Psych Final Flashcards
SSSRI mnemonic
Suicide risk, slow onset and taper, serotonin syndrome, sweaty, rigid muscles, increased HR
Can’t see, can’t pee, can’t spit, can’t shit
TCA side effects
True or false you can take MAOI’s with other antidepressants
False, must take two weeks to come off MAOI before taking another one
MAOI mnemonic
Massive HTN risk, Avoid tyramine, OTC drugs HTN crisis, Increased risk suicide
MAOI food to avoid
Wine and cheese, beer and sausage, chocolate, fermented fruits or veggies
maoi otc drugs to avoid CAAN
Calcium, antacids, acetaminophen, NSAIDS
Which meds have most potential risk for injury?
Looking for which ones are sedating like amytriptyline, diphenhydramine, and alprazolam
Lithium therapeutic level
0.6-1.2
What can contribute to lithium toxicity
Diuretics
Anticholinergic side effects from TCA
Blind as a bat, mad as a hatter, dry as a bone, red as a beet
Meds linked to Steven’s Johnson syndrome
Carbamazepine, lamotrigine
Do not take if have hx of head injury or seizures
Welbutrin bupropion
Which MAOI can come in a patch?
Selegeline
Which class of meds can cause hypoglycemia?
SSRIs
Hypotension is associated with this class of antidepressants
TCA
Med given to help with hand tremors associated with lithium
Propranolol
What three mood stabilizers to avoid during pregnancy
Lithium,carbamazepine, Depakote
Hyper reflex fever agitation abdominal pain nause vomiting
Serotonin syndrome
Why are antipsychotics used with mood stabilizers
They work faster to manage the patients symptoms before the mood stabilizers gets in their system
Abdominal cramping, vomiting, tremors, restlessness, inability to sleep, Increased HR, Increased Respiratory rate, and temperature, transient hallucinations, anxiety, Increased BP, tonic clonic seizures.
Alcohol withdraw symptoms
Confusion, disorientation, hallucination, BP Abnormal, tremors, seizures, hyperthermia, cardiovascular collapse
Delirium tremens
How do you treat delirium tremens?
With benzos to keep the GABA neurotransmitters regulated
What is wernicke syndrome ?
Ataxia, poor coordination, falls, and abnormal eye movement
What deficiency causes wernicke encephalopathy and korsakoff psychosis?
Vitamin B1 or thiamine
What medications do we give someone going through alcohol withdraw
Acamprosate calcium, Ativan, benzos, carbamazepine, clonidine, propranolol, atenolol
What are nursing interventions for the medications we give to withdrawing alcoholics?
Around the clock or PRN, baseline vitals, seizure precautions, neuro status, check HR prior to propranolol
What are medications used for alcohol abstinence and maintenance?
Disulifiram, naltrexone, acamprosate
What drugs are classified as opioids?
Heroin, morphine, hydromorphone
What are the s/s of opioid overdose?
Respiratory depression, lethargy
Sweating, nose bleed, gooseflesh, tremors, irritability, weakness, diarrhea, fever, insomnia, n/v, pain in muscles/bones, muscle spasms
Opioid withdraw
Is withdraw from opioids life threatening
No
What meds are used to treat opioid addiction for detox?
Naloxone, flumazenil
What meds are used to treat opioid addictions for maintenance?
Methadone, clonadine, and buprenorphine
Withdraw symptoms of cocaine?
Depression, fatigue, suicidal, severe craving for coke, agitation, sleep disturbances
Is cocaine withdraw life threatening?
Nope but depression and SI can occur
What puts a patient at risk for abuse?
Female partner, vulnerable persons, pregnancy, older adults, child under 4, child is unwanted, disabled, or vulnerable
Educations for client with ECT therapy
ECT is not permanent cure, weekly or monthly maintenance ECT can decrease incidence of relapse
Nursing care for a patient undergoing ECT
Frequent orientation, safety, assist with ADL as needed, continuous monitoring, vitals
What patient is a good candidate for ECT
One who has been unsuccessful with medication
What are the various types of crisis?
Adventitious (natural disaster), situational/external (unanticipated loss), maturational/internal (new development stages)
Assessment questions for crisis?
Immediate safety, time since last crisis, coping skills, problem that is identified, perception of event, resources used, no hx questions!
What is normal grief
Uncomplicated, anger, resentment, withdraw, hopelessness, guilt but change to acceptance with time
What is anticipatory grief?
Terminal illness, letting go before the loss, have chance to greive before loss
What is disenfranchised grief?
Cannot be publicly shared or not socially acceptable (suicide, abortion)
What is delayed grief?
Does not demonstrate expected behaviors, can remain in denial for long time
What is an appropriate meal for someone who is manic?
