Test 2 Flashcards
What are some of the characteristics of bipolar I?
(formerly called manic depression)
-Most severe form
-highest mortaility rate of 3
-at least one manic episode
What are some characteristics of bipolar II?
-At least one hypomanic episode
-At least one major depressive episode
What is cyclothymic disorder?
-Mood disturbance episodes of hypomania that alternate with symptoms of mile to moderate depression for at least 2 years (adults)
-Rapid cycling possible
During the acute phase of a bipolar episode, what is the goal of treatment?
Prevent injury and stabilization
What is mania?
Mania is a period of intense mood disturbances with persistent elevation, expansiveness, irritability, and extreme goal oriented activity or energy lasting for at least 1 week most of the day, everyday.
What is anosognesia?
The inability due to the bipolar manic illness itself that causes the person not to be able to recognize mania
What are 7 diagnosable symptoms of mania?
-Inflated self esteem or grandiosity
-Decreased need for sleep
-More talkative then usual or pressure to feel talkative
-Flight of ideas or subjective experience that thoughts are racing
-Distractabilty
-Increase in goal directed activity
-Excessive involvement in activities that have high probability for painful consequences
-Mood disturbances are severe enough that they cause an marked impairment in social or occupational functioning
-The episode is not due to a substance
Hypomania refers to?
A low-level or less dramatic mania. Excessive activity and energy for at least 4 days with at least 3 behaviors that are listed for mania
What is ‘rapid cycling’?
When someone with bipolar I or II has at least 4 mood episodes in a 12 month period, however it can occur within a course of a month or even 24 hour period
What are some of the common comorbidities associated with bipolar I disorder?
Anxiety
Panic Attacks
Social Anxiety Disorder
Specific phobias
ADHD/disurbance disorders
Substances use disorder
Migraines
Metabolic Syndrome
What are some of the common comorbidities associated with bipolar II disorder?
Anxiety
Eating disorders (especially binge eating)
Substance use disorder
What are some of the common comorbidities associated with cyclothymic disorder?
Substance use disorders
ADHD
What is pressured speech?
fast speech with a sense of urgency that conveys an innapropriate sense of urgency. It tends to be loud, rapid and incoherent
What is circumstancial speech?
Speech that adds unnecessary details when communicating with others but the person does eventually get to the point
What is tangential speech?
Like circumstancial speech but with one main difference that the person looses the point and never gets to it again
What are “loose associations”
thoughts are only loosely associated in the person’s speech indicating the way that person’s though process is going.
What is a flight of ideas?
a continuous flow of accelerated speech with abrupt changes from topic to topic
What are clang associations?
stringing together or words because of their rhyming sounds regardless of meaning
What are grandiose delusions?
distorted and generally false views of the world that manifest a highly inflated sense of self regard
ex: a person in mania saying that they know famous people that they do not
What are persecutory delusions?
Delusions where the person experiencing them is feeling some sort of persecution, like the FBI is spying on them. As mania escalates, hallucinations can occur
What are some of the primary nursing interventions for a patient experiencing mania?
-Preventing exhaustion
-Risk for injury
-Use firm and calm approach
-Use short/concise explanations
-Be consistent and approach expectations
-Identify expectations in simple concrete terms with consequences
-Provide frequent high calorie fluids
What are the the drugs used to treat bipolar?
Lithium (Eskalith, Lithobid)
Divalproex (Depakote-anticonvulsant)
Olanzapine (Zyprexa)
Risperadone (Risperadal)
What are the 2 2nd generation antipsychotics used to treat bipolar?
Olanzapine (Zyprexa)
Risperadone (Risperadal)
When are benzodiazapams used in the treatment of bipolar?
Short term use until acute mania resides
What is the timeframe for the onset of action of Lithium?
When does lithium begin to reach therapeutic levels?
10 to 20 days
7 to 14 days to reach therapeutic levels
What is the therapeutic range of lithium?
0.8-1.2 for the acute phase
0.6-0.8 for the maitenance phase
What labs should be checked before giving lithium?
Renal and Thyroid function
Pregnancy
What is valproate used to treat?
