week 4 ati hw & ch 14, 15, 23, & 24 & pg 67-80

Question 1

hallucination
vs
delusion

Answer 1

hallucination = seeing/hearing things not there

delusion = fixed false beliefs (distorted reality)

Question 2

4 types of delusions

Answer 2

1. persecution
2. grandiose
3. thought insertion
4. control

Question 3

positive manifestations

Answer 3

ADDED to distort normal function – false feelings, beliefs, or behaviors, that are not typically present

*hallucinations / delusions
*disorganized speech & motor
*CATATONIC behavior
* clanging speech
*depresonalization
*derealization

Question 4

negative manifestation

Answer 4

TAKE AWAY– missing feelings and behavior that are usually present resulting in a decrease/loss of function

*alogia = loss of words
*lack of motivation/interest/energy
*withdrawing from a situation

only managed by 2nd gen antipsychotics

Question 5

3 phases of psychosis

Answer 5

1. Prodromal Phase = early period between onset of initial manifestations & full development
   - withdrawn
   - loss of sleep & concentration
   - increased anxiety
2. Active Phase = mania, depression, hallucination/delusion,
   * incoherently mumbling to oneself w/o awareness they’re doing it
3. Residual Phase = negative manifestations

Question 6

anosognosia

Answer 6

unaware of one’s own mental health

Question 7

diagnosis for schizophrenia relies on

Answer 7

clinical assessment
* observations

Question 8

discharge instructions for a client taking clozapine

Answer 8

WEEKLY BLOOD DRAWS = can cause agranulocytosis (WBC’s)

treats (-) & (+) symptoms
6wks for effect

Question 9

a client w schizo shares that they are feeling lonely and isolated. which action is nurses priority?

1. share info about support groups for people who have SMI
2. Teach the client stress reduction techniques so that they can feel more in control of their social situation
3. Help the client focus on recovery so that their relationships can improve down the road
4. Suggest adding another type of treatment

Answer 9

1. share info about support groups for people who have SMI

Question 10

what factor is involved if schizo was due to complications in utero

Answer 10

physiologic

Question 11

Bipolar 1 & 2 average onset & prevalence (female to male ratio)

Answer 11

1 = equally
2 = females
* avg onset is 18

Question 12

symptoms of Mania

Answer 12

*mood swings
*euphoria
*irritability & aggression
*increased energy (worry of collapse)
* inapporpriately demanding of attention
*intrusive nature
*grandeur delusions “superior”
*rapid speech & thoughts

*DECREASED NEED FOR SLEEP (2 weeks)
DOES NOT THINK TO EAT

Question 13

nursing considerations for a patient experiencing mania

Answer 13

don’t compete or burnout excess energy

Question 14

to be diagnosed w Bipolar 1 disorder

Answer 14

already diagnosed w MDD

mania + MDD & maybe psychosis (grandeur, paranoia & hallucinations)

Question 15

to be diagnosed w Bipolar 2 disorder

Answer 15

HYPOMANIA = no impairment in functioning & mania not as severe

MDD w/ severe depression (suicidal?)

NO psychosis

Question 16

hypomania vs mania

Answer 16

hypo = annoying, poor boundaries, remembers to eat

mania = inappropriately demanding, mood swings, intrusive nature repels others,
does not think to eat

Question 17

delirious mania symptoms
*is treated with?

Answer 17

most serious mania - progresses quickly

disorientation
psychosis
catatonia (slow motion & frozen)

*benzodiazepines

Question 18

in a patient experiencing mania what is priority assessment?

Answer 18

1. physiological status DEHYDRATION- I&O, water & skin
   *cardiac status
2. safety = impulsivity & suicide

**monitor vitals every hour if manic & AVOID GROUP activities

Question 19

implementing the nursing process for a patient w mania consists of :

Answer 19

solitary activities
1:1 sitter
no roommate
no nurses station
use firm & neutral statements
daily routines

1. physiological need
2. safety

Question 20

Lithium

Answer 20

*range 0.5 to 1.2 mEq/L

• inverse relationship w sodium
• first line of treatment for acute mania & depression
  -prevents manic & depressive episodes
• mood stabilizer that prevents mood cycling (3-6 weeks)

*interacts w NSAIDS & diuretics

Question 21

expected side effects of Lithium

Answer 21

*range 0.5 to 1.2 mEq/L
sedation
acne
nausea
excessive thirst
hand tremors
weight gain

Question 22

early lithium toxicity

Answer 22

1.2 - 1.5
* hold med & call dr

n/v/d
muscle weakness
slurred speech

Question 23

advanced lithium toxicity

Answer 23

> 1.5

-EEG changes
-hand tremor
- muscle hyper-irritability
- GI upset
- confusion
-incoordination

*stupor
*blurrred vision

*affects KIDNEYS

**treated w normal saline bolus

Question 24

long term effects of Lithium

Answer 24

hypothyroidism - goiter
kidney dysfuction

*assess levels every 6 months

Question 25

Anticonvulsants

Answer 25

1st line of treatment mood stabilizer -- bipolar mania, hypomania, mixed states, cycling *ValPROic Acid *DivalPROex *ValPROate

Question 26

Expected side effects of valPROic Acid

Answer 26

*anticonvulsant tremor sedation GI pain hair loss weight gain blood dyscarias -- anemia & thrombocytosis hepatotoxicity pancreatitis *taken in patients w kidney dysfunction

