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ATI Mental Health > Mod. 9 ATI ch. 17, 25, 28 > Flashcards

Mod. 9 ATI ch. 17, 25, 28 Flashcards

1
Q

Neurocognitive disorders

A

disruption of thinking, memory, processing, and problem solving

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2
Q

Types of cognitive disorders recognized by. the DSM-5

A

Delirium

Mild neurocognitive disorder (NCD)

Major neurocognitive disorder (dementia)

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3
Q

NCD further classified into;

A

NCD due to Alzheimer’s (most common type of NCD)
***note depression can mimic early stages of Alzheimer’s disease

NCD due to Parkinson’s

NCD due to Huntington’s disease

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4
Q

Risk Factors for delirium

A
  • physiological changes, including neurologic: (Parkinson’s, Huntingtons)
  • metabolic: hepatic/ renal failure, electrolyte imbalances, nutrition)
  • cardio. & respiratory diseases:
  • infections: HIV/ AIDS
  • surgery
  • substance use or withdrawal
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5
Q

Other risk factors for delirium

A
  • older age
  • multiple co-morbidities
  • severity of disease
  • polypharmacy
  • ICUs
  • aphasia
  • restraint use
  • change in environment
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6
Q

Risk factors for neurocognitive disorder and AD

A 
advanced age
prior head trauma
cardiovascular disease
lifestyle factors
family history*
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7
Q

Defense mechanisms

A

Denial

Confabulation- client makes up stories to fill in the gaps when they don’t remember. This is done to preserve self-esteem

Perseveration- avoids answering questions by repeating phrases or behavior

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8
Q

Diagnostic procedures to rule out other pathologies

no real diagnostic for NCD

A 
~ chest and head x-ray
~ EEG
~ ECG
~ liver function studies
~ thyroid function tests
~ neuroimaging (CT and positron emission tomography of brain)
~ urinalysis
~ blood electrolytes
~ folate and vitamin B12 levels
~ vision and hearing tests
~ lumbar puncture
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9
Q

NCD screening tools

A
  • confusion assessment method (CAM)- for delirium
  • neelon-champagne (NEECHAM) Confusion scale- delirium
  • functional dementia scale- gives info. on client’s ability to perform self-care, extent of memory loss, mood changes, degree of danger to self/others
  • brief interview for mental status (BIMS)- for long-term care clients
  • mini-mental status exam (MMSE)
  • functional assessment screening tool (FAST)
  • Global deterioration scale
  • blessed dementia scale-behavioral info. based on an interview with a secondary source
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10
Q

Delirium

A

> Rapid (hours or days)
impairments in memory, judgment, ability to focus, ability to calculate (can fluctuate throughout the day)
disorientation/ confusion worse at night and early morning***
LOC usually altered and can rapidly fluctuate
restlessness, anxiety, motor agitation, fluctuating moods are common
personality change is rapid
hallucinations and illusions can be present
change in reality can cause fear, panic, and anger
vital signs can be unstable
medical emergency

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11
Q

4 types of delirium

A
  1. hyperactive with agitation and restlessness
  2. hypoactive with apathy and quietness
  3. mixed, having a combination of hyper and hypo manifestations
  4. unclassified for those whose manifestations do not classify into the other categories
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12
Q

Neurocognitive disorder

A

^ gradual deterioration of function over months or years

impairments in:
^ memory
^ judgment
^ speech (aphasia)
^ ability to recognize familiar objects (agnosia)
^ executive functioning (managing daily tasks)
^ movement (apraxia)
^ impairments do not change throughout the day

^ LOC usually unchanged
^ restlessness and agitation are common (sundowning can occur)
^ personality change is gradual
^ VS should be stable

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13
Q

Medications for delirium

A

pharmacological management focuses on underlying cause

medications for anxiety. or agitation can be used

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14
Q

Monitor signs of delirium

A

tachycardia
elevated bp
sweating
dilated pupils

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15
Q

Neurocognitive meds. (Alzheimers)

A

donepezil
rivastigmine
galantamine

increase acetylcholine. Allows clients to improve self-care abilities and slow cognitive deterioration IN THE MILD TO MODERATE STAGES

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16
Q

Memantine

A

MODERATE TO SEVERE stages of alzheimers

block the entry of calcium into nerve cells, thus slowing brain-cell death

  • can be used with cholinesterase inhibitors.
  • Adverse. effect: dizziness, headache, confusion, constipation
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17
Q

Medications for mental health issues in Children/ adolescents

A

CNS stimulants

SNRIs

tricyclic antidepressants

alpha2- adrenergic agonists

atypical antipsychotics

SSRIs

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18
Q

Medications for intermittent explosive disorders

A

lithium
mood- stabilizing antiepileptics
beta-adrenergic blockers

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19
Q

If toxicity happens with CNS stimulants

A

treat;
hallucinations with chlorpromazine (typical antipsychotic)

seizures with diazepam

administer fluids

20
Q

SNRIs: things to know

for ADHD in children/ adolescents

A

Atomoxetine, Bupropion

  • monitor height and weight, with or after meals, encourage regular mealtimes and avoid unhealthy choices
  • take with food if GI disturbances occur
  • monitor for signs of depression (changed in mood, excessive sleeping, agitation, and irritability)
  • hepatotoxicity: signs of flu-like symptoms, yellowing skin, abdominal pain
  • insomnia, headache, irritability
  • administer one daily dose or in two divided doses
  • can take a few days - 6 weeks. AVOID alcohol and OTC meds.
21
Q

What are tricyclic antidepressants used for in children/ adolescents

A
  • depression
  • autism spectrum disorder
  • ADHD
  • panic disorder, separation anxiety disorder
  • social phobia
  • OCD
22
Q

