1
Q
What is NAMI
A
National Alliance on Mental Illness
- 12 week program to help deal w. anxiety & guilt
- for family members of individuals w/ mental illness
- family to family program
-psychoeducation
2
Q
Describe Family Interventions
A
- support integrity & functioning of family
includes:
- empowerment
- family therapy (might identify need for referral to therapist for example)
- community resources
- education
3
Q
Outcomes from Family Interventions
A
- resolve conflicts
- use of resources & effective problem solving
- improved communication
- improved ability to cope w/ stressors
4
Q
RN Diagnoses for Family Interventions
A
- caregiver role strain (needing education & support)
- impaired parenting
- dysfunctional family processes (might happen in addiction)
- interrupted family processes (where illness causes changes in the role)
- deficient knowledge
- might need tx or education on the illness
5
Q
Describe 15 Min Family Interview
A
Manners (introduce yourself)
- politeness, respect, kindness
Therapeutic Conversation (awareness every conversation can be therapeutic)
- acknowledge & affirm (show compassion & affirmation)
Genogram (reminder of who is affected)
Therapeutic Questions
Commendations (what the family is doing well…positive feedback)
6
Q
Describe Domains of Family Assessment
A
Biologic
- physical & mental status
Psychological
- family development & life roles (boundaries)
- communication, coping & problem solving
Social
-social & financial status, support networks, fun
Spiritual
-religion, beliefs, meaning, purpose & strengths
7
Q
Describe genogram in a family assessment
A
- multigenerational depiction of biological, legal & emotional relationships
- analyze for composition & patterns
- includes age, health problems, dates of marriage & death
8
Q
Explain the Competence Model
A
- focuses on strengths & building on those
- empowerment
- collaboration
- focus on improvements & what they can learn to get better
9
Q
Describe Concepts of Family Systems Theory
A
- family system is apart of a larger suprasystem (influence & support) & is composed of many subsystems
- family as a whole is greater than the sum of its parts (we get more info assessing the fam as a whole & not just individually)
- change in 1 member affects ALL members
- family is able to create a balance of change & stability (making adjustments by doing more or taking roles)
- family members behaviors are best understood from a view of circular rather than linear causality (domino effect)
10
Q
Describe Family Burden
A
- family experience of mental illness
- objective or subjective including…
- anxiety
- grief
- guilt (feel they contributed to the illness)
- anger
- powerlessness
-fear
11
Q
Describe Families “at risk” population
A
- stigma
- decreased social contact/support
- children of mentally ill parents
- siblings
12
Q
Describe management in Family Functions
A
- where $ and time is spent
- power
- resource allocation
- rules
- financial support
13
Q
Describe families as caregivers
A
- largest group of caregivers for ppl w/ mental illness
- provide info to healthcare providers
- provide support, monitor services & advocate for ill member
- important to “partner” w/ families
14
Q
Lithium Carbonate MOA & USES
A
- prototype mood stabilizer
MOA:
- neurochemical change, serotonin blockade
- affects glutamate activity
- increases neuronal growth & decreases atrophy
USES:
- acute mania
- prevention of mania & depression
- decreases suicide
15
Q
Lithium special considerations
A
- routine lab work required
- narrow TI index 0.8 to 1.4mEq/L
- levels checked every 2 to 3 days initially then every 3-6 months
16
Q
Lithium ADRs
A
- GI distress
- fine hand tremor
- polyuria, thirst
- weight, gain
- bradydyrhythmias, hypotension, eleectrolyte imbalances
- fatigue, lethargy, headache, mental dullness
- renal effects
- hypothyroidism w/ long term tx
17
Q
Causes of increased Lithium levels
A
- decreased sodium intake
