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Mental Health > Mental Health exam 2 bp > Flashcards

Mental Health exam 2 bp Flashcards

1
Q

Typical Antipsych are

A

first gen

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2
Q

Atypical Antipsych are

A

second gen

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3
Q

When do we use Typical antipsych

A

positive symptoms

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4
Q

When do we use Atypical anti

A

negative symptoms

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5
Q

What are positive symptoms

A

symptoms present in a client that should not be there
hallucinations, delusions, illusions, bizzare behaviors

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6
Q

What are negative symptoms

A

Symptoms that are not present or lacking,
5 a’s

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7
Q

What are the 5 a’s?

A

Affect, Avolition, Anergia, anhedonia, Alogia

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8
Q

Affect

A

loss of affect: instead flat or blunted

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9
Q

Avolition

A

loss of motivation, hygiene

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10
Q

Anergia

A

no energy

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11
Q

Anhedonia

A

no pleasure

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12
Q

Alogia

A

poverty in thought, and changes in speech

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13
Q

What can happen when we are treating depression in a client?

A

can trigger an episode of mania

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14
Q

Grief and depression…

A

mimic each other.

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15
Q

Difference between Bipolar 1 and Bipolar 2

A

Bipolar one has an episode of mania and usually requires hospitalization

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16
Q

Bipolar 2 is

A

hypomania and usually does not result in hospitalization

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17
Q

What is the priority intervention for Bipolar Disorders?

A

safety

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18
Q

1.9 lithium level or less interventions

A

hold medication, and notify provider, get blood lithium and sodium level.

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19
Q

Carbamazepine is a

A

anticonvulsant and anti-epileptic

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20
Q

Risk with Carbamazepine

A

blood dyscrasia:
leukopenia, anemia, thrombocytopenia

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21
Q

What blood test should we do to test for with the use of Clozapine?

A

ANC(absolute neutrophil count)

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22
Q

Monitor for what during Clozapine use

A

Agranulocytosis, neutrophil suppression

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23
Q

MAOI can cause what to happen if patients ingest tyramine foods?

A

Hypertensive crisis

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24
Q

What is a fatal side effect that should be included in patient education for clozapine?

A

agranulocytosis

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25
Q

What diet education should the nurse include for a client taking phenelzine?

A

restrict foods containing tyramine

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26
Q

Which client teaching is correct for sertraline?

A

sertraline will not have an immediate effect on the body. It will take even up to 3 months to see an effect

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27
Q

What symptoms only exist with bipolar 1

A

mania

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28
Q

a client experiencing confusion, blood pressure changes, and diaphoresis while taking an SSRI, you suspect?

A

Serotonin Syndrome

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29
Q

What statement might indicate a manic episode?

A

” I have not slept for seven days”

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30
Q

What nursing intervention should be implemented for a client experiencing mania?

A

Place client in a quiet, separate area and maintain safety.

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31
Q

A client replies, “hip hooray, the flip is cast and wide sprinting in the forest”, this is an example of what finding?

A

Word salad

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32
Q

2 most common surgeries that cause delirium

A

cardiac and orthopedic

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33
Q

Unit with the most delirium in the hospital

A

ICU

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34
Q

Describe Echolalia

A

When a patient repeats the exact words you said to them during a conversation

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35
Q

Characteristics of mania

A

lasting one week and present most of the day, every day
decreased need for sleep, more talkative, flight of ideas, distractibility, inflated self-esteem, or grandiosity.

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36
Q

ECT

A

Need to do an ekg, before hand.

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37
Q

Phenelzine client education

A

risk for hypertensive crisis if patient eats tyramine.

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38
Q

Sertraline client education

A

can cause sexual dysfunction which can result in low medication adherence.

Monitor for seratonin syndrome.

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39
Q

Selegiline (MAOI) client education

A

Transdermal patch, observe for cns stimulation )anxiety, agitation, hypomania, and mania).
Remove old patch before applying new one,

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40
Q

Lithium client education

A

No NSAIDs, weight gain, (5 lb difference notify provider).

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41
Q

SSRIS and hyponatremia client education

A

ssris: citalopram, fluoxetine, sertraline
Seratonin syndrome can occur. If this occurs hold medication and notify provider.
sexual dysfunction can occur.

Hyponatremia risk

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42
Q

Meds that trigger mania?

A

anti-depressants

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43
Q

Why is it important to reduce stimulation in patients with Bipolar?

A

can increase mania

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44
Q

Promoting nutritional intake for Patients with Bipolar

A

finger foods, high protein, high calorie, and drinks
Chicken nuggets,
avoid caffeine

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45
Q

Delirium Vs Dementia

A

Delirium is short term with rapid onset and can be reversed.
Dementia is chronic and occurs gradually with no reversal

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46
Q

Which disorder is reversible?

