experience repeated recurrences of frightening images or thoughts. Tolerance occurs when a patient's physiological reaction to a drug decreases with repeated administration of the same dose. Withdrawal causes physiological changes as blood and tissue concentrations of a drug decrease in individuals who have maintained heavy and prolonged use of a substance. The term synergistic effect is used when drugs are taken together and the effect of either or both drugs is intensified.

question

Which condition would the nurse be most concerned about when caring for a patient who abuses alcohol? a. cirrhosis of the liver b. suicidal potential c. Wernicke's encephalopathy d. Korsakoff syndrome

answer

b. suicidal potential; Safety is always the priority when caring for patients. Ensuring safety includes completing a suicide risk assessment. Although the patient may develop or present with cirrhosis, the nurse must first plan care for prevention of self-harm. Wernicke's encephalopathy may develop, but the nurse must first plan care for prevention of self-harm. Korsakoff syndrome is not the priority of care.

question

Which patient response to the question "Have you ever drunk more alcohol or used more drugs than you meant to?" should immediately cause the nurse to assess further? a. No, I have never used drugs or alcohol. b. I have drunk alcohol before but have never let myself get drunk. c. I figured you'd ask me about that. d. Yes, I did that once and will never do it again.

answer

c. I figured you'd ask me about that; Automatic responses such as "I figured you'd ask me about that" serve as red flags that further assessment must be done right away to provide clarification. Further assessment would be appropriate through the context of the general assessment; however, alcohol and drug use would not be the immediate priority.

question

Which patient behaviours should the nurse suspect as related to alcohol withdrawal? a. hyper alert state, jerky movements, easily startled b. tachycardia, diaphoresis, elevated BP c. peripheral vascular collapse, electrolyte imbalance d. paranoid delusions, fever, fluctuating levels of consciousness

answer

a. hyper alert state, jerky movements, easily startled; Patients who are exhibiting hyperalertness and jerky movements and who startle easily are most likely in a state of alcohol withdrawal, a condition that peaks in 24 to 48 hours after cessation or reduction of alcohol intake and then rapidly and dramatically disappears unless the withdrawal process progresses to alcohol withdrawal delirium. Tachycardia, diaphoresis, and elevated blood pressure are associated with alcohol delirium and are considered a medical emergency and can result in death if not treated. Peripheral vascular collapse and electrolyte imbalance are associated with alcohol delirium and are considered a medical emergency and can result in death if not treated. Paranoid delusions, fever, and fluctuating levels of consciousness are associated with alcohol delirium and are considered a medical emergency and can result in death if not treated.

question

A patient at your community mental health centre smokes up to a half a pack of cigarettes daily but has tried with limited success to cut back over the past two weeks. Today he asked the pharmacist about the various products that could aid his attempts to quit smoking in time for him to manage a long overseas flight next month and travel with friends who are allergic to smoke. What phase of change is this patient demonstrating? a. pre contemplation b. contemplation c. preparation d. action

answer

c. preparation; This patient is demonstrating the preparation stage of change. He already has some experience with change and is further trying to change or "testing the waters" by inquiring about pharmacological products to aid his efforts and plans to act within the next month. At the precontemplative stage, people are not intending to take action in the foreseeable future, but this patient has a set goal. Patients who are demonstrating contemplation would still be ambivalent about change, or "sitting on the fence," and not preparing for a change within the next month. Patients who are involved in the action phase of behaviour change are already working toward desired behavioural change, including modification of environment, experiences, or behaviour. This patient is not yet at this stage.

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cognitive disorders

answer

result from changes in the brain and are marked by disturbances in orientation, memory, intellect, judgement, and affect; range from minor - major

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delirium

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a cognitive disturbance characterized by inattention, disorganized thinking, and a fluctuating mental status; should be considered a medical emergency, and immediate attention given to prevent irreversible and serious damage

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A 73 year old woman with pneumonia becomes agitated after being admitted to the ICU through the ER. She continually tries to leave her bed despite being too weak to walk. Her vital signs are erratic, her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated, and from laughing to angry. Her daughter reports that the patient "was never like this at home." What is the most likely explanation for the situation? a. pneumonia has worsened the patients early-stage dementia b. the patient is experience delirium secondary to the pneumonia c. the patient is sundowning due to the decreased stimulation of the ICU d. the patient does not want to be in the hospital and is angry that staff will not let her leave

