Mental health Flashcards
types of delusions and hallucinatinos in schizophrenia
delusions of reference
-believe that songs, newspaper articles, and other events are personal and significant to them
Grandeur: “I need to get to Washington for my meeting with the president.”
Control: “Don’t drink the tap water. That’s how the government controls us.”
Nihilistic: “It doesn’t matter if I take my medicine. I’m already dead.”
Somatic: “The doctor said I’m fine, but I really have lung cancer.”
tactile hallucination,
gives the client the sensation of being touched.
auditory hallucinations hear sounds and voices others do not.
Disulfiram (Antabuse)
aversion therapy that promotes abstinence from alcohol
.
consumes alcohol =unpleasant side effects (eg, headache, intense nausea/vomiting, flushed skin, sweating, dyspnea, confusion, tachycardia, hypotension)
Avoid hidden alcohol in:
liquid cold and cough medications
aftershave lotions, colognes, and mouthwashes
foods such as sauces, vinegars, and flavor extracts
Abstain from alcohol for 2 weeks after the last dose as the disulfiram reaction could still occur
Wear a bracelet alerting others of being on disulfiram therapy
Schizophrenia S/s
reinforce reality while acknowledging the client’s feelings
Positive S/s
Delusions
Hallucinations
Disorganized speech & behavior
Negative (the 5 As)
Affective flattening (reduced emotional expression)
Apathy, avolition (decreased motivation & interest in grooming, activities, work)
Asociality (social isolation)
Alogia (poverty of speech)
Anhedonia (inability to feel pleasure)
acute mania
last at least 1 week
low-stimuli environment
low lighting
private room
one-on-one activities
structured schedule
physical activity
high-protein, high-calorie meals and snacks that are easy to eat
Setting limits on behavior by using a firm communication approach
General adaptation syndrome (GAS)
complex physiological response that occurs after exposure to a perceived stressor (eg, motor vehicle collision)
alarm stage (ie, fight or flight)
resistance stage
body attempts to adapt to the stressor. In this stage, compensatory responses return to baseline
exhaustion stage
hyponatremia
hold the next dose of lithium
notify the health care provider
when serum sodium levels are low, the kidneys reabsorb both sodium and lithium from the urine = life-threatening lithium toxicity
Clozapine (Clozaril)
atypical antipsychotic
to treat schizophrenia that has not responded to standard, more traditional treatment.
risk for agranulocytosis
(dangerously low WBC count)
obtain a baseline complete blood count and ANC
histrionic personality disorder
Attention-seeking
Self-dramatizing, exaggerated or shallow emotional expression
Overly friendly and seductive
Demands immediate gratification and has little tolerance for frustration
delirium
priority: safety
Close observation, including one-on-one supervision
postpartum psychosis
often seen in clients with bipolar disorder
move the pt to a room away from the newborn
ask about thoughts of self-harm,
assist with involuntary placement to a psychiatric hospital.
Alcohol withdrawal syndrome
6-24 hrs
Anxiety, insomnia, tremors, diaphoresis, palpitations, gastrointestinal upset, intact orientation
12-48 hrs
Seizures
hallucinosis
48-96 hrs
Delirium
tremens
Electroconvulsive therapy (ECT)
Any prescribed anticonvulsants should be discontinued prior to ECT.
induces a generalized seizure
major depression, bipolar disorder, and schizophrenia
NPO for 6-8 hours prior
except for sips of water with medications
Anesthesia (eg, methohexital, propofol) and a muscle relaxant (eg, succinylcholine) will be administered; clients are unconscious and feel no pain during
Driving is not permitted during the course of ECT treatment
temporary memory loss and confusion in the immediate recovery period are common side effects
Riluzole (Rilutek) is the only medication approved for ALS
slow disease progression and prolong survival by 3-6 months
St. John’s wort XXXX
SSRIs, MAOIs, or tricyclic antidepressants
combinations can cause serotonin syndrome
Scopolamine
anticholinergic
prevent nausea and vomiting from motion sickness
adjunct to anesthesia to control secretions
random med?
