Final exam Flashcards
What are the diffrent components of an MSE?
A, B/PA, ATI, M/A, S+T, PD, O/C, M+I, R,J/I, MFT
- appearance
- behavior/ psychomotor activity
- attitude towards interviewer
- mood and affect
- speech and thought
- perceptual disturbances
- orientation and consciousness
- memory and intelligence
- reliability, judgement and insight
- motivation for treatment
What falls under behavior and psychomotor activity?
- excessive or limited body movements
- eye contact
- eval excessive or limited eye movement, gestures
What falls under speech and thought?
Speech: rate, volume, speed
Ex. Slurring, stuttering
What falls under reliability, judgement and insight?
- Reliability: credibility and trustworthiness
- Judgement: good or poor
- Insight: understanding of the situation they are in
What is the HEADSS assesment used for?
Psychosocial interview technique that can be used to identify risk factors
What does HEADSSS stand for?
- Home environment (relationship w/ parents + siblings)
- Education and employment ( school employment)
- Activities (sports, music, etc.)
- Drug, alcohol, or tobacco use
- Sexuality (sexually active or practice safe sex)
- Suicide risk
- safety
What is transference?
The patient is reminded of a figure in their life which negatively or positively affects care
What is counter transference?
When the nurse is reminded of someone in her life which can positively or negatively affect care
What does a decrease GABA level indicate?
Increased anxiety
What are examples of monoamine neurotransmitters?
D, NE, S
Dopamine
Norepinephrine
Serotonin
What are examples of amino acid neurotransmitters?
G + G
glutamate
GABA
What are examples of neuropetides
CRH, E
- Cortico releasing hormone
- Endorphins
What is the diagnosis is linked to a monoamine neurotransmitters imbalance?
Depression and schizophrenia
What is the diagnosis that is linked to a amino acid neurotransmitters imbalance?
Schizophrenia and anxiety
What is the diagnosis that is linked to a neuropeptides imbalance?
- PTSD and major depressive (CRH)
- Stress/ pain ( endorphins)
What is the diagnosis that is linked to acetylcholine imbalance?
Alzheimer’s
Why aren’t tricyclic antidepressants the first line of treatment?
can be lethal in an OD and causes sedation
What are second generation antipsychotics associated with?
BS, WG, hyperLD
Metabolic side effects like
- blood sugar
- weight gain
- hyperlipidimia
What are examples of medications used to treat Alzheimer’s?
Don and Rev
- Donepezil ( aricept)
- revastigmine ( exelon)
What do typical antipsychotics cause?
EPSE
Extrapyramidal side affects like TD, dystonia, and Parkinsonism
What functions as an intermediate step between inpatient and outpatient care?
IOPs and PHPs
Intensive outpatient programs and hospitalization programs
What is assertive community treatment?
intensive type if case management developed to treat hard to engage community living people w/ serious psych symptoms
what are the six steps of the nursing process?
A, D, O, P, I, E
- assesment
- diagnosis
- outcomes
- planning
- implementation
- eval
what are community mental health centers?
fed funded that provide service regardless of insurance status
what is assertive community treatment?
- intensive type of case managment to treat hard to engage communities w/ serious and persistent pysch syptoms
how long does it take SSRI’s to start working?
4-6 weeks
what are foods that a person taking MAOI’s cant have?
what are the theraputic lithium levels?
- between 0.8 - 1.2
- elevated 1.2- 1.4
- toxic 1.5 and up
What are the diffrent coping skills for stress?
HSH, WLB, SS
- health sustaining habits
- work life balance
- social supports
What are the differences between maladaptive and adaptive defense mechanisms?
- positive use of defense mechanism
- when the defense mechanism is used in excess
What are some examples of effective stress reduction interventions?
DBE, PR, M, PE, CR, J
- deep breathing exercises
- progressive relaxation
- meditation
- physical exercise
- cognitive reframing ( replacing negative phrase like I will not to I will)
- journaling
What are the three stages for general adaption syndrome ( GAS)?
AS, RS, ES
- alarm stages: a strong reaction to the presented stressor
- resistance stages: the person adapts to the stressor
- exhaustion: the person doesn’t have the resources or energy to overcome the stressor and it becomes chronic
What are the different ethical principles?
B, A, J, F, V, NM
Beneficence
autonomy
justice
Fidelity
veracity
nonmaleficence
What is fidelity?
Maintaining loyalty and commitment to the pt while doing no wrong
What is veracity?
The duty to communicate in truth
what is benefience?
the duty to act to benifit the good of others
what is justice?
the duty to distribute care and resources equally
When age does the first episode of schizoprenia develop?
75% develop between ages 15-25
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
syptoms that should 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 in schizophrenia?
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 are common nursing diagnosis for a patient w/ schizophrenia?
- Disturbed sensory perception
- Altered thought process
- ineffective coping
- self care deficit
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 symptoms does first generation antipsychotic target?