Finger food and high calorie drink cuz they’re on the go!
What meds are cardiotoxic in an overdose?
TCA’s
What med class can cause hyponatremia?
Lithium and SSRI
Psychological risk factors for addiction
Hx of abuse, anxiety, low self esteem, difficulty expressing emotions, mental illness
Result of alcoholic portal HTN due to cirrhosis?
Esophageal varices
CAGE Questionnaire
Have you ever CUT down on drinking? Have people ANNOYED you by telling you about it? Have you ever felt GUILTY about drinking? Have you ever had a drink first thing in the morning? (EYE opener)
Alternative to methadone during pregnancy
Buprenorphine
Why can clonidine be used to treat withdraw?
Decreases autonomic hyperactivity
What is exaggerated grief?
Somatic manifestations to an exaggerated level, unable to perform ADL, remain in anger stage, can develop depression
What are the signs of mild lithium toxicity?
Apathy, lethargy, irritability, muscle weakness, nausea
What are the signs of severe lithium toxicity?
Cardiovascular collapse, coma, seizure
What are the signs of moderate lithium toxicity?
Blurred vision, confusion, drowsiness, progressing tremor, slurred speech, unsteady gait
Sexual dysfunction, CNS stimulation, weight loss/gain, serotonin syndrome, withdraw, hyponatremia
SSRI adverse effects
Do not take SSRI with…
Other antidepressants, warafrin, lithium, NSAIDs and anticoagulants
TCA adverse effects
BP problems (low) anticholinergic effects, CNS effects (sedation, sweating)
CNS stimulation, orthostatic hypotension, hypertensive crisis, rash
MAOI adverse effects
MAOI should not be taken with…
other antidepressants, antihypertensive, mepredine, tyramine, vasopressors (caffeine)
CNS effects, blood effects, teratogensis, hypo-osmolarity, skin disorders (SJS)
Carbamazepine adverse effects
LaMotRiGinE adverse effects
Double or blurred vision, dizziness, headache, nausea, vomiting, serious skin rash
Nausea, vomiting, indigestion, hepatotoxicity, pancreatitis, thrombocytopenia, teratogensis
Depakote adverse effects
Carbamazepine should not be taken with…
Warfarin, oral contraceptives, grapefruit, phenytoin, phenobarbital
Lamotrigine should not he taken with….
Carbamazepine, phenytoin, phenobarbital, Depakote, oral contraceptives
Depakote should not be taken with…
Phenytoin, phenobarbital
Cluster A personality disorders
Paranoid, schizoid, schizotypal
Cluster B personality disorder
Antisocial, borderline, histrionic, narcissistic
Cluster C personality disorder
Avoidant, dependent, obsessive compulsive
A pattern of distrust and suspiciousness such that others motives are interpreted as malevolent
Paranoid personality disorder
A pattern of detachment from social relationships and a restricted range of emotional expression, loners no interest in close relationships
Schizoid personality disorder
A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. Magical thinking, odd speech, inappropriate affect
Schizotypal personality disorder
A pattern of disregard for and violation of the rights of others. Social norms and rules don’t apply, no remorse or guilt
Antisocial personality disorder
Pattern of instability in interpersonal relationships, self-image, and affects and marked impulsivity. Unstable mood, relationships, self image, impulsive and self destructive.
Borderline personality disorder
Pattern of excessive emotionally and attention seeking. Excessive expression overly dramatic, always drawing attention to themselves, seductive.
Histrionic personality disorder
Pattern of grandiosity, need for admiration, and lack of empathy. Exaggerated sense of self importance, needs constant attention, preoccupied with fantasies
Narcissistic personality disorder
Pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation and rejection. Feel inadequate, want unconditional acceptance, fear criticism.
Avoidant personality disorder
Pattern of submissive and clinging behavior related to an excess need to be taken care of.
Dependent personality disorder
Pattern of preoccupation with orderliness, perfectionism, and control. Loves rules, lists, devoted to work.
