Physiological needs, safety, love & belonging, self-esteem, self-actualization.
QUESTION
Rights of voluntary and involuntary admission patients to mental health?
Answer:
Have the right to refuse meds, refuse treatments, and the right to informed consent.
QUESTION
What vitamin isn’t absorbed when taking an MAOI?
Answer:
Tyramine
QUESTION
Characteristic of patient with body dysmorphic disorder?
Answer:
Preoccupied with an image of a defective body part resulting in obsessional thinking and
compulsive behavior, such as mirror checking and camouflaging.
QUESTION
Theraputic Communication Technique (TCT) Silence:
Answer:
using silence allows for meaningful relfection
QUESTION
(TCT) accepting:
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<\/a><\/figure>\n\n\n\nWhat type of patients go to memory care?
Dementia or Alzheimers<\/p>\n\n\n\n
What type of environment is a memory care unit?
Locked unit, 24-7 supervision.<\/p>\n\n\n\n
What type of activities do you implement to interact with memory care patients?
Activities that help them to recall their past-show old photos, ask questions like what was your first job? where did you grow up? what was your parents names?<\/p>\n\n\n\n
If a patient is not engaged in a group of people sharing photos what might they be feeling?
Depressed, Isolated, Angry<\/p>\n\n\n\n
Can a social worker make a decision about placement for an elderly person if that person has living family members, a POA?
No, they cannot make the decision. Nurses must educate family about decisions.<\/p>\n\n\n\n
What does agnosia mean?
Inability to interpret sensations and hence to recognize things, typically as a result of brain damage.<\/p>\n\n\n\n
Example of something that could cause agnosia?
TBI, vascular dementia.<\/p>\n\n\n\n
Characteristics of delirium.
Rapid in onset, 24-72 hours, related to infection, NOT common with aging.<\/p>\n\n\n\n
What is an important intervention for patients with delirium?
Reorient them.<\/p>\n\n\n\n
What are the primary characteristics of borderline personality disorder?
splitting people (Pitting a group against each other). Self-defeating cycle of behavior.<\/p>\n\n\n\n
What do you give a patient who has overdosed on PCP?
Benzodiazepine<\/p>\n\n\n\n
Example of a benzodiazpine antidote?
Flumazenil<\/p>\n\n\n\n
What type of personality disorder might a patient who still lives at home at 30 and depends on their mother for everything, have?
dependent personality disorder<\/p>\n\n\n\n
Give an example of a positive statement made by a recovering alcohol that made signal that they are getting better?
I will identify things that trigger my cravings<\/p>\n\n\n\n
Symptoms of patient with suspected opioid abuse\/overdose?
Contracted pupils, increased HR, shallow Resp., increased temp (but not always).<\/p>\n\n\n\n
What do you give a opioid overdose patient?
Narcan (Naloxone)<\/p>\n\n\n\n
S\/S of acute alcohol withdrawal?
Everything is increased! RR, BP, Temp, HR, delerium<\/p>\n\n\n\n
Characteristics of histrionic personality disorder?
Mania, melodramatic, manipulative, emotional attention seeking behavior, often seductive and flirtatious.<\/p>\n\n\n\n
Interventions for histrionic personality disorder patient
They are very manipulative. Set fine lines, do not offer relationship advice, avoid situations where they are the center of attention.<\/p>\n\n\n\n
Possible fatal complications of patient withdrawing from CNS stimulant
Respiratory failure, suicide, and depression.<\/p>\n\n\n\n
What is a hypochondriac?
Someone who thinks that everything is wrong with them. Ex. their acute headache is caused by a brain tumor.<\/p>\n\n\n\n
How does cocaine stimulate the body? What do cocaine users use to combat these effects?
It is an upper. Alcohol-allows them to sleep.<\/p>\n\n\n\n
Characteristics of borderline personality disorder
Split people apart and are very manipulative.<\/p>\n\n\n\n
Interventions for nurses dealing with borderline personality disorder patients
Keep all the staff on the same page. Set limits and rules.<\/p>\n\n\n\n
What is a personality disorder in general? What type of issues do these patients have?