- fluid/electrolyte loss
- impaired renal function
18
Q
Lithium drug interactions
A
- Ibuprofen
- Diuretics
19
Q
Anticonvulsant Mood Stabilizers MOA & USES
A
MOA:
- alters electrical conductivity of cell membranes
- enhance the effects of GABA
- inhibit glutamate
USES:
- acute episodes of mania & depression
20
Q
Anticonvulsant Mood Stabilizer prototypes
A
- Valporate (Depakote)
- Cabamazepine (Tegretol)
- Lamotrigine (Lamictal)
21
Q
Valporate (Depakote)
A
- FDA approved for acute mania
- wide TI index
22
Q
Valporate (Depakote) ADRs
A
- GI distress
- weight gain
- hepatotoxicity, contradicted in liver disease
- thrombocytopenia
- pancreatitis
- tertogenesis
23
Q
Lamotrigine (Lamictal)
A
- FDA approved for maintenance treatment
- titrated slowly over weeks
- drug of choice for pregnancy
24
Q
Lamotrigine (Lamictal)
A
MOA:
- modulates glutamate & aspartate
ADRs:
- dizziness
- double or blurred vision
- nausea
- vomiting
25
Carbemazepine (Tegretol, Equetro)
- indicated for acute mania & mixed states
- blood dyscrasias
- rash
- drug interactions
- teratogenesis
26
Carbemazepine (Tegretol, Equetro) ADRs
- nystagmus
- double vision
- vertigo
- staggering gait
- headache
27
Describe Mania
period of elevated, expansive, or irritable mood lasting at least 1 week with at least 3 of the following:
- extreme drive & energy
- inflated sense of importance
- decreased need for sleep
- excessive talking & pressured speech
- racing thought
- distractibility
- obsession w/ goals
- purposeless arousal & movement
- excessive involvement in pleasurable, high risk activities
28
Drugs that induce mania
- steroids
- amphetamines
- cocaine
- antidepressants
- levodopa
- thyroid hormone
29
Nursing Interventions for mania
- safety (poor judgement & suicidality)
- calm environment to minimize stimulation
- provide physical outlets
- simple communication (b/c got alot going on)
- assist w/ hygiene
- assist w/ nutrition (allow HAND HELD foods & NUTRITION based)
- facilitate sleep
- constructive limit setting
- focus on positive
- involve family in treatment
- education
30
Describe antidepressant meds
- used for mood & anxiety disorders
- take 2-4 weeks to see TI effect
- should be continued for 6-9 months after symptoms subside
- taper to discontinue..don't stop abruptly
- given once per day
- can trigger manic episode in pts w/ bipolar disorder or psychosis in pts w/ schizophrenia
31
MOA & USES of SSRIs
MOA:
- inhibit reuptake of serotonin at the presynaptic membrane increased serotonin in synapse
USES:
- depression
- anxiety disorders
- bulimia nervosa
- premenstrual dysphoric disorder
- bipolar disorder
32
ADRs of SSRIs
- nausea, GI disturbances (food can help)
- restlessness, jitteriness
- insomnia
- sexual dysfunction
- bruxism (grinding of teeth)
- serotonin syndrome
33
Explain stages of Hans-Selye General Adaptation Syndrome
Alarm
- release of adrenaline, corticosteroids & endorphins
- intense & short time
Resistance/Adaptation
- muscle endurance
- stamina
Exhaustion
- if body doesn't adapt stress becomes chronic
34
Explain denial defense mechanism
avoidance of disagreeable realities
EX: refusing to recognize them
35
Explain displacement defense mechanism
shift emotion from one person to another
EX: fight w/ partner b/c mad at boss
36
Explain intellectualization defense mechanism
reasoning to avoid feelings
EX: get bad diagnosis & become obsessed w/ it
37
Explain rationalization defense mechanism
- offering socially acceptable explanation to justify feelings or behaviors
EX: cheating academically
38
Explain reaction formation defense mechanism
conscious attitudes that are opposite of true feelings
EX: someone who unexpectedly got pregnant & then becomes super mom
39
Explain repression in defense mechanism
INVOLUNTARY exclusion of painful thought
EX: can't remember something terrible that happened to them
40
Explain suppression defense mechanism
VOLUNTARY exclusion of painful thoughts
EX: suspects cheating but ignores the signs
