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NUR-341 > Exam 2 > Flashcards

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

1
Q

What is NAMI

A

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
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2
Q

Describe Family Interventions

A
  • support integrity & functioning of family

includes:
- empowerment
- family therapy (might identify need for referral to therapist for example)
- community resources
- education

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3
Q

Outcomes from Family Interventions

A
  • resolve conflicts
  • use of resources & effective problem solving
  • improved communication
  • improved ability to cope w/ stressors
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4
Q

RN Diagnoses for Family Interventions

A
  • 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
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5
Q

Describe 15 Min Family Interview

A

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)

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6
Q

Describe Domains of Family Assessment

A

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

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7
Q

Describe genogram in a family assessment

A
  • multigenerational depiction of biological, legal & emotional relationships
  • analyze for composition & patterns
  • includes age, health problems, dates of marriage & death
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8
Q

Explain the Competence Model

A
  • focuses on strengths & building on those
  • empowerment
  • collaboration
  • focus on improvements & what they can learn to get better
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9
Q

Describe Concepts of Family Systems Theory

A
  • 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)
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10
Q

Describe Family Burden

A
  • family experience of mental illness
  • objective or subjective including…
    • anxiety
    • grief
    • guilt (feel they contributed to the illness)
    • anger
    • powerlessness
      -fear
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11
Q

Describe Families “at risk” population

A
  • stigma
  • decreased social contact/support
  • children of mentally ill parents
  • siblings
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12
Q

Describe management in Family Functions

A
  • where $ and time is spent
  • power
  • resource allocation
  • rules
  • financial support
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13
Q

Describe families as caregivers

A
  • 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
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14
Q

Lithium Carbonate MOA & USES

A
  • 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

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15
Q

Lithium special considerations

A
  • 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
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16
Q

Lithium ADRs

A
  • 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
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17
Q

Causes of increased Lithium levels

A
  • decreased sodium intake
  • fluid/electrolyte loss
  • impaired renal function
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18
Q

Lithium drug interactions

A
  • Ibuprofen
  • Diuretics
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19
Q

Anticonvulsant Mood Stabilizers MOA & USES

A

MOA:
- alters electrical conductivity of cell membranes
- enhance the effects of GABA
- inhibit glutamate

USES:
- acute episodes of mania & depression

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20
Q

Anticonvulsant Mood Stabilizer prototypes

A
  • Valporate (Depakote)
  • Cabamazepine (Tegretol)
  • Lamotrigine (Lamictal)
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21
Q

Valporate (Depakote)

A
  • FDA approved for acute mania
  • wide TI index
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22
Q

Valporate (Depakote) ADRs

A
  • GI distress
  • weight gain
  • hepatotoxicity, contradicted in liver disease
  • thrombocytopenia
  • pancreatitis
  • tertogenesis
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23
Q

Lamotrigine (Lamictal)

A
  • FDA approved for maintenance treatment
  • titrated slowly over weeks
  • drug of choice for pregnancy
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24
Q

Lamotrigine (Lamictal)

A

MOA:
- modulates glutamate & aspartate

ADRs:
- dizziness
- double or blurred vision
- nausea
- vomiting

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25
Q

Carbemazepine (Tegretol, Equetro)

A
  • indicated for acute mania & mixed states
  • blood dyscrasias
  • rash
  • drug interactions
  • teratogenesis
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26
Q

Carbemazepine (Tegretol, Equetro) ADRs

A
  • nystagmus
  • double vision
  • vertigo
  • staggering gait
  • headache
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27
Q

Describe Mania

A

period of elevated, expansive, or irritable mood lasting at least 1 week with at least 3 of the following:
- extreme drive & energy
- inflated sense of importance
- decreased need for sleep
- excessive talking & pressured speech
- racing thought
- distractibility
- obsession w/ goals
- purposeless arousal & movement
- excessive involvement in pleasurable, high risk activities

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28
Q

Drugs that induce mania

A
  • steroids
  • amphetamines
  • cocaine
  • antidepressants
  • levodopa
  • thyroid hormone
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29
Q

