1
Q
1) What is Akathisia
A
Inability to sit still or restlessness and is more common in middle-aged patients. Person will pace, rock while sitting or standing, march in place, or corss and uncross the legs. All of these repetitive motions have an intensity that is frequently beyond the explanation of the individual. In addition akathisia may be present as a primarily subjective experience without motor behavior. The subjective experience includes feelings of anxiety, jitterness, or inability to relax, which the individual may or may not be able to express. Most difficult acute medication-related movement disorder to relieve. Pathology may involve more than just extrapyramidal motor system. A number o medications used to reduce symptoms include beta-andrengeric blockers, anticholinergics, antihistamines, and low dose antianxiety agents. Physical and psychological stress appear to increase the symptoms and frighten pt. Risk factors for extrapyramidal symptoms (EPS) include previous episodes of EPS
2
Q
2) What is Echoalia
A
Repetition of another’s words that is parrot-like and inappropriate
3
Q
3) What is Referential Thinking
A
Belief that neutral stimuli have special meaning to the individual, such as the television commentator speaking directly to the individual.
4
Q
4) Study extrapyramidal side effects of Antipyschotic medications and treatment for
A
- Parkinsonism: tends to occur in older pts. Symptoms believed o be caused by blockade of D2 receptors in basal ganglia that throws off Ach and dopamine. Increases Ach transmission. Symptoms managed by reducing dosage of antipsychotic or adding an anticholinergic drug such as benzotropin or trihexyphenidyl
- Abrupt discontinuation of anticholinergic can cause cholinergic rebound and result in withdrawl symptoms (nausea, vomiting, sweating, dreams/nightmares). Drug should be tapered.
- Dystonic reactions believed to result from imbalance of dopamine and Ach. Young men more vulnerable to extrapyramidal side effects. Starts with oculogyric crisis (eye movement control tense and pull eyes to ceiling), torticollis (neck pulled to side) retrocollis (head pulled back) orolaryngealpharyngeal hypertonus (extreme difficulty swallowing), contorted extremities. Immediate treatment is administration on benzotropine or diphenhydramine (Benadryl) followed by daily admin of anticholinergic drugs and decrease in antipsychotic
- Akathisia: restless and feel driven to keep moving. Response misinterpreted as anxiety or increase in psychotic symptoms (potential to be given increase in antipsychotics)
- Tardive dyskinesia, tardive dystonia, tardive akathisia: less likely but possible to appear in second generation antipsychs rather than first generation. Tardive dyskinesia late-appearing abnormal movements involve mouth, tongue, jaw, lip smaking, tongue protrusion
- No consistently effective treatment but antipsychotics ask movements of tardive dyskineasia Best management is using lowest possible dose of antipsychotics that minimizes symptoms
5
Q
5) Study Neuroleptic Malignant Syndrome
A
Develops from reaction to antipsychotic medications. Develop severe muscle rigidity with elevated temp and cascade of symptoms (within next 48-72 hrs) and include 2 or more of following: hypertension, tachycardia, tachypnea, diaphoresis, incontinence, mutism, leukocytosis, change in LOC, and lab evidence of muscle injury (incrase creatinine phosphokinase). Most imp aspect of nursing care is early symptom recognition, holding dopamine-blocking antipsychotics and supportive care. Carefully monitor I&O and electrolyte status. Treatment includes admin of dompamine agonist (bromocriptine) and muscle relaxants (dantrolene and benzodiazepine). Some pts see improvement with ECT. Treating temp a priority
6
Q
6) Study Anticholinergic Crisis
A
Caused by overdose or sensitivity to drugs with anticholinergic properties. May result from OD of antimuscarinic drugs (atropine, scopolamine, or belladonna). Drugs prescribed in psychiatric setting include TCAand antipsychotics. May produce acute delirium or reaction resembling schizophrenia. Characterized by: elevated temp, parched mouth, burning thirst, hot dry skin, decreased salivation, decreased bronchial and nasal secretions, dilated eyes, increased HR, constipation, htn or hypotension. May be flushed and experience neuropsychiatric symptoms of anxiety (agitation, delirium, hyperactivity, confusion, hallucination, seizures). Typically self-limiting, usually subside within 3 days. After use of drug d/c, improvements generally follow with 24-36 hrs
7
Q
7) Review the communication technique of Reflection
A
?