answer

b. the patient is experiencing delirium secondary to the pneumonia; Delirium is always secondary to other disorders or causes (such as medications or fever), develops over a short period of time, and presents with emotional lability, unstable vital signs, fluctuating levels of consciousness, disorientation, and disorganized thinking—all of which exist in this case. While pneumonia may result in hypoxia, which could aggravate the symptoms of dementia, the patient's daughter reports that this behaviour is out of the ordinary. Sundown syndrome is the development or worsening of behavioural problems due to reduced sensory input and relative lack of orientation aids (e.g., lighting) and is characterized by increasing disorientation as nightfall proceeds. In this case, the patient's behavioural changes are occurring and changing in a manner seemingly unrelated to the time of day (e.g., persisting through a 24-hour period). The patient may well be angry about being hospitalized, but anger would be an unlikely explanation for the constellation of symptoms and the patient's overall levels of mental deterioration since admission.

question

Interventions appropriate for a hospitalized patient experiencing delirium include which of the following? Select all that apply. a. immediately placing the patient in restraints if she begins to hallucinate or act irrationally or unsafely b. assuring that a clock and a sign indicating the day and date is displayed where the patient can see it easily c. being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care d. preventing sensory deprivation by placing the patient near the nurses' station and leaving the television and multiple lights turned on 24 hours per day e. anticipating that the patient may try to leave if agitated and providing a secure environment with direct observation to prevent wandering f. promoting normalized sleep patterns by encouraging the patient to remain awake during the day and facilitating rest at night

answer

b, c, e, f. Clocks and other items that help orient the patient can prevent or decrease the disorientation. While not prone to violence, patients experiencing dementia may misinterpret the nurse's intentions and respond aggressively with little or no warning, so to increase staff's safety, use caution when the patient is agitated. Speaking with the patient for frequent, brief periods allows for frequent reassessment and reorientation opportunities. It also helps to prevent isolation and disorientation without overstimulating the patient. The risk of elopement should be anticipated, and antielopement precautions, such as direct observation or electronic monitors, should be implemented. Sleep patterns can become disrupted due to sleeping during the day (from sedation or boredom), which, in turn, interferes with sleep at night and increases the risk for sundowning; therefore, interventions that normalize sleep cycles are therapeutic. Restraints tend to increase the patient's fear and resistance and should not be used unless all other options for reassuring the patient's safety have failed. Hospitals tend to provide excess stimulation, particularly if the patient is in a high-traffic area such as the nurses' station. Some lighting is helpful in reducing disorientation, but leaving the TV on 24 hours and placement near the station exposes the patient to excess noise and stimulation, which can be disorienting.

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Which statement about dementia is accurate? a. the majority of people over age 85 are affected by dementia b. disorientation is the dominant and most disruptive symptom of dementia c. people with dementia tend to be distressed by it and complain about its symptoms d. hypertension, diminished activity levels, and head injury increase risk for dementia

answer

d. hypertension, diminished activity levels, and head injury increase risk for dementia; Many factors can contribute to dementia in vulnerable persons, including diet, diminished physical and mental activity, and cardiovascular risk factors such as hypertension. Even among those aged 85 and older, the majority of persons are not significantly affected by dementia, whose primary characteristics include the gradual, progressive loss of memory, cognitive functioning, and decision-making abilities. Although disorientation tends to result at some point in dementia, it is not usually the most dominant or fundamental feature of dementia. Dementia develops insidiously, and most persons with it fail to notice its development and tend to minimize or conceal the presence of symptoms rather than complain or seek assistance.

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trauma

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describes experiences that may overwhelm a person's capability to cope

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PTSD

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(1980) diagnostic criteria include a hx of exposure to a traumatic event of actual or threatened death, serious injury or sexual violation; exposure must result from: - directly experiencing the traumatic event - witnessing the traumatic event in person - learning that the traumatic event occurred to a close family member or close friend - experiencing first-hand repeated or extreme exposure to aversive details of the traumatic event Symptoms (clusters): - re-experiencing (intrusive thoughts, flashbacks) - avoidance (triggers, people, feelings) - negative alterations in cognitions and mood (depression, change in beliefs) - alterations in arousal (reactivity, dissociative identity)

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Complex PTSD

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or sometimes called DESNOS = disorders of extreme stress, not otherwise specified impairments related to: 1. affective functioning: heightened emotional reactivity, outbursts, consciousness/dissociative states when under stress 2. self functioning: persistent beliefs about oneself as diminished, worthless, pervasive feelings of shame and guilt 3. relational functioning: disordered attachment, difficulty sustaining relationships, feeling close to others

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Neurotransmitters: Acetylcholine

answer

Important in treating alzheimer's Decreased: Alzheimer's

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Neurotransmitters: Dopamine

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Important in treating schizophrenia. Increased: Schizophrenia

