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Psych - NUR 223 > Test 1 > Flashcards

Test 1 Flashcards

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1
Q

What are Axis I disorders?

A

clinical disorder (psych disorders)

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2
Q

What is an example of an Axis I disorder?

A

bipolar, PTSD, anxiety, dementia

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3
Q

What are Axis II disorders?

A

personality or intellectual developmental disorders

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4
Q

What is an example of an Axis II disorder?

A

borderline personality disorder

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5
Q

What are Axis III disorders?

A

general medical conditions

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6
Q

What is an example of an Axis III disorder?

A

HTN, COPD, Asthma

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7
Q

What period is the 1st benchmark?

A

enlightenment period (1790s)

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8
Q

What was the significant change in thinking during the 1st benchmark?

A

human dignity upheld

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9
Q

What was the result of the 1st benchmark?

A

asylum movement developed

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10
Q

What period is the 2nd benchmark?

A

period of scientific study (1850s-1870s)

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11
Q

What was the significant change in thinking during the 2nd benchmark??

A

mental illness can be studied

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12
Q

What was the result of the 2nd benchmark?

A

study of the mind and treatment approaches to psychiatric conditions flourished.

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13
Q

What period is the 3rd benchmark?

A

period of psychotropic drugs (1950s)

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14
Q

What was the significant change in thinking during the 3rd benchmark?

A

if some mental disorders are caused by chemical imbalances then chemicals could restore the balance people would no longer need to be confined.

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15
Q

What drugs were developed during the 3rd benchmark?

A

1st antipsychotic - chlorpromazine (thorazine)
1st antimanic - lithium
1st antidepressant - imipramine (tofranil)

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16
Q

What was the result of the 3rd benchmark?

A

hospital stays shortened.

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17
Q

What period is the 4th benchmark?

A

period of community mental health (1960s)

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18
Q

What was the significant change in thinking during the 4th benchmark?

A

the people have the right to be treated in their own community.
deinstitutionalization.
community services board

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19
Q

What occurred with the community mental health centers act in 1963?

A

the continuum of care was created.

using the least restrictive care for patients.

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20
Q

What was the result of the 4th benchmark?

A

deinstitutionalization. intervention in familiar surroundings, but increase in homeless and many people “fall through the cracks” of the system.

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21
Q

What period was the 5th benchmark?

A

decade of the brain (1990s)

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22
Q

What was the significant change in thinking in the 5th benchmark?

A

if we can understand the brain, we can help people with mental disorders.

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23
Q

What was the result of the 5th benchmark?

A

increase in brain research - PET scans, MRIs
biological explanations for mental health
increase in funding for brain research, leading to new treatment strategies.

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24
Q

What are the 3 interventions necessary for psychotherapeutic management?

A

the therapeutic relationship
psychopharmacology
milieu management

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25
Q

What is the priority nursing diagnosis for all milieus?

A

safety

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26
Q

What is the Tarasoff law?

A

The duty to warn. if a patient is targeting someone

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27
Q

How is the Tarasoff law implemented?

A

if patient is targeting someone, the interdisciplinary team meets and decides who will warn and who to warn.

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28
Q

What is the Neurotransmitter associated with Major Depressive Disorder?

A

decrease in norepinephrine

decrease in serotonin

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29
Q

What is the neurotransmitter associated with Bipolar Affective Disorder?

A

Imbalance of serotonin, norepinephrine, and dopamine

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30
Q

What is the neurotransmitter associated with anxiety?

A

decrease in GABA

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31
Q

What is the neurotransmitter associated with Schizophrenia Spectrum disorders?

A

an increase or decrease in dopamine

32
Q

What is the neurotransmitter associated with Alzheimer’s disease?

A

a decrease in acetylcholine

33
Q

What is the concept of continuum of care?

A

Continuum of care is levels of care through which an individual can move depending upon the patients needs at a given point in time. must be least restrictive.

34
Q

What are the 5 stages of the assault cycle?

A
  1. triggering phase
  2. escalation phase
  3. crisis phase
  4. recovery phase
  5. post-crisis depression phase
35
Q

What should you always remember about the assault cycle?