Anticholinergic side effects

A 
dry mouth
urinary hesitancy/ retention
constipation
tachycardia
blurred vision
photophobia

effects can take 1 to 3 weeks, to 6 weeks for max effects

23
Q

How to reduce anticholinergic effects

A

chew gum

sipping water

wear sunglasses

diet high in fiber

2-3 L per day of fluid

void before taking medication

24
Q

tricyclic toxicity signs

A

resulting in cholinergic blockade and cardiac toxicity

evidenced by;
dysrhythmias, mental confusion, and agitation

followed by;
seizures, coma, and possible death

25
Q

Use for Alpha2- adrenergic agonists in children and adolescents
(think adrenergic agonist mimics parasympathetic)

A

ADHD

Tic disorders

conduct and oppositional defiant disorders

26
Q

Things to know for alpha2-adrenergic agonists

A

! discontinuation can cause rebound htn- should be tapered off
! report CNS effects
! participate in regular exercise and eat healthy
! assess use of alcohol or other CNS depressants
! monitor BP and pulse at baseline, with treatment, and each dose change

27
Q

Atypical antipsychotics in children and adolescents

A

mainly block serotonin and dopamine receptors to a lesser degree.
also block receptors for norepinephrine, histamine, and acetylcholine

used for;

  • autism spectrum disorder
  • conduct disorder
  • OCD
  • relief of psychotic manifestations
28
Q

Nursing considerations with atypical antipsychotics in children

A

administer by oral or IM;
risperidone= oral, olanzapine= oral disintegration tab., quetiapine= for adolescents= oral immediate release, aripiprazole= oral tab/ disintegrated tab/ oral solution

29
Q

SSRIs used in the treatment for;

A
  • intermittent explosive disorder
  • autism spectrum disorder
  • OCD
  • major depressive disorder
  • bulimia nervosa
  • generalized anxiety disorder

fluoxetine, sertraline, fluvoxamine

30
Q

Need to know about SSRIs in children/ adolescents

A

*** agitation and hallucinations can be a sing of serotonin syndrome
(also; anxiety, sleep disturbances, tremors, tension headache)

  • take with food to minimize GI effects
  • monitor weight
  • can increase suicidal ideation
  • MAOIs., SNRIs, buspirone, St. John’s wort = serotonin syndrome
  • effects in 1-3 weeks; MAX effect by 12 weeks
31
Q

Disorders that can appear during childhood/ adolescence

A

+ depressive disorders
+ anxiety disorders: (including panic)
+ trauma- and stressor-relate disorders: PTSD
+ substance use disorders
+ feeding and eating disorders
+ disruptive, impulse control, and conduct disorders
+ neurodevelopmental disorders
+ bipolar and related disorders
+ schizophrenia spectrum and other psychotic disorders
+ nonsuicidal self-injury and suicidal behavior disorder: (suicide leading cause in ages 10 - 24)
+ impulse control disorders: intermittent explosive disorder

32
Q

Risk factors for mental health disorders in children

A
  • genetic (schiz., bipolar, autism, ADHD, intellectual dev.disorder)
  • biochemical
  • social and environmental
  • cultural and ethnic
  • witnessing or experiencing traumatic events
33
Q

Disruptive, Impulsive control, Conduct disorders

A

> oppositional disorders
disruptive mood dysregulation disorder
intermittent explosive disorder
conduct disorder (childhood or adolescent onset)

34
Q

Oppositional defiant disorder

A 
antisocial behaviors;
~ negativity
~ disobedience
~ hostility
~ defiant behaviors (especially towards authority figures)
~ stubborness
~ argumentativeness
~ limit testin
~ unwillingness to compromise
~ refusal to accept responsibility for misbehavior
  • can exhibit low self-esteem, mood lability, and low frustration threshold
  • can develop into conduct disorder
35
Q

Disruptive mood dysregulation disorder

A
  • exhibit recurrent temper outbursts: verbally, physically, aggression
  • outburst not appropriate for developmental level
  • outbursts present three or more times per week, in at least two settings
  • mood between outbursts is angry and irritable
  • onset is ages 6 -18
  • manifestations not due to other mental disorders
36
Q

Intermittent explosive disorder

A

recurrent violent and aggressive behavior w/ possibility of hurting people, property, or animals

^ dx as early as 6, but typically 13 to 21
^ more males affected
^ physical or verbal aggression
^ overreaction to normal events followed by shame/ regret
^ can lead to htn, DM. cannot have healthy relationships

37
Q

Conduct Disorder

categories

A

aggression to people and animals

destruction of property

deceitfulness or theft

serious violations of rules

38
Q

Neurodevelopmental Disorders

A
  • ADHD: 3 types; must be dx before age 12
  • Autism spectrum disorder
  • Intellectual developmental disorder
  • Specific learning disorder
39
Q

Meds. for ADHD

A

CNS stimulants

SNRIs

40
Q

Meds. for autism

A 
SSRIs
antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole)
41
Q

Meds. for intermittent explosive disorder

A

SSRIs (fluoxetine)

  • Mood stabilizers (lithium)
  • Antipsychotics (clozapine, haloperidol)
  • beta blockers
42
Q

Meds. for Oppositional defiant disorder

A

no meds. generally prescribed

43
Q

Meds for conduct disorders

A
  • second and third gen. antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole)
  • TCS
  • antianxiety meds.
  • mood stabilizers
  • antipsychotics
44
Q

meds. for Anxiety

A

usually none are prescribed for kids

SSRIs can be used

45
Q

meds. for PTSD

A

antianxiety meds.

SSRIs

46
Q

meds. for Disruptive mood dysregulation disorder

A

antidepressant therapy

ATI Mental Health (8 decks)

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