week 3 ati hw & ch 11-13, 21 &22 & pharm pg 51-66 Flashcards
3 stages of General Adaptation Syndrome
- Alarm phase = fight or flight w/ cortisol release
- Resistance phase = heightened state as body attempts to stabilize
- Exhaustion phase= getting sick- body is depleated
mild anxiety presents as
nail biting, foot tapping, or fidgeting
*hypervigilence
*restlessness
**increased awareness and ability to problem solve
(studying for a test)
moderate anxiety presents as
***PRACTICING DEEP BREATHING
increased vitals
*less concentration
*limited ability to learn new things
**limited perception
(loss of a job)
severe anxiety presents as
***REPEATING PHRASES
*feeling of no solution
*impending doom
*unable to focus on more than 1 thing at a time
*chest pain
*nausea, headache, loud speech, and increased heart rate
(loss of a child)
panic anxiety presents as
*DISSOCIATION & FAINTING
hallucinations
unable to process environment
disorganized
fight or flight
(stuck in an elevator)
brain circuit responsible for OCD, worrying, & apprehension
cortico-striato-thalmo-limbic system
over-reaction of cortico-striato-thalmo-limbic system may cause
*increased bool pressure & heart rate
*restlessness & irritability
2 manifestations of social anxiety
- concerns about other’s opinions of clothing choice
- fear of being in a group of people
a panic disorder involves both
*HEAD & BODY
physiological and psychological manifestations
agoraphobia
fear of not having a way out or escape
*avoidance
trichotillomania
intentionally pulling out one’s hair
triggered by anxiety and bordeom
excorciation disorder
recurrent picking of one’s skin
cyclothymic disorder
clients alternate between mania & mild/moderate depression for 2 yrs
*less severe than bipolar disorder
anhedonia
inability to experience pleasure
M.I.L.C.
suicide assessment tool
M = means
I = intent
L = lethality
C = cues & behavior
hypomania presents as
increased energy & creativity
decreased sleep
decreased talkativeness
mania presents as
risky behavior
racing thoughts/ideas
grandiosity w poor judgement
high distractability
Bipolar 1 vs Bipolar 2
Bipolar 1 = reoccurring episodes of mania, depression, & hypomania (3)
Bipolar 2 = hypomania & depression (2) *not as manic
*depression mimics major depressive disorder
Altman self-rating scale
bipolar disorder scale = 5?’s
1. mood
2. self-confidence
3. speech
4. sleep
5. activity
serotonin syndrome manifests as
abdominal pain
altered mental state
diaphoresis
**dilated pupils
**increased temp
tachycardia
hypertension
muscle rigidity
what age groups are at an increased risk for suicide
younger than 19
older than 45
**generally 10-34
disruptive mood dysregulation disorder
diagnosed in children who exhibit extreme irritability, tantrums, & trouble in school
transcranial magnetic stimulation invloves
*being awake
*client may feel slight head tapping, scalp contractions, & tightening of jaw
* 30 min & outpatient & multiple treatments
*MILD HEADACHE AFTER
*effective when combined w psychotherapy
depression has a higher prevelence in
ADULT FEMALES
lithium levels
0.6 to 1.2
lithium toxicity presents as
> 1.2
altered mental status
blurred vision
bradycardia
tremors
3 findings in generalized anxiety disorder
excessive worry for 6 months
restlessness
sleep disturbance
OCD is more prevalent in
females
hoarding = males
SSRI’s include
serataline & paroxetine
*1st line of treatent for anxiety & ocd antidepressent
SNRI’s include
duloxetine & venlafaxine
*antidepressant for anxiety disorders
short-term use treatment for anxiety is
benzodiazepines (diazepam)
long term use treatment for anxiety is
Busiprone
anticonvolusants function as
mood stabilizers
which of the following findings should the nurse expect with PTSD? sap
- difficulty cocentrating on tasks
- obsessive need to talk about the traumatic event
- negative self-image
- recurring nightmares
- diminished reflexes
- difficulty cocentrating on tasks
- negative self-image
- recurring nightmares
Which of the following strategies should the nurse use to help prevent a trauma-related disorder? sap
- avoid thinking about the incident when it is over
- take breaks during the incident for food & water
- debrief with others following the incident
- avoid displays of emotion in the days following the incident
- take advantage of offered counseling
- take breaks during the incident for food & water
- debrief with others following the incident
- take advantage of offered counseling
which of the following client behviors should the nurse expect with acute stress disorder?
- the client remembers many details about the traumatic incident
- the client expresses heightened eletionn about what is happening
- the client remembers first noticing manifestations of the disorder 6 weeks after the traumatic incident occurred
- the client expresses a sense of unreality about the traumatic incident
- the client expresses a sense of unreality about the traumatic incident
which of the following findings should the nurse identify as an indication of derealization?
1/ the client describes a feeling of above the ground
- the client has suspicions of being targeted in order to be killed and robbed
- the client states that the furniture in the room seems to be small and far away
- the client cannot recall anything that happened during the past 2 weeks
- the client states that the furniture in the room seems to be small and far away
a client has dissociative fugue. which of the following interventions should the nurse add to the plan of care?
