Exam 2 Flashcards by Maxine Paraventii

Feeling of apprehension, tension, or uneasiness from anticipation of danger. Source is largely unknown or unrecognized, may be regarded as pathological when it interferes with social and occupational functioning, achievement of goals or emotional comfort.

Anxiety

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Anxiety can be..

Mild: alert, prepared for action, sense sharpen, awareness of environment, promotes optimL growth and creativity
Moderate: focus on immediate concerns, less alert, less attention, may need help with problem solving
Severe: focus is on specific detail, less perceptual field, GI upset, chest pain, must direction is needed

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Characterized by recurrent panic attacks, onset is unpredictable and manifested by intense apprehension fear terror or doom, intense physical discomfort.

disorganized personality
increase in motor activity
loss of rational thought
frightening and paralyzingly
may or may not be associated with agoraphobia

Panic disorder

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The unstable self identity of an individual with schizophrenia may lead to feelings of unreality
+ symptom of schizophrenia

Depersonalization

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Suicide assessment questions

Directly asking: is she/he thinking of suicide?
-do you have a plan?
-what is the lethality of the plan?
High(gun, jumping, hanging)
Low(cutting, natural gas, overdose)
-do you have the supplies (available means) needed to carry out?
*specify the details

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Thought process: hallucinations, paranoid behavior, delusions
Perception: emotionally disconnected, self neglect, socially impaired
Affect- bizarre, grimacing, anxious, depressed, flat
Behavior- incongruent with environment, social isolation, catatonic, paranoid, suspicious, erratic

Symptoms exhibited by someone with a thought disorder

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Hallucinations can be..

Auditory or visual

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All events within The environment are referred by the psychotic person to him-herself
Example- “someone is trying to send me a message through the articles, tv and radio”
+symptom of schizophrenia

Delusions of reference

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” is a classification of psychotic disorders manifested by changes in cognitive, perceptual, emotional,behavioral and social domains of brain functioning “

serious persistent brain disease
most chronic disabling of the major mental illnesses

Schizophrenia definition

-Education

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Symptoms: +|-
Cognitive: decreased attention, memory loss, decrease learning, decrease ADLs
Mood: dysphonia, suicidal, hopelessness, irritable, paranoid
Triggers- environment, health, attitudes/behaviors
Hallucination management: talk, distract, music

Schizophrenia education

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Support group
Mental health center
Call 911 if strong voices are telling you to kill your self and you can’t make them stop

Schizophrenia education

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Associated with normal brain structures on a CT scab and relatively good responses to treatment with antipsychotics

Positive symptoms of schizophrenia

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Difficult to treat and less responsive to treatment with antipsychotic vs positive symptoms.
Most destructive bc they leave the patient inert and unmotivated.

Negative symptoms of schizophrenia

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Respond well to antipsychotics

delusions: false, fixed belief
hallucinations: false sensory perceptions not based in reality 👂🏻👁
disorganized speech: concrete thinking, loose associations, word salad
bizarre catatonic behaving
illusions
depersonalization: unstable self identity- feeling of unreality

Positive symptoms

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Don’t respond well to antipsychotic Rx

more destructive to patient fxn
flat/inappropriate affect
emotional/social withdrawal: anheclonia
poor abstract thinking
no spontaneous: avolation
poverty Of thought: alogia

Negative symptoms

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Nursing Dx for patient experiencing hallucinations?

Altered/disturbed thought process: delusions

Altered/disturbed sensory perceptions: hallucinations

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What is Tardive Dyskinesia?

Irreversible movements "lip smacking", from antipsychotic medications that effect the lips, jaw, tongue, fingers, hands and while body 
-repetitive 
* EPS of antipsychotic meds 
Evaluation tool: AIMS 
-abnormal involuntary movement scale

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Persistent depressive disorder
Individual with this describes mood as “down in the dumps”
-NO evidence of psychotic symptoms
-the essential feature is a chronically depressed mood (possibly irritable in children/adolescent)

Dysthymia

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Therapeutic range of Lithium

Acute mania: 1.0-1.5 meql

Maintenance: 0.6-1.2 meql

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Therapeutic range of Depakote

50-150 mcg/ml

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What is Lithium used to treat?

Tx and prevention of mania and manic episodes in bipolar disorder

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Depakote

-anticonvulsant and mood stabilizer

Used to treat manic episodes r/t bipolar and depression, seizures

Prolonged bleeding fine, drowsiness, dizziness, headache, GI upset
-caution in elderly, renal impairment, pregnancy and breastfeeding, liver disease

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Dysthymia

Persistent depressive disorder, people with this describe their mood as down in the dumps or sad. No evidence of psychotic symptoms. Must manifest for 2 years. The essential feature is a chronically depressed mood

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Major depression

Characterized by depressed mood, loses interest or pleaser in usual activities, social and occupational functioning impaired for at least two weeks. No history of manic behavior. Cannot be attributed to use of substance or general medical condition .

