Exam 1 Flashcards
Mental Health vs Mental Illness
Mental Health: state of well-being
Mental Illness: health condition affecting area of life
Therapeutic vs Nontherapeutic communication
Therapeutic: active listening, restate, questions, basically showing concern and care for the patient
Non Therapeutic: Interupting, ignoring, assumptions, basically not being respectful or caring
Strategies for establishing therapeutic relationships
active listening, restating, clarification, suggestion, focusing, questions
Milieu Therapy
using things in surrounding or environment to help treat, including things in your day to day life to help
What are DSM-5
includes categories that classify aspects of mental health like depression, bipolar, schizophrenia, substance use, etc
What are Maslow’s hierarchy of needs and priority
Top:
Self actualization
Self-esteem
love and belonging
safety and security
physiological needs
What treatment team member helps with housing for the homeless?
Social Worker
Capacity vs Competency
Capacity: patient’s ability to make healthcare decisions and determined by the provider
Competency: legal term to describe if patient can make global decisions about care and decided by judge
Why do antidepressants work for some but not others?
depends on genes, dose, background, history, tolerance towards drug
Cultural competence
includes awareness, knowledge, skills, encounters, decision all surrounding patients culture
Least restricitve restraint alternatives
deesclation, reassess meds, toileting, check on patient, use bed/chair arms, use family, problem solving, cater to patient needs
Documentation for restraints
clinical justification, type, criteria for discontinuing, continuously monitored
Bipolar Symptoms
DIGFAST
distractibility
impulsivity
grandiosity
flight of ideas
activity increases
sleep deficit
talkativeness
Major depression symptoms
more than 2 weeks with symptoms most of day
DSIGECAPS
Depression mood
Sleep increases or decreases
Intrest in activities decrease
guilt
energy decreases
concentration decreases
appetite increases or decreases
psychomotor dysfunction
suicidal ideation
differences between MDD and grief
MDD always sad not tied to certain things
Grief has ups and downs and tied to certain thought/ loss
Depression association with psychosis
Delusions and halluciantions can reflect patient mood which is bad due to depression and then can make depression worse
Bipolar 1 and 2
Bipolar 1: manic that lasts at least 7 days and life changing
Bipolar 2: hypomania, is less severe that last a few days at most and not life changing
Hypo and Normal mania
Hypomania: few days no as sevre
Mania: weeks and life-changing
Mania Presentation
DIGFAST
Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activity increases
Sleep deficit
Talkativeness
Nonpharmacologic and Noninvasive depression treatment
sleep, light therapy, nutrition, exercise, therapy, relaxation, religion, support, different types of therapy
what is ECT
electroconvulsive therapy: electric conduction through skull to help brain and calm depression symptoms, very invasive, seizures, not very effective
Focus for acute manic patients
Safety, exercise, redirection, eating, bathroom
Which antidepressant is most lethal in OD
Tricylci is most dangerous and can cause arrhythmias, seizures, coma and death
Symptoms of serotonin syndrome
SHIVERS
Shivring
Hyperflexia and myoclono
Increased temperature
Vital signs instability
Encepatholy
Restlessness
Swearing
Treatment for serotonin syndrome and long-term effects if untreated
give benzodiazepines short term, give cyproheptadine med-term
give entrolol or nitroperusis long term
untreated effects are muscle rigidity, delirium, hypertension, hyperthermia
What antidepressant requires the patient to avoid foods
MAO: avoid tyrine food, meat, red wine, aged cheese, avocado, beans, soy sauce
What antidepressant is contradicted in the history of seizures
Selective serotonin-norepinephrine reuptake in inhibitors
Which antidepressant needs close monitoring of BP
Selective serotonin-norepinephrine reuptake inhibitors
Lithium therapeutic range
900-2400 mg a day in 2-4 doses in pill form
Lithium action
mood stablizer, reduce suicidal ideation, 5-7 days o work and peak at up to 3 weeks
Lithium adverse reactions
arrythmias, rash, renal impairment, diabetes, hyperthyroidism, hypothyroidism, GI effects, neurologic effects
Toxicity: seizures, coma, death, tremors, CNS problems, GI problems
What to say to client that wants to die
Therapeutic communciation, ask questions, dont leave alone, give meds or treatment
What herbal remedies can be given for depression