Question 27

lithium affects ____ buut anticonvulsants affect _____

Answer 27

lithium = kidneys anticonvulsants = liver

Question 28

anticonvulsant therapeutic levels & toxicity symptoms

Answer 28

*ValPROic Acid *DivalPROex *ValPROate 85 - 125 ug/mL toxic = intentional overdose - ataxia (loss of body movement) - confusion - somnolence -coma

Question 29

Carbamazepine

Answer 29

*anticonvulsant* treats bipolar disorder, rapid cycling, mixed states treats & prevents acute mania *MONITOR FOR RASHES

Question 30

Adverse effects of Carbamazepine

Answer 30

*anticonvulsant = mood stabilizer - hyponatremia & fluid overload - decreases effectoveness of birth control - blood dyscrasias - hepatic disease *RASH* *fatigue & nausea *diplopia (double vision) *ataxia

Question 31

Lamotrigine treats ___ & adverse effects

Answer 31

**anticonvulsant = bipolar depression--acute &maintenance - monitor for FEVER = aseptic meningitis - lower birth control effectiveness - Steven Johnsons

Question 32

Anxiolytics are

Answer 32

*Benzodiazepenes = Clonazepam & Lorazepam* given when concerned about heart or delirium adjunctive agents for acute mania & psychomotor agitation

Question 33

second - generation antipsychotics are best for

Answer 33

non-compliance for acute mania, bipolar depression, & their prevention

Question 34

when evaluating mood assess & ask about

Answer 34

stable vitals hydration sleep self-control

Question 35

4 phases of schizophrenia

Answer 35

1. Prodromal Phase = identification, depression, withdrawn from society 2. Acute Phase = psychotic break 3. Stabilizaton Phase = no sleep, trouble focusing 4. Maintenance Phase = able to ignore hallucinations

Question 36

catatonia

Answer 36

slow & zombie-like limbs stay in place treated w benzodiazepines & anti-psychotics

Question 37

schizoaffective disorder

Answer 37

major or manic episodes occur at the same time as the active phase of delusions/hallucinations

Question 38

first-generations antipsychotics

Answer 38

Chlorpromazine Loxapine Fluphenazine Haloperidol * treat POSITIVE symptoms - used less = adverse effects

Question 39

extrapyramidal symptoms of first-generation antipsychotics

Answer 39

*PSEUDOPARKINSONISM - fall risk *ACUTE DYSTONIA - (muscle & laryngeal symptoms - concern for airway) *AKATHISIA- (restless feet & extreme stress- suicide risk) *TARDIVE DYSKINESIA - (face droop- irreversible)

Question 40

other side effects of 1st gen antipsychotics

Answer 40

lowered seizure threshold orthostatic hypotension sedation increased prolactin = sex dysfunction, amenorrhea, galactorrhea *high fall risk

Question 41

adverse effects of first gen antipsychotics

Answer 41

*METABOLIC SYNDROME *prolonged QT interval *anticholinergic toxicity *neuroleptic malignant syndrome

Question 42

metabolic syndrome presents as..

Answer 42

weight gain, hypertension, diabetes, & dyslipidemia

Question 43

anticholinergic toxicity presents with..

Answer 43

*dry mouth *urinary retention anxiety, hallucinations, hyperactivity, seizures, & delirium symptoms disappear w stop of first gens

Question 44

Neuroleptic Malignant Syndrome presents as

Answer 44

*high fever (103-105) *muscle rigidity (monitor DVT & rhabdomyolysis) *increased vitals *altered mental status

Question 45

Second & Third Generation Antipsychotics

Answer 45

*CLOZAPINE - last resort *ARIPIPRAZOLE - sedating *RISPERIDONE - stroke risk *LURASIDONE *OLANZIPINE - gain weight *QUETIAPINE - high street value & homeless treat NEGATIVE & POSITIVE

Question 46

when using clozapine

Answer 46

*monitor for FEVER *AGRANULOCYTOSIS - WBC's drooling mycarditis *last-resort

Question 47

Injectable Antipsychotics

Answer 47

Haldol Aripriprazole Risperidone Olanzipine Ziprasidone *must be stable on PO verison first

Question 48

when evaluation antipsychotic medication effectiveness the nurse should ask about..

Answer 48

*have the symptoms LESSENED *medication ADHERENT *support system

Question 49

a nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should expect a prescription for which of the following medications? 1. Chlorpromazine 2. Thiothixene 3. Risperidone 4. Haloperidol

Answer 49

3. Risperidone ( the only 2nd gen)

Question 50

lithium levels during a manic episode

Answer 50

0.8 to 1.4 okay to administer next dose if patient is within the range

Question 51

a nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following meds? sap 1. Olanzapine 2. Quetiapine 3. Aripiprazole 4. Clozapine 5. Asenapine

Answer 51

1. Olanzapine 3. Aripiprazole 4. Clozapine 5. Asenapine

Question 52

a nurse is assessing a client who is currently taking perphenazine. which of the following findings should the nurse identify as an extrapyramidal symptom? sap 1. decreased level of consciousness 2. drooling 3. involuntary arm movements 4. urinary retention 5. continual pacing

Answer 52

2. drooling 3. involuntary arm movements 5. continual pacing

Question 53

a nurse is providing discharge teaching for a client who has schizo & a new prescription for iloperidone. which client statement indicated understanding of the teaching? 1. "I will be able to stop taking this medication as soon as I feel better." 2. "If i feel drowsy during the day, I will stop taking this medication and call my provider." 3. " I will be careful not to gain too much weight while taking this medication." 4. "This medication is highly addictive and must be withdrawn slowly ."

Answer 53

3. " I will be careful not to gain too much weight while taking this medication."