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488 > Class 5: Mental Health > Flashcards

Class 5: Mental Health Flashcards

1
Q

Common outcomes for schizophrenia

A

Reduced risk of harm to self or others
Refrains from attending to and responding to delusions and hallucinations
Increased self-care, medication adherence
Asks for validation of reality, exhibits reality-based thinking

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2
Q

Nursing interventions for schizophrenia

A

-Self-care, milieu, & group therapy

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3
Q

Promoting self-care + nutrition

A

Antipsychotics cause weight gain leading to the onset or worsening of diabetes and metabolic syndrome

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4
Q

Self-care in schizophrenia + attire

A

Clean & weather appropriate clothing

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5
Q

Purpose of milieu therapy

A

-Decrease stimuli, protection from stressors and structured activities
-Monitor for signs of aggression

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6
Q

Structured activities provide…

A

Distraction from delusions and hallucinations

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7
Q

Signs of aggression

A

Externally responding to delusions and hallucinations

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8
Q

Purpose of group therapy in schizophrenia

A

-Increase social skills, modify unacceptable behavior
-Participate in constructive leisure activities
-Provide external support and opportunities to practice new skills

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9
Q

Antipsychotics: General information

A

-Known as neuroleptics
-Highly lipid soluble

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10
Q

Typical antipsychotics

A

-1st gen/conventional antipyschotics
-CHFPFZ
-Chloropromazine
-Haloperidol
-Fluphenazine
-Primozide
-Flupenthixol
-Zuclopenthixol

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11
Q

Typical antipyschotic MOA

A

Block D2 receptors (dopamine receptors that control synthesis, release & reuptake)

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12
Q

Typical antipsychotic indications

A

-Treat positive NOT negative symptoms
-Psychosis, Schizophrenia, Bipolar, Aggression/Agitation

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13
Q

Other information about typical antipsychotics

A

-2nd line tx
-Used for depot injection (long acting, 2 weeks)
-Less weight gain, decreased incidence of metabolic syndrome

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14
Q

Typical antipsychotic interactions

A

-CNS depressants (additive, increased sedative effect)
-Stimulant (competes, decreased effectiveness)

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15
Q

CNS adverse effects + typical antipyschotics

A

Sedation & reduced seizure threshold

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16
Q

Extra pyramidal symptoms + typical antipsychotics

A

Dystonia, akathisia, pseudo parkinsonism, tardive dyskinesia

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17
Q

Neuroleptic malignant syndrome + typical antipsychotics

A

-Muscle rigidity
-Increased temperature, HR & CK, aBP & mental status

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18
Q

Agranulocytosis + typical antipsychotics

A

Decreased neutrophils

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19
Q

Typical antipsychotics CV adverse events

A

Postural hypotension, tachycardia, non-specific ECG changes, arrhythmia

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20
Q

Typical antipsychotic anticholinergic adverse events

A

Dry mouth, blurred vision, constipation & urinary retention

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21
Q

Typical antipsychotic adverse events + endocrine/sexual side effects

A

-Increase prolactin
-Decreased sexual drive, ED, retrograde ejaculation

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22
Q

Typical antipsychotic GI adverse events

A

Constipation/diarrhea

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23
Q

Atypical antipsychotic medications

A

-2nd gen/unoconventional antipsychotics
-“pines”, “dones”, LAZCORQ
-Lurasidone, ziprasidone, risperidone
-Quetiapine, clozapine, olanzapine,
-Aripiprazole

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24
Q

Atypical antipsychotic MOA

A

-ACHS
-Blocks dopamine receptors D1 – D5 (serotonergic, alpha adrenergic, histamine, and cholinergic receptors)
-Preferential binding in the limbic area vs. the striatum area of the brain; reduces EPS

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25
Q

Atypical antipsychotic indications

A

-Treat positive & negative symptoms of schizophrenia
-TX of bipolar disorder, and for aggression/agitation

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26
Q

Atypical antipsychotic: Other information

A

-Less EPS & prolactin elevation, lower risk of TD
-Improve cognition
-Considered 1st Line Treatment

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27
Q

Atypical antipsychotic interactions

A

CNS depressants & stimulants

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28
Q

Atypical antipsychotic adverse reactions

A

-Headache, nausea, sedation, fatigue
-Anticholinergic effects
-Weight gain, edema, dyslipidemia, hyperglycemia, hyperthermia
-HTN, hypotension, tachycardia, increased prolactin, prolonged Q-T
-EPS, NMS

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29
Q

Antipsychotic implications for nursing

A

-Thorough physical assessment, change positions slowly
-Supports, finances (meds can be very expensive)
-Assess for safety concerns (more energy but same mood for first few weeks)

30
Q

Adverse drug reactions: Metabolic syndrome

A

-Abdominal obesity: Waist circumference >40” in men & >35” in women
-Dyslipidemia, elevated fasting glucose & BP
-Lead to CVD

31
Q

Adverse Drug Reaction: Metabolic Syndrome monitoring

A

-BP, BMI and waist circumference at baseline, 1, 2, 3, 6, 9, & 12 months
-Lipid panel & FBG at baseline at 3, 6, & 12 months

32
Q

Adverse Drug Reaction: Metabolic Syndrome tx

A

-Diet, exercise, smoking cessation
-Medications PRN for BP, diabetes, cholesterol, and weight

33
Q

Adverse Drug Reaction: Extrapyramidal symptoms (EPS)

