Exam 2 SG Flashcards
Disorders or illnesses that are caused by neurotransmitter malfunction
Dopamine - increase - Schizophrenia Serotonin - decreased - Depression Norepinephrine - decrease - Depression y-Aminobutyric acid (Glutamate )- decrease - Anxiety disorders Acetylcholine - decrease - Alzheimers
Function of Broca’s area (Assessment)
Broca’s area is responsible for speech.
Patients with damaged broca’s area has difficulty understanding syntactically complex or semantically reversible sentences (e.g., “touch your nose after you touch your foot”).
Mechanism of action for antipsycotics
Many drugs, such the older neuroleptic antipsychotics, interact with ACh and its receptor sites to produce anticholinergic side effects, which occur when muscarinic acetylcholine receptors are blocked. 1st generation ( typical ) antipsychotics - blocks D2 receptors - not selective 2nd generation (atypical) antipsychotics - blocks D2 and 5HT2A receptor (dopamine and serotonin ) - somewhat selective
1st generation (typical) antipsychotic: mechanism of action
blocks D2 receptors - not selective
2nd generation (atypical) antipsychotic: Mechanism of action
blocks D2 and 5HT2A receptor (dopamine and serotonin ) - somewhat selective
Effects of GABA
brain’s principal inhibitory neurotransmitter
Turns off nerve cells and slows or stops actions in postsynaptic neurons.
Education about donepezil (Aricept)
Donepezil (Aricept) and other similar drugs inhibit the cholinesterase enzyme that breaks down ACh. This increases the amount of available ACh, thereby delaying the onset of symptom
Risk factors for mental illness
Genetics
Assessment for patient with injury to temporal lobe
Auditory hallucinations Increased sexual focus Decreased motivation Alterations in memory Altered emotional responses Sensory aphasia Affect fluctuates dramatically
Behavioral changes related to frontal lobe injury
Changes in affect, such as flattening Alteration in language production Alteration in motor functioning Impulsive behavior Impaired decision making Concrete thinking
Behavioral changes related to PTSD
pt may experience intense fear, helplessness, or horror
pt can be agitated or behave in disorganized manner.
Pt can have sleep disturbances, irritability or angry outbursts, difficulty concentrating, hypervigilance, and an exaggerated startle response
Nursing diagnosis for anxiety
Risk for suicide •Anxiety •Death anxiety •Stress overload •Self-mutilation •Hopelessness •Powerlessness •Social isolation •Disturbed sensory perception •Disturbed thought processes •Insomnia•Impaired memory •Deficient knowledge •Fear •Fatigue •Chronic low self-esteem •Disturbed body image •Risk-prone health behavior •Ineffective role performance •Ineffective coping •Defensive coping •Ineffective denia l•Impaired social interaction •Compromised family coping •Interrupted family processes •Spiritual distress •Decisional conflict •Noncompliance •Posttrauma syndrome •Risk for posttrauma syndrome
Cardiovascular C/M of Anxiety:
Palpitations, racing heart, BP changes. fainting,
Respiratory C/M of Anxiety:
Rapid and shallow breathing, pressure in chest, SOB, gasping, lump in throat
GI C/M of Anxiety:
Loss/Increased of appetite, abd discomfort, feeling of fullness, nausea, heartburn, diarrhea
Neuromuscular C/M of Anxiety:
Hyperreflexia, insominia, tremors, pacing, clumsiness, restlessness, flushing, sweating muscle tension
GU C/M of Anxiety:
Decreased libido, increased frequency or urgency of urination
Cognitive C/M of Anxiety:
Decreased attention, inability to concentrate, forgetfulness, impaired judgment, thought blocking, fear of injury or death
Behavioral C/M of Anxiety:
Rapid speech, muscle tension, fine hand tremors, restlessness, pacing, hyperventilation
Affective C/M of Anxiety:
Irritability, impatience, nervousness, fear, uneasiness
Nursing intervention for anxiety
Maintain safety for pt and environment
Assess your own level of anxiety and maintain calm
Recognize relief behaviors of pts.
Inform pt importance of limiting caffeine, nicotine, and other CNS stimulants
Teach pt to distunguish between anxiety with identifiable and nonidentifiable sources
Instruct pt in reducing anxiety techniques: progressive relaxation , mindfulness meditatiom, slow deep breathing exercises, focusing on single object in room, listening to soothing music or relaxation tapes, visual imagery or nature- related DVDs, and exercises.
Help pt build coping methods
Help pt identify support groups who will help pt perform personal tasks and activities that current circumstances make difficult
Assist the pt with gaining control of overwhelming feelings and impulses through brief and direct verbal instructions
Help pt structure environment
Assess presence and degree of depression and suicidal ideation
Administer anxiolytic medication
Help pt understand importance of medication regimen
Nursing intervention for patient experiencing severe anxiety
requires brief, directive verbal interchanges aimed at increasing feelings of safety and security
Education about anxiolytics
Benzodiazepines must be used short term due to tolerance and dependence.
Counsel pt about risk of mixing alcohol with medications and avoid driving or operating machinery.
Teach pt about effects of Kava Kava, St. John’s wort and grapefruit with benzodiazepines.
MAOIs can increase BP with Busipirone
Assessing severity of anxiety
ANS excessively stimulated (increase v/s, diaphoresis, urinary urgency & frequency, present diarrhea, dry mouth, decreased appetite and dilated pupils) muscles rigid and tense Senses affected Hearing and pain sensation decreases Perception field is greatly narrowed Problem solving is difficult Selective attention Distortion of time Dissociative tendencies, Detachment Vigilambulism Feels threatened and startled with new stimuli Activity increases or decreases Appears and feels depressed Demonstrates denial Complains of aches or pains Agitated or irritable Need for space increases Eyes may move around or fixed gaze
Discharge criteria for patient with anxiety disorder
Identify situations and events that trigger anxiety and select ways to prevent or manage them.
Describe anxiety symptoms and levels of anxiety.
Discuss the connection between anxiety-provoking situations or events and anxiety symptoms.
Explain relief behaviors openly.
Identify adaptive and positive techniques and strategies that relieve anxiety.
Demonstrate behaviors that represent reduced anxiety symptoms.
Use learned anxiety-reducing strategies.
Demonstrate the ability to problem solve, concentrate, and make decisions.
Verbalize feeling relaxed.
Sleep through the night.
Use appropriate supports from the nursing and medical communities, family, and friends.
Acknowledge the inevitability of the occurrence of anxiety.
Discuss the ability to tolerate manageable levels of anxiety.
Seek help from appropriate sources when anxiety is not manageable, including websites such as www.adaa.org (i.e., the website of Anxiety Disorders of America)
List the medication that are used to control the symptoms as well as the appropriate dosage and scheduled times.
Continue postdischarge anxiety management, including medication and therapy
light and dark” side of addiction
Light
Pleasure
“feel good transmitters”: dopamine, serotonin, opioid peptides, and other neurochemical predopaminate
Dark
Withdrawal symptoms
Norepinephrine and corticotropin-releasing factors (CRF) as well as the stress circuits are activated
