Exam #2 Flashcards
What is the definition of psychosis
Altered cognition, altered perception and/ or impaired ability to determine what is real
How is schizoaffective disorder disorder characterized?
Mood and thoughts are altered concurrently
When age does the first episode develop?
75% develop between ages 15-25
What are the psychotic symptoms that every diagnosed schizophrenic experience at least one of?
H, D, DS, AT
- hallucinations
- delusions
- disorganized speech
- altered thoughts
What are the risk factors for developing schizophrenia?
- genetics
- neurotransmitter imbalance
- brain structure abnormalities
- prenatal stressor
- environmental factors
What neurotransmitter is closely associated with schizophrenia symptoms?
- dopamine ( can be targeted via drug therapy for reduction of symptoms)
What are the different stages of schizophrenia?
P, A, S, M/R
- prodromal
- acute
- Stabilization
- maintenance of residual
What is the prodromal stage?
Phases of schizophrenia
- mild changes in mood or thoughts
- decreased concentration and social function
When will the symptoms manifest in the prodromal stage?
Phases of schizophrenia
1 month to 1 year before first psychotic episode
What is the acute stage?
Phases of schizophrenia
Ability to function is impaired and hospitalization is required
What is the stabilization stage?
Phases of schizophrenia
Symptoms stabilize or diminish and there is a return to baseline functioning
What is the maintence or residual stage?
Phases of schizophrenia
A new level of baseline functioning is established and positive symptoms are gone or mostly gone
What are positive symptoms of schizophrenia?
Hallucinations, delusions
- presence of something that shouldn’t be present
What are the negative symptoms of schizophrenia?
hygiene, anhedonia, BROAD affect
Absence of something that shouldn’t be present
What are cognitive symptoms of schizophrenia?
- impairment in memory, thinking, attention, judgement, problem solving capabilities
What are affective symptoms of schizophrenia?
Symptoms that impact the emotional response
Common positive symptoms?
D, WS, AP, C, IIC, PB
- delusions
- word salad, rhyming
- altered perception
- catatonic
- impaired impulse control
- poor boundaries
What are common negative symptoms?
4 A’S
- anhedonia: inability to enjoy activities
- avolition: lack of motivation
- affective blunting: reduced affect
- alogia: decreased speech
What is anosognosia?
Inability to realize that they are ill as a result of the schizophrenia
What kinds of assessments would you preform on a pt w/ schizophrenia?
- MSE / psychosocial assessment
- suicide risk
- substance abuse
- med compliance
- family response
- social support
What are common nursing diagnosis for a patient w/ schizophrenia?
- Disturbed sensory perception
- Altered thought process
- ineffective coping
- self care deficit
What would the nurse plan for the patient if they are in the acute phase of schizophrenia?
Goals are focused on saftey and stablization
What would the nurse plan for the patient if they are in the stabilization phase of schizophrenia?
Goals are focused on education and achieving an acceptable treatment regimen
What would the nurse plan for the patient if they are in the maintenance phase of schizophrenia?
Goals are focused on treatment adherence and the prevention of relapse
What are some interventions that can be used to help pt w/ schizophrenia?
S, DS, EB, MPW, UR
- set limits
- decrease stimuli
- observe for escalating behaviors
- minimize potential weapons
- use restraints
What is the first line of defense to treat schizophrenia?
Second generation antipsychotics
What is the mechanism of action of second generation antipsychotics?
Bind to dopamine receptors in the limbic system and also impact serotonin levels
What symptoms does second generation antipsychotic target?
Positive and negative
What are side effects of taking second generation antipsychotics?
wim
- weight gain
- increased mortality rate in dementia pts
- metabolic syndrome
What are sone examples of second generation antipsychotics?
C, Q, O, Z, P
- clozapine ( clozaril) * increased risk for infection
- Quetapine ( seroquel)
- olanzapine (zyprexa)
- ziprasidone ( Geodon)
- paliperidone (in Vega)
What is the second line of defense to treat schizophrenia?
First generation antipsychotics
What is the mechanism of action of first generation antipsychotics?
- works as a strong antagonist to block dopamine
What symptoms does first generation antipsychotic target?
