Exam 2 Flashcards
How is Zyprexa/Olanzapine utilized
rapidly calms agitation. useful in EDs. Produces the most weight. Dont bake pills in half. Can cause skin rash.
Which antipsychotic drugs are used for bipolar disorder as First line
Abilify, Lurasidone
What do typical antipsychotics do
blocks dopamine leading to reduction in psychotic symptoms. Are prone to EPS such as dyskinesias
What are Side Effects of GHB? (Gamma Hydroxyburtyrate
N/V, delusions, depression, vertigo, hallucinations, seizures, LOC, slow HR, Low BP, Amnesia, Coma.
What is a priority action for bipolar I provocately dressed in the mileu
discuss inappropriate clothing, puts pt at risk
What category of drug is riperdol
dopamine and serotonin antagonist.
Client with Wernicke Korsakoff syndrome and history of alochoism. What is a symptoms nurse should expect?
loss of short term and long term memory and the use of confabulation
Dose for Lithium
300-1200 mg daily
Clozaril is a lower potency atypical antipyschotic, what needs to be monitored when taking this
type II diabetes, WBC count, lowers WBCs
Priority dx for client experiencing cocaine withdrawal?
powerlessness
Nursing considerations with pehnothiazines
parkinson like symptoms, orthostatic hypotension, avoid strenuous exercise in hot weather, wear suncscreen, no alcohol, dizziness
Client experiencing nausea, vomiting, anorexia from Carbamazepine , what is an appropriate intervention
admin next dose with food.
Describe Bipolar I- Mania
- angers easily
- grandiose
- can’t sleep
- unlimited energy
Therapeutic Level for Lithium
0.5 - 1.5 mEq/L
How should valproic acid be given (mood stabilizer)
two divided doses, 500 - 2000 mg daily. Increases GABA
Parts of the CAGE questionnaite
- have you felt you should cut down
- have people annoyed you by criticising your drinking
- have you ever felt guilty about your drinking
- have you ever had a drink in the morning to steady your nerves?
How are atypical antipsychotics used to MGMT bipolar disorder
sedative and mood stabilizing
Olanzapine, Aripiprazole(Abillify), Risperidone
Relapse prevention strategies for substance dependence
present information simply, and easily understood terminology
A client with cofnitivie deficitys and alchol abuse. What drug is appropriate for recovery?
Naltrexone (Revia), opiate antagonist
What is the medication of choice with Bipolar disorder
lithium carbonate. Can be toxic.
What medication would be expected to administer with benzos and obsessive compulsive personality disorder?
Clonazepam
How do anticonvulsants work as mood stabilizers
enhances effects of GABA and desensitizing the kindling of bipolar disorder.
Topamax Uses
Bipolar, mania, migrain headaches, fibromyalgia, schizoaffective
What outcome would you hope to see with a pt with disturbed thought processes
The pt can distiguish reality from delusions
What is anhedonia
inability to experience pleasure risk for suicide.
Halperidol nursing considerations
- dystonia, muscle tighening
- akathisia
- shuffling gait
- weight gain
- dry mouth, blurred vision, constipation
- seizures
What drug has similar effects to Ketamine?
PCP “Angel Dust”
Pt complains of muscle pain, swelling and weakness of extremtieis and reddish tinged urine. What lab value should you assess?
elevated creatine phosphokinase
A client verbally provokes another patient who is paranoid, what is the priority implementation of the nurse
limit setting
waxy flexibility
having one’s arms or legs placed in certain position and holding that same position for hours
Common traits of all personality disorders
- Failure to accept consequences of own behavior
- coipe by altering env’t instead of self
- lack of insight
Lamictal/Lamotrigine
- Anticonulsant/Mood Stabilizer
- Good for rapic cyclers
- Steven Johnson Syndrome
- Stop medication first sign of rash
- may change estrogen oral contraceptives
What category drug is Rohypnol- Date Rape Drug
Benzodiazepine, like Valium. 10x more potent.
schizophrenia and psychosis
ALL schizophrenia are psychosis but not all psychosis are schizophrenia
A narcissist states “I do not think that the whole world owes me a living” what defense mechanism is this?
denial
A schizotypal personality disorder stated “I envision my future death by fire”, what is appropriate response?