Only positive symptoms
What are some examples of first generation antipyschotics?
Haloperidol ( Haldol)
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 are common side effects of taking tricyclic antidepressants?
- anticholinergic side effects
- sedation
- hypotension
- tachycardia
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 due tp high intake of foods high in tyramine
What is the nurses role for ECT?
- educate about procedure
- pre and post MSE
- presence during procedure
- post vitals signs and LOC
What should a nurse plan for a patient with SI?
- development of safety plan
- SI precaution
- encouraging pt to express feelings
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
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
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 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 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
- address 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 are the diffrent types of boundaries?
C, D, R
clear
diffuse
rigid
What are some ways we can teach our pt’s to reduce the risk for Alzheimer’s?
- staying physically active
- stop smoking
- maintain healthy weight
- drink mod or not at all
- adequate sleep
- avoid chronic stress or depression
What are the different stages of Alzheimer’s disease?
M, M, S
Mild
moderate
severe
How is mild Alzheimer’s characterized ?
Stage 1
memory lapse occurs but the pt can still function independently
How is moderate Alzheimer’s characterized?
Stage 2
Symptoms become noticeable and behavior is markedly changed
How is severe Alzheimer’s characterized ?
Stage 3
May have difficulty w/ communication and needs 24hr care
What is the treatment used for Alzheimer’s?
cholinesterase inhibitor which doesn’t cure but helps delay or prevent symptoms from becoming worse
What are some possible intervention for a pt experiencing Alzheimer’s?
transportation
suppor groups
home health services
How is cluster A personality disorders characterized by?
odd
eccentric
What personality disorders fall under cluster A?
PSS.. do you know the government is watching us??
Paranoia PD
Schizoid
schizotypical
How is cluster B personality disorders characterized by?
dramatic
emotional
erratic
What personality disorders fall under cluster B?
BANH
borderline
narcissistic
antisocial
histrionic
How is cluster C personality disorders characterized by?
fearful
anxious
What PD’s fall under cluster C?
avoidant
dependent
obsessive compulsive
What are the clinical manifestations of cluster B borderline personality disorder?
instability ( moods, relationships)
impulsive
distorted self image/ identity
labile
splitting
separation anxiety
self harm
What are some nursing interventions of cluster B borderline personality disorder?
- therapeutic relationship is essential
- monitor for manipulation and splitting
- monitor for self harm behaviors
What are some treatments for cluster B borderline personality disorder?
DBT
antidepressants and mood stabilizers
What are the clinical manifestations of antisocial personality disorder?
disregards the right of others and frequently violates
deceitful, manipulative, and hostile when they can’t manipulate the person
no remorse / guilt
criminal misconduct and substance misuse are common
What are some nursing interventions for cluster b antisocial PD?
- direct and clear language to avoid manipulation
- monitor for violence
- usually not hospitalized
What are some treatment options for cluster b antisocial PD?
mood stabilizers
antidepressants
benzodiazepines
therapy
What are the clinical manifestations of cluster B narcissistic PD?
- feelings of entitlement
- exaggerated belief in ones importance
- lack of empathy
- poor self esteem and hypersensitive to criticism
What are some nursing intervention for a person with cluster b narcissist PD?
- remain neutral
- model healthy communication/ empathy
- do not engage in power struggles
What are treatment options for a person with cluster b narcissist PD?
CBT
group therapy
lithium
antidepressants
What are the clinical manifestations of cluster C dependent PD?
overwhelming need to be cared for
submissive and clingy behavior
intensive fear of separation
What are some nursing interventions used for Cluster C dependent PD?
- identify stressor
- teach assertiveness training
- beware of countertransference
What are some treatment options used for Cluster C dependent PD?
CBT
antidepressants
anti anxiety
How is mild anxiety characterized?
- they are able to perceive what’s happening around them
- restlessness, irritability, psychomotor agitation
( foot tapping, fidgeting)
How is moderate anxiety characterized?
- decreased perception and grasp less information, and has selective attention
- thinking is impaired but learning can still occur
- increased RR/ HR, GI problems, tremors, and headache
How is severe anxiety characterized?
- very low perception, unable to learn or problem solve
- nausea, dizziness, confusion, hyperventilation, impending doom
How is panic anxiety characterized?
complete loss of touch of reality
screaming, shouting, social withdrawal, or hallucinations
What is the most lethal substance to have a pt withdrawal on?
Alcohol then benzo’s
What is conduct disorder?
- rights of others are violated and societal normal or rules are disregarded
- if left untreated it will develop into antisocial personality disorder
What are the common side effects of taking stimulants?
WL/A, WT, HTN, IS, T, I
weight loss
anorexia
worsen tics/ tremors
HTN
impaired sleep
tachycardia
opiate widthdrawl S + S
- increased respirations
- N/V
- dilated pupils