- teach the client to recognize how stress brings on a personality change in the client
- repeatedly present the client w info about past events
- make decisions for the client regarding routine daily activities
- work w the client on grounding techniques
- work w the client on grounding techniques
dissociative fugue
type of dissociative amnesia in which client travels to a new area & is unable to remember identity & one’s past
derealization vs depersonalization
derealization = feeling that outside events are unreal or that objects are smaller/bigger than they should
depersonalization = feeling that a person is observing one’s own personality or body from a distance
a nurse is caring for a client with MDD. which of the following should the nurse identify as a risk factor for depression? sap
- Male sex
- history of chronic bronchitis
- recent death in client’s family
- family history of depression
- personal history of panic disorder
- history of chronic bronchitis
- recent death in client’s family
- family history of depression
- personal history of panic disorder
a nurse is admitting a client with MDD & a comorbid anxiety disorder. what is the nurse’s priority action?
- Placing the client on one-to-one observation
- assisting the client to perform ADL’s
- Encouraging the client to participate in counseling
- Teaching the client about medication adverse effects
- Placing the client on one-to-one observation
a nurse is teaching a client with premenstrual dysorphic disorder. which of the following statements indicates an understanding of the teaching?
- “I can expect my problems w PMDD to be worse when I am menstruating.”
- “I should avoid exercising when I am feeling depressed.”
- ” I am aware that my PMDD causes me t have rapid mood swings.”
- ” I should increase my caloric intake with a nutritional supplement when my PMDD is active.”
- ” I am aware that my PMDD causes me t have rapid mood swings.”
A charge nurse is discussing the care of a client w MDD w a new nurse. which statement indicates an understanding of the teaching?
- Care during the continuation phase focuses on treating continued manifestations of MDD
- The treatment of MDD during the maintenance phase lasts for 6 to 12 weeks
- The client is at greatest risk for suicide during the first weeks of an MDD episode
- Medication and psychotherapy are most effective during the acute phase of MDD.
- The client is at greatest risk for suicide during the first weeks of an MDD episode
a nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. which of the following findings should the nurse expect?
- wide fluctuations in mood
- report of a minimum of 5 clinical findings of depression
- presence of manifestations for at least 2 years
- Inflated sense of self-harm
- presence of manifestations for at least 2 years
Major depressive disorder
episodes of unipolar depression resulting in change of normal functioning w FIVE clinical findings occurring all day for a minimum of 2 weeks
*hallucinations
side effects of SSRI’S
*SERTRALINE
*FLUOXETINE
*CITALOPRAM
sexual dysfunction and weight gain
SSRI’S
first line of treatment for depression
*sertraline
*fluoxetine
*citalopram
adverse effects of SSRI’s
nausea / headache
anxiety
agitation
insomnia
when caring for a patient on tricyclic antidepressants..
AMITRIPTYLINE
*watch for ORTHOSTATIC HYPOTENSION
*increase fluid & fiber
*sugar less gum
MAOI’s foods to avoid
- phenelzine*
avoid TYRAMINE
no :
-cheese
-avocado
-beer/wine
-smoked meats
- liver
-fish
patients taking phenelzine are at risk for…
hypertensive crisis
*MAOI’s
adverse effects of buproprione
nausea/headache
dry mouth
insomnia
restlessness
constipation
gi distress
increase heart rate
SNRI’S
*VENLAFAXINE
*DULOXETINE
contraindicated in hypertension
Venlafaxine
& duloxetine adverse effects
SNRI’S
sexual dysfunction
insomnia
nausea
weight gain
diaphoresis
adverse effects of ST John’s wort
*abdominal pain
*photosensitivity
sking rash
gi distress
increased heart rate
serotonin syndrome
a nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. which of the following statements indicates the client understands the use of this medication?
- “I will take the medication at bedtime. “
- “I will follow a low-sodium diet while taking this medication.”
- “I will need to discontinue this medication slowly.”
- “I will be at risk for weight loss with long-term use of this medication.”
- “I will need to discontinue this medication slowly.”
a nurse is assessing a client 4hrs after receiving an initial dose of fluoxetine. which of the following findings should the nurse report to the provider as indications of serotonin syndrome? sap
- hypothermia
- hallucinations
- muscular flaccidity
- diaphoresis
- agitation
- hallucinations
- diaphoresis
- agitation
a nurse is caring for a client who is taking paroxetine to treat PTSD. the client states, “i grind my teeth at night & it causes pain in my mouth. The nurse should identify which of the following interventions as possible measures to manage the patients bruxism? sap
- Concurrent administration of buspirone
- administration of a different ssri
- use of a mouth guard
- changing to a different class of antianxiety medication
- increasing the dose of paroxetine
- Concurrent administration of buspirone
- use of a mouth guard
- changing to a different class of antianxiety medication
What medicines treat panic disorders
1, Benzodiazepenes (panic attack0
- SSRI’s (anticipatory)
in treating clients with panic disorders
rule out the physical
*DO NOT LEAVE PATIENT ALONE
monitor suicide risk
Agoraphobia
fear of no help or escape
*avoidant beaviors
*treated with ssri’s
