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1
Q

what are MAOIs?

A

anti depressents

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2
Q

what do MAOIs do?

A

Increases the amounts of neurotransmitters such as serotonin by inhibiting reabsorption (avoid in foods and beverages) no cheese, pizza, salami, and wine

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3
Q

what drugs fall under MAOIs?

A

Nardil, Parnate

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4
Q

why are MAOIs the last choice for an antidepressent?

A

it can cause hyhpertensive crisis

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5
Q

what should you do after stopping MAOIs before starting SSRIs?

A

must take a break! atleast 2 weeks

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6
Q

what medication falls under benzodiazepine?

A

Valium (diazepam)

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7
Q

what patients usually take benzodiazepines?

A

detox patient, ant-anxiety

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8
Q

what are the cons of benzodiazepines?

A

habit forming and overdose can be fatal?

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9
Q

what do anticholinergics do?

A

they are used for the negative side effects that are caused by traditional and atypical

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10
Q

what medications fall under anticholinergics?

A

Cogentin, Benadryl, and Artane

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11
Q

what is an SSRI?

A

antidepressent, inhibit serotonin reuptake

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12
Q

what medications fall under SSRIs?

A

Prozac, Paxil, and Zoloft

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13
Q

what are tricyclic antidepressents?

A

block the reabsorption of serotonin

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14
Q

what medications fall under tricyclic antidepressents?

A

Amitriptyline, Despiramine, and imipramine

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15
Q

what medications fall under mood-stabilizers?

A

Lithium, Depakote, Carbamazepin, and trileptal

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16
Q

What medications fall under the category of Anxiolitics?

A

Think benzodiazepines

Valium, Xanax, Ativan, klonopin

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17
Q

What medications are considered traditional Anti Psychotics medications?

A

Haldol, Thorizine, Prolixin, Navane

Male can have female features

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18
Q

What is Clozapine use for?

A

It is for schizophrenia that hasn’t been relieved with any other medications.

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19
Q

What special considerations does the nurse/patient need to know?

A

Anyone who takes this must go under a national registry, and WBCs must be within a certain range, monitored weekly for up to a year.
Dosage decreased very slowly!

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20
Q

what are the SE of Clozapine?

A

Agranulocytosis (wipes it out quickly), drooling (very excessive), sudation (aspiration pneumonia), hypotension (potential for all antipsychotic patients), NOT for dementia patients.

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21
Q

What medications are considered atypical Anti Psychotics medications?

A

Abilify, Zyprexa, Resperidal, Geodone

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22
Q

What are the major side effects related to all medications covered in class and the appropriate treatment?

A

Constipation (will put patient on DSS)
Dry mouth) give patient ice chips)
EPS symptoms: (to correct give Benadryl)
• Occulo-gyral crisis (eyes roll up and tongue sticks out). These patients will have the cogwheel symptom. This is reversible if you discontinue medication. It will eventually just go away by itself.
• Antiemetic’s: (Compazine) can cause EPS
Akathisia: constant restlessness of the legs. Restless leg syndrome.
Acute dystonie: (another term for EPS)
• Treatment: intramuscular anti-cholinergic.
Tardive Dyskinesia:
• Mainly from traditional antipsychotics; NOT REVERSIBLE (Haldol and Thorazine).
• Involuntary movements of the tongue, lips, face, trunk, and extremities.
• NO TREATMENT

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23
Q

What is Neuroleptic malignant syndrome and how is it treated?

A
  • Idiosyncratic reaction to neuroleptic medication
  • Symptoms: fever, muscular rigidity, altered LOC, autonomic dysfunction. • Organ shutdown (regulation of BP, HR, temperature, GI secretion)
  • Only treatment is to watch for early symptoms and take them off the antipsychotic.
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24
Q

What is Serotonin syndrome?

A 
occurs mainly when taking antidepressents, often 2 or more drugs that both effect serotonin. 
high fever
irregular heart beat
seizures 
unconsciousness
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25
Q

how is seretoning syndrome treated?

A

Treat this by taking the patient off the medication.

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26
Q

What cultural differences can be expected when interviewing/educating patients of different cultures? How should nurses deal with cultural treatments/beliefs that differ from their own?

A
  • It is essential that is there is a culture where family is extremely involved make sure patient is still getting care
  • If patient tells you their experiences you need to figure out how that culture views mental illnesses in their country.
  • Try to see everything from the perspective from the patient and be empathetic.
  • Racial bias
  • Stereotypes
  • Prejudice
27
Q

what is informed consent?

A

process for getting permition before conducting a healthcare intervention on a person

28
Q

What medications require informed consent?