8
Q
8) Study the neurotransmitter-Acetylcholine
A
Primary cholinergic neurotransmitter. Greatest concentration in PNS. Provides basic synaptic communication. Important role in learning and memory; some role in wakefulness and basic attention; peripherally activates muscles and is major neurotransmitter of the ANS; involved in higher intellectual functioning and memory. Role in communicating emotional state
9
Q
9) Review Diazepam and side effects
A
Side effects typically areise within 2-3 weeks after medication begins. Side effects include: appetite suppression, insomnia, irritability, weight loss, nausea, headache, palpitations, blurred vision, dry mouth, constipation, and dizziness. Some experience BP changes, tachycardia, tremors, irregular HR. Monitor height and weight in children Avoid in pts with Tourettes syndrome. Symptoms of OD include: agitation, chest pain, hallucination, paranoia, confusion, dysphoria, seizures with fever, tremor, palpitations, hypo-/hypertension, rashes, aggression, difficulty breathing, leg and abd pain. Toxic dose above 20 mg.
10
Q
Study Clozaril (Clozapine) adverse effects
A
- Antipsychotic; Interferes with dopamine receptor binding with lack of EPS. Acts as adrenergic, cholinergic, histaminergic, sertonergic antagonist
- used for management of schizophrenic pts for whom other antipsychs have failed; recurrent suicidal behavior
- Black Box Warning: Severe CNS depression, hypotension, myocarditis
- Can be taken w/ or w/o food. Confirm PO med swallowed and monitor for hoarding of med
- Side effects: Neuroleptic maglignant syndrome, seizures, leukopenia, agranulocytosis, eosinophilia, death w/ dementia pts EPS
11
Q
Study symptoms of Tardive Dyskinesia
A
Involves irregular, repetitive involuntary movements of mouth, face, tounge. Begin no earlier than 6 months after med began or when med is reduced/withdrawn. May be irreversible Prevention includes using lowest dose of typical antipsychs and usage of atypical antipsychs. Risk factors include: age over 50, female, affective disorder (depression), brain damage/dysfunction, increased duration of treatment, standard antipsych med
12
Q
Review the medication Lithium
A
Gold standard in bipolar pharmacologic treatment; indicated for manic symptoms (rapid speech, flight of ideas, irritability, grandiose thinking, impulsiveness, and agitation). Also used as augmentation in pts with major depression that only partially respond to antidepressants. Actively transported across cell membranes and alters Na transport in nerve and muscle cells. Leads to increased storage of catecholapines, reduced dopamine, increased norepipinephrine, increased GABA activity, and increased serotonin sensitivity. Assess: mental status, sodium intake (decreased intake with decreased fluids can lead to lithium retention; increased sodium, fluids may decrease lithium retention)
13
Q
Study Tricyclic Antidepressants and Serotonin Syndrome
A
- Just as effective as other antidepressants but more serious side effects and higher lethal potential.
- Act on variety of neurotransmitter (norepinephrine and sereotonin reuptake system)
- Common side effects: sedation, orthostatic hypotension, anticholinergic side effects.
- Other side effects: tremors, restlessness, insomnia, n/v, confusion, edema, headache, seizures, blood dyscrias, fever, sore throat, malaise and rash.
- May produce symptoms of NMS and mild forms of EPS
14
Q
Study herbal supplements and depression
A
Regulated like foods, not meds and exempt from FDA efficacy and safety standards. Often have adverse reactions and interact with Rx meds. St. John’s Wort (SJW) used for depression, pain, anxiety, insomnia, and PMS. Believed to modulate serotonin, dopamine and norepinephrine. Risk for developing serotonin syndrome increases with other serotonergic drugs. Should not be taken with antidepressants.
15
Q
15) Study indication of use for Antipsychotics
A
Indicated for schizophrenia, mania and autism and to treat symptoms of psychosis (hallucinations, delusions, disorganized thinking, agitation, bizarre behavior)
16
Q
Review what Oculogyric crisis
A
Muscles that control eye movement tense and pull eyeball so pt is looking at ceiling.