41
Explain undoing defense mechanism
communication negates a previous one
EX: gossiping about friend & then being super nice next time u see that friend
42
S&S of Separation Anxiety Disorder
- gastro issues
- headaches
- don't sleep
- usually before age 18
symptoms present for at least 1 month
43
S&S of Panic Disorder
- palpitations
- SOB
- feelings of suffocation
- chest pain
- fear of dying
- chills or hot flashes
- nausea
- depersonalization
- paresthesia
44
S&S of Agoraphobia
- anxiety about being in places or situations where escape can be difficult or embarrassing
- avoidance behaviors
- impaired ability to work
- impaired ability to perform duties
45
S&S of Specific Phobia
- persistent, irrational fear of specific object or situation
-immediate anxiety response
- interferes w/ normal routines
- avoiding doing things
46
S&S of Social Anxiety (Social Phobia)
- avoidance behavior
- blushing
- tachycardia
47
S&S of GAD (Generalized Anxiety Disorder)
- aches & pains
- muscle tensions
- headaches
- fatigue
- restlessness
- poor concentration
- poor decision making
- irritability
- sleep disturbance
- physical complaints
48
S&S for OCD
- impairs w/ functioning in life
- interferes w/ life
49
S&S Body Dysmorphic Disorder
- significant distress
- impaired in functioning
- feel disgust
- feel shame
- feel dression
50
S&S for Hoarding Disorder
- impairment in normal living
51
S&S for Hair Pulling & Skin Picking Disorders
- picking decreases anxiety
52
Biological Factors for Anxiety
- genetics
- dysfunction of amygdala
- GABA system
-serotonin system
- general health
53
Psychological Factors for Anxiety
- early life experiences
- learned response
- distorted thoughts
- low resilience
54
RN Interventions for Anxiety
- physical exam
- assess current level of anxiety & safety
- establish trusting relationship
- therapeutic communication
- physical presence
- self assessment
- encourage activity
- assist w/ nutrition, hygiene, sleep
- identify defense mechanism
- cognitive restructuring
- education
- signs & triggers
- stress management
- medications
55
Several & Panic Level Interventions
- maintain safety
- decrease stimulation
- stay with pt
- stay calm
- physical activity
- administer antianxiety med
56
Benzodiazepines
Prototype: Alprazolam (Xanx)
Used for:
- panic disorder
- GAD
- insomnia
- alcohol withdrawal
- muscle relaxation
- seizure disorder
- agitation
ADRs:
- CNS depression - ataxia sedation, dizziness, amnesia w/ large doses
- use of alcohol is life threatening
MOA:
- decreased cell excitation = calm
- fast & effective
- high TI
Antidote:
- Flumazemil (Romazicon)
-AZE, - ZOLAM, - ZEPAM
- short term tx
- don't stop med abruptly
- highly addictive
- most widely used
57
Buspirone (Buspar)
- anxiety only
- no addictive potential
- no sedation
Used for:
- panic disorder
- OCD
- SAD
- GAD
ADRs:
- dizziness
- nausea
- headache
- lightheadedness
- agitation
MOA:
- works like an antidepressant
- binds to serotonin & dopamine receptors
- takes 2-6 weeks for full effect
- must be taken regularly (2-3x/day)
58
SSRI & SNRI
- long term
- does not combine w/ MAO-Is & St. Johns Wort
Used for:
- 1st tx for anxiety disorders
ADRs:
- Serotonin syndrome - tremors, muscle rigidity, mental changes, increased HR BP & temp
- Sexual dysfunction
- Stomach issues
- Swollen (weight gain)
MOA:
- similar to depression
- inhibit reuptake of NT= more NT
- take 4 to 8 weeks for full effect
- stay on med for at least a year
59
Identify S&S of major depression & persistent depressive disorder
- diminished ability to think, concentrate, indecisiveness
- insomnia or hypersomnia
- weight loss or gain
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings or worthlessness or guilty
- recurrent thoughts or death or suicidal ideation
60
Identify risk factors for major depression
- past episodes of depression
- family history
- female gender
- over age 65
- stressful life events
- medical illness
- postpartum period
