Mental Health ABC's Flashcards
What is a 302
Involuntary admittance ( court hearing must be within 72 hr, after 72 hours if a judge determines you are safe to go home; you go home, if deemed unsafe, you get 303 all the way up to 305.
How do hospitals manage relaying info in accordance to
HIPPA?
Give a code out to ppl authorized to receive info
What does ROI mean
Release of information
When can info be disclosed without consent
To protect the safety of others. If the person states a plan to cause harm to a specific person, putting a person in immediate danger.
What does informed consent entail
A person has the right to know about treatment, alternatives, right to decline.
What is the exception to informed consent
2 Drs must deem the person may cause harm to self or others which leads to the informed consent to be overturned. The meds will be forced usually by injection.
What is least restrictive seclusion
In a room by ones self with the door open
What is restrictive seclusion
In a room by ones self with door closed and locked
Can a nurse initiate restraints?
Yes! She doesn’t have to call the dr first. After applying the restraints, she MUST THEN CALL THE DR WHO MUST PHYSICALLY ASSESS THE PT WITHIN 1 HOUR
What does Mileu mean
Environment
What is a 201
Voluntary admittance
What are the positive symptoms of szhizophrenia
Altered perception, hallucinations, delusions
Hallucinations can occur with all 5 senses
Exhopraxia
Imitating movements of others
Echolalia
Repeat words said
Flat affect
No expression on face
Apathy
Don’t care
Unconcerned
Positioning
Take on bizarre positions
What are nursing diagnosis Related to schizophrenia
Risk for violence: self directed or others directed
Disturbed thought process
Social isolation
Disturbed sensory perception
What are typical antipsychotics
The oldest form of antipsychotics
BLOCKS DOPAMINE
targets positive symptoms
What are contraindications to typical antipsychotics
Parkinson’s disease, liver, renal or cardiac insufficiency ( may prolong QT INTERVAL), uncontrolled seizure disorder
What are interactions of typical antipsychotics
They have an additive hypotensive effect with hypotensive agents
Why is Parkinson’s a contraindication to typical antipsychotics
Parkinson’s already is due to a decreased dopamine and you don’t want to decrease the levels of dopamine even further.
What is a select prototype of typical antipsychotics
Chlorpromazine ( Thorazine)
What are other typical antipsychotics
Haloperidol ( haldol)
Fluphenazine ( prolixin)
Perphenazine ( trilafon)
There are many more this is only a short list.
What are atypical antipsychotics
They were developed after typical antipsychotics, they have less side effects.
THEY BLOCK SEROTONIN AND to some degree DOPAMINE
Target both positive and negative symptoms
What are contraindications of atypical antipsychotics
Severly depressed ppl
Elderly ppl with dementia related psychosis
What are commonly used atypical antipsychotics
Risperidone ( risperdal) Olanzapine ( zyprexa) Quetiapine ( seroquel) Aripipraziole ( abilify) Ziprasidone ( geodon) Clozapine ( clozaril) this does not include a list all drugs.
What are potential side effects of all antipsychotics
- seen to a lesser degree in atypical antipsychotics*
Extrapyramidal symptoms
Pseudoparkinsonism- tremor, shuffling gait, drooling, rigidity
Akathisia- restlessness
Akinesia- muscle weakness
Dystonia- spasms and stiffness of neck, face, arms or legs
Oculogyric crisis- rolling back of eyes
What are medications to reverse EPS
anticholinergics such as benztropine ( cogentin), trihexphenidyl ( artane)
Antihistamines such as diphenhydramine ( Benadryl)
What anticholinergic can be given in conjunction with psychotic meds
Benztropine ( cogentin) can be given as a maintenance dose in conjunction with psychotic meds to prevent dystopia and oculogyric crisis.
What is tardive dyskinesia
Seen months to years after prolonged use of antipsychotics
Consists of bizarre facial and tongue movements, stiff neck, difficulty swallowing
Symptoms are potentially irreversible
What is neuroleptic malignant syndrome ( NMS)
Rare but potentially life threatening
Typically seen after initiation of antipsychotics but can be years afterwards
Consists of muscle rigidity, VERY HIGH FEVER, tachycardia, tachypnea, and changes in LOC
What is treatment for neuroleptic syndrome
Immediately stop antipsychotics
Monitor VS, IV fluids, I&O
What are other side effects seen with antipsychotic therapy
Anticholinergic effects- dry mouth, paralytic ileus, urinary retention, photophobia,
Metabolic syndrome- seen with new atypical antipsychotic meds, causes pt to gain weight as a result diabetes develops.
What drug must be monitored very carefully because of agranulocytosis
Clozaril- before initiation a baseline WBC cont and absolute neutrophil count is drawn.
WBC must be at least 3500/mm3. WBC count and absolute neutrophil must be drawn weekly for first 6 months, then every 2 weeks
What is the definition of depression
A mood disorder expressed by feelings of sadness, despair, and pessimism
It is one of the leading causes of disability in the U.S.
rates are higher in woman but suicide rate is higher in men
What are types of depressive disorders
Seasonal affective disorder (SAD)
Postpartum depression
Major depression disorder (MDD)
What is major depressive disorder characterized as
Characterized by a depressed mood and or loss of interest or pleasure in ones usual activities. There must be impaired social and occupational functioning that has lasted for at least 2 weeks.
What are the rating scales for major depressive disorder
Beck depression inventory (BDI)
Hamilton depression rating scale
What is subjective assessment data of major depressive disorder.
