Mental Health exam 3 Flashcards
substance use nursing history Q’s
- type of substance
- amount of substance
- pattern and frequency of use (look for changes)
- age at onset
- date of last substance use
- changes in occupational/school performance
- hx of abstinence periods
- previous withdrawal manifestations
rate of substance abuse is highest in ages
18-25
people at increased risk of substance disorder
- alaska natives
- native american groups
people at a decreased risk of substance disorder
asian groups
older adult indications of substance abuse
- decreased self care
- incontinence
- manifestations that look like dementia
opioid intoxication antidote
naloxone
opioid abstinence syndrome s/sx
- starts with sweating and rhinorrhea
- piloerection
- tremors
- irritability
- diarrhea
- weakness
- insomnia
- N/V
- pupil dilation
- muscle weakness/pain
- suicidal ideation
things BAC depends on
- weight
- gender
- alcohol concentration
- number of drinks
- gastric absorption rate
- tolerance level
when does alcohol withdrawal start?
4-12 hours after last drink
how long does alcohol withdrawal last?
5-7 days
when does alcohol delirium start?
2-3 days after last drink
alcohol delirium is considered a
medical emergency
nicotine abstinence syndrome s/sx
- cravings
- irritability
- nervousness
- restlessness
- anxiety
- insomnia
- anger
- depressed mood
- increased appetite
safety for substance use disorders
- prevent falls
- seizure precautions
- 1:1 observation (withdrawal)
- low stimulation
- monitor for covert substance use during detox
education for substance use disorders
- addiction
- initial tx goal
- removing unnecessary meds
- not sharing meds
emergency plan components
- what client needs to do
- who client needs to contact
12 step program
Alcoholics Anonymous (AA)
family groups
- Al-anon
- Ala-teen
what does a 12-step program teach?
- abstinence is needed for recovery
- a higher power can assist with recovery
- clients are not responsible for their disease, but are responsible for their recovery
- client cannot blame others
- client must acknowledge their feelings and problems
disulfiram: acetaldehyde syndrome s/sx
- N/V
- weakness
- sweating
- palpitations
- hypotension
what tests/labs should you monitor while taking disulfiram?
LIVER (hepatotoxicity)
should you take naltrexone with food?
yes to decrease GI distress
who should not take acamprosate?
pregnant women
what medication must be administered from an approved tx center?
methadone
what medication does not reduce the cravings of opioids?
clonidine
mild tension relieving behaviors
- finger/foot tapping
- fidgeting
- lip chewing
at what level of anxiety should gross motor activities be encouraged?
- severe
- panic
(walking)
how should you speak to those with severe/panic level anxiety?
- firm, short, simple, statements
- repetition
- slow, low-pitched, calm voice
generalized anxiety disorder criteria
uncontrollable, excessive worry
- majority of days
- at least 6 months
manifestations of separation anxiety
- during or in anticipation
- HA
- N/V
- sleep disturbances
how might people with specific phobias try to decrease anxiety?
alcohol or substances
panic attack criteria
- 15-30 minutes
- 4+ manifestations
what type of environment should be provided for anxiety?
- safe
- calm
- quiet
- structured
when should you teach someone with anxiety?
after acute anxiety subsides
obsessive-compulsive behaviors are
- time consuming
- repetitive
how long does ASD last?
3 days to 1 month following event
how long does PTSD last?
longer than 1 month following event
how long does dissociative fugue last?
weeks to months
what does severity of trauma depend on?
- duration
- amount of personal threat
- far from home or familiar surroundings
individual vulnerabilities of ASD/PTSD
- past coping mechanisms
- personality
- preexisting mental disorders
intrusive findings of ASD/PTSD
- involuntary, distressing
- memories
- flashbacks
- nightmares/dreams
behavior changes in adjustment disorder
- arguing
- erratic driving
when should the nurse help with decision making in dissociative disorders?
during dissociative periods
when are grounding techniques used and what are they?
- clapping hands
- touching objects
should you talk to those with dissociative disorders about their past?
not too much
what problems are avoided with buspirone that are problems with benzos?
- sedation
- tolerance
- dependence
- withdrawal
defense mechanisms without a maladaptive use
- altruism
- sublimation
defense mechanisms without an adaptive use
- conversion
- splitting
- projection
3 characteristics of ADHD
- inattention
- hyperactivity
- impulsivity
what are those with ADHD at risk for?
injury
ADHD criteria
- behaviors present prior to age 12
- behaviors present in more than 1 setting
autism s/sx
- delayed cognitive/language development
- inability to maintain eye contact
- repetitive actions
- strict routines
when is autism diagnosed?
early childhood
who is autism more common in?
boys
how should you talk to those with ADHD, disruptive, impulse control, and conduct disorders?
- be calm, firm, and respectful
- use short, clear explanations
- obtain attention before giving directions
how should you talk to those with autism?
be short, concise, and developmentally appropriate
what system should you develop with parents?
a reward system
when should you give plenty of notice to those with autism?
before changing routines
what can separation anxiety in children develop into?
- school phobia
- phobia of being left alone
- depression
- panic disorder
how is play affected in children with PTSD?
- decreases
or - involving aspects of traumatic events
when do manifestations of disruptive, impulse control, and conduct disorders worsen?
- situations that required sustained attention (classroom)
- unstructured group situations (playground)
when do those with ODD misbehave most?
- home
- toward the person they know the best
what can ODD develop into?
conduct disorder
temper outburst criteria
- present 3+ times per week
- observable by others
- in at least 2 settings
- does not correlate with situation
DMDD onset
ages 6-18
IED onset
- typically ages 13-21
- as early as age 6
IED can lead to
chronic disease (HTN, DM)
conduct disorder behaviors
- aggression to people/animals
- destruction of property
- deceitfulness/theft
- violation of rules
conduct disorder childhood onset
- before age 10
- more common in males
conduct disorder adolescent onset
- after age 10
- prevalence equal in males and females
what do those with conduct disorder do?
- lie
- bully
- threaten
- intimidate
- shoplift
- truant from school
education for children/adolescents
- gun/weapon control
- seat belts
- protective sports gear
- contraceptives, STI’s, abstinence
- substance use
- who to voice concern to: police, school nurse, counselor, teacher
when should you take methylphenidate?
- 30-45 mins before meals
- last dose before 4 pm
transdermal methylphenidate location and timing
- hip (alternate)
- no more than 9 hours
what type of prescription is needed for methylphenidate?
handwritten
when should atomoxetine/bupropion be taken?
- with or after meals
- last dose before 4 pm
when should TCA’s be taken?
bedtime
what happens when guanfacine/clonidine are stopped abruptly?
rebound HTN
who should not be given guanfacine/clonidine?
children under 6 y/o
when should you take SSRI’s?
- in the morning
- with food to decrease GI effects