Obsessive compulsive personality disorder
Odd and eccentric
Cluster A
Dramatic and emotional
Cluster B
Anxious, fearful, depressed, compliant, tense, inflexible, rigid routines, low self confidence
Cluster C
Safety, gentle approach be consistent with care, respectful of client need fir distance, privacy, remember they withdraw to protect themselves
Nursing implications for cluster A
Set limits, be aware of manipulative behavior, use consistency, be firm in what is expected
Nursing interventions for antisocial personality disorder
Safety, set limits, be consistent with firm guidelines, provide structure, do not give a reaction to self injury
Nursing interventions for borderline personality disorder
Use self awareness, need to relieve feedback on their behavior and how it affects others
Interventions for histrionic and narcissistic personality disorder
Redirect their perceptions of self in relationships with others, short but frequent contacts to show interest, important to boost self esteem
Nursing interventions for avoidant personality disorder
Teach assertive skills, help learn that it’s okay to express anger, reward for independence, ignore dependent behavior
Nursing interventions for dependent personality disorder
Talk about behavior and gains, teach assertive behavior, modify perfectionist standard, decrease anxiety
Nursing interventions for obsessive compulsive personality disorder
Haloperidol, fluphenazine, trifluophenazine, chlorpromazine
Typical antipsychotics
Risperidone, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, ziprasidone, ariprozole, brexpiprazole
Atypical antipsychotics
pseudoparkinsonism, akathesia, neuroendocrine effects, orthostatic hypotension, sexual dysfunction, skin effects, liver impairment, anticholinergic effects
Common and expected side effects of typical antipsychotics
Metabolic syndrome, orthostatic hypotension, anticholinergic effects, agitation, dizziness, sedation, sleep disruption, mild EPS (tremor), elevated prolactin levels, sexual dysfunction, anticholinergic effects
Common and expected side effects of atypical antipsychotics
Agranulocytosis, tardive dyskinesia, neuroleptic malignant syndrome, sedation, seizures, severe dysrhythmias, acute dystonia
Serious side effects of typical antipsychotics
Prolonged QT interval, sedation, neuroleptic malignant syndrome, DRESS, Steven Johnsons, agranulocytosis, severe dysrhythmias, hepatotoxicity
Serious side effects of ATYPICAL antipsychotics
Metabolic toxic state. Drug use, head injury, delirium, dementia, Huntington, MS, thyrotoxicosis
Neuro conditions that can cause psychosis
Client has psychotic thinking or behavior present for at least 6 months areas of functioning are school, work, self-care, and interpersonal relationships are impaired
Schizophrenia
Client has manifestations of schizophrenia but the duration is from 1 to 6 months and social/occupational dysfunction may or may not be present
Schizophreniform disorder
Client meets both criteria for schizophrenia and bipolar disorder
Schizoaffective disorder
Hallucinations, delusions, alterations in speech, bizarre behavior
Positive schizophrenia symptoms
Blunted affect, alogia, anergia, anhedonia, avolition
Negative schizophrenia symptoms
Disordered thinking, inability to make decisions,poor problem solving, difficulty concentrating, memory deficits
Cognitive symptoms of psychotic disorders
Hopelessness, suicidal ideation
Affective symptoms
Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal are talking about him
Ideas of reference
Made up words that have meaning only to the client
Neologisms
Client repeats the words spoken to him
Echolalia
Meaningless rhyming of words often forceful such as oh fox box lox
Clang association
Words jumbled together with little meaning or significance to the listener such as hip hooray the flip is cast and wide sprinting in the forest
Word salad
I like birds, birds can fly, flying a plane is hard, hard boiled eggs are good
Loose association
Extreme agitation, stereotyped behaviors, automatic obedience, wavy flexibility, stupor, negativism, echopraxia
Alterations in behavior
Purposeful imitation of movements made by others
Echopraxia
Excessive maintenence of behavior
Wavy flexibility
Doing the opposite of what is requested
Negativism
Lack of hygiene, outbursts, unusual behavior, anxiety, confusion, terror, unreasonable fear
Prodromal or initial phase
Hallucinations, delusions, disorganized speech, disorganized behavior
Active or acute phase
Positive symptoms tend to become less intense, may regain some social skills, not all individuals experience this
Residual phase
How does benztropine work?
Blocks effect of acetylcholine to help relieve tremors, rigidity, and complete loss of muscle movement
Late onset, very serious, can be irreversible, initial lip smacking, tongue darting, progress to rapid movement of arms, legs and trunk
Tardive dyskinesia
Pacing, squirming, inability to sit still, uncontrollable need to move
Akathisia
High fever, unstable VS, Muscle rigidity, can be fatal
Neuroleptic malignant syndrome (NMS)
Your pt is taking olanzapine, what should you carefully monitor for?
Increased blood glucose
Client takes quetiapine (seroquel) which lab tests should the nurse monitor
Lipid profile
Client receiving haloperidol complains of stuff jaw and difficulty swallowing. Your first action is to
Administer as needed benztropine IM as ordered
Which instruction by the nurse to a client prescribed diazepam for anxiety is appropriate
This medication Is good fir short term only
How does the nurse differentiate fear and anxiety?
Fear results in physiological response, anxiety is psychological
Which is the priority nursing action when providing care to a client who demonstrate signs of escalating anxiety?
Provide a safe, quiet, and protective environment
A client is prescribed fluoxetine for treatment of obsessive compulsive disorder. During the office visit they note the client is still exhibiting OCD behaviors. What should be the priority assessment?
