Psych

Question 1

1 problem in abuse is

Answer 1

denial

Question 2

Denial

Answer 2

• Refusal to accept the reality of their problem
• Treatment
  
  • Confront it by pointing out to the person the difference between what they say and what they do.

Question 3

Wernicke’s (Korsakoff’s Syndrome

Answer 3

• Psychosis induced by vitamin B1 (thiamine) deficiency
• Symptoms
  
  • Amnesia (memory loss)
  • Confabulation (make-up stuff)
  • Preventable (take vitamin)
  • Irreversible (kills brain cells)

Question 4

Alcoholism treatment

Answer 4

• Antabuse/Revia (Aversion Therapy)
  
  • Onset and duration of effectiveness - 2 weeks
  • Avoid all forms of alcohol to avoid nausea, vomiting, death
  • Alcohol avoidance
    
    • Mouth wash, cologne, perfume, aftershave, elixir, most OTC liquid medicines, insect repellant, vanilla extract, vinaigrettes (red wine vinaigrettes acceptable), hand sanitizer

Question 5

Alcohol Withdrawal Syndrome vs. Delirium Tremens

Answer 5

• AWS
  
  • Every alcohol goes through this
  • semiprivate room
  • regular diet
  • up ad lib
  • Give anti-HTN meds
  • Give tranquilizer
  • Give multivitamin to prevent Wernicke’s
• DT
  
  • can kill you
  • Danger to self and others
  • Private room near nurse’s station
  • Clear liquid or NPO
  • bedrest w/o bathroom privileges
  • vest or 2 point restraints
  • Give anti-HTN meds
  • Give tranquilizer
  • Give multivitamin to prevent Wernicke’s

Question 6

Non-psychotic vs. psychotic

Answer 6

• Non-psychotic
  
  • has insight (reality based)
    
    • know they’re sick and that it’s affecting them
• Psychotic
  
  • no insight (non-reality based)
  • therapeutic communication can’t be used
  • Delusions
    
    • Paranoid/Persecutory Delusion - false, fixed belief that people are out to harm you
    • Grandiose - false, fixed belief that you are superior
    • Somatic - False, fixed belief about a body part
  • Hallucinations
    
    • Auditory, Visual, Tactile, Gustatory, Olfactory
  • Illusion
    
    • Misinterpretation of reality → sensory experience

Question 7

Types of Psychotics

Answer 7

• Types of Psychotics
  
  • Functional Psychotics
    
    • Schizophrenia, Schizoaffected, Major depression, Manic
    • Teaching reality
      
      1. Acknowledge feelings
      2. Present reality
      3. Positive - what is reality
      4. Negative - what is not reality
      5. Set a limit
      6. Enforce the limit
  • Psychosis of Dementia
    
    • Brain damage
    • Alzheimer’s, Wernicke’s, Organic Brain Syndrome, Dementia
    • Can’t learn reality
    • Treatment
      
      1. Acknowledge feelings
      2. Redirect - get them to express the fixation that they are expressing inappropriately to appropriately
  • Psychotic delirium
    
    • Temporary episodic sudden onset loss of reality due to chemical imbalances
    • UTI, thyroid imbalance, electrolyte imbalance, adrenal crisis
    • Treatment
      
      1. Acknowledge feelings
      2. Reassure them of safety and temporariness

Question 8

Loosening of association

Answer 8

• Flight of ideas
  
  • Stringing phases together (loosely associated phrases; tangentiality)
• Word salad
  
  • Throw words together
• Neologisms
  
  • Making up new words

Question 9

ABN - Abnormal Personality Disorders

Answer 9

• Antisocial, Borderline, Narcissistic
  
  • most severe personality disorders

Question 10

All psych drugs cause…

Answer 10

• Hypotension
• Weight changes (primarily weight gain)

Question 11

Phenothiazines

Answer 11

• 1st gen anti-psychotics (typical)
• All end in -zine (“zines for the zany”)
  
  • Thorazine, compazine
• Reduces symptoms
• Actions
  
  • large doses - antipsychotic
  • small doses - antiemetic
  • major tranquilizers
• S/E
  
  • A = anticholinergic (dry mouth)
  • B = blurred vision and bladder retention
  • C = constipation
  • D = drowsiness
  • E = EPS (tremors, parkinsonisms)
  • F = “f”otosensitivity (skin burns)
  • G = aGranulocytosis (low WB count)
  • Treat Side Effects
• Teaching
  
  • Teach patient to report sore throat and symptoms of infection to PCP
  • Never stop the zine
• # 1 diagnosis is safety
• Deconate or … D
  
  • Long-acting IM form given to non-compliant patients

Question 12

Tricyclic Antidepressants (NSSRI)

Answer 12

• “Mood elevators” to treat depression
  
  • Must take for 2-4 weeks before beneficial effects
• Ex. Elavil, Trofranil, Aventyl, Desyrel
• S/E
  
  • A = Anticholinergic (dry mouth)
  • B = blurred vision
  • C = constipation
  • D = drowsiness
  • E = euphoria

Question 13

Benzodiazepines

Answer 13

• Antianxiety meds (considered minor tranquilizers)
• Always have “pam/lam” in name
• Indications
  
  • induction of anesthetic
  • muscle relaxant
  • alcohol withdrawal
  • seizures (status)
  • facilitates mechanical ventilation
• Work quickly
• Must not take for more than 6 weeks → 3 months
  