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Neurotransmitters: GABA

answer

Important in treating anxiety Decreased: Anxiety

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Neurotransmitters: Norepinephrine

answer

Important in treating depression Decreased: Depression

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Neurotransmitters: Serotonin

answer

Important in treating depression, bipolar, mood symptoms Decreased: Depression

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Medications for Anxiety

answer

Antianxiety Anxiolytics

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Medications for Psychosis

answer

Antipsychotics Neuroleptics

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Medications for Mood Disturbance

answer

Antidepressants Antimanics Anticonvulsants Mood Stabilizers

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1st Generation Antipsychotics

answer

Thorazine, Fluphenazine, Haldol

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2nd Generation Antipsychotics

answer

Clozaril, Risperdal, Olanzapine (Zyprexa), Quetiapine (Seroquel), Geodon

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New Generation Antipsychotic

answer

Aripiprazole (Abilify)

question

Action of Antipsychotics

answer

Block receptors in brain to dopamine. All neuroleptics have ACH and EPS effects. Some have none.

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Use of Antipsychotics

answer

Psychotic reactions, schizophrenia, hyperactivity in children, n/v, sedation, agitation, severe anxiety, bipolar, ticks, tourettes, organic brain stiulant induced psychosis

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S/E of Antipsychotics

answer

Anticholinergic s/s, orthostatic hypotension, tachycardia, sedation, neurological changes, EPS effects: pseudoparkinsonism, akathesia, dystonia, tardive dyskinesia, NMS, agranulocytosis

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Nursing Considerations

answer

Assess/test for reality orientation Do not hesitate to ask questions about hallucinations, SI, HI

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Antiparkinsonian Agents to Treat EPS s/e of Antipsychotics

answer

Anticholinergics(Cogentin, artane, benadryl) Used to treat Parkinsonism of various causes and drug induced extrapyramidal reactions

question

EPS Sx: Tardive Dyskinesia

answer

Protrusion ; rolling of the tongue Lip sucking ; smacking Chewing motion Facial Dyskinesia Involuntary body movements

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EPS Sx: Akathisia

answer

Restless Paces Difficulty standing still Feel constantly in motion, rocking

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EPS Sx: Pseudoparkinsonism

answer

Shuffling gait Rigidity Posture stooped Tremors at rest Pill rolling motion

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EPS Sx: Acute Dystonia

answer

Facial grimacing Laryngeal spasms Involuntary upward eye movements Muscle spasms of face, tongue, neck ; back (cause trunk to arch forward)

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EPS Sx: NMS

answer

Muscle rigidity Altered LOC Autonomic instability: (hyperthermia, inc. BP, tachy, diaphoresis) Immediate tx begins with discontinuing the drug, fluid resuscitation, reducing fever.

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EPS Sx: Agranulocytosis

answer

Extremely low WBCs Fever Sore throat Malaise *Can occur with Clozaril

question

SSRI Examples

answer

Prozac, Luvox, Paxil, Zoloft, Lexapro

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Tricyclic Compounds: NE Examples

answer

Tofranil, Norpramin, Elavil, Pamelor, Anafranil

question

SNRI Examples

answer

Effexor, Cymbalta, Remeron

question

Other Antidepressant Examples

answer

Trazadone (Desryl), Welbutrin

question

Action of Antidepressants

answer

Increase NE and/or Serotonin levels in the CNS by blocking their reuptake by presynaptic neurons. Wellbutrin also decreases the uptake of Dopamine. Least likely to produce a manic episode so is often used in conjunction.

question

Uses of Antidepressants

answer

Depression, Anxiety, agitated depression, eating disorders

question

S/E of Antidepressants

answer

Orthostatic hypotension, hypertension, arrythmias, headache, sedation early in use, dry mouth, constipation, fine tremors, abnormal liver fx, urinary retention, lethargy, fatigue, blurred vision

