Final Review Slides - both tests are comprehensive Flashcards
1
Q
Substance abuse: Hallucinogens
A
Hallucinogens, such as, Phencyclidine (PCP) and Lysergic acid diethylamide (LSD) often cause paranoia; can have flashbacks after ingestion of the drug. There are some therapeutic uses of LSD including for chronic alcoholism & intractable pain (more research is needed)
2
Q
S. Abuse: Heroin:
A
Many people use for pain without intention of addiction. Not expensive, easily attainable. Depresses CNS: overdose can result in death. Naloxone is reversible medication (opioid antagonist)
3
Q
S. Abuse: Opioid withdrawal
A
…is uncomfortable - can last about 10 days; w/d symptoms include: N/V, aches, rhinorrhea, diarrhea, yawning, fever, insomnia. Opiate reversal agent is Naloxone (Narcan)
4
Q
S. Abuse: Cocaine withdrawal
A
Causes irritability, depression, anxiety, fatigue, insomnia, SI
5
Q
Alcohol and benzodiazepine withdrawal
A
- Can be fatal
- Must use substitution therapy and withdraw pt. safely.
- Most often used: Benzo’s such as chlordiazepoxide
6
Q
Use of restraints
A
- Understand they are used as a last resort - only to protect from harm to self or others. Most important to check extremities for circulation Q 15 min. Maintain airway, offer fluids, food, toileting
- When threat is over they must be released
- Seclusion is a form of restraint
- Medication can also be a form of restraint
7
Q
ECT
A
- Safe and effective
- Know how to prepare for procedure and expected S/E
- Memory loss & confusion - usually temporary
- ECT causes a seizure
- Very effective for elderly with depression who cannot tolerate medications
8
Q
Eating disorders
A
- Know the difference between anorexia nervosa & bulimia nervosa
- Understand aspect of control by patient
- Need healthier coping mechanisms
- Behavioral therapy is effective along with cognitive
- Understand the role of family dynamics— remember perfectionism and control
- Study nursing diagnosis and appropriate interventions/outcomes
9
Q
Intellectual disability disorder (IDD)
A
- Mild IDD - IQ 50 - 70 children progress up to about a 6th grade level/functions pretty well
- Moderate IDD - IQ 35 - 49 use simple directions/statements; difficult in social/peer relations
- Severe IDD - IQ 20 - 34 understand pts. will often “act out”; usually verbal skills are minimal
- Profound IDD - IQ below 20 no capacity for independent function; needs constant assistance/supervision
- YOU DO NOT NEED TO MEMORIZE IQ NUMBERS; BUT DO KNOW WHAT BEHAVIORS/INTERVENTIONS ARE MOST APPROPRATE FOR DIFFERENT LEVELS
10
Q
1st generation antipsychotics know side effects
A
- Thiothixene (Navane)
- Chlorpromazine (thorazine)
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
- These may be on Kaplan!!
- Remember TD and that the AIMS test was developed specifically to measure for TD.
11
Q
2nd gen antipsychotics
A
- Olanzapine
- Quetiapine
- Risperidone
- Clozapine
- Be prepared for questions - you should know what these drugs are, uses & s/e
12
Q
Antidepressants - SSRIs
A
- Fluoxetine, Paroxetine, Sertraline
- S/E: Sex dysfunction is common, and pts will stop due to this. Wt gain, sedation, increased SI (esp with initial tx)
- Serotonin syndrome: agitation, restless, confusion, tachycardia, hypertension, muscle rigidity. STOP TX. GIVE CARE.
- SSRIs are often used for OCD, often in higher doses than for depression
13
Q
Tricyclic antidepressants
A
- Imipramine & others
- Smoking interfieres with metabolism, takes several weeks for effectiveness, highly lethal in overdose so not the best to use in suicidal pts.
- If necessary, give small amounts at a time. Imipramine s/e is urinary retention so this is used for childhood enuresis
14
Q
MAOIs
A
- Trancypromine, phenelzine: FRESH IS BEST. avoid tyramine.