A

delirium

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47
Q

Dementia does what at 65?

A

once you hit 65, every 5 years your chances double

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48
Q

Dementia is leading cause of death. Dementia does not lead to death but what does

A

bed sores, infections, aspiration pneumonia

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49
Q

First stages of dementia are?

A

symptomless

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50
Q

Risk for Dementia

A

age, head trauma, genetics, lewy body disease, hiv infection, vacular disease, prion disease

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51
Q

Sundown syndrome

A

insomnia, anxiety, agitation, pacing, walking, confusion, paranoia, hallucinations, restlessness

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52
Q

Interventions for dementia

A

safety, structured schedule activities, strict feeding and toileting times, walk with client, restrict access to departure on unit.

DO NOT come up behind them or put hands on them.

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53
Q

What is Catatonia

A

Refers to a significant motor disturbance (no motor activity) to excessive motor activity and agitation,

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54
Q

Symptoms of psychosis

A

Disorganization of the personality, deterioration in social functioning, and loss of contact with or distortion of reality.

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55
Q

Symptoms of Schizoaffective disorder

A

Client may appear, depressed with psychomotor delay, si, euphoria, grandiosity, and hyperactivity

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56
Q

Symptoms of dementia

A

aphasic, self-care deficit, isolation, difficulty naming objects, common personality changes, inability to carry out purposeful motor activities or use objects properly.
Vague language, inappropriate behavior.

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57
Q

Frontal lobe effects what?

A

A client has difficulty with brushing their teeth and buttoning their shirt.

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58
Q

Parietal lobe does what

A

recognizes my own environment and where things are located.

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59
Q

Temporal lobe

A

A client is experiencing hallucinations and cannot ask for help

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60
Q

Hippocampus

A

short term memory.
The client can remember her name but not your name

61
Q

Amygdala

A

The client is scared and paranoid of the staff.

62
Q

Occipital

A

a client sees a picture of a fork but cannot name the object

63
Q

Black box warning for antipsychotic meds

A

do not give to people with neuro disorders.

64
Q

What drugs are MAOI

A

Phenlzine, Selegiline,

65
Q

Interventions for a client with hallucinations

A

ask client directly about the hallucinations
do not argue with them
provide safety
identify what triggers the hallucinations

66
Q

Anticholinergic side effects

A

dry mouth, blurred vision, constipation, urinary retention

67
Q

Tardive Dyskinesia

A

side effect of antipsych

lip smacking, tongue thrusting, irreversible. severe eps

68
Q

Use of benztropine

A

Is used to treat symptoms of eps

69
Q

What is a flat affect?

A

no facial expression

70
Q

Neuroleptic Malignant syndrome

A

Lifethreatneing medical emergency that occurs with the use of anti-psych (typical)

71
Q

Onset of Schizophrenia

A

high school and early in college

72
Q

What is waxy flexibility

A

associated with catatonia
Client with Schizophrenia allows body parts to be placed in bizarre or uncomfortable positions.

73
Q

What is word salad

A

a group of words put together but no logical connection

“most forward action grows life double plays circle uniform”

74
Q

Clozapine client education

A

blood drawn every week for 6 months.

75
Q

Disturbed sensory perception interventions

A

Observe patients for signs and symptoms of hallucinations.
“are you hearing other voices?”
“are you able to distinguish those voices?”
safety, keep the bed at the lowest position, reorient them, walking rhythmic dancing

76
Q

Symptoms of alcohol intoxication

A

Behavioral/cognitive: mood liability, impaired judgement, slurred speech, incoordination, unsteady gait, nystagmous and facial flushing

PPhysical: Cns depression, hypoglycemia, hypothermia, hyper or hypotension, vomitting.

77
Q

Symptoms of alcohol withdrawl

A

Coarse tremors of hands. tongue or eyelids. n/v, malaise and weakness, tachycardia, sweating, elevated bp, anxiety, depressed mood, and irritability, transient hallucinations or illusions, headaches and insomina.

78
Q

Gambling addiction

A

Persistant and reoccurring problematic gambling behavior leading to clinically significant impairments or distress.

79
Q

Benzo withdrawl

A

anxiety, insomnia, diaphoresis, hypertension, possible psychotic reactions, hand tremors, n/v hallucinations and illusions, psychomotor agitation, and possible seizure threshold.

80
Q

Risk factors in substance use disorders

A

genetics, chronic stress, lowered self esteem, few life successes, risk taking tendencies, history of trauma, lowered tolerance of pain.