A

• Anything we give to stabilize mood, anxiety, or any psychiatric condition DOES need consent. ONLY MOOD STABILIZERS OR PSYCHIATRIC DISORDERS!
o You do not need med consent to Benadryl or Tylenol (if test says do you need med consent for every medication? Answer is NO.

29
Q

What is the Tarosoff decision?

A

• Tarasoff decision: is a duty to warn. Usually happens on discharge day.

30
Q

What hearing is used to force medications against a patients will?

A

• Riese hearing (except for meds that can last longer than the time in the hospital): forcing patients to take medications against their will. (Patient must have a legitimate reason for not wanting to take the medication).
o Clear and convincing evidence
o Informed consent was given that includes why the medication is needed, likelihood of improvement, alternative treatment available
o Document refusal
o Petition and notice
o Presentation of the case.

31
Q

what is a 5150?

A

5150: 3 day (72 hour) legal hold, for a psychiatric condition. Person has to be a danger to themselves, danger to others, or gravely disabled (cant provide for their own food shelter or clothing).
• Police, social worker, or a doctor can put you on a 5150

32
Q

what is a 5250?

A

5250: An additional 14 day hold for danger to self, danger to others, or GD (now they are in 17 day range).
• Within 3 days you will have a hearing in the hospital. An advocate will speak on why you should leave against a hospital advocate who argues why you should stay, and then judge decides.
• Doctor has the authority to lift the hold at any time.
• If patient has filed a writ when they first came in they do not get that chance to go to the judge after 3 days.

33
Q

wha tis a 5260?

A

5260: an additional 14 days tacked onto 5250 is they have a desire to commit suicide.

34
Q

what is a Tee con?

A

Tee-con: an additional 30 days. Can’t function outside w/o supervision.

  1. takes to the hospital
  2. takes off clothes
  3. assesses the patient
  • If patient does not want to be there they can file a writ habeas corpus: patient will be seen by a judge and released if they can prove that they should be to the judge. (Legal option one time).
  • If 72 hours is up and they did not serve a 5250 the patient has the right to walk out.
35
Q

what is schizophrenia?

A
  • Lasts for at least 6 months and includes at lest 1 month with two or more active-phase symptoms. Can be triggered by stress, drugs.
  • First onset is between 18-25
36
Q

what are the negative symptoms of scizophrenia?

A

• Negative symptoms
o Inexpressive facial expression
o Monotone monosyllabic speech
o Few gestures
o Lack of interest in the world or other people (anadonia)
o Inability to feel pleasure
o An absence of normal emotion and social sensitivity (flat affect)

37
Q

what are the positive symptoms for schizophrenia?

A

• Positive symptoms (aka positively bad)
o Hallucinations
o Delusions
o Exaggerations of normal perceptions and thinking (paranoia)

38
Q

what is disorganized schizophrenia?

A

o Thoughts, behaviors, that are inappropriate and don’t make sense. Babbling away about nothing.

39
Q

what is residual schizophrenia?

A

o When patient no longer displays prominent symptoms
o They are under control
o Flat blunted affect

40
Q

what is paranoid schizophrenia?

A

o Loss of touch with reality with delusions that are not based in reality
o This condition can lead to suicidal and violent behaviors (because they cant get away from paranoid thinking)
(tinfoil head)

41
Q

what is catatonic schizophrenia?

A

o Physical immobility. Will be unaware of there surroundings. Patient may become dehydrated on you because they are just quiet! They are so engaged inside of their mind that they don’t come out.
o If you agitate them enough to engage with you they will step out of their mind and become violent with you because they want to be where they are.
o Waxy flexibility (can mold patient into a position and they will stay there)
o Catatonic stupor
o Psychiatric emergency.

42
Q

what is treatment for schizophrenia?

A

o Traditional antipsychotic (used for acute disorders). Knocks out psychosis faster than anything else. SE: severity of EPS symptoms, TD, and neuroleptic syndrome.
o Atypical antipsychotic (not soooo far out there). First line of choice*
o Intensive case management
o Deconate; put it in IM, and it will last 2 weeks (use for people who need help with med compliance)

43
Q

how should we care for patient with schizophrenia?

A

• Empower patients to take control of their own care. Make patient part of the treatment modality. Let patient decide when they want to come off the medications and support them, we monitor for psychotic symptoms to come back.

44
Q

what are normal changes of aging?

A
  • Normal for them t use the wrong words
  • Have a little forgetfulness
  • HOH
  • This does not mean the patient has dementia or delirium
  • If they aren’t demented they can count back by 7.
45
Q

what are the signs of dementia?