17
Q
Review Clozaril (Clozapine) and monitoring of side effects
A
- Assess: I&O, hypotension, EPS (akathisia, tardive dyskinesia, pseudoparkinsonism) NMS, constipation.
- Interactions: weak inhibitors include antidepressants (fluvoxamine,j nefazodone, and norfluoxetine) Potent inhibitors include ketoconazole, protease inhibitors, erythromycin. If used with carbamazepine, dose should be increased. Antidepressants (fluoxetine and paroxetine) can increase level of antipsych
18
Q
Review Disordered Water Balance
A
May go undetected for months or years. Ingesting large amounts of water over prolonged period leads to ccomplications such as: renal dysfunction, incontinence, cardiac failure, malnutrition, permanent brain damage. Can progress to water intoxication when kidney’s capacity is overwhelmed and serum sodium falls below 120 (Symptoms of muscle twitching, irritability; risk for seizures, coma, or death). Pts are “driven to drink” and may consume 4-10 L/ day. May drink from fountains, showers, or toilets. Frequent trips to bathroom. Responses to fluid restrictions: emotional, increased psychotic symptoms, irritability, lability. Caused by changes in sodium levels
19
Q
Review Antipsychotic Drugs-first and second generation on page 353 (table
A
?
20
Q
Study Schizoaffective Disorder and Risk factors
A
Varying degrees of schizophrenia and mood disorders. Pts at risk for suicide. Pts with psychosis are increased risk with comorbid depression. Risk factors for suicide increase with use of alcohol/substances, cigarette smoking, previous suicide attempt, and hospitalization. Lack of regular contact may be long term risk.
21
Q
Review Borderline Personality Disorder and wrist cutting
A
Pts with BPD are impulsive and may respond to stress by harming self. Self-harm is effort to self-soothe by activating endogenous endorphins. Linehan suggests Five Senses Exercise:
- Vision- go outside and look at star or flowers or leaves
- Hearing- listening to invigorating music or sounds of nature
- Smell- light a scented candle, boil a cinnamon stick in water
- Taste- drink soothing, warm, nonalcoholic beverage
- Touch- take a hot bubble bath, pet dog or cat, get a massage
22
Q
Study Paranoid Personality Traits
A
Traits are longstanding suspiciousness and mistrust of persons in general. Refuse to assume personal responsibility for feelings, assign responsibility to others, and avoid relationships in which they are not in control or lose power. Pts are suspicious, guarded and hostile. Actions of others misinterpreted as deception, depreciation, and betrayal. Often unforgiving and hold grudges. Distance self from others. Persistent ideas of self-importance and tendency to be rigid and controlled
23
Q
Know the most common indicator for ECT:
A
Most effective treatment for sever depression, also used for mania, schizophrenia (when other treatments failed).
24
Q
Know common aftereffects of ECT
A
Headache, nausea, muscle pain. Memory oss is long-term effect
25
Know contraindications of ECT
Contraindicated in pts with increased intracranial pressure. Risk increases in pts with myocardial infarction, cerebrovascular event, retinal detachment, pheochromocytoma, pts at high risk for complications from anesthesia
26
Review Narcissistic Personality Disorder: Clinical Course and Diagnostic
Criteria on pages 526-527
Traits are grandiose, have inexhaustible need for admiration, and lack of empathy. Starting in childhood, they believe they are superior, special, or unique. Preoccupied with fantasies of unlimited success, power, beauty, or ideal love. Overvalue personal worth, direct affection towards themselves, and expect to be held in high esteem. Overlapping characteristics of BPD and ASPD
27
27) Review suicide and suicide attempt
Voluntary act of killing oneself. Fatal, self-inflictive destructive act with explicit or inferred intent to die. Suicide attempt is a nonfatal, self-inflicted destructive act with explicit intent to die. . Most completed suicides occur during the first year after hospitalization for a failed attempt.
28
Review Priority care issues and suicide
First priority is pts safety with least restrictive care. Risk of suicide is always present in those having a depressive or manic episode. Hospitalization should be reserved for those whose safety cannot be ensured in outpatient setting.