  • Keep on valium until elavil kicks in
• # 1 nursing diagnosis is safety
• S/E
  
  • A = anticholinergic
  • B = blurred vision
  • C = constipation
  • D = drowsiness

Question 14

Monoamine Oxidase (MAO) Inhibitors

Answer 14

• Antidepressants
• Prevent breakdown of norepinephrine, dopamine, and serotonin
• Ex. MARplan, NARdil, PARnate
• S/E
  
  • A = anticholinergic
  • B = blurred vision
  • C = constipation
  • D = drowsiness
• Teaching
  
  • Must avoid foods containing tyramine to avoid hypertensive crisis
    
    • “BAR” - Bananas, Avocados, Raisins (any dried fried)
    • avoid things made from active yeast
    • No organ meats
    • no preserved meats (smoked, dried, cured, pickled, hot dogs)
    • No cheese except mozzarella and cottage cheese (no aged cheese)
    • No yogurt
    • No alcohol, elixirs, tinctures (iodine/betadine), caffeine, chocolate, licorice, soy sauce
  • Avoid OTC meds

Question 15

Lithium

Answer 15

• Used for bipolar disorder (decreases mania)
• S/E (3 Ps)
  
  • Peeing
  • Pooping
  • Paresthesia
• Toxic S/Es
  
  • Tremors
  • Metallic taste
  • Severe diarrhea
• # 1 intervention → good fluid hydration
• If sweating, give sodium (or other electrolyte) as well as fluid
• Don’t give water
  
  • →give gatorade or other electrolyte drink
• Monitor Na+ levels
  
  • high sodium will cause lithium to not work
  • low sodium will make lithium toxic

Question 16

Prozac (SSRI)

Answer 16

• Similar to Elavil
• Antidepressant - mood elevator
• S/E
  
  • A = anticholinergic
  • B = blurred vision
  • C = constipation
  • D = drowsiness
  • I = Insomnia
    
    • give before noon
• Watch for suicide in adolescents and young adults after a dose change

Question 17

Haldol (Haloperidol)

Answer 17

• Tranquilizer
• Also has a deconate (D) form
  
  • Long-acting IM form given to non-compliant patients
• S/E
  
  • A = anticholinergic
  • B = blurred vision
  • C = constipation
  • D = drowsiness
  • E = EPS
  • F = fotosensitivity
  • G = aGranulocytosis
  • Safety concerns related to S/E
• NMS (neuroleptic malignant syndrome)
  
  • medical emergency
  • develops in elderly patients from an overdose
  • high fever (105+), tremors, anxiety
    
    • similar to EPS except for fever
  • elderly patients should be on half usual dose
• only antipsychotic that can be given to pregnant women

Question 18

Clozaril (clozapine)

Answer 18

• Atypical antipsychotic
• Do not confuse with Klonopin (clonazepam)
• Used to treat severe schizophrenia
• S/E
  
  • no A→F
  • G = aGranulocytosis (worse than cancer drugs)
    
    • does not affect everyone
    • measure WBC Q4 weeks,, then once a month for 6 months, then every 6 month

Question 19

Geodon

Answer 19

• Should not be used in people with heart problems
• can cause elongated Q-T intervals

Question 20

Zoloft (Sertraline) (SSRI)

Answer 20

• Antidepressant
• S/E (“SAD Head”)
  
  • Sweating
  • Apprehensive
  • Dizzy
  • Headache
  • Insomnia, but can be given in the evening
• Watch for interaction w/ St. John’s wort (serotonin syndrome) and warfarin (bleeding)

Question 21

Adulthood

Answer 21

• Early adulthood (19-35 years)
  
  • Intimacy vs. Isolation
• Middle adulthood (35-64 years)
  
  • Generativity vs. Stagnation
• Late adulthood (65 - death)
  
  • Ego integrity vs. Despair

Question 22

Eating disorders

Answer 22

• Anorexia
  
  • females under 25
  • Weight loss of 15% of body weight
    
    • Hospitalize if loss of 30%
  • symptoms
    
    • Bradycardia
    • Amenorrhea
    • lanugo

Question 23

Psych Protocol Overview

Answer 23

• Nurse will examine their own feelings usually best choice
• Establish a trust relationship

Question 24

Psycho treatment protocol

Answer 24

• Depression
  
  • watch for suicide risk
  • Activities with other people that doesn’t require interaction
• Schizophrenia
  
  • If pacing, reduce stimulation and offer presence
  • Need reality based activities but not competitive
  • Should be with other people
• Bipolar
  
  • Manias can’t go to work or maintain family order, whereas a hypomaniac can
  • Finger foods best, especially high caloria
  • 8 hours of sleep, encourage naps
  • Gross motor exercise that is non-competitive
• Anxiety disorder
  
  • Phobia treatment
    
    • desensitization (gradually expose, ensure no anxiety before moving to next step)
      
      • talk about it
      • show pics
      • be around
      • interact
• Violent clients
  
  • takes 5 people to control a violent client (one for each limb and one for head)
  • only one person talks

Question 25

Defense Mechanisms

Answer 25

• Projection
• Repression
  
  • person unconsciously choosing to disbelieve the truth
  • Psychosomatic illness
• Rationalizing
  
  • patient makes an excuse about something bad that happened
• Regression
  
  • Patient becomes demanding and self-centered and attention-seeking
• Intellectualization
  
  • patient talking about very upsetting events but acts cool and calm
• Displacement
  
  • Patient expresses their emotions toward another object