A

not every stage is exhibited, nor in any specific order.

36
Q

What is the triggering phase of the assault cycle?

A

nonviolent anger

37
Q

What is the escalation phase of the assault cycle?

A

irrational, threatening anger/loss of control impending

38
Q

What is the crisis phase of the assault cycle?

A

loss of control

39
Q

What is spiritual distress?

A

inability to experience and integrate meaning and purpose in life through one’s connectedness with self and others.

40
Q

What is cultural competence?

A

process whereby the nurse shows proficiency in developing cultural awareness, knowledge, and skills to promote effective health care.

41
Q

What are the 4 depressive disorders?

A
  1. Major depressive disorder
  2. dysthymia
  3. premenstrual dysphoric disorder
  4. disruptive mood dysregulation
42
Q

What is the most common NANDA nursing diagnosis for depressive disorders?

A

chronic low self-esteem

43
Q

What is the priority NANDA nursing diagnosis for someone with depression?

A

risk for injury (harm to self)

44
Q

What is the s/s for Major depressive disorder (MDD)?

A 
depressed mood
anhedonia or apathy
significant change in weight
insomnia or hypersomnia
increased or decreased psychomotor activity
fatigue or energy loss
feeling of worthlessness or guilt
diminished concentration or indecisiveness
recurrent death or suicidal thoughts
45
Q

What is the s/s for dysthymia?

A

when a person has a depressed mood that occurs for most of the day for at least 2 years. symptoms are more subtle and nonremittent. they describe their mood at sad or “down in the dumps” may also complain of sleeping and eating disturbances, fatigue, low self-esteem, difficulty making decisions, and feelings of hopelessness.

46
Q

What are the s/s of premenstrual depressive disorder?

A

mood swings, irritability, or anger, dysphoria, and anxiety symptoms that occur before and during menstruation. other symptoms include lethargy, fatigue, sleep disturbances, difficulty concentrating, changes in appetite, and a sense of being overwhelmed or out of control.

47
Q

What are priority nursing interventions for patients with depression?

A 
protect patient from hurting self- may require 1:1
accept patient, focus on strengths
reinforce efforts to make decisions
never reinforce hallucinations/delusions
accept anger
spend time with withdrawn patients
provide activities designed for sucess
48
Q

What is the three criteria for admission to an acute psychiatric facility?

A

risk of harm to self
risk of harm to others
so psychotic they cant care for themselves

49
Q

What is the 1:1 process?

A

patient needs attentive supervision at all times. a provider must be within arms length of patient 24 hours a day.

50
Q

What are 5 SSRI’s for depressive disorders?

A 
celexa (citalopram)
Lexapro (escitalopram oxalate)
Prozac (fluoxetine)
Paxil (paroxetine)
Zoloft (sertraline)
51
Q

How long does it take to get a therapeutic effect from SSRI’s?

A

2 to 4 weeks

52
Q

What are the 4 most common anticholinergic side effects?

A

dry mouth
blurred vision
urinary retention
constipation

53
Q

SSRI’s are also associated with what other side effect?

A

serotonin syndrome

54
Q

What are s/s symptoms of serotonin syndrome?

A 
mental status changes, headache-coma
restlessness/agitation
myoclonus
hyperreflexia
diaphoresis
shivering, tremor,
ataxia
hyperthermia
nausea/diarrhea
55
Q

What causes serotonin syndrome?

A

SSRI taken with any of the following.

  • MAOIs
  • Drugs that are serotonin agonists (cocaine, ecstasy)
  • St John’s wort
  • some opioid pain meds (demoral, tramadol) combined with MAOIs
56
Q

How do we treat serotonin syndrome?

A

benzodiazepines
cyproheptadine (periactin)
IV fluids (NaCl)
stop meds that are causative

57
Q

What are 4 tricyclic antidepressants?

A

Elavil (amitriptyline)
nopramin (desipramine)
tofranil (imipramine)
pamelor, aventyl (nortirpityline)

58
Q

Why do MDs not use tricyclic antidepressants as 1st choice meds for patients with depression?

A

not good for outpatient use. only can get 1 week of meds at a time. They are toxic and causes cardiac changes

59
Q

What are the MAOIs for depressive disorders?