81
Q

Inhalant intoxication

A

irritation around the eyes, nose, and mouth and blurred vision

82
Q

opioid intoxication sx

A

Euphoria followed by apathy, dysphoria, psychomotor agitation, and impaired judgement.
Physical: anorexia, drowsiness, slurred speech, and impairment in attention and memory.

83
Q

What is tolerance?

A

need more of a drug to reach a desired effect

84
Q

Acamprostate indication

A

alcohol absteince

85
Q

symptoms of alcohol use

A

Relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, and sleep .

86
Q

Screening tools for substance use disorders

A

CAGE, cwa, SBRI used for after alcohol withdrawal,

87
Q

Disulfiram education

A

avoid alcohol while on this medication. If patient drinks on this medication they can experiance a disulfiram reaction.

Reaction sx: Hangover symptoms. Flushed face, confusion, n/v, tachycardia, sweating, headache.
Too much alcohol ingestion can cause, Respiratory depression, cardiovascular collapse, arrthymias, mi, heart failure.

88
Q

Carbamazepine client education

A

notify provider if indications of blood dyscrasias are present.
Do not get pregnant
avoid grapefruit
know fluid overload.
notify provider if steven-johnson syndrome occurs

89
Q

Purpose of MMSE

A

evaluate client for Neurocognitive disorders. (dementia)

90
Q

Perserving self esteem in neurocognitive disorders

A

we need to allow them time to do their own adls, recognize when their self esteem is low,
3 defense mechanisms: denial, confabulation (making up memories)
preservation (random words or phases to avoid answering questions)

91
Q

Donepezil indications

A

used in tx for dementia, does not cure, just helps

92
Q

Seratonin syndrome

A

can begin 2-72 hours after the start of treatment and can be lethal

93
Q

Grief and depression difference

A

Grief is time limited. If a client gets stuck in the first stages of grief then they can slip into depression

94
Q

Important for Electroconvulsive therapy.

A

get chest x ray, blood test, ekg before administering this therapy

95
Q

What are the different neurotransmitters?

A

seratonin, dopamine, epi, nore epi, gaba

96
Q

Gambling causes what to happen?

A

Gamblers experience a sensation of relief when they win a match causing them to have decreased stress. Many use gambling as a way to try and cope with stress or regain a sense of control.

97
Q

What behavior might we see in an individual that has a gambling addiction?

A

absence from work, borrowing or stealing money from families, forgery and theft and embezzlement.
Acquiring money from illegal sources.

98
Q

which receptor is believed to be connected to gambling addiction

A

dopamine.

99
Q

Why is treating someone with a gambling addiction hard?

A

They have to come to the realization that they have a problem.
Most of the time they will only seek out treatment based on legal problems, family pressure or psychiatric complaints.

100
Q

First gen(typical) meds include

A

Phenothiazines, Haloperidol.
These improve positive symptoms and cause negative symptoms to worsen

101
Q

Second gen (atypical) meds include

A

Clozapine, aripiprazole, olanzapine, risperidone,

improvement of positive and negative symptoms.

102
Q

How do first gen anti-psych work?

A

They lower the brain levels of dopamine by blocking dopamine receptors. This causes a reduction of psychotic symptoms.

103
Q

First gen antipsych can have effects like,

A

EPS, and neuroleptic malignant syndrome

104
Q

What are symptoms of EPS

A

dystonia, akathisia, pseudoparkinsonism and tardive dyskinesia

105
Q

What medication can we give to treat eps

A

benzotropine

106
Q

What are symptoms of NMS

A

sudden high fever, blood pressure flucuations, diaphoresis, tachycardia, muscle rigidity, d, loc, coma.

107
Q

Interventions of NMS

A

stop antipsych med
apply cooling blankets
monitor vs
admin antipyretic
admin dantrolene or bromocriptine to induce muscle relaxation, immediate transfer to icu

108
Q

What disorders does Catatonia appear in?

A

Schioaffective, Schizophrenia.

109
Q

What symptom is used for dx of Schizoaffective disorder

A

presence of hallucination and or delusions that occur for at least 2 weeks in the absence of major mood episode

Prominant mood disorder sx must be evident most of the time

110
Q

Loose association speech

A

speech ideas shift from one unrelated subject to another

“we wanted to take the bus but the airport took all the traffic. Driving is the ticket when you want to get somewhere. We all have it in our pockets”

111
Q

Clang Association

A

Words are governed by sounds. Rhyming
“it is very cold, i am cold and bold, the gold has been sold.”

112
Q

Hallucinations are what?

A

False sensory perceptions not associated with real external stimuli. Can include any of the 5 senses.

113
Q

Illusions are what?