Nursing Interventions for mania

A
  • safety (poor judgement & suicidality)
  • calm environment to minimize stimulation
  • provide physical outlets
  • simple communication (b/c got alot going on)
  • assist w/ hygiene
  • assist w/ nutrition (allow HAND HELD foods & NUTRITION based)
  • facilitate sleep
  • constructive limit setting
  • focus on positive
  • involve family in treatment
  • education
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30
Q

Describe antidepressant meds

A
  • used for mood & anxiety disorders
  • take 2-4 weeks to see TI effect
  • should be continued for 6-9 months after symptoms subside
  • taper to discontinue..don’t stop abruptly
  • given once per day
  • can trigger manic episode in pts w/ bipolar disorder or psychosis in pts w/ schizophrenia
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31
Q

MOA & USES of SSRIs

A

MOA:
- inhibit reuptake of serotonin at the presynaptic membrane increased serotonin in synapse

USES:
- depression
- anxiety disorders
- bulimia nervosa
- premenstrual dysphoric disorder
- bipolar disorder

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32
Q

ADRs of SSRIs

A
  • nausea, GI disturbances (food can help)
  • restlessness, jitteriness
  • insomnia
  • sexual dysfunction
  • bruxism (grinding of teeth)
  • serotonin syndrome
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33
Q

Explain stages of Hans-Selye General Adaptation Syndrome

A

Alarm
- release of adrenaline, corticosteroids & endorphins
- intense & short time

Resistance/Adaptation
- muscle endurance
- stamina

Exhaustion
- if body doesn’t adapt stress becomes chronic

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34
Q

Explain denial defense mechanism

A

avoidance of disagreeable realities

EX: refusing to recognize them

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35
Q

Explain displacement defense mechanism

A

shift emotion from one person to another

EX: fight w/ partner b/c mad at boss

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36
Q

Explain intellectualization defense mechanism

A

reasoning to avoid feelings

EX: get bad diagnosis & become obsessed w/ it

37
Q

Explain rationalization defense mechanism

A
  • offering socially acceptable explanation to justify feelings or behaviors

EX: cheating academically

38
Q

Explain reaction formation defense mechanism

A

conscious attitudes that are opposite of true feelings

EX: someone who unexpectedly got pregnant & then becomes super mom

39
Q

Explain repression in defense mechanism

A

INVOLUNTARY exclusion of painful thought

EX: can’t remember something terrible that happened to them

40
Q

Explain suppression defense mechanism

A

VOLUNTARY exclusion of painful thoughts

EX: suspects cheating but ignores the signs

41
Q

Explain undoing defense mechanism

A

communication negates a previous one

EX: gossiping about friend & then being super nice next time u see that friend

42
Q

S&S of Separation Anxiety Disorder

A
  • gastro issues
  • headaches
  • don’t sleep
  • usually before age 18

symptoms present for at least 1 month

43
Q

S&S of Panic Disorder

A
  • palpitations
  • SOB
  • feelings of suffocation
  • chest pain
  • fear of dying
  • chills or hot flashes
  • nausea
  • depersonalization
  • paresthesia
44
Q

S&S of Agoraphobia

A
  • anxiety about being in places or situations where escape can be difficult or embarrassing
  • avoidance behaviors
  • impaired ability to work
  • impaired ability to perform duties
45
Q

S&S of Specific Phobia

A
  • persistent, irrational fear of specific object or situation
    -immediate anxiety response
  • interferes w/ normal routines
  • avoiding doing things
46
Q

S&S of Social Anxiety (Social Phobia)

A
  • avoidance behavior
  • blushing
  • tachycardia
47
Q

S&S of GAD (Generalized Anxiety Disorder)

A
  • aches & pains
  • muscle tensions
  • headaches
  • fatigue
  • restlessness
  • poor concentration
  • poor decision making
  • irritability
  • sleep disturbance
  • physical complaints
48
Q