Transdermal patch
Apply the patch ≥4 hours before starting travel
Replace the patch every 72 hours
Remove and discard the old patch before placing a new one to prevent accidental overdose
Dispose of the old patch out of reach of children
Wash hands with soap and water after handling the patch to avoid inadvertent drug absorption or contact with the eyes
place new on a hairless, clean, dry area behind the ear
anticholinergic drugs XXX glaucoma
phenytoin (anticonvulsant)
gingival hyperplasia
pause enteral feedings for 1-2 hours before and after phenytoin administration
side effects:
gingival hyperplasia (overgrowth of the gum tissues or reddened gums that bleed easily), especially in high doses.
increase in body hair,
rash,
folic acid depletion,
decreased bone density (osteoporosis).
early signs of toxicity:
neurological manifestations, including ataxia (eg, unsteady gait) as well as nystagmus, nausea, and vomiting
trigeminal neuralgia
drug of choice is carbamazepine
It is a seizure medication but is highly effective for neuropathic pain. Carbamazepine is associated with agranulocytosis (leukopenia) and infection risk.
report any fever or sore throat.
The primary intervention for trigeminal neuralgia includes pain control and limiting pain triggers.
Triggers can include washing the face, chewing food, brushing teeth, yawning, or talking
Naltrexone does not reduce opioid withdrawal symptoms. Instead, it decreases the euphoric effect of opioids to reduce the urge to take them
must stop taking opioids for at least 7-10 days before starting naltrexone
Trazodone
orthostatic hypotension and sedation
avoid concurrent intake of other medications or substances that cause sedation
benzodiazepines (eg, alprazolam, lorazepam, diazepam),
sedating antihistamines (eg, chlorpheniramine, hydroxyzine), and alcohol
Priapism is a known serious side effect of trazodone. A client with an erection lasting several hours should go to the hospital.
panic attack
fast-acting medications, such as benzodiazepines (eg, alprazolam, lorazepam
Methylphenidate
Stimulant medications are commonly used to treat ADHD
The major problems with stimulant medications include:
Decreased appetite and weight loss – can lead to growth delays
Cardiovascular effects – hypertension and tachycardia (particularly in adults)
Appearance of new or exacerbation of vocal/motor tics
Excess brain stimulation – restlessness, insomnia
Abuse potential – misuse, diversion, addiction
SSRIs XXXXXXXX MAOIs
dont use together
sertralin XXXXXX phenelzine
When used concurrently, SSRIs and MAOIs can drastically increase the available serotonin, which can induce life-threatening adverse reactions, including serotonin syndrome
extrapyramidal symptoms
tx:
Benztropine
is an anticholinergic/antiparkinson
used to treat extrapyramidal symptoms (EPS), which are adverse effects of some antipsychotic medications
Acute dystonia: involuntary muscle contraction
Akathisia: motor restlessness and repetitive movements
Pseudoparkinsonism: shuffling gait and muscle rigidity
Tardive dyskinesia: uncontrollable rhythmic movements (eg, lip smacking, facial grimacing)
Serotonin syndrome
overdose or combination of serotonergic drugs
St. John’s wort + serotonergic drugs
Mental status changes (eg, restlessness, agitation, confusion)
Shivering and tremors
Autonomic dysregulation (eg, diaphoresis, hypertension, tachycardia
In severe cases, serotonin syndrome can progress to cardiovascular shock, seizures, or even death
resolves within one day after discontinuation of the causative drug and starting supportive treatment.
atypical antipsychotic
Ziprasidone hydrochloride
used for acute bipolar mania, acute psychosis, and agitation
risk for QT prolongation leading to torsade de pointes
baseline electrocardiogram and potassium
hypotension and seizures,
monoamine oxidase inhibitors
(MAOI)
“HOA no charcuterie boards”
Foods containing high amounts of tyramine can precipitate a hypertensive crisis.
Eliminating tyramine-containing foods
overripe foods; aged cheese; pickled and fermented foods; smoked, processed, and cured meats
clozapine
(anti-psychotic)
side effect
neuroleptic malignant syndrome
high fever, muscular rigidity, altered mental status, and autonomic dysfunction
immediate discontinuation
supportive care (eg, rehydration, cooling body temperature
Lithium toxicity
maintain an adequate sodium and fluid intake.
occurs with
dehydration,
hyponatremia,
decreased renal function
drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs,
thiazide diuretics
Isotretinoin (Accutane, Amnesteem)
teratogenic
two negative pregnancy tests before initiating isotretinoin
need two forms of contraception
Refills can be only obtained after a negative pregnancy test (performed monthly during therapy)
Dryness of the eyes, mouth, and skin are common side effects. Lubricating eye drops may be needed to wear contacts
Capsules should be swallowed whole with ≥8 oz of water or other fluid.
Capsules should not be broken, crushed, or chewed as the contents could irritate the esophagus
Isotretinoin sometimes causes photosensitivity
tetracyclines (eg, tetracycline, doxycycline, minocycline):
Take on an empty stomach
Avoid antacids or dairy products
Take with a full glass of water
Photosensitivity
additional contraceptive techniques
