exam 3 Flashcards
OCD and stress
it can wax and wane depending on stress levels
do people with OCD know their behavior is unreasonable
yes
first line meds for ocd
SSRI
what is response prevention theory
delay or avoid performing ritual
initial ntervention for compulsions
dont stop them, but instead have person identify stressors and involve them in ADLs
schizo is a _______
brain illness/brain syndrome
when is schizo dx
when someone shows positive ss for 6 months
preservation
adhering to a single topic or word
alogia
speaking little
anhedonia
no joy or pleasure
catatonia
immobility
clang associations
ideas relating based on sound and rhyming - jill kill
neologisms
inventing words
verbigeration
repetition of words
stilted language
flowery language
echollia
copying nurse or others words or actions
schizoaffective disorder
psychotic and mood disorder ss
schizophreniform disorder
acute reactive psychosis less than 6 months
delusional disorder
non bizzare delusions
lasts 1 day to 1 month
what to do if someone is hearing voices
are the voices making you do anything
how to deal with innnapropriate client
redirect
loss of ego boundaries
loss of sense where someone body mind and influence is
3 social implications of schizo
isolation, no trust, low self esteem
what to do if someone is delusional
clarify but do not agree
interventions for delusions
keep stimulation low and say things like” i find that hard to believe” or “I have seen no evidence of that” - presenting reality and voicing doubt
recognize signs of relapse
how to dx MDD
2 or more weeks of sad mood and 4 other ss
dysthmic disorder
MDD but milder
BP 1 vs 2
1: one or more manic accompanied with depression
2: hypomania
cyclothymic disorder
mood swings but milder
how to treat SAD
light therapy
why do people do nonsuicidal self injury
avert suicidal thoughts
4 nursing interventions for ECT
NPO, no polish, void before, start IV
vegetative signs of depression
lethargy, low energy, apathy
lability in mania vs dep
mania too fast, dep too slow
3 goals of psychotherapy
reverse neg thoughts, improve self image, gain competence and self mastery
education about diet for pt taking lithium
adequate Na and fluids
suicide precautions
C - current plan -are you having thoughts of suicide?
P- pain - do you have unbearable pain?
R- resource - do you feel you have any resourses?
examples of 1,2,3 gen antipsychotics
1:zines and haloperidol
2: pines
3: prazole
acute dystonic -
muscle spasms in deiscrete muscle groups
pseudoparkinsonism
muscle stiffness, cog wheeling, drooling, slow muscle start
akasthisia and tx
restlessness - propanolol Beta blocker
when to use AIMS
tardive dyskinesia (ss like involuntary movemens)
neuroleptic malignant syndrome
board like rigidity
3 meds to treat EPS
benadryl, benzotropine, trihexphenidryl (Antihistamines and anticholinergics)
MOA of antipsychs
blocks dopamine
3 TCA meds
imipramine
amitriptyline
clomipramine
moa of tca
block neph reuptake
2 ed for TCA
reposiiton slowly and works in 4-6 weeks
7 SE of TCA
ortho hypo, urinary retention, sedation, anticholinergic, wt gain, sweet craving, sex dysfunction, tachycardia
which drugs can be lethal in overdose
MAOis and TCA
SSRI clinical course
3-4 days insomnia decreases
5-7 apeitire returns
4-7 energy returns
7-10 mood concentration improve
4 interventions for SSRI
surgar free bevs or candy
fluids
monitor for hyponatremia
contact HCP if sexual difficulties
3 MAOi meds
phenelzine
isocarboxacid
tranylcypromine
what can happen if someone eats tyramine with MAOI
HTN crisis
serotonin syndrome occurs when
no wash out period between MAOI and SSRI
4 atypical antidepressanta
venlafaxine SNRI
duloxetine SNRI
buproprion NDRI
tranzodone
2 causes of lithium toxicity
renal impairemnt and low Na due to diuretics, dehydration or diarrhea
intervention and education for pt on lithium
monitor blood levels
3 anticonvulsants
lithium, valpropic acid, lamotrigine
AE of lamotrigine
stevens johnsons so report rash
A client is hospitalized on a psychiatric unit secondary to a suicide attempt. The client has been diagnosed with depression and is consistently depressed. When assessing the client, which finding would alert the nurse that the client’s suicidal risk has increased?