S&S for OCD

A
  • impairs w/ functioning in life
  • interferes w/ life
49
Q

S&S Body Dysmorphic Disorder

A
  • significant distress
  • impaired in functioning
  • feel disgust
  • feel shame
  • feel dression
50
Q

S&S for Hoarding Disorder

A
  • impairment in normal living
51
Q

S&S for Hair Pulling & Skin Picking Disorders

A
  • picking decreases anxiety
52
Q

Biological Factors for Anxiety

A
  • genetics
  • dysfunction of amygdala
  • GABA system
    -serotonin system
  • general health
53
Q

Psychological Factors for Anxiety

A
  • early life experiences
  • learned response
  • distorted thoughts
  • low resilience
54
Q

RN Interventions for Anxiety

A
  • physical exam
  • assess current level of anxiety & safety
  • establish trusting relationship
    - therapeutic communication
    - physical presence
    - self assessment
  • encourage activity
  • assist w/ nutrition, hygiene, sleep
  • identify defense mechanism
  • cognitive restructuring
  • education
    - signs & triggers
    - stress management
    - medications
55
Q

Several & Panic Level Interventions

A
  • maintain safety
  • decrease stimulation
  • stay with pt
  • stay calm
  • physical activity
  • administer antianxiety med
56
Q

Benzodiazepines

A

Prototype: Alprazolam (Xanx)

Used for:
- panic disorder
- GAD
- insomnia
- alcohol withdrawal
- muscle relaxation
- seizure disorder
- agitation

ADRs:
- CNS depression - ataxia sedation, dizziness, amnesia w/ large doses
- use of alcohol is life threatening

MOA:
- decreased cell excitation = calm
- fast & effective
- high TI

Antidote:
- Flumazemil (Romazicon)

-AZE, - ZOLAM, - ZEPAM
- short term tx
- don’t stop med abruptly
- highly addictive
- most widely used

57
Q

Buspirone (Buspar)

A
  • anxiety only
  • no addictive potential
  • no sedation

Used for:
- panic disorder
- OCD
- SAD
- GAD

ADRs:
- dizziness
- nausea
- headache
- lightheadedness
- agitation

MOA:
- works like an antidepressant
- binds to serotonin & dopamine receptors
- takes 2-6 weeks for full effect
- must be taken regularly (2-3x/day)

58
Q

SSRI & SNRI

A
  • long term
  • does not combine w/ MAO-Is & St. Johns Wort

Used for:
- 1st tx for anxiety disorders

ADRs:
- Serotonin syndrome - tremors, muscle rigidity, mental changes, increased HR BP & temp
- Sexual dysfunction
- Stomach issues
- Swollen (weight gain)

MOA:
- similar to depression
- inhibit reuptake of NT= more NT
- take 4 to 8 weeks for full effect
- stay on med for at least a year

59
Q

Identify S&S of major depression & persistent depressive disorder

A
  • diminished ability to think, concentrate, indecisiveness
  • insomnia or hypersomnia
  • weight loss or gain
  • psychomotor agitation or retardation
  • fatigue or loss of energy
  • feelings or worthlessness or guilty
  • recurrent thoughts or death or suicidal ideation
60
Q

Identify risk factors for major depression

A
  • past episodes of depression
  • family history
  • female gender
  • over age 65
  • stressful life events
  • medical illness
  • postpartum period
  • lack os social support
  • unmarried
  • current substance abuse

No specific factors for ethnicity, education, income

61
Q

Describe appropriate RN interventions for patients w/ depression

A
  • self assessment
  • assess suicidality
  • safety
  • provide hope
  • respond w/ empathy & compassion
    physical activity & social interaction
  • education
    involve family in tx
  • develop insight into negative thinking
62
Q

State the indications for benefits of & ADRs of ECT

A
  • works faster than antidepressants
  • no or poor response to med
  • marked agitation, negative symptoms or catatonia

ADRs:
- general anesthesia risk
- cardiovascular
- systemic: headache, drowsy, sore muscles