St john wort, ashwagandha, chamomile
Priority for happy depressed client
safety, protection, therapy, happy can be sign of suicide plan and intent
Priority for MDD client that doesnt do therapy
Medication, sleep, reading, ADL, diet, etc
Risk factors for suicide/ protective factors
Genetic, biology, age (18-25), environment, traumatic life events, psychology
Give therapy, med, adl
Non suicidal self injury and example
self inflicted harm to feel something or cope but not wanting to die
Cutting, burning, scratching, hitting, etc
DSM5 criteria and etiology for schizophrenia
2 or more symptoms for a month
Hallucinations (AVH), delusions, disorganized speech/ thought, negative symptoms social problems
Positive vs Negative Symptoms
Positive: add to life, AVH, delusions, disorganized
Negative: take away from ones life \, social withdrawal, alopecia (hair loss), blunted effects, avolition (lack of motivation), alogia (reduced speech)
What is EPS and what symptoms
Dystonia: cramping and muscle spams, eye twitching
Pseudoparkisoms: shuffling gait, muscle rigidity, masked faces
Tardive dyskinesia: involuntary movements, tongue, legs, arms, face
Akathisia: restless, fidgeting, shaking
Non pharmacologic interventions for schizophrenia
Therapy, support, ADL, education
1st vs 2nd gen antipsychotics
1st gen (Halodol): block b2 receptos, reduce positive symptoms, only affect dopamine, side effects increased EPS
2nd gen (respridone): block b2 and 5htra receptors, reduce positive and negative symptoms, affect dopamine and serotonin, risk of weight gain and diabetes
What gen of antipsychotic is preferred
2nd, less bad side effects and better treatment
What are antipsychotics for
decrease psychosis symptoms, alter levels of neurotransmitters in brain and decrease suicide symptoms
Neuroleptic malignant syndrome
days to weeks, antipsychotics can cause it, symptoms are same as serotonin syndrome: diaphoresis, tachycardia, hypertension, rigidity
Normal GI and pupils
kidney problems
stop antipsychotic and IV drugs
Metabolic syndrome
side effects of antipsychotic drugs, obesity, hypertension, elevated triglycerides, low HDL cholesterol, insulin resistant, diabetes
Labs to monitor while on antipsychotics
CBC monitoring (decrease in WBC), BMI, weight, BP, lipid levels, glucose levels
What should a nurse do during hallucinations
be therapeutic, reassure, safety, ask questions, don’t judge or challenge, say what you see
Different types of delusion
Grandiose: inflated self-worth, powerful, wealthy, ruler, etc
Persecutory: someone is watching them, out to get them
Control: someone else controls what they say or do, they are forced
Thought insertion: they are not themselves, someone else is them
DSM5 for Substance Use Disorder
4 areas
Impaired control, social problems, risky use, physical dependence
Predisposing Factors for SUD
Biological: genetics, fewer d2 receptors, ADHD, depression
psychological: personality, impulsivity, aggression, age of use, sensation
Environmental: exposure to stressors, hx of abuse, peer pressure, imitation
Wernicke- Korsakoff Syndrome (Wet brain)
caused by thiamine defiencey (Vitamin b1) which converts glucose to energy
Wernicke Encepenopathy: acute, confusion, loss of muscle coordination, eye muscle paralysis
Korsakoff Psychosis: chronic, memory impairment, difficulty learning
Wernicke-Kosakoff Syndrome Treatment
Stop drinking, good nutrition with vitamin B1, manage electrolytes/hydration, give folic acid, give benzodiazepines
Symptoms of alcohol intoxication
confusion, vomiting, seizure, slow HR/RR, dulled response, difficult breathing
Symptoms of alcohol withdrawal
Gi upset, tremors, seizures, AVH, insomnia, increased heart rate and bp, craving
Opioid Toxicity symptoms
shallow breathing, confusion, loss of LOC, seizure
Opioid OD treatment
give naloxone, respiratory support
Systemic effects of Alcohol on the body
Liver damage, heart problems, cancer, neurologic issues
What are delirium tremors
30-120 hours after last drink
Shaking, vomiting, increased HR/BP/Temp, sweating
peaks at 24-48 hours
Nonpharmacologic treatment for SUD
therapy, support groups (AA), family help, ADL, sponsor
What class of med is used for acute alcohol withdrawal
benzodiazepines, depressant drugs, but also just wait and time
Misconceptions of clients with SUD
brain-based disorder, not helpless, treat with respect, not bad people
Why is it important to recognize early signs of SUD
Get treatment, help, education, lessen long-term effects
Manifestations of non-substance abuse disorder (like gambling)
restlessness, cant quit, lying about use, seeking financial help, losing relationships, use to relieve stress