A
  • Dementia is a progressive loss of cognitive function with symptoms similar to delirium
  • Changes in memory
  • Changes in judgment
  • Decreased ability to calculate numbers
  • Decreased abstract reasoning
  • Decreased problem solving
46
Q

what are common causes of dementia?

A
  • Amyloid plaques and neurofibrillary tangles
  • Nerve cell degeneration
  • Cerebrovascular and cardiovascular problems
47
Q

what are the warning sighs for alzheimers dementia?

A 
Warning signs for AD:
•	Memory loss that affects job skills 
•	Difficulty performing Tasks
•	Language problems 
•	Disorientation to time and place
48
Q

what is the treatment for dementia?

A
  • Pharmacological therapies
  • Behavioral modification
  • Assistance
  • Safety measures
  • Liquid nutrition
  • Frequent repositioning
  • 24 hour care
49
Q

what is delirium?

A

• a temporary condition characterized by confusion, rapidly altering mental states, disorientation, and possible personality changes.

50
Q

what causes delirium?

A
  • Infection (UTI)
  • Medications (antihistamines, anticholinergics, benzodiazepenes)
  • Anesthesia
  • Electrolyte imbalance
  • Pain
  • Sleep disturbance
  • Underlying dementia
51
Q

what are the treatments for delirium?

A
  • Treat the underlying cause
  • Check for alcohol withdraw
  • Think seizure precautions
  • Provide vitamin and nutritional support
52
Q

– What is SBAR and how is it

Use in handoff report?

A

S: Situation
B: Background (first hospitalization, family problems, medical issues, current medications)
A: Assessment (medical issues, safety issues, support system issues, self esteem issues, and discharge/readiness/education needs)
R: Recommendations (what does the nurse on the next shift need to be concerned about and what potential issues need to be addressed?)

53
Q

what are the maslows heirarchy of needs?

A

• Do they have any medical problems? (It is possible that the medical is masked as a psychological condition).
• Safety of self and others.
o Are they HI or SI?
o Assess the patients safety concerns
• Support systems:
o Assess patients relationship with doctor/nurse/social worker
o Assess patients relationship with peers (on unit)
o Assess patients support systems outside the hospital setting
• Self esteem/self determination:
o Assess patients personal hygiene/self-care
o Assess patients perceived barriers to health
• Discharge readiness:
o Assess patient for symptom improvement, gained knowledge, increased control over own mental health issues/symptoms.
• Do they know and understand medication?
• Do they have a support system to help them manage their recovery plan?
• Do they have an insight to why they were hospitalized and how to prevent that?

54
Q

what is florence nightingale theory?

A

(environmental); she believed that the right environment helped healing. She also believed that the proper use of fresh air, light, warmth, cleanliness, and diet. She started the first “real systematic” nursing school. She also believed in “fostering Hope” and to never lose hope

55
Q

what is hildegard peplau theoury?

A

“Mother of psychiatric nursing” her main focus was interpersonal relationships. Get to know the patient (they teach us and we teach them). Do not tell the patient what to do. Considered nursing to be a healing art.

56
Q

what is martha rogers theory?

A

(energy field). Focused on Energy flow between the human and environment/objects. Combined nursing as an art and nursing as a science; Self aware-ness of the dynamics of the energy field. The energy field “provides a way to perceive people and environment as irreducible wholes.”
• Openness:
o The human field and the environmental fields are constantly changing their energy
o There are no boundaries or barrier that inhibit energy flow between fields.

57
Q

what is jean watson theory?

A

Caring theory). It is a holistic approach to health care. It instilled a faith/ hope base. Focused on developing a help-trust relationship. People should have comfort in dying; no one should have to go out mad and angry.

58
Q

What is the Mini Mental Status Examination, What does it cover, how is it administered?

A

This is an objective examination to assess a clients cognitive status by evaluating the following:
• Orientation to time and place
• Attention span and ability to calculate by counting backwards by 7
• Registration and recalling of objects
• Language, including naming of objects, following of commands, and ability to write.

59
Q

what is loose association?

A

things are close but not quite right. It is kind of on topic but it is not completelymaking sense. (Ex. Weather is nice outside and patient starts talking about wintertime).

60
Q

what are hallucinations?

A

auditory, visual, tactile (touching), all factories (often associated with a tumor). Figure out what type of hallucinations they are having

61
Q

what is delusion?

A

you perception is skewed (ex. Thinking you are the president of the US).

62
Q

what is broadcasting?

A

belief that you can give me information without talking. They think you can read their mind.

63
Q

what is amgical thinking?

A

believing you have powers that are magical.

Mental Health (2 decks)

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