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May last a few weeks- months, associated with hormonal changes, tryptophan metabolism and cell alterations. Tx- antidepressants and psychosocial therapy S/S- fatigue, irritability, lose of appetite, sleep disturbances, decreased libido, cannot care for infant

Post partum depression

Bipolar 1 disorder | -Mania

Stage 1- hypo mania Stage 2- acute mania Stage 3- Delerious mania

Stage 1-hypo mania

Impairment in social and occupational function, hospitalization not required -cheerful, easily distracted, increased motor activity, extroverted, superficial

Stage 2- acute mania

Intensified symptoms, hospitalization required, euphoria, elation, fragmented thinking, flight of idea, hallucinations, excessive activity, increased energy, increased libido, no sleep, bizarre dress/makeup

Stage 3- Delerious mania

Grave form of the disorder, clouding of consciousness, intensified of stage 2, may be psychotic

Mania | Mostly manic symptoms, possible episodes of depression

Bipolar 1 disorder

Recurrent bouts of major depression Episodes of hypo mania -has not experienced an episode that meets the criteria for mania

Bipolar 2 disorder | Depression

Lithium | -mood stabilizer

Prevention and Tx of manic episodes of bipolar disorder Caution in pregnancy and lactation Elderly, renal disease, urinary retention

Lithium side effects

Drowsiness, dizziness, headache, dry mouth, thirst, GI upset, NV, fine hand tremors, hypotension, HR irregularities, polyuria, dehydration

Non-pharmacological nursing interventions for patients with General anxiety disorder (GAD)

Relaxation exercises-deep breathing, physical exercises, walking, jogging, meditation CBT-reframe cognition to a positive thought process, interrupt distorted thoughts, talk therapy

What medications are used to treat anxiety?

Anxiolytics -benzodiazepines (BZDs) Targeted S/S- irritability, uneasiness, worry, fear, sense of doom, panic, insomnia MOA: GABA agonists, potentiate GABA and calm the CNS down=decrease anxiety

Alprazolam (Xanax) | Lorazepam (Ativan)

Short acting BZD | Short duration

Librium Klonopin Valium

Long acting Not long term Can be used for mild-severe anxiety

Buspirone (buspar)

Very long term anxiolytic Inhibits the actions of serotonin Little potential for abuse, good choice in substance abuse patients Non sedating

Presence of obsessions or compulsions or both Person recognizes that the behavior is excessive or unreasonable but bc the feeling of relief from discomfort it brings, the person continues the act. -obsessions=intrusive thoughts -compulsions=repetitive behaviors

OCD

Implies a relationship with OCD - some personality disorders are considered to be less severe versions of particular mental disorders - preoccupied with details, rules, lists - perfection with tasks - devoted to work

OCD personality disorder

Nursing interventions for OCD

Do not prevent the compulsive act unless safe Build self esteem Develop rapport with the patient Encourage and aknowledge acceptable ventilation of feelings

Signs and symptoms of Lithium toxicity | -SS appear at levels greater than 1.5

Blurry vision, ataxia, tinnitus, NVD Diluted urine OP, tremors, confusion, giddiness Decreased LOC, nystagmus, seizure, coma, MI

What is serotonin syndrome?

A potentially life threatening Syndrome associated with increased serotonergic activity at the 5-HT receptions in the cns and receptors in the Pns -associated with high doses of an SSRI and concurring use of 2 or more drugs known to potentiate serotonin transmission

S/s of serotonin syndrome

Fever, tachycardia, hyper and hypotension, anxiety, confused, hallucinations, tremors, rigidity

What is neuromalignant syndrome?

Rare but life threatening emergency associated with the use of antipsychotic agents - associated with dopamine blockage or dopaminergic antagonism in the cns - characterize by loc change, rigidity, fever and dysautonomia

``` Develops 24-48 hours Agitated, confused, catatonic "Lead pipe rigidity" Hyperthermia- defining symptom Tachycardia, high BP, tachypnea, sweating ```

S/S of neuromalignant syndrome

"A sudden even in ones life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem." -person becomes non-functional, thoughts become obsessional, behavior is aimed out of relieving anxiety.

Crisis

Cognitive functions are distorted, emotions are liable, behavior may reflect the presence of psychotic thinking.

Crisis | -homeostasis is affected

What is mood? | -also called affect

Mood is a persuasive and sustained emotion that may have a major influence on a personals perception of the world. Examples: depression, joy, elation, anger, anxiety Affect- the emotional reaction addicted with an experience

Characterized by recurring panic attacks with unpredictable onset and manifested by apprehension, fear, and feelings of impending doom, intense physical discomfort. - symptoms come on unexpectedly - doesn't occur after exposure to situation and not triggered by social situations - ❤️palpations, sweating, shaking, sob, chest pain, GI upset

Panic Disorder

Characterized by persistent, unrealistic and excessive anxiety and worry occurring more days than not for at least 6 months. - not associated with caffeine or hyperthyroidism - often avoid activities or events that may result in a negative outcome - procrastination, impaired decision making - chronic with frequent stress relayed exacerbations - muscle tension, restless, on edge

Generalized anxiety disorder (GAD)

Drugs to use for long term treatment of GAD?

Buspirone (buspar) - long term therapy - non addictive - inhibits action of serotonin

How should someone respond to someone with schizophrenia?

