Mental Health Exam 2 Flashcards
1
Q
What is clozapine? What does it treat?
A
2nd generation atypical antipsychotic? Typically used to treat schizophrenia.
2
Q
What are some patient teaching points for clozapine?
A
educate men to report nipple secretions
report fever, sore throat (s/s infection) can cause weight gain so eat a low calorie diet, monitor daily weight, regular exercise
causes sun sensitivity so wear sunscreen
3
Q
What is the adverse effect for clozapine?
A
R/f Metabolic Syndrome
Agranulocytosis
4
Q
What do you need to monitor for with agranulocytosis?
A
s/s of infection, ANC
5
Q
What are side side effects of clozapine?
A
agitation, dizziness, sedation, sleep deprivation
6
Q
What do you need to obtain weekly for clozapine?
A
(WBC) blood levels
7
Q
What type of generation is a typical antipsychotic? What symptoms does this antipsychotic treat?
A
1st, positive
8
Q
What type of generation is an atypical antipsychotic? What symptoms does this antipsychotic treat?
A
2nd, negative
9
Q
What does positive symptoms mean?
A
hallucinations, illusions, delusions, bizarre behaviors
10
Q
What does negative symptoms mean?
A
5 A’s
Affect
Alogia
Anergia
Anhedonia
Avolution
11
Q
What is electroconvulsive therapy? (ECT)
A
induces a brief, grand Mal seizure to relieve symptoms of severe major depression or bipolar disorder in patients that have not responded to other treatments by enhancing the effects of neurotransmitters
12
Q
What document do you need to obtain prior to ECT?
A
informed consent
13
Q
What labs do you need to obtain prior to ECT?
A
EKG/ECG (check for dysrthmias)
Chest x-ray
blood work
14
Q
What medication will you use during ECT to reduce secretions and counteract bradycardia?
A
atropine and glycopyrrolate
15
Q
What medication will you use to put the patient to sleep during ECT?
A
propofol
16
Q
What medication will be administered for paralytic effects during ECT?
A
succinylcholine and oxygen, have a crash cart ready
17
Q
How long after ECT will the client become alert?
A
15 min
18
Q
What will you need to monitor for after ECT?
A
memory deficits
confusion
19
Q
What neurotransmitter does an SSRI act on?
A
serotonin
20
Q
What neurotransmitter does a SNRI act on?
A
norepinephrine
21
Q
What neurotransmitter does a MAOI act on?
A
norepinephrine, serotonin, dopamine
22
Q
What 2 drugs can you NOT take together?
A
SSRI and MAOI
MAOI and TCAS
all antidepressants
23
Q
What does an MAOI treat?
A
depression
24
Q
What drugs did we talk about in the MAOI category?
A
Phenelzine, selegiline
25
What patient teaching will you need to give to a patient taking phenelzine?
move slowly
avoid OTC medications (nasal decongestants)
avoid foods high in tyramine
26
What can occur if a patient who is taking an MAOI ingests foods high in tyramine?
hypertensive crisis, medical emergency!!!!
27
What are some examples of food high in tyramine?
smoked meats, aged cheese, wine, beer, avocados
28
You patient taking an MAOI says they are going to go eat a peperoni pizza with Gouda cheese and an IPA. What do you tell them as the nurse?
no
29
What blood pressure indicates a hypertensive crisis?
180/120
30
How is selegilline administered?
transdermal patch
31
What should be done in the administration of a selegilline transdermal patch?
remove old patch before applying new one. Time and date the patch
32
What is contraindicated in the selegilline patch?
carbamazepine because it can increase the blood levels of the MAOI
33
What lab is decreased when taking selegilline?
prolactin secretion
34
What two meds put a patient at risk for developing metabolic syndrome?
Phenelzine, selegiline
35
What is sertraline?
SSRI, first line of treatment for anxiety and OCD disorders
36
What is a medical emergency that is caused by sertraline?
serotonin syndrome
37
What are some side effects of sertraline?
sexual dysfunction (low adherence) , insomnia/anxiety/agitation (avoid caffeine) , weight changes, hyponatremia, rash, GI bleeding, and bruxism (wear a mouth guard)
38
What is lithium?
mood stabilizer, treats bipolar
39
T/F : Patients should take lithium with food or milk to decrease GI upset.