When people rely on others to make decisions. They have difficulties in their social life, work, relationships, family problems. Place the blame on others. Many go undiagnosed.<\/p>\n\n\n\n
What is conversion disorder?`
Something psychological happens and it then manifests somatically. Ex. Someone has fake blindness<\/p>\n\n\n\n
What is the difference between objective and subjective data?
Subjective is what the patient tells you, objective is what you see and obtain from the physical assessment of the patient.<\/p>\n\n\n\n
What is somatoform disorder?
A mental illness that causes bodily symptoms that cannot be tracked back to any specific cause.<\/p>\n\n\n\n
Are the symptoms real for a patient with somatoform disorder?
Yes, the symptoms are real. It is frustrating because many doctors will perform tests but find nothing. Many go undiagnosed.<\/p>\n\n\n\n
What are younger patients with body image problems at risk for?
Suicide<\/p>\n\n\n\n
A nurse caring for a patient with borderline personality disorder should try to find out what?
What the patients secondary gains are. What are they trying to get? Attention? Money? Pain pills?<\/p>\n\n\n\n
Characteristics of an antisocial personality disorder patient in a locked setting with other clients?
Manipulative, aggressive, angry, yelling.<\/p>\n\n\n\n
What is a main cause of death for anorexia nervosa patients?
Cardiac problems d\/t potassium imbalances *hypokalemia<\/p>\n\n\n\n
What is re-feeding syndrome?
Occurs when malnourished patient begins to receive nourishment again. Severe change in intake and electrolyte increases cause heart to work harder and can cause dysrhythmias.<\/p>\n\n\n\n
What is the difference between bulimia and anorexia?
Bulimia is the binging of food and then purging. Anorexia is starving self from food.<\/p>\n\n\n\n
If you’re throwing up and or taking a laxative? What electrolyte might be out of balance?
Potassium<\/p>\n\n\n\n
What are hallucinations?
Experiences that are real to the patient but are not actually real.,<\/p>\n\n\n\n
What should you do for a patient that is having hallucinations?
Make sure they have everything they need (Glasses, hearing aid etc), keep lights on in room, do not place large clocks or calendars on the walls.<\/p>\n\n\n\n
What type of med would a dr. give a cognitive impaired elderly client who pulled out all of her tubes?
Atypical antipsychotic<\/p>\n\n\n\n
How long til we see complications with patients withdrawing from alcohol?
24 to 48 hours.<\/p>\n\n\n\n
When giving narcan, what should you monitor closely?
VS, at least every 15 min. Stay with patient!<\/p>\n\n\n\n
What would you give a patient with a heroin overdose? What would we expect to improve?
Narcan. HR and Resp<\/p>\n\n\n\n
OD heroin patient receives narcan, 1 hr. later present with abd cramps, goose bumps. What is going on?
Symptom of narcotic absence. “withdrawal”<\/p>\n\n\n\n
What should the nurse do for a sexual assault victim?
Make sure counseling is available for them, set up an appointment<\/p>\n\n\n\n
Who is at the highest risk for physically abusing a nurse?
A patient with dementia or a delusional patient<\/p>\n\n\n\n
What type of meds do ADHD patients receive?
CNS stimulant<\/p>\n\n\n\n
Early signs of autism in kids?
Isolation, not loving towards people, nonverbal, doesn’t like to be touched, difficult relationship with parents<\/p>\n\n\n\n
Can restraints be PRN?
NO!! Must clarify with doctor.<\/p>\n\n\n\n
What is lorazepam (Ativan) used for?