``` Honestly, respect their personal space Short and concise Give direction Give time to respond *do not reinforce hallucinations, use "the voices" not "they" *dont argue ```

Dystonia | -EPS

Most dramatic and acute of all EPS * *dramatic muscle movements - sustained muscle contraction, contorting, abnormal posture - affects primarily musculature of the head and neck - high potency meds

Tardive Dyskinesia | -EPS

**irreversible Bizarre facial and tongue movements -"lip smacking" -increased risk by long term antipsychotic use -more common with typical (1st gen) antipsychotics

Parkinsonism (Akinesia) | -EPS

Looks like PD-decrease dopamine pathway - shaky tremors, shuffling gait, drooling, rigidity, cogwheel - "pretty shaky" - confused with - symptoms of schizophrenia - caused by low potency meds

Akathisia | -EPS

Can't sit still, restless, fidgeting - internal drive/restless - often confused with worsening of the disease state but increase antipsychotic meds will make this worse - associated with suicide - caused by high potency meds

With Dysthymic disorder what do you see?

Mood is sad or "down in the dumps" - no psychotic features - chronically depressed mood for at least 2 years**

Mood stabilizer: anti manic

Lithium

Mood stabilizer: anticonvulsant

``` Valproic acid- Depakote Carbamazepine Clonazepam Lamotrigine Topiramate ```

Mood stabilizer: antipsychotics

Olanzapam-Zyprexa Ariprizole- ability Seroquil Risperidone- risperdal

Three stages Typically seen in bipolar 1 disorder -changes in mood, cognition and perception, activity and behavior are present in each stage

Mania

What is Agoraphobia?

"Fear of the marketplace" Fear of being in open shops and markets Fear of being separated from a source of security -escape might be difficult or help may not be available -provokes fear and aviary -may be associated with panic disorder

Depressive disorders | -affective mood disorders

Major depressive d/o- depressed mood, loss of interest, either single episode or recurrent Dysthymic d/o- mood is down in the dumps or sad, chronically depressed mood for at least 2 years

Bipolar Disorders 1&2 | Mood disorders

Bipolar 1 disorder- individual experiencing a recent manic episode or hx of 1 or more manic episodes *mania Bipolar 2 disorder- recurrent bouts of major depression with episode of hypo mania, never experienced a full manic episode * depression

Traits "enduring patterns of perceiving, relaying to and thinking of the environment and oneself that are exhibited in a wide range of social and personal contexts" * personality disorders occur when these traits become inflexible and maladaptive * Axis 2

Personality Disorders

Personality Disorder Clusters A,B,C Defined by the different behaviors exhibited

Cluster A: odd and eccentric Cluster B: dramatic, emotional, erratic Cluster C: anxious, fearful

Cluster A: odd and eccentric

Paranoid PD Schozoid PD Schizotypal PD

Cluster B: dramatic, emotional, erratic

Antisocial PD Histrionic PD Narcissistic PD Borderline PD

Cluster C: anxious, fearful

Avoidant PD Dependent PD Obsessive-compulsive PD

Pervasive, persistent, inappropriate mistrust of others Not psychotic -Cluster A

Paranoid PD

Inability to form personal relationships or respond to others in a meaningful way; detachment issues - begins in early adulthood - Cluster A

Schozoid PD

Bland/apathetic affect, ideas of reference, depersonalization, odd beliefs, illusions, paranoid ideas - cluster A - "schizophrenia look a like"

Schizotypal PD

Exaggerated sense Jr self worth, lack empathy, hypersensitive to the evaluation of others, fantasy about success/power, requires admiration "Special" sense of entitlement -arrogant/haughty -Cluster B

Narcissistic PD

Colorful, dramatic, extroverted behavior, excitable/emotional people, must be center of attention, sexually provocative, shifty emotions, used physical appeal to attract others, theatrical display of emotions- dramatic, excitable, extroverted -Cluster B

Histrionic PD

Socially irresponsible, exploitable, guiltless behavior, disregard the rights of others. Repeats breaking the law, irritable and aggressive, impulses, disregards safety, lack of remorse (conduct disorder before age 15) -cluster B

Antisocial PD | Cluster B

Pattern of intense and chaotic relationships with affective unstability and fluctuating attitudes toward people. Impulsive and directly and indirectly self destructive, lack of clear sense of identity -cluster B

Borderline PD | -cluster B

A pattern of relying excessively on others for emotional support. Feel helpless when alone, act submissively, fail to act when feelings of dominance surrounds. Excessive need to be taken care of, clingy, need others to be responsible. -cluster C

Dependent PD | Cluster C

Extremely sensitive to rejection and may become socially withdrawn, extremely shy and has a strong fear of rejection. Avoids relationships out of fear of rejection or critisim, wants relationship, shy and lonely -cluster C

Avoidant PD | Cluster C

``` Difficult expressing emotions, overly disciplined, perfectionist, preoccupied with rules All work no play Inflexible Hoards meaningless items Cluster C ```

Obsessive Compulsive PD | Cluster C