Exam 2 Flashcards
Stress and anxiety 5 DONE Anti-anxiety meds 4 DONE Depression 5 DONE Mania 3 DONE Antidepressant meds 6 DONE Mood stabilizer meds 5 DONE ECT 3 DONE Family interventions: 5 DONE Group therapy 3 DONE
What is NAMI
National Alliance on Mental Illness
- 12 week program to help deal w. anxiety & guilt
- for family members of individuals w/ mental illness
- family to family program
-psychoeducation
Describe Family Interventions
- support integrity & functioning of family
includes:
- empowerment
- family therapy (might identify need for referral to therapist for example)
- community resources
- education
Outcomes from Family Interventions
- resolve conflicts
- use of resources & effective problem solving
- improved communication
- improved ability to cope w/ stressors
RN Diagnoses for Family Interventions
- caregiver role strain (needing education & support)
- impaired parenting
- dysfunctional family processes (might happen in addiction)
- interrupted family processes (where illness causes changes in the role)
- deficient knowledge
- might need tx or education on the illness
Describe 15 Min Family Interview
Manners (introduce yourself)
- politeness, respect, kindness
Therapeutic Conversation (awareness every conversation can be therapeutic)
- acknowledge & affirm (show compassion & affirmation)
Genogram (reminder of who is affected)
Therapeutic Questions
Commendations (what the family is doing well…positive feedback)
Describe Domains of Family Assessment
Biologic
- physical & mental status
Psychological
- family development & life roles (boundaries)
- communication, coping & problem solving
Social
-social & financial status, support networks, fun
Spiritual
-religion, beliefs, meaning, purpose & strengths
Describe genogram in a family assessment
- multigenerational depiction of biological, legal & emotional relationships
- analyze for composition & patterns
- includes age, health problems, dates of marriage & death
Explain the Competence Model
- focuses on strengths & building on those
- empowerment
- collaboration
- focus on improvements & what they can learn to get better
Describe Concepts of Family Systems Theory
- family system is apart of a larger suprasystem (influence & support) & is composed of many subsystems
- family as a whole is greater than the sum of its parts (we get more info assessing the fam as a whole & not just individually)
- change in 1 member affects ALL members
- family is able to create a balance of change & stability (making adjustments by doing more or taking roles)
- family members behaviors are best understood from a view of circular rather than linear causality (domino effect)
Describe Family Burden
- family experience of mental illness
- objective or subjective including…
- anxiety
- grief
- guilt (feel they contributed to the illness)
- anger
- powerlessness
-fear
Describe Families “at risk” population
- stigma
- decreased social contact/support
- children of mentally ill parents
- siblings
Describe management in Family Functions
- where $ and time is spent
- power
- resource allocation
- rules
- financial support
Describe families as caregivers
- largest group of caregivers for ppl w/ mental illness
- provide info to healthcare providers
- provide support, monitor services & advocate for ill member
- important to “partner” w/ families
Lithium Carbonate MOA & USES
- prototype mood stabilizer
MOA:
- neurochemical change, serotonin blockade
- affects glutamate activity
- increases neuronal growth & decreases atrophy
USES:
- acute mania
- prevention of mania & depression
- decreases suicide
Lithium special considerations
- routine lab work required
- narrow TI index 0.8 to 1.4mEq/L
- levels checked every 2 to 3 days initially then every 3-6 months
Lithium ADRs
- GI distress
- fine hand tremor
- polyuria, thirst
- weight, gain
- bradydyrhythmias, hypotension, eleectrolyte imbalances
- fatigue, lethargy, headache, mental dullness
- renal effects
- hypothyroidism w/ long term tx
Causes of increased Lithium levels
- decreased sodium intake
- fluid/electrolyte loss
- impaired renal function
Lithium drug interactions
- Ibuprofen
- Diuretics
Anticonvulsant Mood Stabilizers MOA & USES
MOA:
- alters electrical conductivity of cell membranes
- enhance the effects of GABA
- inhibit glutamate
USES:
- acute episodes of mania & depression
Anticonvulsant Mood Stabilizer prototypes
- Valporate (Depakote)
- Cabamazepine (Tegretol)
- Lamotrigine (Lamictal)
Valporate (Depakote)
- FDA approved for acute mania
- wide TI index
Valporate (Depakote) ADRs
- GI distress
- weight gain
- hepatotoxicity, contradicted in liver disease
- thrombocytopenia
- pancreatitis
- tertogenesis
Lamotrigine (Lamictal)
- FDA approved for maintenance treatment
- titrated slowly over weeks
- drug of choice for pregnancy
Lamotrigine (Lamictal)
MOA:
- modulates glutamate & aspartate
ADRs:
- dizziness
- double or blurred vision
- nausea
- vomiting