A

Misperceptions or misinterpretations of real external stimuli.

114
Q

With waxy flexibility, once the body part has been placed in a position, will the patient immediately drop that part?

A

no, they will hold it for a long period of time regardless of how uncomfortable it may be for them.

115
Q

what are signs and symptoms in a client experiencing a hallucination?

A

Listening pose, laughing or talking to self, stopping mid sentence.

116
Q

What is important to remember when intervening with a patient experiencing a hallucination?

A

Do not touch them without permission. Approach them from the front and keep a distance. Keep an attitude of acceptance.

117
Q

Why is it important to keep an attitude of acceptance with patients having hallucinations?

A

This will encourage the patient to share the content of the hallucination with you.

118
Q

What question should we ask to assess the source of the voices in hallucinations?

A

“Do these voices seem familiar to you, or do they seem to be unfamiliar?”

119
Q

How do we avoid reinforcing the hallucinations?

A

use “the voices” instead of referring to the voices as, “they”.

120
Q

Dopamine blockage can result in?

A

EPS and prolactin increasage (galactorrhea, gynecomastia)

121
Q

What can we teach our patients taking a second gen antipsych (atypical) to minimize weight gain?

A

Follow a healthy low cal diet, monitor weight and encourage regular exercise.

122
Q

SNRIs

A

duloxetine, venlafaxine, levomilnacipram, desvenlafaxtine

123
Q

What is a major manifestation of inhalation withdrawl?

A

Flashback hallucinations can occur immediately or years later for years.

124
Q

How do SSRI work?

A

selectively block reuptake of the monoamine neurotransmitter seratonin in the synaptic space. This intensifies the effects of seratonin.

125
Q

Hyponatremia with SSRI education and intervention

A

IF patient is taking diuretics can increase risk for hypnatremia,
obtain baseline sodium level and periodically obtain levels throughout tx.

126
Q

manifestations for seratonin syndrome

A

mental confusion, abd pain, diarrhea, hyperflexia, diaphoresis, tremors, hallucinations,

127
Q

Nursing interventions for seratonin syndrome

A

admin meds to create a seratonin receptor blockade and muscle rigidity, cooling blankets, anticonvulsants and artificial ventilation.

128
Q

SSRIs can not be taken in conjuction with which meds?

A

MAOIS and TCAS, NSAIDs,

129
Q

SNRI teaching

A

do not stop abruptly, need to gradually quit. Sexual dysfunction can occur. teach patient how to deal with this.

130
Q

Selegiline is contraindicated in?

A

patients taking carbamazepine or oxcarbazpine. Taking these meds with MAOI can increase blood levels of maoi

131
Q

Tyramine foods

A

beer, aged cheese, pepperoni, salami, avacados, figs, bananas, red wine, smoked fish, some dietary products.

132
Q

Donepezil does what

A

increases acetylcholine that ultimately increases the availability of acetylcholine at receptor sites. This helps aid in improving ability to preform self care and slow cognitive deterioration.

133
Q

lithium toxicity 1.9 less

A

tremors, mental confusion, ongoing gi distress

134
Q

meds given during electroconvulsive therapy

A

glycopyrolate, atropine, propofol, etimidate, succi

135
Q

acronym for cage

A

C: Has anyone told you to cut down your drinking?
A: does anyone get annoyed by your drinking
G: Do you every feel any guilt when you drink?
E: Do you ever start out your day drinking or do you ever need it to relax
/

136
Q

acetylcysteine

A

reduces seeking withdrawal and toxicity

137
Q

Chlordiazepoxide (benzo)

A

given for alcohol withdrawal,

138
Q

Withdrawal occurs within ____ after cessation or reduction

A

4-12 hours

139
Q

If we don’t treat alcohol withdrawal within 24-48 hours, (Delirium Tremons).

A

delirium

140
Q

Benzodiazepine withdrawal interventions

A

seizure, fall and suicide precautions

141
Q

prevent benzo withdrawal

A

taper and do not stop abruptly

142
Q

opioid abuse starts off with what

A

an injury

143
Q

Benzodiazepines can do what

A

and decrease seizure threshold.

144
Q

When do we give clonidine?

A

reduction of alcohol abstinence.
Treat with benzo first then clonidine
clonidine works with blood pressure.

145
Q

what brain structures are most associated with the drive complex for compulsive substance use?

A

Amygdala, Prefrontal cortex, Basal ganglia

146
Q

Exposure to acetaldehyde leads to which of the following symptoms?

A

flushing, n,v, hypertension,

147
Q

A cns depressant such as a sedative works on which areas of the body?

A

nerves, brain, muscle, heart,

148
Q
A

Mental Health (4 decks)

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