A

Nardil (phenelzine)

Parnate (tranylcypromine)

60
Q

What are the 6 foods and 2 meds contraindicated when taking an MAOI?

A

cheddar/aged cheeses, herring, bananas, yeast, avocado, and chicken liver

antidepressants and decongestants

61
Q

What adverse effect can occur if consuming contraindicated foods and/or meds with MAOIs?

A

hypertensive crisis

62
Q

What are the s/s of a hypertensive crisis?

A 
headache, stiff neck
nausea, vomiting
sweating
dilated pupils, photophobia
tachycardia, bradycardia
sudden nosebleed
chest pain
63
Q

What medication does the nurse expect the MD to order for a hypertensive crisis?

A

antihypertensive meds

labetalol

64
Q

What are the 5 novel antidepressants?

A 
Wellbutrin, zyban (buproprion)
Remeron (mirtazapine)
desyrel (trazodone)
Effexor (venlafaxine)
Cymbalta (duloxetine)
65
Q

What are the risk factors for suicide?

A 
hopelessness
general medical illness
inability to experience or even imagine pleasure (anhedonia)
male
Caucasian or native American
living alone
prior suicide attempts
family member or friend has had suicide attempts
elderly or teen
unemployed
substance abuse
66
Q

What is the prototypical person that is at highest risk of committing suicide?

A

older Caucasian male, unemployed, living alone, with a history of prior suicide attempts and substance/etoh abuse

67
Q

What is the ECT process?

A

electric current passed through the brain, causing a seizure. viable treatment approach to depression. typically given 2 to 3 times a week, for up to a total of 6 to 12 treatments. relapse occurs frequently.

68
Q

What are the nursing interventions for before an ECT?

A 
keep patient NPO.
give atropine
ask patient to urinate before treatment
remove hairpins, dentures, contact lenses, hearing aids
take vitals
69
Q

What are the nursing interventions after an ECT?

A

ventilate patient
monitor vitals
watch for post-ECT confusion
evaluate for agitation on awakening

70
Q

What medications are necessary for an ECT?

A

atropine - reduces secretions (before ECT)
methohexital (brevital) - cause immediate anesthia
succinylcholine (anectine) - neuromuscular blocking effect

71
Q

What are the S/S of Bipolar affective disorder I?

A

swings between manic episodes and major depression. also includes anxious distress, mixed features, rapid cycling, melancholic features, a typical features, psychotic features, catatonia, peripartum onset, seasonal pattern.

72
Q

What are the S/S of Bipolar affective disorder II?

A

similar to BAD I, except person has never experienced a manic episode, only a hypomanic episode. person has experienced major depression lasting at least two weeks but has experienced hypomanic episode lasting at least 4 days, rather than a full manic episode.

73
Q

What are the S/S of Cyclothymia?

A

swing between a hypomanic episode and dysthymia. not severe swings in either direction. symptoms occur for at least 2 years without symptom remission for more than 2 months.

74
Q

What are the S/S of mania?

A

elevated, expansive or irritable mood.
begins suddenly, escalates rapidly. can last from a few days to several months. must persist 1 week.
excessive energy, activity, restlessness, racing thoughts, and pressured speech
denial that anything is wrong
extreme “high” or euphoric feelings
easily irritated or distracted
decreased need for sleep
unrealistic beliefs, poor judgement, unusual sex drive, abuse of drugs
provocative, intrusive, or aggressive behavior.

75
Q

What are S/S of hypomania?

A

less severe level of impairment. abnormal period of persistent elevated, expansive, or irritable mood. must be at least 4 days in duration. must experience at least 3 of the following…
increase self-esteem, grandiosity
decrease need for sleep
distractibility
increase in motor agitation, or goal-directed activity
excessive involvement in pleasurable activity that have high potential for painful consequences
racing thoughts

76
Q

What nursing considerations are for people with mania?

A 
safety
assess for suicidal/homicidal thoughts
set limits
do not allow manipulation
clear, concise
monitor therapeutic levels
assess for SE.
reorient to reality
maintain positive, therapeutic relationship

Psych - NUR 223 (2 decks)

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