Only positive symptoms
What are some examples of first generation antipyschotics?
H, L
Haloperidol ( Haldol)
Loxapine ( loxitane)
What are the serious side effects of taking antipsychotics?
ANAL
- anticholinergic
- neuroleptic malignant syndrome
- agranulocytosis ( associated with clozaril)
- liver impairment
What are the CM neuroleptic malignant syndrome?
- Decreased LOC
- temp over 103
- increased muscle rigidity
What is disruptive mood regulation disorder?
- severe irritability and anger in children/ adolescents
What is persistent depressive disorder?
Chronic depressed emotional state but less severe than MDD
What is premenstrual dysphoric disorder ?
Depressive symptoms one week prior to start of the menstrual cycle
What is the leading cause of disability in the US?
MDD nearly affects 17 million of the population
What are risk factor for MDD?
G, BC, H, HPAXA, I
- genetics
- biochemical
- hormonal
- hypothalamic pituitary adrenal cortical axis
- inflammation
What parts of the MSE would you see abnormalities in for a patient with a depressive disorder?
- affect ( flat or blunted)
- thought process ( decreased ability to problem solve)
- poor judgement ( indecisive or neg focused thoughts)
- mood ( depressed/ sad, anhedonia)
What is the mechanism of SSRI’s?
First line treatment of depression
Selectively block neuronal uptake of serotonin
What are the adverse effects of taking SSRI’s?
A, SD, GIU, SD
- anxiety/ agitation
- sleep disturbances
- GI upset
- sexual dysfunction
What are the severe side effects of taking SSRI’s?
- serotonin syndrome
What are the CM of serotonin syndrome?
IHR+BP+T, D, T, A
- increased HR, BP, and Temp
- delirium
- tremors
- apnea leads to death
What should the nurse teach a pt who is taking SSRI’s?
- 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)
What is the mechanism of action of tricyclic antidepressants?
- inhibit the uptake of norepinephrine and serotonin
What are the contraindications of tricyclic antidepressants?
CI, NAG, HxS
- cardiovascular issues
- narrow angle glaucoma
- Hx of seizures
What are common side effects of taking tricyclic antidepressants?
- anticholinergic side effects
- sedation
- hypotension
- tachycardia
What should the nurse educate a patient on about tricyclic antidepressants?
- toxicity and lethal OD
What is the mechanism of action of MAOI’s?
Inhibits the enzyme monoamine oxidase that breaks down neurotransmitters
What are the side effects of taking MAOI’s?
MAUI IS HAVING TROUBLE FINDING A WOMAN
- weight gain
- sexual dysfunction
- cardiac issues
What are the potential life threatening side effects of taking MAOI’s?
- HTN crisis
- high intake of foods high in tyramine
what should the nurse educate the pt on when taking MAOI’s?
- 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
What is ECT?
A psychiatric treatment in which seizures are electrically induced in pt to provide relief from mental disorders
* treatment resistant depression/ Catatonia
What is transcranial magnetic stimulation (rTMS)?
Noninvasive treatment which uses MRI strengthen magnetic pulses to stimulate focal areas of the cerebral cortex
* mild treatment resistant depression
What is the nurses role for ECT?
- educate about procedure
- pre and post MSE
- presence during procedure
- posy vitals signs and LOC
Risk factors for suicide?
- co morbid medical condition
- substance abuse
- psychiatric disorders
- no positive protective factors
What is passive SI?
Dreamt of their own funeral
Having fantasies about death mild and fleeting
What is active SI?
Desire to die that is persistent and involving a plan
What should a nurse plan for a patient with SI?
- development of safety plan
- SI precaution
- encouraging pt to express feelings
What are examples of NSSI ( non suicidal self injury)?
- cutting
- burning
- biting
- eraser burns
- scratching
- interference w/ wound healing
- swallowing objects
What is the nurses role in management of self destructive behaviors?
- 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
How is bipolar disorder characterized?
General
Mood disorder w/ extreme highs and low
How is bipolar I characterized?
Most severe bipolar type
- at least one episode of mania alternating w/ MDD
What are the symptoms of mania?
- 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)
What are symptoms of depressive episodes?
