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behavioral health > week 4 ati hw & ch 14, 15, 23, & 24 & pg 67-80 > Flashcards

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

schizophrenia

1
Q

hallucination
vs
delusion

A

hallucination = seeing/hearing things not there

delusion = fixed false beliefs (distorted reality)

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2
Q

4 types of delusions

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

positive manifestations

A

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

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4
Q

negative manifestation

A

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

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5
Q

3 phases of psychosis

A
  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    - withdrawn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
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6
Q

anosognosia

A

unaware of one’s own mental health

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7
Q

diagnosis for schizophrenia relies on

A

clinical assessment
* observations

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8
Q

discharge instructions for a client taking clozapine

A

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

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

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9
Q

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
A
  1. share info about support groups for people who have SMI
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10
Q

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

A

physiologic

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11
Q

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

A

1 = equally
2 = females
* avg onset is 18

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12
Q

symptoms of Mania

A

*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

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13
Q

nursing considerations for a patient experiencing mania

A

don’t compete or burnout excess energy

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14
Q

to be diagnosed w Bipolar 1 disorder

A

already diagnosed w MDD

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

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15
Q

to be diagnosed w Bipolar 2 disorder

A

HYPOMANIA = no impairment in functioning & mania not as severe

MDD w/ severe depression (suicidal?)

NO psychosis

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16
Q

hypomania vs mania

A

hypo = annoying, poor boundaries, remembers to eat

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

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17
Q

delirious mania symptoms
*is treated with?

A

most serious mania - progresses quickly

disorientation
psychosis
catatonia (slow motion & frozen)

*benzodiazepines

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18
Q

in a patient experiencing mania what is priority assessment?

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

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

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19
Q

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

A

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

  1. physiological need
  2. safety
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20
Q

Lithium

A

*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

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21
Q

expected side effects of Lithium

A

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

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22
Q

early lithium toxicity

A

1.2 - 1.5
* hold med & call dr

n/v/d
muscle weakness
slurred speech

23
Q

advanced lithium toxicity

A

> 1.5

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

*stupor
*blurrred vision

*affects KIDNEYS

**treated w normal saline bolus

24
Q

long term effects of Lithium

A

hypothyroidism - goiter
kidney dysfuction

*assess levels every 6 months

25
Q

Anticonvulsants

A

1st line of treatment mood stabilizer – bipolar mania, hypomania, mixed states, cycling

*ValPROic Acid
*DivalPROex
*ValPROate

26
Q

Expected side effects of valPROic Acid

A

*anticonvulsant

tremor
sedation
GI pain
hair loss
weight gain

blood dyscarias – anemia & thrombocytosis
hepatotoxicity
pancreatitis

*taken in patients w kidney dysfunction

27
Q

lithium affects ____ buut anticonvulsants affect _____

A

lithium = kidneys

anticonvulsants = liver

28
Q

anticonvulsant therapeutic levels & toxicity symptoms

A

*ValPROic Acid
*DivalPROex
*ValPROate

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

29
Q

Carbamazepine

A

anticonvulsant

treats bipolar disorder, rapid cycling, mixed states

treats & prevents acute mania

*MONITOR FOR RASHES

30
Q

Adverse effects of Carbamazepine

A

*anticonvulsant = mood stabilizer
- hyponatremia & fluid overload
- decreases effectoveness of birth control
- blood dyscrasias
- hepatic disease

RASH
*fatigue & nausea
*diplopia (double vision)
*ataxia

31
Q

Lamotrigine treats ___ & adverse effects

A

**anticonvulsant = bipolar depression–acute &maintenance

  • monitor for FEVER = aseptic meningitis
  • lower birth control effectiveness
  • Steven Johnsons
32
Q

Anxiolytics are

A

Benzodiazepenes = Clonazepam & Lorazepam

given when concerned about heart or delirium

adjunctive agents for acute mania & psychomotor agitation

33
Q

second - generation antipsychotics are best for

A

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

34
Q

when evaluating mood assess & ask about

A

stable vitals
hydration
sleep
self-control

35
Q

4 phases of schizophrenia

A
  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
36
Q

catatonia

A

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

37
Q

schizoaffective disorder

A

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

38
Q

first-generations antipsychotics

A

Chlorpromazine
Loxapine
Fluphenazine
Haloperidol

  • treat POSITIVE symptoms
  • used less = adverse effects
39
Q

extrapyramidal symptoms of first-generation antipsychotics

A

*PSEUDOPARKINSONISM - fall risk

*ACUTE DYSTONIA - (muscle & laryngeal symptoms - concern for airway)

*AKATHISIA- (restless feet & extreme stress- suicide risk)

*TARDIVE DYSKINESIA - (face droop- irreversible)

40
Q

other side effects of 1st gen antipsychotics

A

lowered seizure threshold
orthostatic hypotension
sedation
increased prolactin = sex dysfunction, amenorrhea, galactorrhea

*high fall risk

41
Q

adverse effects of first gen antipsychotics

A

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

42
Q

metabolic syndrome presents as..

A

weight gain, hypertension, diabetes, & dyslipidemia

43
Q

anticholinergic toxicity presents with..

A

*dry mouth
*urinary retention
anxiety, hallucinations, hyperactivity, seizures, & delirium

symptoms disappear w stop of first gens

44
Q

Neuroleptic Malignant Syndrome presents as

A

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

45
Q

Second & Third Generation Antipsychotics

A

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

treat NEGATIVE & POSITIVE

46
Q

when using clozapine

A

*monitor for FEVER
*AGRANULOCYTOSIS - WBC’s

drooling
mycarditis
*last-resort

47
Q

Injectable Antipsychotics

A

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

48
Q

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

A

*have the symptoms LESSENED
*medication ADHERENT
*support system

49
Q

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
A
  1. Risperidone ( the only 2nd gen)
50
Q

lithium levels during a manic episode

A

0.8 to 1.4

okay to administer next dose if patient is within the range

51
Q

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
A
  1. Olanzapine
  2. Aripiprazole
  3. Clozapine
  4. Asenapine
52
Q

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
A
  1. drooling
  2. involuntary arm movements
  3. continual pacing
53
Q

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 .”
A
  1. ” I will be careful not to gain too much weight while taking this medication.”
54
Q
A

behavioral health (12 decks)

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