- lack os social support
- unmarried
- current substance abuse
No specific factors for ethnicity, education, income
61
Describe appropriate RN interventions for patients w/ depression
- self assessment
- assess suicidality
- safety
- provide hope
- respond w/ empathy & compassion
physical activity & social interaction
- education
involve family in tx
- develop insight into negative thinking
62
State the indications for benefits of & ADRs of ECT
- works faster than antidepressants
- no or poor response to med
- marked agitation, negative symptoms or catatonia
ADRs:
- general anesthesia risk
- cardiovascular
- systemic: headache, drowsy, sore muscles
63
Identify appropriate candidates for ECT
- severe depression
- catatonic schizophrenia
- acute mania
64
Describe RN interventions for the pt receiving ECT
- ventilate pt
- monitor vital signs
- observe pt every 15 mins
- assess mental status every 30 mins
- assist pt to resume normal activities
- treat ADRs
65
Side Effects of Lithium
- GI distress
- fine hand tremor
- polyuria, thirst
- weight, gain
- bradydysrhythmias
- hypotension
- electrolyte imbalances
- fatigue, lethargy, headache, mental dullness
- renal effects
- hypothyroidism w/ long term tx
66
MOA of Bupropion
- blocks reuptake of dopamine & norepinephrine
- inhibits nicotonic acetylcholine receptors
67
Prototype of SSRI meds
Fluoxetine (Prozac)
68
3 uses of Bupropion
- depression
- seasonal depression
- smoking cessation
- adult ADHD
69
ADRs of Bupriopion
- headache
- decreased appetite
- weight loss
- restlessness
- tremor
- insomnia
- decreased seizure threshold
70
ADRs of tricyclic antidepressants (TCA's)
- cardiac dysrhythmias
- heart block
- sedation
- anticholinergic effects
- ortho hypotension
- increased appetite
- excessive sweating
- decreased seizure threshold
71
How often & when tricyclics antidepressants should be taken
once a day at night since it causes sedation
72
MOA of tricyclic antidepressants
- block reuptake of serotonin & norepinephrine (dual action)
73
Prototype of MAO-I meds
Phenelzine (Nardil)
74
Common ADR reactions of MAO-Is
- anxiety
- agitation
- ortho hypotension
- drowsiness
- anticholinergic effects
75
Food interactions with MAO-Is
- avoid foods high in tyramine
- avoid aged cheese
- avoid pickled & smoked fish
- wine
- beer
- avoid fermented foods
- avoid smoked & cured meats
- avoid overripe fruits
76
Drug interactions with St.Johns Wort
- antidepressants
- busprione
- meperedine
77
Common symptoms of HTN Crisis
- sudden increased BP & HR
- N&V
- headache often occipital
- diaphoresis
- decreased LOC
78
RN interventions for HTN Crisis
- early identification of S&S
- stop med
- don't lie flat
79
TI range of lithium
0.8-1.4 mEq/L
80
Appropriate fluid intake for lithium
1.5 liters a day
81
How often pts should get lithium level checked when its first started
initially every 2-3 days & then every 3-6 months
82
Meds to avoid when taking lithium
Ibuprofen
NSAIDs
Diuretics
take Tylenol or ASA instead
83
What are the anticonvulsant mood stabilizer meds
- Valporate (Depakote)
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
84
What lab must be monitored in pts taking valporic acid
- liver function b/c it can be liver toxic
85
Advantages of anticonvulsant mood stabilizer meds over lithium
- less ADRs
- wide TI index
86
Describe the characteristics of the different phases & stages of a therapeutic group
87
Identify the 3 types of group roles
Task: focused on purpose/work of group
- coordinator
- elaborator
-energizer
- info giver/seeker
Maintenance: create cohesion
- encourager
- harmonizer
- gatekeeper
- follower
- observer
- standard setter
Individual: distract from work of group
88
Describe therapeutic factors of group therapy to Irvin Yalom
- imparting of info
-universality
- altruism
- socializing techniques
- instillation of hope
- corrective reenactment
- interpersonal learning
- existential factors
- catharsis
- group cohesiveness