Valproate also called Divalproex (Depakote) and valproic acid is used to treat acute mania
What labs must be monitored for valproate?
Liver function
Pancreatic function
Pregnancy
What is carbamazepine (Equetro) and what is it used to treat?
An anticonvulsant
Acute mania
What must be monitored when administering carbamazepine?
Any signs of rash due to the side effects of epidermal necrolysis and Stevens Johnson Syndrome
What is Lamotrigine (Lamactil) and what is it used to treat?
It is a mood stablizer medication and is used to treat the maintenance phase of bipolar in people 18 years or older
What electrolyte effects lithium levels?
Sodium
What are the nonpharmacological treatments for bipolar?
ECT
Repetitive Transcranial magnetic stimulation
CBT
Interpersonal and social rhythm therapy
Family focused therapy
What is delirium?
A constellation of symptoms rather than a disorder often classified by inability to direct, focus, sustain and shift attention, with an abrupt onset and periods of lucidity and disorganized thinking
What are the key known risk factors for delirium?
Cognitive impairment
Immobilization
Psychoactive medications
Dehydration
Sleep deprivation
Vision/hearing impairment
What are illusions?
errors in perception of sensory stimuli -the stimulus is a real object in the environment like a blanket
What are hallucinations?
False sensory stimuli
What nursing diagnosis are common in delirium?
Risk for injury
Fever
Dehydration
Impaired fluid intake
Impaired sleep
Impaired verbal communication
What is dementia?
A broad term used to describe the deterioration of cognitive functioning and global impairment of cognitive functioning
What is Alzheimer’s Disease?
The most common cause of dementia that exists in 3 stages
What is the mild stage of Alzheimer’s Disease?
A person’s loved ones begin to notice their cognitive decline
Person experiences difficulty retrieving words or names
Trouble remembering names when introduced to new people
Challenges performing tasks at work or in social gatherings
However, this person still may be able to function independently
What is the moderate stage of Alzheimer’s Disease?
Person confuses words, is angered easily, or acts in unexpected ways. Some examples are:
-Forgetting events or personal history
-Becoming moody/withdrawn in challenging social or mental situations
-Becoming disoriented to time/place
-Need for help choosing appropriate clothing for season
-Changes in sleep patterns
-Becoming at risk for getting lost
-Becoming suspicious/delusional/compulsive
What is the severe stage of Alzheimer’s Disease?
Persons loose ability to respond to their environment, carry a conversation, and eventually control movement.
What is agnosia?
The inability to identify familiar objects and people-such as spouses
What is a genetic risk factor for Alzheimer’s Disease?
the e4 form of a gene called apolipoprotein E which supports lipid transport and injury repair in the brain
What is confabulation?
Creation of stories or answers in place of actual memories to maintain self esteem
What is perserveration?
persistent repetition of a word when the original stimulus has stopped
What is apraxia?
loss of purposeful movement in the absence of a sensory or motor impairment
What is hyperorality?
tendency to put everything in the mouth to taste and chew
What role do cholinesterase inhibitors play in the treatment of Alzheimer’s Disease?
Because a lack of neural acetylcholine is linked to AD these medications aim to prevent it’s breakdown which leads to temporary improvement in some of the symptoms of AD
The most common side effect of cholinesterase inhibitors are?
Gastrointestinal effects, therefore patients should take these medications with food
What is Memantine (Nameda) and what is it used to treat?
It is an N-methyl-D-aspartate receptor antagonist and is used for moderate to severe AD
What is mild anxiety?
Anxiety that occurs in the normal experience of everyday living and allows the individual to perceive reality in sharp focus
What is moderate anxiety?
the person experiencing the anxiety may grasp less information and may demonstrate selective inattention. The ability to think is clearly hampered, but learning and problem solving can still take place while hampered.
However, sympathetic nervous system symptoms can kick in at this stage involving tension, pounding heart, increased pulse rate & RR, perspiration, and mild somatic symptoms
What is severe anxiety?
the person experiencing the anxiety has a greatly reduced perceptual field and may only focus on one particular detail/have difficulty knowing what is going on in the environment.
