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488 > Class 4: Mental Health > Flashcards

Class 4: Mental Health Flashcards

1
Q

Bipolar collaborative goal setting is always…

A

a balance between depression and hypomania or mania

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2
Q

Bipolar collaborative goal setting + patients must practice

A

Managing symptoms, making healthy decision, grieving what they can not do

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3
Q

Bipolar collaborative goal setting + nursing interventions are based on…

A

the degree of mastery that the patient has acquired

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4
Q

Acute phase of mania interventions

A

-Impose external control to maintain safety
-Provide medication
-Set limits and boundaries

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5
Q

Continuation phase of mania interventions

A

-Prevention of relapse, provide additional resources
-Facilitate medication adherence

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6
Q

Maintenance phase of mania interventions

A

-Minimize frequency and severity of relapse

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7
Q

NOC for bipolar disorder

A

-Decreased risk of harm to self or others
-Realistic self appraisal
-Increased self-care
-Develop healthy coping skills
-Adherence to medications

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8
Q

Realistic self appraisal

A

Seeing oneself as valuable and having realistic expectations of oneself and others

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9
Q

Develop healthy coping skills

A

-Developing accurate perception
-Maintain healthy supports
-Problem solving, conflict resolutions, identifying triggers and behaviors leading to relapse
-Ability to develop a plan and seek help
-MAPD

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10
Q

Adherence to medications

A

-Mood stabilizers
-Other: for the maintenance of good health (i.e. Thyroid medications)

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11
Q

Nursing interventions for bipolar disorder occur in 3 domains

A

Environmental, physiological, and therapeutic communication

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12
Q

Physiological interventions for bipolar disorder

A

Self care: Nutrition, sleep, elimination, attire and medication

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13
Q

Bipolar disorder labs

A

-Therapeutic trough levels for medications
-Kidney function
-BUN, GFR, Urea
-STIs

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14
Q

Therapeutic communication for bipolar disorder

A

-Strengths-based approach
-Maintains healthy boundaries

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15
Q

Therapeutic communication categories

A

-Personal Attributes; how you accept and manage the patient’s and your own emotions
-Communication Skills
-An unfolding process – Your ability to pace the therapeutic interaction and identify what is pertinent

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16
Q

The purpose of therapeutic communication

A

-Build a trusting rapport
-Decrease defensiveness, increase self-esteem
-Manage the consequences of past manic episodes
-Increase the patient’s social and life skills, improve strained relationships

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17
Q

LEAP approach in therapeutic communication is based on the idea that…

A

Building trusting relationships is key to being able to help people heal

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18
Q

LEAP approach

A

-L; listen
-E; empathize
-A; agree, identify the points that the nurse and patient can agree on, make it concrete, needs to be reality-based
-P; partner

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19
Q

Characteristics of therapeutic communication

A

-Honest
-Hopeful; identifying the patient’s strengths
-Resilient; conflict is not taking it personally
-Collaborative
-Mindful

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20
Q

What therapeutic communication sounds like

A

-Calm voice
-Presenting factual information
-Redirecting the patient to focus on the topic

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21
Q

Health teaching & promotion in bipolar disorder

A

-S&S of impending episodes (i.e. vegetative shifts)
-Side effects of medication
-Often collaborative; family, patient & healthcare team

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22
Q

Environmental interventions in bipolar disorder (overview)

A

-Promoting safety through milieu, groups, medication, seclusion & restraints

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23
Q

Milieu therapy

A

-Decrease stimuli
-Include structured activities ie. time for rest & nutrition
-Monitor relationships

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24
Q

Safety interventions

A

-Medication is used to promote long-term stability OR immediate safety and control
-Seclusion reduces stimuli, used when there is substantial risk of harm towards others
-Restraints are a last resort

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25
Q

Mood stabilizers

A

-Lithium
-Carbamazepine
-Valproic acid
-Lamotrigine
-CVL; anticonvulsants that also act as mood stabilizers

26
Q

Medications + older adults

A

Increased risk for side effects due to decreased liver and renal functioning

27
Q

Used in conjunction with mood stabilizers

A

Antipsychotics and benzodiazepines can be used in conjunction with mood stabilizers to treat symptoms r/t escalation and medical conditions resulting from extended manic episodes

28
Q

Lithium MOA

A

-Generally unknown
-Alters the Na+ transport in nerve and muscle cells; explains why the movements of a patient experiencing Lithium toxicity are rigid AND why we monitor for cardiac arrhythmias

29
Q

Lithium MOA cont’d

A

-Increases NE uptake and serotonin receptor sensitivity
-Use caution if the patient is also prescribed medications that decrease serotonin reuptake

30
Q

Lithium dose

A

-Appropriate dose is calculated based on weight and benefit for the patient
-Initial dose is sub-therapeutic and the dose is slowly increased until a therapeutic level is reached

31
Q

Lithium: Other information

A

-Metabolized in the liver & excreted through the kidneys
-Is a salt, so therapeutic levels can be altered by fluid and nutritional intake

32
Q

Lithium interactions

A

-ACE I
-Diuretics
-Haldol; increased neurotoxicity without increasing the serum levels of Lithium
-NSAIDS; may decrease the renal clearance of Lithium; toxicity

