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Mental Health > Exam #2 > Flashcards

Exam #2 Flashcards

1
Q

What is the definition of psychosis

A

Altered cognition, altered perception and/ or impaired ability to determine what is real

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2
Q

How is schizoaffective disorder disorder characterized?

A

Mood and thoughts are altered concurrently

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3
Q

When age does the first episode develop?

A

75% develop between ages 15-25

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4
Q

What are the psychotic symptoms that every diagnosed schizophrenic experience at least one of?

H, D, DS, AT

A
  • hallucinations
  • delusions
  • disorganized speech
  • altered thoughts
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5
Q

What are the risk factors for developing schizophrenia?

A
  • genetics
  • neurotransmitter imbalance
  • brain structure abnormalities
  • prenatal stressor
  • environmental factors
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6
Q

What neurotransmitter is closely associated with schizophrenia symptoms?

A
  • dopamine ( can be targeted via drug therapy for reduction of symptoms)
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7
Q

What are the different stages of schizophrenia?

P, A, S, M/R

A
  • prodromal
  • acute
  • Stabilization
  • maintenance of residual
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8
Q

What is the prodromal stage?

Phases of schizophrenia

A
  • mild changes in mood or thoughts
  • decreased concentration and social function
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9
Q

When will the symptoms manifest in the prodromal stage?

Phases of schizophrenia

A

1 month to 1 year before first psychotic episode

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10
Q

What is the acute stage?

Phases of schizophrenia

A

Ability to function is impaired and hospitalization is required

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11
Q

What is the stabilization stage?

Phases of schizophrenia

A

Symptoms stabilize or diminish and there is a return to baseline functioning

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12
Q

What is the maintence or residual stage?

Phases of schizophrenia

A

A new level of baseline functioning is established and positive symptoms are gone or mostly gone

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13
Q

What are positive symptoms of schizophrenia?

Hallucinations, delusions

A
  • presence of something that shouldn’t be present
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14
Q

What are the negative symptoms of schizophrenia?

hygiene, anhedonia, BROAD affect

A

Absence of something that shouldn’t be present

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15
Q

What are cognitive symptoms of schizophrenia?

A
  • impairment in memory, thinking, attention, judgement, problem solving capabilities
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16
Q

What are affective symptoms of schizophrenia?

A

Symptoms that impact the emotional response

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17
Q

Common positive symptoms?

D, WS, AP, C, IIC, PB

A
  • delusions
  • word salad, rhyming
  • altered perception
  • catatonic
  • impaired impulse control
  • poor boundaries
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18
Q

What are common negative symptoms?

4 A’S

A
  • anhedonia: inability to enjoy activities
  • avolition: lack of motivation
  • affective blunting: reduced affect
  • alogia: decreased speech
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19
Q

What is anosognosia?

A

Inability to realize that they are ill as a result of the schizophrenia

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20
Q

What kinds of assessments would you preform on a pt w/ schizophrenia?

A
  • MSE / psychosocial assessment
  • suicide risk
  • substance abuse
  • med compliance
  • family response
  • social support
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21
Q

What are common nursing diagnosis for a patient w/ schizophrenia?

A
  • Disturbed sensory perception
  • Altered thought process
  • ineffective coping
  • self care deficit
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22
Q

What would the nurse plan for the patient if they are in the acute phase of schizophrenia?

A

Goals are focused on saftey and stablization

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23
Q

What would the nurse plan for the patient if they are in the stabilization phase of schizophrenia?

A

Goals are focused on education and achieving an acceptable treatment regimen

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24
Q

What would the nurse plan for the patient if they are in the maintenance phase of schizophrenia?

A

Goals are focused on treatment adherence and the prevention of relapse

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25
Q

What are some interventions that can be used to help pt w/ schizophrenia?

S, DS, EB, MPW, UR

A
  • set limits
  • decrease stimuli
  • observe for escalating behaviors
  • minimize potential weapons
  • use restraints
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26
Q

What is the first line of defense to treat schizophrenia?

A

Second generation antipsychotics

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27
Q

What is the mechanism of action of second generation antipsychotics?

A

Bind to dopamine receptors in the limbic system and also impact serotonin levels

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28
Q

What symptoms does second generation antipsychotic target?