A

-Dystonia, tardive dyskinesia, akathesia, & parkinsonism
-DTAP

34
Q

Parkinsonism

A

Tremor, shuffling gait, drooling, cogwheel, rigidity

35
Q

Akathesia

A

Muscle weakness, restlessness & rigidity

36
Q

Dystonia

A

Spasms & cramping in face, arms, legs, and neck

37
Q

Tardive dyskinesia

A

Bizarre facial, tongue, and upper/lower extremity movement: Lip smacking, blinking or grimacing, stiff neck, difficulty swallowing

38
Q

Medications For the Treatment of Extrapyramidal symptoms (EPS): EPS can be minimized by

A

-Decreasing antipsychotic dose
-Adding an antiparkinsonian drug or anticholinergic agent

39
Q

Medications For the Treatment of Extrapyramidal symptoms (EPS): General (trade) name

A

-TBD
-Trihexyphenidyl
-Benztropine mesylate
-Diphenhydramine hydrochloride

40
Q

Trihexyphenidyl & benztropine mesylate + Medications For the Treatment of Extrapyramidal symptoms (EPS)

A

-Antiparkinsonian drugs & anticholinergic agents

41
Q

Diphenhydramine hydrochloride + Medications For the Treatment of Extrapyramidal symptoms (EPS)

A

Antihistamine (used for its anticholinergic properties)

42
Q

Adverse Drug reaction: Neuroleptic malignant syndrome (NMS)

A

-Has been treated with neuroleptics within 7 days
-aMental status & BP, tachycardia, hyperthermia
-Muscle rigidity, leukocytosis, & incontinence

43
Q

Managing toxicity of antipsychotics in order

A

-Hold medication
-Manage life threatening adverse reactions
-Notify physician
-Document

44
Q

Benzodiazepines may be used to…

A

Treat intermittent episodes of intense anxiety

45
Q

Other medications may be used for…

A

-Their off-label sedative effects
-Examples: Imovane (hypnotic), Trazadone (antidepressant), Seroquel (antipsychotic)
-SIT

46
Q

Caffeine

A

May be helpful for patients who exhibit negative psychotic symptoms

47
Q

Nicotine can…

A

Decrease the release of dopamine, resulting in less intense hallucinations

48
Q

Stimulants such as cocaine…

A

Mimic dopamine and are contraindicated in the treatment of psychotic disorders

49
Q

Health teaching & promotion + schizophrenia

A

-Emphasis on the chronic and recurrent nature of the illness
-S&S of impending episodes: Vegetative shifts (changes in nutrition, sleep and activity)
-Side effects of medication

50
Q

Evaluation of schizophrenia

A

-r/t quality of life
-Frequent assessment, do not evaluate presence or absence of delusions and hallucinations

51
Q

BPD patient outcomes

A

-Personal behaviors promote effective relationships
-Positive adaptation to significant events
-Patient can exercise self-restraint of negative and destructive behaviors

52
Q

Guidelines for interventions

A

-Set realistic goals
-Communication is clear & straightforward
-Avoid rejecting and rescuing patient when problem behaviors arise
-Consistently implement the care plan

53
Q

Avoid rejecting and rescuing patient when problem behaviors arise: Examples

A

-Attributing behavior to past events (reminds pt of all the bad things that have happened to them)
-Attributing behavior to the diagnosis (says that patient IS a personality disorder)
-Not offering hope for change

54
Q

Facilitating consistent client care

A

Slide 48

55
Q

Nursing intervention strategies: Limit setting

A

-Establishing boundaries of acceptable behavior:
-Create a plan with consequences
-Accommodate reasonable changes but be careful that accommodation does not turn into bargaining
-ACE

56
Q

Nursing intervention strategies: Controlling anger

A

-Assist the patient to identify the source of their anger
-Encourage patient to seek assistance to manage anger
-Can be a warning sign
-ACE

57
Q

Nursing intervention strategies: Managing impulsivity + problem solving strategies

A

-Identify the problem
-Use a stop and think approach
-Brainstorm alternative courses of action
-Evaluate the outcome for the chosen course of action

58
Q

Nursing intervention strategies: Managing self-harm

A

Slide 53

59
Q

BPD dialectical behaviour therapy (DBT) premise

A

-Combines cognitive and behavioral techniques with mindfulness
-Emphasizes being aware of your thoughts and actively shaping them

60
Q

BPD dialetical behaviour therapy (DBT) goal

A

Increase distress tolerance & improve social skills

61
Q

BPD dialetical behaviour therapy (DBT) tx targets

A

Identify interventions for suicidal behavior & interrupt destructive behaviors

62
Q

DBT core strategies

A

-Acceptance Strategies: Validation & cheerleading
-Change Strategies: Observing Limits & skill Teaching

63
Q

Acceptance strategy: Validation

A

-Recognize the kernel of truth
-Communicates that staff accept the pt

64
Q

Change strategies: Skills training

A

Mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness

65
Q

Skills training: Mindfulness

A

-Helps to distinguish between thoughts, assumptions, and FACTS

66
Q

Skills training: Distress tolerance

A

-Used in the moment to reduce stress and increase safety. NOT an effective long term survival skill
-Tasks: Stay present, tolerate and accept distress, avoid impulsive actions

67
Q

Skills training: Emotional regulation (emotions can be…)

A

Important for effective communication, can be self validating and guiding

68
Q

BPD medications do…

A

Not treat the underlying personality disorder

69
Q

BPD health teaching & promotion

A

-Emphasis on chronic nature of the illness
-Education r/t understanding triggers, behaviours contributing to safety risks, and establishing a safety plan

70
Q

BPD long term evaluation

A

-Develops relationships, positive coping strategies and free from self-harm

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