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Nursing Considerations of Antidepressants

answer

Use carefully in clients with cardiac disease, seizures, urinary problems, BPH, pregnancy/lactation, hyperthyroidism, narrow angle glaucoma. *Do NOT give with MAOIs (serotonin syndrome) Monitor BP, hemopoietic system, liver fx, withdrawal gradually, increase fiber and fluid, provide oral hygiene, monitor mood and affect, use alcohol with care *Response takes 2 weeks

question

MAOI Examples

answer

Nardil, Parnate

question

Action of MAOIs

answer

Psychomotor stimulation; block oxidative deamination of naturally occurring enzymes/monoamines (Epinephrine, NE, ; Serotonin) to prevent breakdown of NE and serotonin leading to CNS stimulation, *Effect lasts for weeks: works on amines that impact neurotransmitters

question

Use of MAOIs

answer

To treat depression

question

S/E of MAOIs

answer

Interactions with food/drugs (Tyramine; leading to hypertensive crisis, increased BP) Orthostatic hypotension Dry mouth Constipation Hesitancy Confusion in Elderly Delayed Ejaculations Jaundice Leucopenia Anorexia Insomnia H/A

question

Nursing Considerations of MAOIs

answer

Avoid: Aged cheese, sour cream, beer, wine, yogurt, yeasts, pickled herring, aged meats, meat tenderizers, chicken livers, turkey, chocolate ; caffeine. Teach methods to avoid orthostatic hypotension, warn about delayed initial response ; prolonged effect after discontinuing drugs; teach about s/e, monitor mood ; affect, should be taken only as prescribed, do not give at bedtime, monitor for hypertensive crisis, avoid OTC cold medications, allergy medications, diet preparations *Risk for Serotonin Syndrome if taken with SSRI

question

Mood Stabilizer

answer

Lithium Carbonate (Lithane, Eskalith, Lithobid)

question

Use of Lithium

answer

7-10 days, treats: elation, flight of ideas, irritability, manipulativeness, anxiety, insomnia, psychomotor agitation, threatening or assaultive behavior, distractibility in Bipolar patients

question

Therapeutic Range for Lithium

answer

0.4-1.0mEq/L

question

S/E of Lithium

answer

Polyuria, mild thirst, nausea, weight gain, hand tremor, lethargy, h/a, impaired memory, ECG changes, hypothyroidism, anorexia, diarrhea, leukocytosis, muscle weakness, confusion

question

Action of Lithium

answer

Enhance the uptake of biogenic amines in the brain, thus lowering levels int he body; may alter sodium metabolism within nerve and muscle cells

question

Lithium: Early Signs of Toxicity ;1.5mEq/L

answer

N/V/D, thirst, polyuria, slurred speech, muscle weakness

question

Lithium: Interventions for Early Toxicity

answer

Hold dose, close evaluation, blood draw

question

Lithium: Advanced Signs of Toxicity 1.5-2mEq/L

answer

Coarse hand tremor, persistent GI upset, mental confusion, muscle hyperirritability, electroencephalographic changes, incoordination

question

Lithium: Interventions for Advanced Toxicity

answer

Hold dose, close eval, blood draw, and contact the physician!

question

Lithium: Advanced Signs of Toxicity 2-2.5mEq/L

answer

Ataxia, serious electroencephalographic changes, blurred vision, clonic movements, large output of dilute urine, seizures, coma, hypotension (Think: symptoms similar to a seizure)

question

Lithium: Interventions of Advanced Toxicity 2-2.5

answer

Same as the others, plus excretion with emetic agents or laxatives.

question

Lithium: Toxicity greater than 2.5

answer

Coma, death, circulatory collapse.

question

Lithium: Treatment of Toxicity greater than 2.5

answer

Same as others, plus hemodialysis

question

Anticonvulsants: Carbamazepine (Tegretol)

answer

Indications: bipolar, mood, ETOH withdrawal Precautions: Hypersensitivity. With MAOIs, laction. Careful with elderly, liver/renal/cardiac disease, pregnancy

question

Anticonvulsants: Valproic Acid (Depakene: Depakote)

answer

Indications: Bipolar, Mood, ETOH Withdrawal Precautions: Hypersensitivity, liver disease, caution in elderly/renal/cardiac, pregnancy and lactation

question

Anticonvulsants: Lamotrigined (Lamictal)

answer

Indications: Bipolar, Mood stabilization Precautions: Hypersensitivity. Caution in renal and hepatic insufficiency, pregnancy, lactation and children ;16 years old

question

Anticonvulsants: Topiramate (Topamax) and Oxcarbazepine (Trileptal)

answer

Indications: Partial onset seizures. Unlabeled Use: bipolar, alcohol and opiate abuse Precautions: Hypersensitivity, caution in renal and hepatic impairment, pregnancy, lactation, children, and the elderly

question

Anxiolytics Examples (Benzodiazepines)

answer

Alprazolam (xanax), Chlordlazepoxide (librium[alcohol withdrawal]), Clonazepam (Klonopin), Clorazepale (Tranxene), Diazepam (Valium), Halazepam (Paxlpam), Lorazepam (Ativan), Oxazepam (Serax), Prozepam (Centrax)

question

Anxiolytics Examples (Non benzodiazepines)

answer

Buspirone (buspar): binds to primarily serotonin receptors and dopamine receptors

