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
Carbemazepine (Tegretol, Equetro)
- indicated for acute mania & mixed states - blood dyscrasias - rash - drug interactions - teratogenesis
26
Carbemazepine (Tegretol, Equetro) ADRs
- nystagmus - double vision - vertigo - staggering gait - headache
27
Describe Mania
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
28
Drugs that induce mania
- steroids - amphetamines - cocaine - antidepressants - levodopa - thyroid hormone
29
Nursing Interventions for mania
- 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
30
Describe antidepressant meds
- 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
31
MOA & USES of SSRIs
MOA: - inhibit reuptake of serotonin at the presynaptic membrane increased serotonin in synapse USES: - depression - anxiety disorders - bulimia nervosa - premenstrual dysphoric disorder - bipolar disorder
32
ADRs of SSRIs
- nausea, GI disturbances (food can help) - restlessness, jitteriness - insomnia - sexual dysfunction - bruxism (grinding of teeth) - serotonin syndrome
33
Explain stages of Hans-Selye General Adaptation Syndrome
Alarm - release of adrenaline, corticosteroids & endorphins - intense & short time Resistance/Adaptation - muscle endurance - stamina Exhaustion - if body doesn't adapt stress becomes chronic
34
Explain denial defense mechanism
avoidance of disagreeable realities EX: refusing to recognize them
35
Explain displacement defense mechanism
shift emotion from one person to another EX: fight w/ partner b/c mad at boss
36
Explain intellectualization defense mechanism
reasoning to avoid feelings EX: get bad diagnosis & become obsessed w/ it
37
Explain rationalization defense mechanism
- offering socially acceptable explanation to justify feelings or behaviors EX: cheating academically
38
Explain reaction formation defense mechanism
conscious attitudes that are opposite of true feelings EX: someone who unexpectedly got pregnant & then becomes super mom
39
Explain repression in defense mechanism
INVOLUNTARY exclusion of painful thought EX: can't remember something terrible that happened to them
40
Explain suppression defense mechanism
VOLUNTARY exclusion of painful thoughts EX: suspects cheating but ignores the signs
41
Explain undoing defense mechanism
communication negates a previous one EX: gossiping about friend & then being super nice next time u see that friend
42
S&S of Separation Anxiety Disorder
- gastro issues - headaches - don't sleep - usually before age 18 symptoms present for at least 1 month
43
S&S of Panic Disorder
- palpitations - SOB - feelings of suffocation - chest pain - fear of dying - chills or hot flashes - nausea - depersonalization - paresthesia
44
S&S of Agoraphobia
- 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
S&S of Specific Phobia
- persistent, irrational fear of specific object or situation -immediate anxiety response - interferes w/ normal routines - avoiding doing things
46
S&S of Social Anxiety (Social Phobia)
- avoidance behavior - blushing - tachycardia
47
S&S of GAD (Generalized Anxiety Disorder)
- aches & pains - muscle tensions - headaches - fatigue - restlessness - poor concentration - poor decision making - irritability - sleep disturbance - physical complaints
48
S&S for OCD
- impairs w/ functioning in life - interferes w/ life
49
S&S Body Dysmorphic Disorder
- significant distress - impaired in functioning - feel disgust - feel shame - feel dression
50
S&S for Hoarding Disorder
- impairment in normal living
51
S&S for Hair Pulling & Skin Picking Disorders
- picking decreases anxiety
52
Biological Factors for Anxiety
- genetics - dysfunction of amygdala - GABA system -serotonin system - general health
53
Psychological Factors for Anxiety
- early life experiences - learned response - distorted thoughts - low resilience
54
RN Interventions for Anxiety
- 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
Several & Panic Level Interventions
- maintain safety - decrease stimulation - stay with pt - stay calm - physical activity - administer antianxiety med
56
Benzodiazepines
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
Buspirone (Buspar)
- 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
SSRI & SNRI
- 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
Identify S&S of major depression & persistent depressive disorder
- 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
Identify risk factors for major depression
- 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
Describe appropriate RN interventions for patients w/ depression
- 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
State the indications for benefits of & ADRs of ECT
- 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
Identify appropriate candidates for ECT
- severe depression - catatonic schizophrenia - acute mania
64
Describe RN interventions for the pt receiving ECT
- 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
Side Effects of Lithium
- 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
MOA of Bupropion
- blocks reuptake of dopamine & norepinephrine - inhibits nicotonic acetylcholine receptors
67
Prototype of SSRI meds
Fluoxetine (Prozac)
68
3 uses of Bupropion
- depression - seasonal depression - smoking cessation - adult ADHD
69
ADRs of Bupriopion
- headache - decreased appetite - weight loss - restlessness - tremor - insomnia - decreased seizure threshold
70
ADRs of tricyclic antidepressants (TCA's)
- cardiac dysrhythmias - heart block - sedation - anticholinergic effects - ortho hypotension - increased appetite - excessive sweating - decreased seizure threshold
71
How often & when tricyclics antidepressants should be taken
once a day at night since it causes sedation
72
MOA of tricyclic antidepressants
- block reuptake of serotonin & norepinephrine (dual action)
73
Prototype of MAO-I meds
Phenelzine (Nardil)
74
Common ADR reactions of MAO-Is
- anxiety - agitation - ortho hypotension - drowsiness - anticholinergic effects
75
Food interactions with MAO-Is
- 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
Drug interactions with St.Johns Wort
- antidepressants - busprione - meperedine
77
Common symptoms of HTN Crisis
- sudden increased BP & HR - N&V - headache often occipital - diaphoresis - decreased LOC
78
RN interventions for HTN Crisis
- early identification of S&S - stop med - don't lie flat
79
TI range of lithium
0.8-1.4 mEq/L
80
Appropriate fluid intake for lithium
1.5 liters a day
81
How often pts should get lithium level checked when its first started
initially every 2-3 days & then every 3-6 months
82
Meds to avoid when taking lithium
Ibuprofen NSAIDs Diuretics take Tylenol or ASA instead
83
What are the anticonvulsant mood stabilizer meds
- Valporate (Depakote) - Carbamazepine (Tegretol) - Lamotrigine (Lamictal)
84
What lab must be monitored in pts taking valporic acid
- liver function b/c it can be liver toxic
85
Advantages of anticonvulsant mood stabilizer meds over lithium
- less ADRs - wide TI index
86
Describe the characteristics of the different phases & stages of a therapeutic group
87
Identify the 3 types of group roles
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
Describe therapeutic factors of group therapy to Irvin Yalom
- imparting of info -universality - altruism - socializing techniques - instillation of hope - corrective reenactment - interpersonal learning - existential factors - catharsis - group cohesiveness