Anxiety disorder or preop sedation.<\/p>\n\n\n\n
Side effects of lorazepam (Ativan)
Drowsiness, respiratory depression, dizziness, lethargy, physical dependence<\/p>\n\n\n\n
Contraindications of lorazepam (Ativan)
Angle closure glaucoma, hx of drug dependence, pre-existing CNS depression, severe hypotension, and sleep apnea<\/p>\n\n\n\n
Lithium therapeutic range
0.5-1.5<\/p>\n\n\n\n
Levels of maslow hierarchy of needs?
Physiological needs, safety, love & belonging, self-esteem, self-actualization.<\/p>\n\n\n\n
Rights of voluntary and involuntary admission patients to mental health?
Have the right to refuse meds, refuse treatments, and the right to informed consent.<\/p>\n\n\n\n
What vitamin isn’t absorbed when taking an MAOI?
Tyramine<\/p>\n\n\n\n
Characteristic of patient with body dysmorphic disorder?
Preoccupied with an image of a defective body part resulting in obsessional thinking and compulsive behavior, such as mirror checking and camouflaging.<\/p>\n\n\n\n
Theraputic Communication Technique (TCT) Silence:
using silence allows for meaningful relfection<\/p>\n\n\n\n
(TCT) accepting:
conveys an attitude of reception and regard<\/p>\n\n\n\n
(TCT) Giving recognition:
Acknowledging indicates awareness<\/p>\n\n\n\n
(TCT) Offering self:
Making oneself available on an unconditional basis, increasing the clients feeling of self-worth<\/p>\n\n\n\n
(TCT) offering general leads:
Allows the person to take direction in the discussion indicates that the nurse is interested in what comes next. (“go on”, “and then?”)<\/p>\n\n\n\n
(TCT) giving broad openings:
clarifies that the lead is to be taken by the patient (“Where would you like to begin?”)<\/p>\n\n\n\n
(TCT) Making observations:
Calls attention to the person’s behavior, encourages the person to notice behavior and to describe thoughts and feelings for mutual understanding. Helpful for mute or withdrawn people.<\/p>\n\n\n\n
(TCT) Encouraging description of perception:
Increase the nurse’s understanding of the patient’s perceptions. Talking about feelings and difficulties can lessen the need to act them out inappropriately<\/p>\n\n\n\n
Non-therapeutic communication (NTC) Giving premature advice
Assumes the nurse knows best and the patient cannot think for self.<\/p>\n\n\n\n
(NTC) Minimizing feelings:
Indicates the nurse is unable to understand or empathize with the patient. The patient’s feelings or experiences are being belittled.<\/p>\n\n\n\n
What is beneficence?
The duty to act as a benefit or to promote the good of others.<\/p>\n\n\n\n
What is autonomy?
Respecting the rights of others to make their own decisions<\/p>\n\n\n\n
What is justice?
The duty to distribute resource or care equally, regardless of personal attribtutes.<\/p>\n\n\n\n
What is fidelity (nonmaleficence)
Maintaining loyalty and commitment to the patient and doing no wrong to the patient<\/p>\n\n\n\n
What is veracity?
One’s duty to communicate truthfully.<\/p>\n\n\n\n
What does a patient lose when they are admitted d\/t suicide attempt\/ideation?
Right to privacy.<\/p>\n\n\n\n
What are negative symptoms?
A lack of feelings or behaviors that are usually present. Losing interest in daily activities, lack of feeling or emotion, having little emotion or inappropriate feelings in certain situations, agnosia.<\/p>\n\n\n\n
What are positive symptoms?
Feelings or behavior that are not usually present. Delusions, hallucinations, disorganized speech and behavior.<\/p>\n\n\n\n
What do atypical antipsychotics treat?
Negative symptoms.<\/p>\n\n\n\n
Examples of atypical antipsychotics
Clozapine, risperidone, olanzapine, aripiprazole, ziprasidone, and quetiapine.<\/p>\n\n\n\n
SE of atypical antipsychotics
fewer EPS symptoms, temp, increased wt, glucose, and triglycerides<\/p>\n\n\n\n
Three types of crisises?