I can see you thoughts are bothersome, how can I help?
How is Saphris given and what are SEs
Sublingual tablet only, watch for getting bit by pt. Can cause oral numbing, weight gain, EPS like typical antipsychotics.
Client with borderline personality disorder what is the unmet developmental need
awareness of separateness of self
Client states “We wanted to take the bus, but the airport took all the traffic”.
associative looseness
A client diagnosed with borderline personality disorder requests diazepam (Valium). The physician refuses, the client gets mad and demands to see another physican. What defense mechanisms is the client using?
splitting
How should Latuda be given
with 350 calories of food. Watch for increase in SI for bipolar, depressed pt. Hyperglycemia
What characteristics is representative of passive aggressive behavior?
seeks subtle retribution when feeling others have wronged him or her
what does echopraxia mean
repeating movements of another person
Valproic Acid/Depakore
- Anticonvulsant/Mood Stabilizer- First line for Mania, rage, rapid cyclers
- Liver Problems
- avoid alcohol
- taper
What medication is used for maintenance therapy for bipolar disorder?
Lamotrigine (Lamictal)
What are other medication used to reduce symptoms of bi polar disorder
Valproic Acid (Depakote), Carbamazepine (Tegretol)
What happens as trust in other increases w/ delusions
delusions decrease
SE of Rohypnol Date Rape Ddrug
drowsiness, headaches, memory loss, dizzy, nightmares, tremors. Can induce aggression and excitability
What is the action behind lithium
alters sodium transport across cell membranes, alters metabolism of neurotranmitters
“Then dentist put a filling in my tooth, now receive transmission that control what i think and do:, What is this a symptom of
client is experiencing delusion of influence. Believing objects have control of behavior.
Common Atypical antipsychotics
seroquel, risperidone, alnzapine, clozapine, aripiprazole, Latuda
What is true about outcomes of nursing interventions for clients experiencing chemcial dependence?
should be tailored to the individual’s immediate needs and abilities
Nursing considerations with Lithium
- do not administer with NSAIDS
- can cause seizures dysrthmia
- EKG changes
- fatigue, confusion, Nausea, norexia
- Hypothyroidism
- tremors
- ACE inhibitors may increase serum levels
- lots of fluids and sodium
Speaking as if words are being forced out quickly
pressured speech
What can large doses of ketamin do?
vomiting convulsions oxygen starvation to the brain and muscles. 1 gram can cause death. Flashbacks can occur 1 year after use.
What medication is commonly used for treatment of EPS
Benztropine (Congentin)
When do schizophrenia symptoms develop
late adolescent or earl adulthood
Antisocial personality disorder pt demands to speak with ethics committe at midnight. What is appropriate response?
“Let me give you a sleeping pill to help your mind at ease”
expresses empathy
DSM V Criteria for avoidant personality disorder
- does not form intimate relationships
- unwilling to be invovled with people unless certain of being liked
- views self as socially inpet, unappealing and inferior
A client admitted for chest pain r/t cocaine abuse states. “This is nothing but a little indigestion. What is all the fuss about?” What defense mechanism?
denial
When should Divalproex (Depakote) be taken
at bedtime, 500-2000mg mood stabilizer
Disorganized schizophrenia looks like
regressive, primitive behavior. Poor contact with reality. Flat affect. Personal appeance is neglected and social impairment is extreme.
Ectasy (MDMA) Side effects
muscle tension, involuntary teeth clenching, nausea, blurred vision, feeling faint, tremors, rapid eye movement. Sweating or chills. Increase HR and BP. Long term use can produce Parkinson’s Syndrome. Damage to brain that are critical to thought and memory
A client in active phase of paranoid schizphrenia. What nursing intervention would facilitate other interventions
difficulty to establish trust. Make sure staff is consisstent.