- Remember not to give other antidepressants with MAOIs cause of potential for hypertensive crisis (can be fatal)
15
Q
Mood stabilizers
A
- Know S/E of lithium & range
- Symptoms of Lithium toxicity?
- Lithium is a salt…
- Atypical antipsychotics and anticonvulsants are often used for mood stabilization
16
Q
Misc. drug info
A
- Remember which ones need blood-level monitoring, valproic acid, lithium, and clozapine
- Know S/E of clozapine - agranulocytosis can be fatal
- Which meds with EPS?
- Benztropine and diphenhydramine for EPS tx
- Danger of benzos with ETOH
- Limit sun exposure with many meds
17
Q
ADHD
A
- Meds: Specifically know S/E of methylphenidate, best to administer earlier in day
- Just because a child is disruptive does not mean they have ADHD
18
Q
Autism
A
- Symptoms: withdrawal into self, lack of eye contact, hand flapping, repetitive behaviors, speech delays, often do not like being touched or hugged
- consistency of caregivers/trust is important
- Safety: helmets, pads
- No known cause
19
Q
Children
A
- Play therapy is important as children are not able to effectively verbalize their feelings; they will often re-enact things they see
- Pic books
- symptoms of depression in children can include aches and pains, boredom with things they used to find interesting, wont be interested in playing with others. Ask parents!
- Children with separation anxiety often have a parent who experiences anxiety
- Antipsychotic meds can be effective for Tourette’s
- Teach parents about development levels
20
Q
Antisocial personality disorder
A
- Initially will be friendly, engaging, ingratiating
- No remorse
21
Q
Narcissistic personality disorder
A
- Gain self-esteem by putting down others
- Inflated sense of self-worth
22
Q
Borderline personality disorder
A
- Rules must be consistently enforced by all staff
- Manipulative/staff-splitting
- Self-harm / suicidal gestures
- Testing limites/boundaries; difficult time regulating emotions
23
Q
Dependent personality disorder
A
- Complete reliance on others
- May not be able to problem solve or make decisions on their own
24
Q
Gen info
A
- Pts with schizophrenia are often paranoid, have concrete thinking, black and white thinking
- Understanding triggers that exacerbate mental illness symptoms is important
- Structure and routines are important: Avoid caffeine (esp with bipolar)
- Psych units should be structured. Not overly-stimulating or overly restrictive; provide hope
- Understand informed consent and duty to warn
25
Q
Gen info 2
A
- Domestic violence/crisis: victims feel powerlessness. Help patients with choices and alternatives. Always remain non-judgmental.
- Know cycles of abuse: 1) tension building (2) acute battering (3) honeymoon
- Provide education: safety plans (shelters, numbers to call, etc)
- Psych disorders in elderly, know that depression is often dx for the first time in older pts
- NCDs –> keep pts safe and comfy. Often get lost.
26
Q
Gen info 3
A
- Agoraphobia: fear of being in open or crowded spaces which leads to patients being home bound
- OCD comes from underlying anxiety: They are not able to stop the compulsion (such as hand-washing)
- Conversion disorder: pt may become blind after witnessing a horrible event (easier to deal with physical symptoms)
- Coping skills: Goal is to help patient regain pre-crisis level of mental illness; gain skills to better cope with future problems
27
Q
Suicide
A
- Guns are leading method used in the U.S.
- Giving away items can be a sign of impending suicide
- Those with black and white (dichotomous) thinking are more prone to suicide
- Always ask - important part of mental status assessment
- Safety is always first
28
Q
Therapeutic comm.
A
- Communication (verbal & non-verbal) are most important foundation for understanding mental illness
- Always validate feelings
- Best to ask open-ended questions
- “Tell me how much alcohol you use each day?” NOT “Do you drink?”
29
Q
Ego defense mechanisms
A
- Review chapter 1
- Normal to use these unless they interfere with adaptation:
- Denial
- Rationalization
- Regression
- Reaction formation