Anergia Anhedonia Anxiety Fatigue Somatic complaints Loss of appetite Sleep disturbances Negative thoughts
What is objective assessment data of major depressive disorder
Affect Disheveled appearance Slowed physical movements Socially isolated Slowed thought process and speech patterns
For a suicide assessment what should the nurse do
Be direct
Talk openly and matter of factly about suicide. Ask ARE YOU AHVING THOUGHTS OF KILLING YOURSELF?
Assess for a plan,means and intent
What are nursing diagnosis For major depressive disorder
Risk for suicide
Social isolation
Self care deficit
Imbalanced nutrition; less than body requirements
What Are interventions for major depressive disorder
Cognitive behavior therapy- a type of therapy that helps a person realize and change negative thoughts
Group therapy
Individual therapy
What is true regarding therapeutic levels of antidepressants
Relief is not immediate. May take 2-4 weeks to reach full therapeutic level. Patients are at risk for suicide because as the mood lightens the patient experiences more energy to act out
What is the prototype TCA
Amitriptyline ( elavil)
What are side effects of TCAs
Orthostatic hypotension
Anticholinergic effects
Sedation - advise to take at bedtime
Decreased seizure threshold- use cautiously in someone with seizure disorder
What do TCAs do
Blocks the reuptake of norepinephrine and serotonin in the synaptic space
What is the prototype SSRI
fluoxetine ( Prozac)
What are side effects of fluoxetine ( Prozac)
Sexual dysfunction
CNS stimulation - take in the am can make A person more alert
Changes in weight
Serotonin syndrome
What is serotonin syndrome
Can become life threatening
May begin 2-72 hr after initiation of SSRI treatment
Symptoms include mental confusion, fever, hallucinations,diaphoresis,,abdominal pain with diarrhea
How do SSRIs work
By blocking the reuptake of serotonin
What are MAOIs
Blocks MAO in the brain thereby increasing norepinephrine, dopamine, and serotonin
What is the prototype MAOI
Phenelzine (Nardil)
What are side effects of phenelzine (Nardil)
Serotonin syndrome, if used with SSRIs
Hypertensive crisis
What is a hypertensive crisis
Results from ingestion of foods containing tyramine
What foods contain tyramine that should be avoided while on MAOI therapy
Cheese
Figs
Yogurt
Raisins
What are atypical antidepressants
They are a alternate to SSRIs
Blocks the reuptake of dopamine
What is the prototype atypical antidepressant
Bupropion ( Wellbutrin)
* also combats nicotine addiction**
What are side effects of bupropion ( Wellbutrin)
Weight loss
Seizures
Anticholinergic effects
What are indications for electro convulsive therapy
MDD- no response to medications
Certain schizophrenia disorders
Acute manic
Can ECT happen on a outpatient basis
It can happen on a inpatient or outpatient basis
Can a client eat food before ECT
they must be NPO after midnite of the procedure
What are nursing interventions of ECT
Establish IV line, monitor VS, IM robinul or atropine 30 min prior to treatment
What is nursing care during ECT
Mechanical ventilation with 100% O2
Cardiac monitoring
Anesthesiologist administers anesthetic breuvital and then a muscle relaxant anectine by IV
Electrical stimulus provided by physician
What is aftercare of ECT
Transfer to recovery room Monitor VS especially HR and BP position in side to prevent aspiration Assess for headache, muscle soreness, and nausea Assess memory
What is the definition of bipolar
A mood disorder manifested by cycles of mania and depression
What is the prevalence of bipolar
Incidence of bipolar equal between males and females
Average age is 20’s
Genetic predisposition
Types of bipolar disorder
Bipolar 1 disorder- full blown manic episodes
Bipolar 2 disorder- distinguished by bouts of MDD with episodes of hypomania.
What are nursing diagnosis of bipolar disorder
Risk for injury
Risk for violence: self directed or other directed
Imbalanced nutrition: less than body requirements
Disturbed thought process
Insomnia
What are medications for bipolar disorder
Lithium carbonate
What are contraindications of lithium carbonate
Cardiac or renal disease, dehydration, sodium depletion
What are side effects of lithium carbonate
The margin between therapeutic levels and toxic levels is very narrow
What is the therapeutic ranges of lithium
Acute mania- 1.0 to 1.5
Maintenance- 0.6 to 1.2
Lithium toxicity- symptoms begin to appear at levels above 1.5
How often are labs drawn on a person prescribed lithium
1-2 times a week until levels are stable then monthly afterwards
Hold med until lithium levels are drawn
What are the clinical manifestations of lithium toxicity with a serum level of 1.5 to 2.0
Blurred vision Ataxia Tinnitus Fine hand tremors Persistent nausea and vomiting Severe diarrhea
What are clinical manifestations of lithium toxicity with serum levels of 2.0 to 3.5
Excessive output of dilute urine
Increasing tremors
Mental confusion
What are clinical manifestations of lithium toxicity with a serum level above 3.5
Decreased LOC anuria Seizures Coma Death
What is pt education for lithium administration
Drink 2-3 liters of water daily,by not drinking enough, lithium levels can rise
Maintain a sufficient level of sodium not more not less
Avoid use of NSAIDs
Use diuretics cautiously
What is the anticonvulsant valproic acid ( depakote) used for
It is used to treat bipolar disorder
What is the prototype typical antipsychotic
Haldol
What is the prototype atypical antipsychotic
Risperidal
What is a major symptom to watch out for with clozaril
Agranulocytosis
What are anticholinergic meds used to treat side effects
Cogentin
Diphenhydramine
What labs are assoc with depakote therapy
LFT
PLATELETS
What is included in a suicide assessment
Plan means intent hx of past attempts
What are assoc side effects of TCAs
Orthostatic hypotension