TRUE
40
What is an adverse effect in lithium that can indicate lithium toxicity?
motor skills, displayed as hand tremors
41
Hand tremors are worsened by what stimulant?
caffeine
42
What will you give your patient taking lithium who has a goiter and s/s of hypothyroidism?
levothyroxine
43
What med class are you not allowed to have when taking lithium?
NSAIDS
44
What should the nurse do if the patients labs are above 1.9?
STOP THE MEDS, NOTIFY THE PROVIDER, get blood, lithium, and sodium levels. Anticipate doctor to change does and promote excretion
45
What part of the body is lithium hard on?
Thyroid
Kidneys
46
Lithium causes a decrease or increase in vital signs?
Decrease
47
If your patient has a 5 pound weight gain over a short period of time, what is the nurse's priority action?
notify provider
48
What is serotonin syndrome?
can begin 2-72 hours after treatment, is deadlyw
49
What are some signs and symptoms of serotonin syndrome?
confusion, agitation, hallucinations, delirium, seizures, tachycardia, diaphoresis, fever, GI distress, and coma.
50
What are some nursing interventions for serotonin syndrome?
Cooling blanket, anticonvulsant, artificial vent if needed
51
What's the difference between grief and depression?
Grieving is time limited phases, so the end of the cycle is resolution
Depression is where a patient can get stuck in grief and denial
52
What age group is hyponatremia common in when taking SSRIS?
SSRIs can cause hyponatremia in older adult clients that are also taking diuretics
53
What should the nurse do in regards to hyponatremia and SSRIS?
Obtain baseline blood sodium and monitor the levels periodically throughout treatment
54
How long does depression and mania last in a patient with bipolar 1? Does this patient have hypomania?
depression lasts for 2 weeks
mania continuously lasts for 1 week
May present hypomania
55
Does a patient with bipolar 1 experience psychosis?
Yes, has hallucinations and delusions
56
Is a patients daily life affected with bipolar 1?
Yes, daily function is interfered with significantly and requires hospitalization
57
How long does depression and mania last in a patient with bipolar 2? Does this patient have hypomania?
depression lasts for 2 weeks or longer
patient does not have mania
hypomania is present, lasts 4 days consecutive
58
Does a patient with bipolar 2 experience psychosis?
NO
59
Is a patients daily life affected with bipolar 2?
No, it has a low impact.
60
What statement made by a patient will displays mania?
“ I haven't slept for days”
61
What signs and symptoms does a patient with mania have?
Sense of euphoria or elation, cognition includes racing and disorganized thoughts perceives grandiose delusions and paranoia
excessive psychomotor active
sexually inappropriate with poor grooming
62
What signs and symptoms does a patient with hypomania have?
mood is cheerful and expansive
cognition is flighty, rapid flow of ideas
perception of self worth and ability is great
social
loud and inappropriate behavior
63
How many episodes of mania do you need to have in order to qualify for bipolar 1?
1
64
What are some priority nursing interventions for a patient with bipolar disorder?
SAFETY
Place them into quiet and separate room with patients consent
Decrease stimulation to decrease agitation
65
What meds trigger mania?
Antidepressants
Tricyclic and MAOIs
66
What are some nursing interventions for patients and provocative clothing?
Reestablish rules of the unit while being calm and respectful
Asking them questions lie “what do you wear to church”
67
Why do we decrease stimulation in patients with bipolar disorder?
reduces agitation
68
What is carbamazepine?
anti epileptic medication that treats and manages bipolar disorder
69
What are some adverse effects of carbamazepine?