A

Positive and negative

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29
Q

What are side effects of taking second generation antipsychotics?

wim

A
  • weight gain
  • increased mortality rate in dementia pts
  • metabolic syndrome
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30
Q

What are sone examples of second generation antipsychotics?

C, Q, O, Z, P

A
  • clozapine ( clozaril) * increased risk for infection
  • Quetapine ( seroquel)
  • olanzapine (zyprexa)
  • ziprasidone ( Geodon)
  • paliperidone (in Vega)
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31
Q

What is the second line of defense to treat schizophrenia?

A

First generation antipsychotics

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32
Q

What is the mechanism of action of first generation antipsychotics?

A
  • works as a strong antagonist to block dopamine
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33
Q

What symptoms does first generation antipsychotic target?

A

Only positive symptoms

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34
Q

What are some examples of first generation antipyschotics?

H, L

A

Haloperidol ( Haldol)
Loxapine ( loxitane)

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35
Q

What are the serious side effects of taking antipsychotics?

ANAL

A
  • anticholinergic
  • neuroleptic malignant syndrome
  • agranulocytosis ( associated with clozaril)
  • liver impairment
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36
Q

What are the CM neuroleptic malignant syndrome?

A
  • Decreased LOC
  • temp over 103
  • increased muscle rigidity
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37
Q

What is disruptive mood regulation disorder?

A
  • severe irritability and anger in children/ adolescents
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38
Q

What is persistent depressive disorder?

A

Chronic depressed emotional state but less severe than MDD

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39
Q

What is premenstrual dysphoric disorder ?

A

Depressive symptoms one week prior to start of the menstrual cycle

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40
Q

What is the leading cause of disability in the US?

A

MDD nearly affects 17 million of the population

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41
Q

What are risk factor for MDD?

G, BC, H, HPAXA, I

A
  • genetics
  • biochemical
  • hormonal
  • hypothalamic pituitary adrenal cortical axis
  • inflammation
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42
Q

What parts of the MSE would you see abnormalities in for a patient with a depressive disorder?

A
  • affect ( flat or blunted)
  • thought process ( decreased ability to problem solve)
  • poor judgement ( indecisive or neg focused thoughts)
  • mood ( depressed/ sad, anhedonia)
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43
Q

What is the mechanism of SSRI’s?

First line treatment of depression

A

Selectively block neuronal uptake of serotonin

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44
Q

What are the adverse effects of taking SSRI’s?

A, SD, GIU, SD

A
  • anxiety/ agitation
  • sleep disturbances
  • GI upset
  • sexual dysfunction
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45
Q

What are the severe side effects of taking SSRI’s?

A
  • serotonin syndrome
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46
Q

What are the CM of serotonin syndrome?

IHR+BP+T, D, T, A

A
  • increased HR, BP, and Temp
  • delirium
  • tremors
  • apnea leads to death
47
Q

What should the nurse teach a pt who is taking SSRI’s?

A
  • let the nurse know if you are exp restlessness, tremors
  • dont mix with OTC drugs and other antidepressants
  • kidney and liver testing
  • don’t abruptly stop ( discontinuation syndrome)
48
Q

What is the mechanism of action of tricyclic antidepressants?

A
  • inhibit the uptake of norepinephrine and serotonin
49
Q

What are the contraindications of tricyclic antidepressants?

CI, NAG, HxS

A
  • cardiovascular issues
  • narrow angle glaucoma
  • Hx of seizures
50
Q

What are common side effects of taking tricyclic antidepressants?

A
  • anticholinergic side effects
  • sedation
  • hypotension
  • tachycardia
51
Q

What should the nurse educate a patient on about tricyclic antidepressants?

A
  • toxicity and lethal OD
52
Q

What is the mechanism of action of MAOI’s?

A

Inhibits the enzyme monoamine oxidase that breaks down neurotransmitters

53
Q

What are the side effects of taking MAOI’s?

MAUI IS HAVING TROUBLE FINDING A WOMAN

A
  • weight gain
  • sexual dysfunction
  • cardiac issues
54
Q

What are the potential life threatening side effects of taking MAOI’s?

A
  • HTN crisis
  • high intake of foods high in tyramine
55
Q

what should the nurse educate the pt on when taking MAOI’s?