The client’s behavior makes a marked switch from irritability to calmness
A client with bipolar disorder is experiencing a major depressive episode. Which would the nurse expect to assess? Select all that apply.
a.
Flight of ideas
b.
Obsessive rumination
c.
Hypersomnia
d.
Excessive shopping sprees
e.
Difficulty concentrating
bce
A client with bipolar disorder is experiencing acute mania. The client is unable to sit still, moving from place to place. Medication therapy has been prescribed but not yet initiated. Which would the nurse include in the plan of care to meet the client’s physical needs?
high energy snacks
A client has just been diagnosed with a major depressive disorder following recent problems with the client’s mood, work performance, and sleep quality. When planning this client’s care, the nurse should anticipate what interventions? Select all that apply.
a.
Administration of an monoamine oxidase inhibitor (MAOI)
b.
Administration of a selective serotonin reuptake inhibitor (SSRI)
c.
Repetitive transcranial magnetic stimulation (rTMS)
d.
Cognitive therapy
e.
Phototherapy
bd
A client receiving lithium therapy has a plasma blood concentration of 2.2 mEq/L. Which would the nurse expect to assess?
slurred speech
A 42-year-old client with major depression is in an inpatient psychiatric hospital. The client has been taking phenelzine for depression. The therapist writes an order to discontinue the phenelzine and begin fluoxetine. Which action by the nurse is indicated?
call hcp for washout period
A client with bipolar disorder, having experienced a depressive episode, is prescribed lamotrigine. After educating the client on this medication, the nurse determines that the education was successful when the client states what?
ill notify if i get a rash
An inappropriately dressed client has not slept for 3 days and has been making excessive long-distance phone calls. When the client can be heard singing loudly in the examining room, the nurse makes initial plans to focus on what?
food fluid and rest
The nurse is preparing to discharge a client from the inpatient facility where the client was treated following an unsuccessful suicide attempt. The priority assessment for the nurse to make is to assess whether or not the client can do what?
Identify a person to whom he or she can turn to for help after discharge
A client is admitted to the unit in an acute manic episode. The client has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which disorders would reflect the client’s symptom profile?
BP 1
A client who has a recent diagnosis of bipolar I disorder is scheduled to begin therapy with lithium. Which instruction should the nurse provide to this client?
“Avoid exercise at the hottest times of the day.”
education for ECT
“Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer.”
A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client?
Ability to concentrate and process the information
A client with bipolar disorder has been taking lithium, and today the client’s serum lithium level is 1.8 mEq/L. What effects would the nurse expect to see?
nausea, diarrhea, confusion
The nurse knows that the most dangerous time period following a previous suicide attempt is what?
first 3 mo
A client’s depression is being treated in the community with phenelzine. The client has presented to the clinic stating, “I had a few beers and I’m feeling absolutely miserable.” What is the nurse’s best action?
BP
A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching?
the higher the Na the lower the lithium
A nurse is assessing a client and suspects obsessive-compulsive disorder .The nurse understands that to rule a behavior as obsessive-compulsive disorder (OCD), the obsession or compulsion must meet which criteria?
They take up more than 1 hour/day and cause stress to the client.
The nurse is teaching relaxation techniques to a client with obsessive-compulsive disorder (OCD). When does the nurse teach relaxation techniques to the client?
when low anxiety
The nurse is evaluating the plan of care for a client with schizophrenia. Which observation best suggests that the plan has been effective?
The client has resumed employment and attends social functions.
When teaching a class of nursing students about brief psychotic disorder, the instructor explains that the episode lasts for at least 1 day but less than which time frame?
1 month
A client with schizophrenia has returned to the clinic because of an increase in symptoms. The client reports the client stopped taking the medication because the client did not like the side effects. The nurse educates the client about managing uncomfortable side effects. Which is included in the teaching plan? Select all that apply.
a.
Use stool softeners as needed
b.
Decrease the amount of daily fluid intake
c.
Spend at least 30 minutes outside in the sun daily
d.
Suck on hard sugar-free candy as desired
e.
Maintain a balanced calorie-controlled diet
ade
A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of which of the following?
infection
education for clozapine
WBC count every week for 6 mo