33
Q

Lithium side effects

A

-GI, pancreatitis, lethargy, weight gain, edema
-Tremor, sore throat, fever, rash, alopecia, jaundice
-Birth defects; epstein’s anomaly

34
Q

Lithium implications for nursing

A

-Monitor salt and fluid intake, ins & outs
-CBC
-Assess for aMental status, gait, and flu-like symptoms
-Respiratory & suicide assessment

35
Q

Lithium expected adverse effects

A

-<0.4-1.0mEq/L
-Hand tremor, polyuria, thirst, nausea, weight gain
-Symptoms start when dosing changes and reside in 2-3 weeks, start on low dose

36
Q

Lithium early signs of toxicity

A

-<1.5mEq/L
-Hand tremor, polyuria, thirst, N/V, diarrhea, lethargy, slurred speech & muscle weakness
-Hold medications, get Li+ levels
-Rehydrate PRN

37
Q

Lithium advanced signs of toxicity

A

-1.5-2.0mEq/L
-Coarse hand tremor, GI upset, confusion, sedation, incoordination, muscle hyperirritability & electroencephalographic changes
-Hold medications, get Li+ levels
-Rehydrate PRN
-Assess fall risk & MSE

38
Q

Lithium severe signs of toxicity

A

-2.0-2.5 mEq/L
-Ataxia, aVision, confusion, large output of dilute urine, hypotension, seizures, clonic movements, pulmonary complications & serious electroencephalographic changes
-Stop medication, IV fluids, administer emetic if pt is alert, maybe hemodialysis

39
Q

Carbamazepine & valproic acid MOA

A

-Release and reuptake of serotonin, NE, GABA, dopamine, & glutamate
-Presence of GABA increases the number of receptors for these medications
-Antikindling properties

40
Q

Antikindling properties

A

Decrease sensitivity of nerve cells to electrical stimulation occurring in ion channels

41
Q

Carbamazepine & valproic acid dose

A

-Based on weight

42
Q

Carbamazepine & valproic acid: Other information

A

-Metabolized in the liver, excreted through the kidneys
-Binds to protein
-Easily crosses into the CNS
-Shorter half life; frequent dosing to avoid side effects

43
Q

Carbamazepine & valproic acid: Interactions

A

-PO contraceptives & anticoagulants
-TCAs
-Acetaminophen

44
Q

Carbamazepine & valproic acid side effects

A

-GI (even if enteracoated), pancreatitis, tremor, lethargy, weight gain
-Alopecia, jaundice (d/t increased liver enzymes and may lead to agranulocytosis)
-Sore throat, fever, rash
-Birth defects (spina bifida)

45
Q

Adverse drug reaction with carbamazepine & valproic acid: Steven Johnson Syndrome

A

-Rash similar to hives begin on the person’s trunk
-Open sores appear on mucosal membranes
-The nurse needs to observe for Steven Johnson Syndrome specifically with Lamictal; however, it can happen with any drug (i.e. Tylenol, Ibuprofen). It is like an allergic reaction

46
Q

Carbamazepine & valproic acid implications for nursing

A

-Fluids, CBC
-Assess for muscle rigidity & HTN, ins & outs
-Respiratory & suicide assessment

47
Q

Carbamazepine & valproic acid: Managing toxicity

A

-Discontinue the medication, notify physician
-Manage S&S

48
Q

Evaluation of mania

A

-VSS
-Attend to ADLs, consistent sleep/wake cycle
-The patient and family understand the diagnosis and implications on the well-being
-Med adherence
-Stable employment, healthy relationships

49
Q

Physical restraint

A

-Brief period of time, in order to restore calm to the individual
-Does not refer to holding a person to apply a mechanical restraint

50
Q

Acute control medication (Chemical) restraint

A

Psychotropic medication as an immediate response to control agitation or aggression

51
Q

Seclusion

A

A person is placed in a room that confines them

52
Q

Mechanical restraint

A

Either able or unable to ambulate

53
Q

Physical restraints are..

A

Less traumatic than other restraint forms in children

54
Q

In adults, before restraining

A

-De-escalation
-Chemical restraints used before mechanical

55
Q

In older adults, restraints

A

-Consideration for fall risk and co-morbid diagnoses such as arthritis, osteoporosis, skin integrity, and delirium/dementia

56
Q

Nursing responsibilities + restraints

A

-Some require immediate informed decisions, most develop over a long period of time and a 5 step framework can be used to make a decision regarding usage of restraints

57
Q

Nursing responsibilities: Care planning (ADPIE, kind of)

A

-1.Observe
-2.Detective work
-3.Consider options and make a decision
-4.Implement the plan
-5.Monitor and review the plan

58
Q

Physical risks of restraints

A

-Functional decline, incontinence
-Decrease circulation, pressure ulcers, nerve damage

59
Q

Psychosocial risks of restraints

A

-R/t feelings
-Withdraw from therapeutic relationship

60
Q

Restraint risks for staff

A

-Physical injury, emotional consequences
-Fractured team
-Legal repercussions

61
Q

Restraint risks for co-patients and visitors

A

-Physical injury, emotional trauma, confusion
-Negative impact on relationships
-Destabilize current health status

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