Blood dycrasias, hyperosmolarity, Steven Johnsons syndrome, hepatotoxicity, GI effects
70
What are some nursing considerations for a patient taking carbamazepine?
monitor for s/s of infection, thrombocytopenia (gum bleeding/bruising), obtain CBC and platelets
71
What are some patient teaching points for a client taking carbamazepine?
avoid NSAIDs and pregnancy, can cause GI ulcers, blood dyscrasias
72
How does a nurse promote nutritional intake for a client with bipolar disorder?
finger foods, high protein and high calorie (chickie nuggies)
73
What type of blood dycrasias occur with carbamazepine?
thrombocytopenia, anemia, and leukopenia
74
What is the purpose of a MMSE?
gets a feel for how the patient feels and their cognitive function
75
How do you preserve self esteem in patients with dementia?
Treating patients with dementia the same
Do not ask degrading questions
Allow clients independence and allow them to do daily tasks such as brush teeth, fix hair, etc.
76
What are the indications for Donezepil?
treats Alzheimer’s (does not cure, but will stop the disease from progressing)
77
What does delirium look like in a patient, how fast is the onset?
acute, rapid onset, can be reversed
78
What are some of the causes of delirium?
underlying medical conditions
hospitalization
infection
malnutrition
depression
dehydration
UTI
substance use disorder
surgery
impaired respiratory function
79
How will a patient present while experience delirium?
very distractible, AOx2 (time and place)
impairment of recent memory, misinterpretation of environment, false perceptions, sleep-wake cycle disturbed, fluctuations in consciousness
80
What does dementia look like in a patient, how fast is the onset?
chronic, slow onset, cannot be reversed, degenerative
81
How does dementia kill people ?
Dementia itself doesn't, Dementia does not kill ppl, bed sores, infection, and aspiration pneumonia does
82
What is sundowners?
A set of symptoms or dementia-related behaviors that may include difficulty sleeping, anxiety, agitation, hallucinations, pacing and disorientation. Although the exact cause is unknown, sundowning may occur due to disease progression and changes in the brain.
83
What is a priority nursing intervention for dementia patients?
SAFETY
84
What are some other nursing interventions for patients with dementia?
Accommodate client disabilities.
SAFETY
Keep bed in lowest position.
Room near nursing station
Remove potentially dangerous items.
Assist with ambulation.
Lower stimulation in environment
Black box warning for antipsychotic medication
Remain calm, avoid confrontation.
Practice relaxation, walking, dance, or rhythmic movement.
85
What are some risk factors for dementia?
Family history
High BP
Stroke
Depression
Alcohol use disorder
Vitamin D deficiency
Drug use
86
What happens to your chances for dementia once you hit 65?
They double every 5 years
87
What should the nurse do to avoid misdiagnosis for dementia?
Make sure that it is dementia and not just signs and symptoms often seen with depression.
88
Is dementia more common in women or men?
women
89
What is catatonia? What are some signs and symptoms of catonia?
difficulty moving and responding to the world around them
motor disturbances (catalepsy, muscle rigidity), mutism, withdrawal
(muscle rigidity can be so severe that the limbs remain stiff in place)
90
What is psychosis?
Loss of touch with reality
91
What is schizoaffective disorder?
combination of both schizophrenia and depressive or bipolar disorder (mood disorders)
92
What are some characteristics of schizoaffective disorder?
persistent psychosis (eg, hallucinations, delusions) and mood episodes of depressive, manic, and/or mixed types
93
What does the 5 negative symptoms stand for?
Affect (blunt or flat expression)
Alogia (poverty of thought or speech, mumbles)
Anergia (lack of energy)
Anhedonia (lack of pleasure)
Avolution (lack of motivation in activities or hygiene)
94
What are some nursing interventions for a patient who has hallucinations?
Determine if they are command hallucinations
Divert attention away from the hallucinations
Drug therapy
Milieu therapy (calm environment)
95
When dopamine is blocked, what happens in the body?
Dopamine controls movement –>
when block patients seem slower –>
extrapyramidal symptoms (slow coordination, tongue darting, shuffling gait, pill roll, psuedoparkinsonism, tremors)
96
Anticholinergic effects?
can't see spit poop pee
97
What is tardive dyskinesia?
