Test Map 1; chpts 15-18 Flashcards
Physiologic signs of anxiety
tachycardia, palpitations, tremor, sweating, gastrointestinal upset
Symptoms of psychotic behavior
loss of reality; perceptual deficits: hallucinations and delusions; and deterioration of social functioning; disorganized thinking; loosening of association;, disorganized behavior; negative symptoms: changes in affect, diminished emotional expressiveness, poor eye contact, reduced spontaneous movement, withdrawn, face often immobile and unresponsive, speech often minimal (alogia), brief, slow, monotone replies given in response to questions; withdrawn from areas of functioning: affect interpersonal relationships, work, education, and self-care (asociality) and the decreased ability to experience pleasure from positive stimuli or reduced pleasure from previously positive stimuli (anhedonia)
Uses of Vistaril – besides helping with anxiety
antihistamine: relieves itching; preop and postop sedative to control vomiting, diminish anxiety and reduce amount of opioids needed for analgesia; mild tranquilizer for psychiatric conditions
MOAIs – foods to avoid
No tyramine: aged cheese, yeast extricate, red wine, pickled herring, sauerkraut, overripe bananas, avocados, figs, chicken liver, beer- will cause high bp; use caffeine cautiously
How would hallucinations be defined
false sensory perceptions that are experienced without an external stimulus and seem real to the pt; auditory hallucinations: voices that are characteristically heard saying negative comments about pt in the third person; hallucinations of touch, sight, taste, smell, and bodily sensations can also occur
Benefits of giving benzodiazepines with antipsychotic meds when patient’s first begin treatment
the benzo’s cause relaxation/calmness
How to taper antianxiety medications
withdrawal should be instructed by hcp, usually requires 4 weeks of gradual reduction in dosage and widening the intervals of administration
Serious side effect of Lamictal – what do you do about it
aseptic meningitis: contact hcp if they experience s/s of meningitis (headache, fever, stiff neck, nausea, vomiting, rash, and sensitivity to light)
How would you describe mania in regard to bipolar disorder?
heightened mood (euphoria), quicker thoughts (flight of ideas), more and faster speech (pressured speech), increased energy, increased physical and mental activities (psychomotor excitement), decreased need for sleep, irritability, heightened perceptual acuity, paranoid or grandiose delusions, increased sexual activity, impulsivity
What symptoms does a patient exhibit when experiencing dystonic reactions?
intense muscular contractions that cause them to fall to the ground, lose consciousness, and lie rigid
Premedication assessments for patients diagnosed with a mood disorder include what
History of mood disorder
Basic mental status
Interpersonal relations
Mood and Affect
Clarity of thought
Suicidal Ideation
Psychomotor function
Sleep pattern
Dietary History
Nonadherence
Drug of choice for tonic clonic seizures
phenytoin Dilantin is effective in tonic-clonic seizures with minimal side effects
What symptom would indicated possible Dilantin toxicity?
seizures
Assessment criteria that is very important to know prior to giving a patient Tegretol
-baseline and repeat at regular intervals of CBC, serum iron, liver function tests, urinalysis, BUN, serum creatinine, serum sodium, and ophthalmologic exam
-exclude Asian ancestry, including South Asian Indian ancestry
-baseline assessment of pt’s speech patterns, degrees of alertness, and orientation to name and place, and time before therapy
-review pt’s seizure hx
Signs/symptoms that support the diagnosis of psychosis
-delusions
-hallucinations
-loosening of associations
-disorganized behavior
-negative symptoms- diminished emotional expressiveness (e.g. poor eye contact and reduced spontaneous movement
-Before initiating therapy
What patient would benefit the most from depot antipsychotic medication regimens
pt’s experiencing acute psychosis and help with nonadherence problems
Adverse effects that may occur when taking antipsychotic drug therapy
Dystonias- spasmodic movements of muscle groups such as tongue protrusion, rolling of eyes, jaw spasms, and neck torsion.
Pseudoparkinsonian symptoms- tremor, muscular rigidity, mask-like, expression, shuffling gait, loss or weakness of motor function (typically begin 2-3 weeks of antipsychotic drug therapy but may occur up to 3 months); commonly seen in older adults
Akathisia- subjective feelings of anxiety and restlessness and objective signs of pacing, rocking, and inability to sit or stand in one place for extended periods of time
Tardive dyskinesia- persistent and involuntary hyperkinetic abnormal movements; mild forward-backward, or lateral tongue movements, tongue thrusting, rolling, or “fly-catching” movements, chewing or lateral jaw movements interfering with pt’s ability to chew, speak or swallow
Neuroleptic malignant syndrome (NMS)- potentially fatal often w/ high potency antipsychotic therapy; symptoms include fever, severe EPS, autonomic instability, and alterations in consciousness
What do you do when a patient has suicidal ideation
-assess for a presence of a detailed plan with the intention and ability to carry it out
-Do Not Leave the Patient Alone and notify the HCP
When are adverse effects of antipsychotic medications most likely to occur
Within the first 72 hours of therapy
Safest narcotic to give a patient taking MAOIs, thyroid hormones and multivitamins
Morphine might be an alternative at lower doses, but monitoring is needed.
Side effects of the medication Dilantin and what to do about it
-Blood dyscrasias (Routine labs, Monitor for sore throat, fever, purpura, jaundice, or excessive or progressive weakness)
-hyperglycemia (Watch this very closely and work with HCP on correct medication dosage), -gingival hyperplasia (Good oral hygiene, including gum massage, frequent brushing, and proper dental care)
-nystagmus toxicity (Report to HCP immediately due to being a sign of toxicity)
Information that is important to educate patients about before having a baby when then take benzodiazepines
-Recommended that benzos not be administered during the first trimester of pregnancy. There may be an increased incidence of birth defects because these agents readily cross the placenta and enter fetal circulation. Baby should be monitored after birth for signs of withdrawal.
Adverse side effects associated with hydantoins/what about a patient with diabetes?
-nausea, vomiting, indigestion, sedation, drowsiness, fatigue, lethargy, confusion, blurred vision, nystagmus, gingival hyperplasia, hyperglycemia, blood dyscrasias, hepatotoxicity
-monitor for hyperglycemia; may elevate blood glucose levels, pt with DM are more susceptible to hyperglycemia, particularly during the early weeks of therapy
Potency of antipsychotic medications relates to what
-The ability of the liver to process the medication