Learning and problem solving are not possible, and the person may be dazed or confused. Somatic symptoms are greatly increased
What is the panic level of anxiety?
The most extreme and results in a markedly dysregulated behavior. Person is unable to comprhend what is going on in reality.
Hallucinations may be experienced
Physical behavior becomes erratic, uncoordinated, and impulsive
Defensive Behaviors:
What is altruism?
Largely unconscious motivation to feel caring and concern for others and act for the wellbeing of others
Defensive Behaviors:
What is Compensation?
used to counterbalance perceived deficiences by emphasizing strengths
Defensive Behaviors:
What is Conversion?
the unconscious transformation of anxiety into a physical symptom with no cause
Defensive Behaviors:
What is denial?
The escape of anxiety induced feelings by ignoring their existence
Defensive Behaviors:
What is dissociation?
the disruption of conscious memory, identity, or perception of the environment that results in the comparmentalization of uncomfortable or unpleasant aspects of one’s self
Defensive Behaviors:
What is intellectualization?
Process where events are analyzed with cold, hard facts and without feelings
Defensive Behaviors:
What is projection?
unconscious rejection of emotionally unacceptable features and attributing them to others
Defensive Behaviors:
What is rationalization?
justification of illogical or unreasonable ideas/actions/feelings by developing acceptable explanations satisfy the teller and the listener
Defensive Behaviors:
What is reaction formation?
When unacceptable actions/feelings are kept secret by the person exhibiting the opposite behavior
Defensive Behaviors:
What is splitting?
the inability to cohesively view the positive and negative qualities of one’s self in one’s own eyes
Defensive Behaviors:
What is sublimation?
the act of transforming negative qualities/impulses into less damaging or even positive ones
ex: a woman who is mad at her boss cleans her house until she feels better
What are the first line pharmacological treatments for anxiety disorders?
SSRIS
Fluoxetine (Prozac)
Paroxetine (Paxil)
Escitopram (Lexapro)
Setraline (Zoloft)
What two SNRIs are used to treat anxiety disorders?
Venlafaxine (Effexor)
Duoloxetine (Cymbalta)
Which antihistamine is used as an alternative to benzodiazapines?
Hydroxyzine (Vistaril)
Treatment modalities:
What is modeling?
Therapist/Trusted other acts as a role model to demonstrate appropriate behavior in a feared situation
Treatment modalities:
What is systematic desensitization?
Patient is gradually introduced to a feared object through a series of steps from least frightening to most frightening where the patient is taught relaxation techniques at each step
Treatment modalities:
What is flooding?
Patient is exposed to a large amount of undesired stimulus in a effort to extinguish the anxiety response. Through exposure the pt learns survivial is possible
Treatment modalities:
What is thought stopping?
Negative thought or obsession is interrupted by something else, like the pt saying stop or snapping a rubber band on the wrist
What is reactive attachment disorder?
An attachment disorder where children have a consistent pattern of inhibited and emotionally withdrawn behavior
What is disinhibited social engagement disorder?
An attachement disorder where children show no normal fear of strangers, and are unfazed by separation from their caregiver
How can PTSD symptoms manifest in childhood?
Reduction in play
Diminished interest in significant activities
Irritability/Destructive behavior
Sleep disturbances
Problems concentrating
Hypervigilance
What are the three different sections of the sympathetic nervous system according to polyvagal theory?
Myelinated ventral vagal responses
Unmyelinated ventral vagal responses
Dorsal vagal response
What are Myelinated ventral vagal responses?
These responses are activated when an individual is “on” at a state of pleasant but not overwhelming arousal
What are Unmyelinated ventral vagal responses?
The state that is activated when we perceive a threat-think traditional fight or flight which cannot be sustained
What are dorsal vagal responses?
This response is designed to dampen down the results of the sympathetic nervous system and activating the parasympathetic NS
What is a ‘window of tolerance’?
Window of tolerance is a term that means the balance between sympathetic and parasympathetic arousal and how treatment of traumatized children is modeled