Extrapyramidal effects: Blinking eyes rapidly, chewing motions, smacking lips, puffing out cheeks, grunting, frowning or grimacing.
98
What are some fun facts about TD? :DDD
Can be permanent
Evaluate patients 12 months after therapy then q3 months
Patients original dose should be lowered or switched to a 2nd gen antipsychotic
99
What is tardive dyskinesia an adverse effect of?
antipsychotic drugs
100
What is benzotropine?
the management of extrapyramidal symptoms, usually associated with tardive dyskinesia, antiparkinsonism agent
101
What is a flat affect?
lack of facial expression
102
What is Neuroleptic Malignant syndrome?
A life threatening medical emergency, can occur within the first week of antipsychotic treatment, adverse effect
103
What are the s/s of neuroleptic malignant syndrome?
sudden high fever
tachycardia
decreased LOC
coma
104
What are some nursing interventions for neuroleptic malignant syndrome?
Treat arrhythmia with medication
Administer antipyretics
Stop antipsychotic meds
Monitor vitals
Administer dantrolene or bromocriptine to indue muscle relaxation
105
What is the onset of schizophrenia?
Late teens to early thirties
106
What qualifies a patient for schizophrenia?
The client has psychotic thinking or behavior present for atleast 6 months
107
Describe echolalia?
Repeats things being said
108
What are therapeutic interventions for a client with communication deficit ?
109
What is waxy flexibility?
Maintaining a specific position for an extended period of time
110
What is a word salad ?
words scrambled are unintelligible words put together that cannot be understood.
111
What are some disturbed sensory perception interventions?
Reassure the client that you believe them even if you dont see/ hear what they do.
112
Symptoms of alcohol intoxication include?
Slurred speech, Memory impairment, altered judgment, Decreased motor skills, Decreased L.O.C, respiratory arrest.
113
Symptoms of chronic alcohol intoxication include?
Cardiovascular damage, Liver damage, GI inflammation and bleeding, Acute pancreatitis, Sexual dysfunction
114
Symptoms of alcohol withdrawal include?
bdominal cramping, Vomiting, Cramping, Tremors, Restlessness and Insomnia, Transient hallucinations or illusions, anxiety, Increased BP, respiratory rate and temperature, Tonic- clonic seizures
115
Gambling addiction
Non-substance-related disorder
116
Benzodiazepines are what kind of medication?
(-pams, -lams) depressants that relieve anxiety, alcohol withdrawal, muscle spasms and reduce seizures.
117
What are the signs and symptoms of benzodiazepine withdrawal?
Anxiety, insomnia, diaphoresis, hypertension, hand tremors, nausea, vomiting, hallucinations or illusions, seizures
118
What are the risk factors for benzodiazepine withdrawal?
Abruptly stopping benzodiazepine use. Benzodiazepine should be tapered off.
119
What are the signs and symptoms of inhalant intoxication?
Behavioral or psychological changes, dizziness, nystagmus, uncoordinated movements or gait, slurred speech, drowsiness, muscle weakness, diplopia, stupor or coma, respiratory depression, death.
120
What are the signs and symptoms of opioid intoxication?
121
Define tolerance
Tolerance occurs when a client requires increased amounts of the substance to achieve the desired effect.
122
What are the indications for Acamprosate?
taken orally three times a day to reduce the unpleasant effects of abstinence (maintaining sobriety) following withdrawal (dysphoria, anxiety, restlessness)
123
What are the symptoms of alcohol use?
A decrease in ability for self-care, urinary incontinence, manifestations of dementia i.e. memory loss
124
What screening tool do we use with alcohol abuse?
CAGE Questionnaire: Ask questions to determine how they perceive their current alcohol use
125
What do you need to avoid when taking Disulfiram?
alcohol, can cause respiratory depression, cardiac suppressions, seizures and death
126
What are some products that contain alcohol that should be avoided in patients taking disulfiram?
Alcohol products; Cough syrup, Aftershave lotion, Mouthwash, Hand sanitizer
127
How long is the medication effective for?
2 weeks following discontinuation of disulfiram.