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Action of Anxiolytics

answer

CNS depressant potentiates the effects of the powerful inhibitory neurotransmitter gamma-amniobutyric acid (GABA) in the brain, producing a calamative effect in 7-10 days.

question

Use of Anxiolytics

answer

To treat anxiety. Pre-op sedation, status epilepticus, acute alcohol withdrawal, mild muscle relaxant

question

Common S/E of Anxiolytics

answer

Conusion, h/a, agitation, oversedation, constipation, decreased libido, urinary retention, hypersensitivity, dry mouth, blurred vision, ACH side effects

question

Nursing Considerations for Anxiolytics

answer

Withdraw drugs slowly, not safe for use in pregnancy, watch for changes in liver fx, paradoxical excitement, mood and affect, avoid use with alcohol or other CNS depressant, use carefully with renal or hepatic failure or glaucoma, give withfood, no driving or operating machinery until you know your reaction

question

Thorazine

answer

Antipsychotic; prevents vomiting but ^QTC

question

Haloperidol

answer

Antipsychotic; old drug

question

Depot/Decanoate drugs

answer

long acting injectables

question

Akathisia

answer

internal restlessness

question

Clozapine (Clozaril)

answer

Atypical antipsychotic; watch out for neutropenia, king of antipsychotics

question

Olanzapine (Zyprexa)

answer

atypical antipsychotic; OD associated with Post-injection Delirium Sedation Syndrome (easy to OD)

question

Risperidone (Risperdal)

answer

atypical antipsychotic; no weight problem, approved for autism

question

Quetiapine (Seroquel)

answer

atypical antipsychotic; bipolar mania, bipolar depression

question

Aripiprazole (Abilify)

answer

atypical antipsychotic; LAI for schizophrenia, depression adjunct, approved for autism

question

Rexulti (Brexpiprazole)

answer

atypical antipsychotic; schizophrenia

question

Ziprasidone (Geodon)

answer

atypical antipsychotic; should be given with food

question

Neuroleptic Malignant Syndrome

answer

idiosyncratic life-threatening reaction to psych meds; big ticket = ^ CPK (creatinine phosphokinase) levels

question

Four phases of schizophrenia

answer

Premorbid, prodromal, schizophrenia, residual

question

Positive schizophrenic symptoms

answer

Symptoms present that should not be present

question

Hallucinations

answer

something a person sees, smells, hears, tastes, or feels that isn't there

question

Delusions

answer

false belief

question

idea of reference

answer

the ordinary pertains to you

question

neologisms

answer

made up words that have meaning only to the person who invents them

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word salad

answer

group of words put together in random fashion

question

clang associations

answer

choice of words is governed by sound (often rhyming)

question

tangentiality

answer

inability to get to the point of communication due to introduction of many new topics

question

Negative symptoms

answer

features which should be present but are not

question

affect

answer

inappropriate, bland/flat

question

apathy

answer

disinterest in the environment

question

volition

answer

no drive (not even to clean yourself)

question

Catatonia

answer

waxy flexibility

question

Cognitive symptoms

answer

associated with disturbed thinking

question

Delusional disorder

answer

the existence of prominent, nonbizarre delusions

question

brief psychotic disorder

answer

sudden onset of psychotic symptoms following a sever psychosocial stressor ~ <1 month & return to full premorbid level

question

Tricyclic Antidepressants

answer

Very dangerous and easy to OD

question

SSRIs

answer

increase suicidal ideation

question

Sertraline (Zoloft)

answer

SSRI

question

Escitalopram (Lexapro)

answer

isomer of citalopram

question

SNRIs

answer

may raise BP

question

MAOIs

answer

avoid tyramine foods

question

Buproprion (Wellbutrin)

answer

Atypical Antidepressant; stop smoking aid, helps with ADHD (unless h/o sz or eating DO)

question

Lithum

answer

Mood stabilizer; tx bipolar mania... can cause pt to become hyponatremic because it replaces Na in body

question

Therapeutic lithium level

answer

0.8-1.0 = Lithium is the ONE

question

Valproic Acid (Depakote)

answer

Mood stabilizer; cannot be used for women of childbearing age

question

Lamotrigine (Lamictal)

answer

Mood stabilizer; more for bipolar depression than mania... may cause steven-johnson syndrome

question

CNS stimulants

answer

for ADHD; SE = anorexia & decrease in growth and development

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