Situational\/external, maturational\/internal, and adventitious<\/p>\n\n\n\n
What is a situational .external crisis?
Often unanticipated loss or change.<\/p>\n\n\n\n
What is maturational\/internal crisis?
Achieving new developmental stages, which requires learning additional coping mechanisms.<\/p>\n\n\n\n
What are adventitious crisis?
The occurrence of natural disasters, crime, or national disasters.<\/p>\n\n\n\n
What is a particular drug of choice for alzheimers?
Donepezil (Aricept) or rivastigmine (Exelon)<\/p>\n\n\n\n
Characteristics of pt. with borderline personality disorder?
Instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment, often tries self injury, possibly suicidal.<\/p>\n\n\n\n
Bipolar suddenly D\/C lithium. What could happen?
symptoms of mania or hypomania. May be worse than when they 1st started the med.<\/p>\n\n\n\n
2 things for the tx of alcohol dependency
Detox, then rehab<\/p>\n\n\n\n
Healthy defense mechanisms (4)
Altruism, sublimation, suppression, and humor.<\/p>\n\n\n\n
What is altruism?
Healthy defense mechanism. Emotional conflicts and stressors are addressed by meeting the needs of others.<\/p>\n\n\n\n
What is sublimination?
Healthy defense mechanism. An unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not acceptable in their original form.<\/p>\n\n\n\n
What is suppression?
The constant denial of a disturbing situation or feeling.<\/p>\n\n\n\n
What are the intermediate defenses? (4)
Repression, displacement, reaction formation, reationalization<\/p>\n\n\n\n
What is repression?
Intermediate Defense. cornerstone of defense mechanisms and is the first life of defense against anxiety. Exclusion of unpleasant experiences, emotions, or ideas from conscious awareness.<\/p>\n\n\n\n
What is displacement?
Intermediate defense. Transfer of emotions associated with a particular person, object, or situation to another person object or situation that is nonthreatening.<\/p>\n\n\n\n
What is reaction formation?
Intermediate defense. Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion.<\/p>\n\n\n\n
What is rationalization?
Intermediate defense. Consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener.<\/p>\n\n\n\n
What are the immature defenses? (4)
Passive aggression, splitting, projection, denial.<\/p>\n\n\n\n
What is passive aggression?
Indirectly and unassertively expressing aggression towards others. Expressed through procrastination, failure, inefficiency, and illness that affects others more than oneself.<\/p>\n\n\n\n
What is splitting?
The inability to integrate the positive and negative qualities of oneself or others<\/p>\n\n\n\n
What is projection?
A person unconsciously rejects emotionally unacceptable personal features and attributes them to other people objects or situations.<\/p>\n\n\n\n
What is denial?
Escaping unpleasant realities by ignoring their existence.<\/p>\n\n\n\n
In regards to the MMSE? What does it focus on?
Cognitive screening tool used to screen for dementia<\/p>\n\n\n\n
S\/S of depression
depressed mood, insomnia, excessive sleeping, indecisiveness, decreased ability to concentrate, suicidal ideation, increase or decrease in motor activity, increase or decrease in wt. and agnosia.<\/p>\n\n\n\n
Who influence peplau?
Influenced by Sullivan’s interpersonal relationship theory.<\/p>\n\n\n\n
What was peplau’s theory?
Interpersonal theory of nursing. Nurses therapeutic use of self during the nurse-patient interaction had a direct impact on the outcome of the patient’s well-being.<\/p>\n\n\n\n
What is impulsive behavior?
Common in borderline personality disorder. tendency to act w\/o thinking about the consequences of your actions<\/p>\n\n\n\n
Characteristic of conversion disorder
Marked by symptoms or deficits that affect voluntary motor or sensory functions.<\/p>\n\n\n\n
Symptoms of conversion disorder.
Involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, and deafness. Symptoms cannot be lnked back to a certain cause.<\/p>\n\n\n\n
Foods high in tyramine
aged cheese, cured meats, smoked or processed meats, pickled or fermented foods, sauces, soybeans, peas, dried or overripe fruits, alcoholic beverages.<\/p>\n\n\n\n
Difference between compassion and empathy?
Compasson-sympathetic feeling towards other w\/o attempt to know their feeling or understand suffering. Empathy-imagine another’s problem coupled with strong feeling for that person.<\/p>\n\n\n\n
Preferred questionnaire for possible alcohol abuse?
MAST (Michigan alcoholism screening testing) MAST-G for geriatrics<\/p>\n\n\n\n
What is dopamine?
NT-involved in cognition, motivation, and movement. Controls emotional responses and the brain’s reward and pleasure center. Stimulate the heart and increases blood flow to vital organs.<\/p>\n\n\n\n
With what diseases does dopamine increase? decrease?
increase-schizophrenia decrease-Parkinson’s disease and depression<\/p>\n\n\n\n
What is serotonin?
NT found in the brain and SC. Regulate mood, arousal, attention, behavior, and body temp.<\/p>\n\n\n\n
With what diseases does serotonin increase? Decrease?
Increase-anxiety. Decrease-depression<\/p>\n\n\n\n
What is norepinephrine?
NT that Plays a role in regulating mood.<\/p>\n\n\n\n
With what diseases does norepinephrine increase? Decrease?
Increase-mania, anxiety, and schizo. Decrease-depression<\/p>\n\n\n\n
What is GABA?
NT that reduces anxiety, excitation, and aggression. May play a role in pain perception, anticonvulsant and muscle relaxing properties, may impair cognition, and psychomotor functioning.<\/p>\n\n\n\n
With what diseases does GABA increase? Decrease?
Increase-reduction in anxiety. Decrease-increase in anxiety, mania, and schizophrenia<\/p>\n\n\n\n
What is glutamate?
Plays a role in learning and memory.<\/p>\n\n\n\n
What is primary prevention?
Aims to prevent disease or injury before it ever occurs.<\/p>\n\n\n\n
What is secondary prevention?
Aims to reduce the impact of a disease that has already occurred.<\/p>\n\n\n\n
What is tertiary prevention?
Soften the impact of an ongoing illness or injury that has lasting effects.<\/p>\n\n\n\n
EX. of primary prevention
legislation and enforcement to ban or control the use of hazardous products, ed. about healthy and safe habits, immunizations<\/p>\n\n\n\n
Ex. of secondary prevention
regular exams, screening, exercise programs to prevent further heart attacks.<\/p>\n\n\n\n
Ex. of tertiary prevention
Cardiac\/stroke rehab programs, support groups, vocational rehab programs<\/p>\n\n\n\n
What is dystonia?
Abnormal muscle tone resulting in muscular spasm and abnormal posture, d\/t neurological disease or side effect of meds<\/p>\n\n\n\n
What is alprazolam (Xanax) used for? SE?
Antianxiety\/sedative. SE: drowsiness, respiratory depression, dizziness, lethargy, physical dependence<\/p>\n\n\n\n
Contraindications for alprazolam (Xanax)
Angle closure glaucoma, hx of drug dependence, pre-existing CNS depression, severe hypotension, and sleep apnea.<\/p>\n\n\n\n
What is amphetamine (Adderall) used for? SE?
CNS stimulant used for ADHD. SE: insomnia, restlessness, wt. loss, dysrhythmias, and hypertension<\/p>\n\n\n\n
Names of common benzos
Clonazepam, diazepam, alprazolam, lorazepam, chlordiazepoxide, flumazenil, clorazepate, and oxazepam<\/p>\n\n\n\n
Indications for benzos
Anxiety, seizure disorders, insomnia, muscle spasm, alcohol withdrawal, anesthesia.<\/p>\n\n\n\n
SE of benzos
CNS depressant-sedation, light headed, drowsiness, respiratory depression, dizziness, lethargy, and physical dependence<\/p>\n\n\n\n
What is buspirone (buspar) used for?