- daytime sleepiness
- excessive eating
- weight gain
- leaden paralysis ( feeling you cant move)
- paranoid thought/ hallucinations
- irritability
How is bipolar II characterized?
- hypo manic episodes alternating w/ MDD
What is hypomania?
Period of excessive energy w/ expansive mood that is less dramatic than mania ( not accompanied by psychosis)
What are the symptoms of hypomania?
- 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
What is cyclothmyia?
Hypomania episodes alternating with minor depressive episodes
Risk factors for bipolar disorder?
- 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
When preforming a psychosocial assessment what would be abnormal in a patient?
- 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
What are common nursing diagnosis for a pt with bipolar disorder?
- risk for injur
- sleep deprivation
- altered thought process
- impaired social interaction
What is the goal for a pt with bipolar disorder?
- stabilization and care management in a safe and secure environment, biological needs such as sleep, medication management, nutritional intake
How would you talk to a patient with bipolar?
- firm, calm
- short and concise
- remain neutral
- reinforce reality
How is the milieu managed with a pt with bipolar?
• 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
How can a nurse promote Nutrtion and sleep in a pt w/ bipolar?
- finger foods
- high protein
- high caloric
- multivitamins
- weigh regularly
- quiet environment for sleep
What is the theraputic blood level for lithium?
0.6-1.2 mEq/L
What are the early symptoms of lithium toxicity?
1.5 mEq/L
- GI upset
- sedation
- tremors
What should the nurse teach the pt about lithium?
- 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
How long does anticonvulsants take before they are fully therapeutic?
2-3 weeks
What are primary groups?
Usually informal because they are personal and close
What are secondary groups?
They are time limited groups and the purpose is to meet specific goals
what are closed therapeutic groups?
have selected membership and for an extended period of time
what is an open group?
doesnt have defined membership
what is an homogenous group?
share common goals and characteristics like diagnosis or demographic
what are the diffrent leader styles?
A, D, LF
- authoritarian group leader
- democratic group leader
- laissez faire group leader
what is the characteritics of the authoritarian group leader?
- takes full responsibilty
- this style works best when there is limited time to make descions
what is the characteritics of the democratic group leader?
- inivtes member participation
- can adpat leadership style to fit the chnaging needs of the group
- goal oriented and flexiable
what is the characteristics of the laissez-faire group leader?
- disengaged
- doesn’t control group decision-making
What is a group norm?
Unwritten behavioral rules expected of group members
what is group content?
- the transcript of the group
what is group process?
how the group members interact
what are the diffrent group phases?
P, O, W, T
- Planning
- orientation
- working
- termination
what is planning?
group phases
first group phase that the group scructure and characteristics are determined
what is the orientation phases?
group phases
2nd phase that relationships begin to form and a level of trust is developed among the group members
what is the working phase?
group phases
communication is focused on problem solving
what is th termination phase?
group phases
4th phase where feedback occurs and the summary is presented
how does the nurse deal with the monopolizing group member?
Ned in groups
- privately or publicly adress them
- limit contrubution
how does the nurse deal with the disruptive group member?
- listen objectivley and remind them the group is there to support them
- adress anger directly
how does the nurse deal with the silent group member?
- allow them extra time to share
- assign everyone in the group to group
what are the disadvantages of theraputic groups?
- some may feel cheated of participation time
- distruptive group members reduce group effectiveness
- not all pt’s benefits
what is the definiton of boundaries?
- provide oppurtunity for individuality
what are the diffrent types of boundaries?
C, D, R
- clear
- diffuse
- rigid
what are clear boundaries?
firm but flexiable
what are diffused boundaries?
boundaries and roles are unclear and individuality is discouraged
what are rigid boundaries?
strict rules result in distance and seperation as well as limited sharing of feelings and thoughts
what is triangulagtion?
occurs when one family member will not directly communicate with another family member but w/ someone else
what are double bind messages?
“oh ok have fun, ill just be here by myself watching tv”
contradicting messages given by a person in power, either choice will result in displeasure
what is the interventation used for a dysfunctional family dynamic?
promote positive coping skills and communication to improve mental health of the family unit
what is intergrative care?
outside standard medical practice
focuses on prevention and wellness and the holistic needs of the person