63
Q

Identify appropriate candidates for ECT

A
  • severe depression
  • catatonic schizophrenia
  • acute mania
64
Q

Describe RN interventions for the pt receiving ECT

A
  • ventilate pt
  • monitor vital signs
  • observe pt every 15 mins
  • assess mental status every 30 mins
  • assist pt to resume normal activities
  • treat ADRs
65
Q

Side Effects of Lithium

A
  • GI distress
  • fine hand tremor
  • polyuria, thirst
  • weight, gain
  • bradydysrhythmias
  • hypotension
  • electrolyte imbalances
  • fatigue, lethargy, headache, mental dullness
  • renal effects
  • hypothyroidism w/ long term tx
66
Q

MOA of Bupropion

A
  • blocks reuptake of dopamine & norepinephrine
  • inhibits nicotonic acetylcholine receptors
67
Q

Prototype of SSRI meds

A

Fluoxetine (Prozac)

68
Q

3 uses of Bupropion

A
  • depression
  • seasonal depression
  • smoking cessation
  • adult ADHD
69
Q

ADRs of Bupriopion

A
  • headache
  • decreased appetite
  • weight loss
  • restlessness
  • tremor
  • insomnia
  • decreased seizure threshold
70
Q

ADRs of tricyclic antidepressants (TCA’s)

A
  • cardiac dysrhythmias
  • heart block
  • sedation
  • anticholinergic effects
  • ortho hypotension
  • increased appetite
  • excessive sweating
  • decreased seizure threshold
71
Q

How often & when tricyclics antidepressants should be taken

A

once a day at night since it causes sedation

72
Q

MOA of tricyclic antidepressants

A
  • block reuptake of serotonin & norepinephrine (dual action)
73
Q

Prototype of MAO-I meds

A

Phenelzine (Nardil)

74
Q

Common ADR reactions of MAO-Is

A
  • anxiety
  • agitation
  • ortho hypotension
  • drowsiness
  • anticholinergic effects
75
Q

Food interactions with MAO-Is

A
  • avoid foods high in tyramine
  • avoid aged cheese
  • avoid pickled & smoked fish
  • wine
  • beer
  • avoid fermented foods
  • avoid smoked & cured meats
  • avoid overripe fruits
76
Q

Drug interactions with St.Johns Wort

A
  • antidepressants
  • busprione
  • meperedine
77
Q

Common symptoms of HTN Crisis

A
  • sudden increased BP & HR
  • N&V
  • headache often occipital
  • diaphoresis
  • decreased LOC
78
Q

RN interventions for HTN Crisis

A
  • early identification of S&S
  • stop med
  • don’t lie flat
79
Q

TI range of lithium

A

0.8-1.4 mEq/L

80
Q

Appropriate fluid intake for lithium

A

1.5 liters a day

81
Q

How often pts should get lithium level checked when its first started

A

initially every 2-3 days & then every 3-6 months

82
Q

Meds to avoid when taking lithium

A

Ibuprofen
NSAIDs
Diuretics

take Tylenol or ASA instead

83
Q

What are the anticonvulsant mood stabilizer meds

A
  • Valporate (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
84
Q

What lab must be monitored in pts taking valporic acid

A
  • liver function b/c it can be liver toxic
85
Q

Advantages of anticonvulsant mood stabilizer meds over lithium

A
  • less ADRs
  • wide TI index
86
Q

Describe the characteristics of the different phases & stages of a therapeutic group

A
87
Q

Identify the 3 types of group roles

A

Task: focused on purpose/work of group
- coordinator
- elaborator
-energizer
- info giver/seeker

Maintenance: create cohesion
- encourager
- harmonizer
- gatekeeper
- follower
- observer
- standard setter

Individual: distract from work of group

88
Q

Describe therapeutic factors of group therapy to Irvin Yalom

A
  • imparting of info
    -universality
  • altruism
  • socializing techniques
  • instillation of hope
  • corrective reenactment
  • interpersonal learning
  • existential factors
  • catharsis
  • group cohesiveness

NUR-341 (3 decks)

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