A
  • avoid food high in tyramine ( red wine, aged cheese or meats)
  • avoid all meds ( especially cold meds)
  • go to the ED if you are experiencing a severe headache
  • monitor BP
56
Q

What is ECT?

A

A psychiatric treatment in which seizures are electrically induced in pt to provide relief from mental disorders
* treatment resistant depression/ Catatonia

57
Q

What is transcranial magnetic stimulation (rTMS)?

A

Noninvasive treatment which uses MRI strengthen magnetic pulses to stimulate focal areas of the cerebral cortex
* mild treatment resistant depression

58
Q

What is the nurses role for ECT?

A
  • educate about procedure
  • pre and post MSE
  • presence during procedure
  • posy vitals signs and LOC
59
Q

Risk factors for suicide?

A
  • co morbid medical condition
  • substance abuse
  • psychiatric disorders
  • no positive protective factors
60
Q

What is passive SI?

Dreamt of their own funeral

A

Having fantasies about death mild and fleeting

61
Q

What is active SI?

A

Desire to die that is persistent and involving a plan

62
Q

What should a nurse plan for a patient with SI?

A
  • development of safety plan
  • SI precaution
  • encouraging pt to express feelings
63
Q

What are examples of NSSI ( non suicidal self injury)?

A
  • cutting
  • burning
  • biting
  • eraser burns
  • scratching
  • interference w/ wound healing
  • swallowing objects
64
Q

What is the nurses role in management of self destructive behaviors?

A
  • asses safety of milieu and limit use of items to self harm
  • closely observe for signs of self harm
  • care for pt w/ wounds and injuries
  • encourage expression of feelings
  • help pt develop pos alt to self harm
65
Q

How is bipolar disorder characterized?

General

A

Mood disorder w/ extreme highs and low

66
Q

How is bipolar I characterized?

Most severe bipolar type

A
  • at least one episode of mania alternating w/ MDD
67
Q

What are the symptoms of mania?

A
  • elevated mood for 1 week
  • grandiosity
  • days w/o sleep
  • speech is loud, urgent, rapid
  • easily distracted
  • psychomotor agitation
  • labile ( happy one moment, angry the next)
68
Q

What are symptoms of depressive episodes?

A
  • daytime sleepiness
  • excessive eating
  • weight gain
  • leaden paralysis ( feeling you cant move)
  • paranoid thought/ hallucinations
  • irritability
69
Q

How is bipolar II characterized?

A
  • hypo manic episodes alternating w/ MDD
70
Q

What is hypomania?

A

Period of excessive energy w/ expansive mood that is less dramatic than mania ( not accompanied by psychosis)

71
Q

What are the symptoms of hypomania?

A
  • 4 days long
  • not severe enough to warrant hospitalization
  • persistent elevated and irritable mood
  • grandiosity
  • decreased need for sleep
  • easily distracted
  • increased goal directed activity
72
Q

What is cyclothmyia?

A

Hypomania episodes alternating with minor depressive episodes

73
Q

Risk factors for bipolar disorder?

A
  • genetics
  • hypothalamic pituitary thyroid adrenal axis dysfunction
  • high stress/ trauma
  • too much of the neurotransmitter and left over and unable to find a receptor site to bind to
74
Q

When preforming a psychosocial assessment what would be abnormal in a patient?

A
  • failed relationships
  • job loss/ failure
  • need to engage people but often become overbearing and intrusive
  • increased sex drive
  • alienation of family/ friends due to extreme mood disorders
75
Q

What are common nursing diagnosis for a pt with bipolar disorder?

A
  • risk for injur
  • sleep deprivation
  • altered thought process
  • impaired social interaction
76
Q

What is the goal for a pt with bipolar disorder?

A
  • stabilization and care management in a safe and secure environment, biological needs such as sleep, medication management, nutritional intake
77
Q

How would you talk to a patient with bipolar?

A
  • firm, calm
  • short and concise
  • remain neutral
  • reinforce reality
78
Q

How is the milieu managed with a pt with bipolar?

A

• Monitor milieu for safety concerns
• Provide solitary activities
• Staff should practice consistency in rule enforcement and limit setting
• Reduce environmental stimuli
• Avoid escalating patient
• Reinforce appropriate hygiene, dress
• Monitor nutrition and sleep

79
Q

How can a nurse promote Nutrtion and sleep in a pt w/ bipolar?