Whether the client is taking the medication as prescribed
Which assessment findings would indicate that the client is experiencing PTSD?
fear of returning to sleep, terrifying nightmares, aggressive behavior
Which outcomes would indicate the intervention in the plan of care has been effective for someone with PTSD
The client has been sleeping throughout the night, client verbalizes future plans with family and friends
What medication do you anticipate client being ordered with PTSD who is depressed, suicidal, and irritable?
Prazosin
What is the priority nursing dx for client with PTSD SI, and sleep disturbances with frequent nightmares
Risk for self-directed violence
Which treatment is most appropriate for pt with generalized anxiety disorder
Long-term treatment with buspirone
Nurse is giving d/c instructions for pt with benzodiazepine. What statement needs further teaching
I will need to schedule blood work in order to monitor for toxic levels of thus drug
Best nursing interventions for pt with generalized anxiety disorder
Encourage client to recognize signs of escalation, employ newly learned relaxation techniques, cognitively reframe thoughts about situations that generate anxiety, avoid caffeine
What symptoms can be present in both bulimia and anorexia?
Binge eating and purging, highly focused on wt and appearance, inaccurate perceptions of the body
Dehydration, hypophosphatemia, muscle cramps, irregular heart beat
Refeeding syndrome
Avoid driving until client knows how it effects them, do not drink alcohol or take other CNS depressants, notify provider of all OTC medications, notify provider of any abnormal movements
Education for buspirone
Advise pt to weigh self twice weekly to assess for fluid retention, may cause dizziness or drowsiness, avoid sudden changes in position, do not breastfeed on medication
Education for prazosin
Restlessness, increased motivation, irritability
Mild anxiety
Agitation, muscle tightness
Moderate anxiety
Inability to function, ritualistic behavior, unresponsive
Severe anxiety
Distorted perception, loss of rational thought, immobility
Panic level anxiety
Stay with the pt, reassure you will not leave, give clear concise directions, assist to an environmental with little stimulation, walk or pace with the patient, administer medication, allow pt to vent
Interventions for panic
Fear/anxiety, ineffective coping, social isolation, sleep pattern disturbance, impaired communication, risk for self harm
Nursing dx for anxiety
Dizziness, nausea, headache, light headed, agitation, no sedation, do not take while pregnant, or breast feeding, caution in older adults, liver dysfunction, renal dysfunction, no not take with MAOI
Buspirone complications and contraindications
Erythromycin, ketoconazole, St. John’s wort, grapefruit may increase levels
Buspirone medication/ food interaction
Take with meals, effect does not occur immediately,should be taken on regular basis, tolerance, dependence, or withdraw are not an issue with this medication
Buspirone nursing admin
CNS depression, ataxia, decreased cognitive function, amnesia, acute toxicity, paradoxical response, withdraw
Adverse effects of benzodiazepines
Experience a loss or alteration in physical functioning, loss of functioning appears to be a physical problem. Really an expression of emotional conflict or need, la Belle indifference, primary and secondary gains
Conversion disorder
Pt has seizure when it is their turn to share about their trauma, pt no longer has to share trauma. Later patient gets special care for having seizure
Primary and secondary gains
The falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified deception
Fictitious disorder
Individuals may take actions to misrepresent, stimulate, or cause signs and symptoms of illness or injury in the absence of obvious external rewards
Factitious disorder
Establish therapeutic relationship, provide calm reassurance, show empathy but focus on feelings rather than physical complaints, encourage verbalizing feelings, redirect client, coordinate physical and psych care
Nursing care for somatic disirders
Sudden high fever, blood pressure fluctuations, diaphoresis, tachycardia, muscle rigidity, decreased level of consciousness, coma
Neuroleptic malignant syndrome
What is the difference between NMS and serotonin syndrome?
Serotonin syndrome is hyperrelfexive, NMS is muscle rigidity
Which meds address both positive and negative symptoms?
Atypical antipsychotics
Which meds only address positive symptoms?
Typical antipsychotics
What do we watch for with antipsychotics?
Liver function, BP, ECG, CBC, cholesterol, glucose
How often is a CBC done with clozapine?
Every 2 weeks
What is the AIMS scale used for?
Delirium tremens
Is prazosin a benzo?
No
Which alcohol withdraw meds help with cravings
Naltrexone
Which narcotic withdraw meds help with cravings
Buprenorphine
Pseudoparkinsonism, acute dystonia, akathisia, tardive dyskinesia are associated with what?
EPS, associated with typical antipsychotics
Restless, unable to sit still
Akathesia
Confusion, agitation, poor concentration, hostility, disoriented, hallucinations, delirium, seizures, tachycardia, labeled blood pressure, diaphoresis HYPERREFLEXIA nausea, vomiting
Serotonin syndrome