Anxiety, OCD, panic disorders, and PTSD<\/p>\n\n\n\n
SE of buspirone (buspar)
Dizziness, nausea, headaches, lightheadedness, and agitation<\/p>\n\n\n\n
What is chlorpromazine (Thorazine)?
First gen antipsychotic used for positive symptoms of schizophrenia.<\/p>\n\n\n\n
SE of chlorpromazine (Thorazine)
EPS symptoms, orthostatic hypotension, NMS<\/p>\n\n\n\n
What is codeine?
Opioid used for mild pain and is sometime in cough meds<\/p>\n\n\n\n
What is disulfiram (Antabuse) used for?
Treatment of alcohol abuse as an aversion therapy.<\/p>\n\n\n\n
What is lithium used for? SE of toxicity?
Bipolar disorder; tremors, ataxia, confusion, convulsion, nausea, and vomitting<\/p>\n\n\n\n
Examples of MAOIs (3)
Phenelzine (nardil), tranylcypromine (parnate), and isocarboxazid (Marplan)<\/p>\n\n\n\n
What should you watch for when administering narcan?
Increased BP, tremors, hyperventilation, nausea, vomiting<\/p>\n\n\n\n
What is nortriptyline (pamelor)?
Tricyclic antidepressant.<\/p>\n\n\n\n
SE of nortriptyline?
Sedation, orthostatic hypotension, decreased libido, dry mouth, urinary retention, and cardiac dysrhytmias<\/p>\n\n\n\n
Example of opioids?
Codeine, hydrocodone, and oxycodone<\/p>\n\n\n\n
SE of opiods
Respiratory depression, urinary retention, confusion, constipation, nausea, vomiting, orthostatic hypotension, drug dependence<\/p>\n\n\n\n
S\/S of opioid overdose
Resp depression, pin point pupils, coma<\/p>\n\n\n\n
What is rivastigmine (Exelon) used for?
Combat symptoms of alzheimers disease. Slows progression of disease-not a cure<\/p>\n\n\n\n
Adverse reactions of rivastigmine (Exelon)?
Nausea, diarrhea, and bradycardia`<\/p>\n\n\n\n
What is selegiline used for? Contraindications?
Parkinsons disease. Not to be used with SSRIS or trycicylics-serotonin syndrome.<\/p>\n\n\n\n
SE of selegiline?
Serotonin syndrome, confusion, dizziness, hallucinations, insomnia, sedation, nausea, dry mouth, and abd pain<\/p>\n\n\n\n
Examples of SSRIs (3)
Fluoxetine, sertraline, and paroxitine<\/p>\n\n\n\n
SE of ssris
fewer anticholinergic effects than tricylic agents and nausea and vomitting<\/p>\n\n\n\n
Examples of Tricyclic antidepressants (4)
amitriptyline (Elavil), doxepin (Sinequan), notriptyline (pamelor), imipramine (tofranil<\/p>\n\n\n\n
What are tricyclic antidepressants used for?
Depression, bipolar disorder, fibromyalgia, neuropathic pain, OCD, ADHD, and chronic insomnia.<\/p>\n\n\n\n
SE of tricyclic antidepressants?
Sedation, orthostatic hypotension, decrease libido, dry mouth, urinary retention, and cardiac dystrhytmias.<\/p>\n\n\n\n
What is valproic acid (Depakote) used for?
Seizure disorder also used for manic episodes with bipolar patients<\/p>\n\n\n\n
What effect does valproic acid have on neurotransmitters?
Increases levels of GABA<\/p>\n\n\n\n
SE of valproic acid?
Suicidal thoughts, agitation, dizziness, hepatotoxicity, pancreatitis, hypothermia, and tremors.<\/p>\n\n\n\n