DSM VI Borderline personality disorder
- avoid real or imagined abandonment
- recurrent suicidal and self mutilating behaviors
- feelings of emptiness
interventions for aggressive behavior
- identify feelings of frustration
- encourage discussion
- identify precipitating events
- describe consequences
- previous coping mech
What is a priority action for pt with pressured speech and increased levels of anziety
vital signs. Physican complications can occur due to pyschological symptoms
Antisocial personality disorer pt is smoking in a non smoking area. what do you do?
Confront the client about the behavior. Must be done in a timely manner
Early alocholic phase s.sx
amnesia occurs during or immediately after period of drinking
Flight of ideas
constant flow fo speech in which client jumps from one topic to another in rapid succession
What intake do you need when monitoring pt on lithium
dietary sodium and fluid (2-3 L/day)
Alcoholic client with ineffective health maintenance. What is a longterm goal
the client will exhibit reduced medical complications r/t alcoholism within 6 months
Common Typical Antipsychotics
Haloperidol, Perphenazine
What drug helps client control cravings for alcohol
Naltrexone (ReVia)
How are antianxiety agents used to MGMT bipolar disorder
managing psychomotor agitation characteristics of mania
avoid if pt has substance abuse
A client with nursing dx of disturbed thought processes has an expected outcome of recognizing delusional thinking. What should the nurse implement?
appreciate that the client has experienced disturbing delusional thinking. Shows empathy
Types of delusions
grandiose persecutaory
What is a longer acting medium potency Atypical antipsychotic?
zypreza/olanzapine. Injectable form
What sort of state the Ketamine put the user in?
dissasociative
Why does pt receive Lorazepam for high CIWA score?
detterent therapy that helps to motivate clients to maintain alcohol abstinence
Manipulative behavior
- set clear limits
- communicate expectations
- clear about consequences
- discuss behavior in non judgmental way
- gather staff to provide an escort to take pt to room
What kind of effects does Ketamine/PCP have?
numbness, loss of coordination, muscle rigidity, aggresssive, slurred speech/blocked speach. Blank Stare, exaggerated speech.Does not depress CNS. Relieves pain, may cause user to hurt themselves. Intensifies colors/sounds
Assessment for Schizophrenia physical characteristics
unkempt appearnce, body image distortions, hyponatremia, somatic complaince, poor sleep
Lamotrigine (Mood stabilizer), mode of action
inhibits release of glutamate and excitatory neurotransmitter. Dose 100-200 mg daily
What type of approach is attaching consequences to adaptive and maladaptive behavior
behavioral therapy approach
What are antipsychotic drugs predominatnlty
dopamine antagonists. Treat positive symptoms of schizphrenia
What does echolalia mean
repeating speech of another person
Which medication has the highest potential for client to experience serious side effects?
Clozapine. Life threatening agranulocytosis.
A client with borderline personality disorder has disturbed personal identiy. What is an appropriate nursing intervention?
help the client identify values and beliefs.
fixation from early developmental level
a client diagnosed with substance dependence states, “My wife causes me to abuse meth. She uses and expects me to. What defense mechanism?
projection
Medications commonly used for bipolar affective disorder
Depakote (Anticonvulsant), Verapamil (Caclium Channel Blocker), Olanzapine
Positive prognosis after being diagnosed with schizophrenia
diagnosed at ate 35, female whose s/sx began after rape, family with hx of mood disorder
What is the purpose of delusions
establish identity and self esteem
What does Gamma Hydroxybutyrate (GHB) do?
relaxant, causing loss of muscle tone and reduced inhibitions
What symptom of schizoid personality disorder is a high risk for schizophrenia
limited range of emotional experience and expression. Do not enjoy close relationships
A client with antisocial personality disorder states “my kids are busy at home they don’t miss me or even know i’m gone”. Which nursing dx is applicative
ineffective denial
what is catatonic excitement
moving excitedly with no environmental stimuli present
Olfactory hallucinations
smeeling things that do not exist
What is an appropriate nursing intervention for a pt risk for injury r/t extreme hyperactivity
use prn antipsychotic meds. Need to sedate the pt quickly. A mood stabilizer can be given concurrently for maintenance therapy.