A
  • finger foods
  • high protein
  • high caloric
  • multivitamins
  • weigh regularly
  • quiet environment for sleep
80
Q

What is the theraputic blood level for lithium?

A

0.6-1.2 mEq/L

81
Q

What are the early symptoms of lithium toxicity?

1.5 mEq/L

A
  • GI upset
  • sedation
  • tremors
82
Q

What should the nurse teach the pt about lithium?

A
  • comply with drug therapy to prevent relapse
  • maintain consistent salt and fluid intake ( 1500- 300ml/day)
  • stop taking if dehydration develops from sweating, N/V, diarrhea
  • lithium level mornin blood draw 8-12 hours after last dose
83
Q

How long does anticonvulsants take before they are fully therapeutic?

A

2-3 weeks

84
Q

What are primary groups?

A

Usually informal because they are personal and close

85
Q

What are secondary groups?

A

They are time limited groups and the purpose is to meet specific goals

86
Q

what are closed therapeutic groups?

A

have selected membership and for an extended period of time

87
Q

what is an open group?

A

doesnt have defined membership

88
Q

what is an homogenous group?

A

share common goals and characteristics like diagnosis or demographic

89
Q

what are the diffrent leader styles?

A, D, LF

A
  • authoritarian group leader
  • democratic group leader
  • laissez faire group leader
90
Q

what is the characteritics of the authoritarian group leader?

A
  • takes full responsibilty
  • this style works best when there is limited time to make descions
91
Q

what is the characteritics of the democratic group leader?

A
  • inivtes member participation
  • can adpat leadership style to fit the chnaging needs of the group
  • goal oriented and flexiable
92
Q

what is the characteristics of the laissez-faire group leader?

A
  • disengaged
  • doesn’t control group decision-making
93
Q

What is a group norm?

A

Unwritten behavioral rules expected of group members

94
Q

what is group content?

A
  • the transcript of the group
95
Q

what is group process?

A

how the group members interact

96
Q

what are the diffrent group phases?

P, O, W, T

A
  • Planning
  • orientation
  • working
  • termination
97
Q

what is planning?

group phases

A

first group phase that the group scructure and characteristics are determined

98
Q

what is the orientation phases?

group phases

A

2nd phase that relationships begin to form and a level of trust is developed among the group members

99
Q

what is the working phase?

group phases

A

communication is focused on problem solving

100
Q

what is th termination phase?

group phases

A

4th phase where feedback occurs and the summary is presented

101
Q

how does the nurse deal with the monopolizing group member?

Ned in groups

A
  • privately or publicly adress them
  • limit contrubution
102
Q

how does the nurse deal with the disruptive group member?

A
  • listen objectivley and remind them the group is there to support them
  • adress anger directly
103
Q

how does the nurse deal with the silent group member?

A
  • allow them extra time to share
  • assign everyone in the group to group
104
Q

what are the disadvantages of theraputic groups?

A
  • some may feel cheated of participation time
  • distruptive group members reduce group effectiveness
  • not all pt’s benefits
105
Q

what is the definiton of boundaries?

A
  • provide oppurtunity for individuality
106
Q

what are the diffrent types of boundaries?

C, D, R

A
  • clear
  • diffuse
  • rigid
107
Q

what are clear boundaries?

A

firm but flexiable

108
Q

what are diffused boundaries?

A

boundaries and roles are unclear and individuality is discouraged

109
Q

what are rigid boundaries?

A

strict rules result in distance and seperation as well as limited sharing of feelings and thoughts

110
Q

what is triangulagtion?

A

occurs when one family member will not directly communicate with another family member but w/ someone else

111
Q

what are double bind messages?

“oh ok have fun, ill just be here by myself watching tv”

A

contradicting messages given by a person in power, either choice will result in displeasure

112
Q

what is the interventation used for a dysfunctional family dynamic?

A

promote positive coping skills and communication to improve mental health of the family unit

113
Q

what is intergrative care?

outside standard medical practice

A

focuses on prevention and wellness and the holistic needs of the person

Mental Health (4 decks)

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