Deescalation techniques
- Large personal space
- non aggressive posture
- calm approach
- determine client’s need
- don’t argue
- problem solving
Gustatory
experiencing tast in the absence of stimuli
Hallucination interventions
- ask about hallucination
- do not react as if it were real
- decrease stimuli
- do not negate experience
- engage through a concrete activity
- avoid touching client
- monitor for anxiety/agitation (hallucinations could be icnreasing
Why should a pt pacing the halls be a priority
most at risk for assaultive behavior due to hyperactivity
What is confabulation
fillin in memory gap with detailed fantasy
Mixture of words and phrases that has no meaning
word salad
Describe schizophrenia
disordered throught processes, disrupted interpersonal relationship. Disturbances in affect, mood, behavior and thought processes.
Cuation for women taking antipsychotic medications
amenorrhea can occur but ovulation still occurs. Risk for pregnancy
What is a priority nursing dx for alcohol withdrawal
risk for injury
What may have a good prognosis on schizphreniform disorder?
confusion and perplexity, good premorbid social and occupational functioning, absence of blunted or flat affect, onset of psychotic symptoms within 4 weeks of noticeable behavioral change.
How should Carbamazepine (Tegretol) Mood Stabilizer be given
2 divided doses, inhibits release of glutamate, an excitatory neurotransmitter.
400-1200 mg daily
Oscarbazepine
- Anticonvulsant Bipolar
- Birth control pills may not work
- taper
Looseness of association
haphazard, illogical and confused thinking. Interrupted connections (Mostly schizophrenic)
Topamax
- Anticonvulsant/Mood Stabilizer
- May alter liver enzymes
- No Alcohol
- Taper
- Decrease hormonal contraceptives
- May feel groggy
What do atypical antipsychotics do
block dpamine, boost serotonine. Less prone to EPS, but have metabolic side effects
When would a schizophrenic pt benefit from group therapy
diagnosed in an outpatient clinic
What classification of drugs shares similar featurs with alchol overdose and withdrawal
anxiolytics
Thought Blocking
sudden cessation of a thought in the middle of a sentence. Unable to continue the train of thought.
Abnormal thought processs: circumstantiality
pt gets caught up in countless details and explanations
What is catatonic posturing in schizo client
holding bizarre postsures for long periods of time
What symptoms might you expect of pt lithium level is 2.6 mEq/L
excessive output of dilute urine, tremors and muscular irritability
When alcohol is consumed, what percentage is absorbed immediately into the blood stream?
20% through the stomach wall
Medication combination for auditory hallucination and bipolar I
riperidone for auditory hallucination and Lamitrigine mood stabilizer for bipolar I
Abnormal thought processs: confabulation
filling a memory gap with detailed fantasy belived by the teller, maintains self esteem
Lithium is to mania as clozapine is to
psychosis
Crucial phase of drinking pattern?
client lost family, job, driver’s license
Carbazepine
- Anticonvulsant/Mood stabilizer
- Steven Johnson syndrome
- Taper
- decrease oral contraceptives
- avoid alcohol
- no grapefruit juice
Overcompliance
deny responsibility for any action by doing only what another person instructs exactly
Describe Bipolar II- Depression
- affects appetite
- easily fatigued
- can’t make decisions
- lack of energy
- no self confidence
Neologisims
makes up words that have meaning only for the individual. Part of a delusional system
A client insists that grandmother has come back to life as a pet kitten through reincarnation. Which personality disorder?
Schizotypal personality disorder
What is the process of delusions
- denial
- projection
- rationalization
Can a true alcoholic go on benzos?
No never
what co morbidity can alcoholic have
ADHD
Assessment for alcohol
how much, what type, how long
Treatment for Alcohol withdrawal
- Folic Acid
- Thiamine
- Antacid prn
- Ecotrin for headache and pain (safest for kidneys
- need to have platelets
- pepsid
- lactulose for liver
What drug is used to reverse effects of benzos
flumezenil
What can overdose of inhalants cause
damage to nervous system and death