29
Review Diagnostic Criteria for Dysthymic Disorder
Milder but more chronic major depressive episode (either a depressed mod or a loss of interest or pleasure in nearly all activities for at least 2 weeks) and is diagnosed when the depressed mood is present for most days for at least 2 years with 2 or more of the following: poor appetite or overeating, insomnia or oversleeping, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.
30
Review Tricyclic Antidepressants and suicide risk
TCA are contraindicated because lethal dose is only 3-5 times greater than therapeutic dose. Most common effects are antihistamine (sedation and weight gain) and anticholinergic (potentiation of CNS drugs, blurred vision, dry mouth, constipation, urinary retention, sinus tachy, and decreased memory) side effects. Serum levels should be evaluated when overdose is suspected. Basic OD treatment includes induction of emesis, gastric lavage, and cardioresp. supportive care.
31
Study Depressive Disorder and assessment
Biologic assessment must include a physical ROS and though hx of medical problems with special attention to CNS fx, endocrine fx, anemia, chronic pain, autoimmune illness, diabetes, or menopause. Additional medical history includes: surgeries, hospitalizations, head injuries, loss of consciousness, pregnancies, childbirths, miscarriages and abortions. Complete list of Rx and OTC meds. Physical exam useful in establishing a baseline. Also includes evaluating patient for characteristic of neurovegetative symptoms: appetite and weight change, sleep disturbances, and decreased energy, tiredness, and fatigue.
32
Study Serotonin Syndrome
?
33
What is anhedonia
Loss of interest or pleasure. May report not caring anymore, have decrease in libido, irritability and anger.
34
Review Bipolar Disorder and priority Care Issues
Safety is a priority Risk of suicide is always present in those having a depressive or manic episode. During depressive episode, pt may feel life is not worth living. During manic episode, poor judgment and impulsivity lead to risk-taking behaviors.
35
35) Review Body Dissatisfaction
Pt begins to compare body with others. Results from comparison, own body falls short of ideal, may be dissatisfied about weight, shape, size, or certain body part. Body becomes overvalued as way of determining one’s worth. Body dissatisfaction strongly associated with low self-esteem
36
Review Anorexia Nervosa and Comorbidity
Depression is common and at risk to attempt suicide. Anxiety disorders such as OCD, phobias, and panic disorders are associated with anorexia nervosa. OCD is often a causative factor in AN
37
Review the characteristics of Bulimia Nervosa
More prevalent than AN and generally older at age of onset than in AN. Individuals often binge and purge in secret and normal weight. Treatment can be delayed for years. Pts typically recover completely except in cases in which personality disorders and comorbid serious depression is present. Often overwhelmed and overly committed individuals, “social butterflies,” difficulty setting limits and establishing appropriate boundaries. They have enormous number of rules regarding food and food restriction. They feel shame, guilt, and disgust over binge eating and purging.
38
Review Nursing diagnosis for anorexia nervosa and the biologic domain
Imbalanced Nutrition: Less Than Body Requirements
39
A nurse assess a client with alcohol withdrawl. Which finding is most concerning to the nurse?
1. Hallucinations
2. Nervousness
3. Diaphoresis
4. Nausea
Hallucinations
40
. The nurse is assessing a client with prolonged chronic alcohol intake. Which of the following findings would the nurse expect?
1. Enlarged liver
2. Nasal irritation
3. Muscle wasting
4. Limb paresthesia
Enlarged liver
41
A client has an order for chlordiazepoxide (Librium) to be giver as needed for signs and symptoms of alcohol withdrawl. Which symptoms indicate that the client needs this medication?
1. Mild tremors, htn, tachycardia
2. Bradycardia, hyperthermia, sedation
3. Hypotension, decreased reflexes, drowsiness
4. Hypothermia, mild tremors, slurred speech
Mild tremors, htn, tachycardia
42
A client who abuses alcohol tells a nurse, “Alcohol helps me sleep.” Which information about alcohol and sleep is most accurate
1. Alcohol doesn’t help promote sleep
2. Continued alcohol use causes insomnia
3. One glass of alcohol at dinnertime can induce sleep
4. Sometimes alcohol can make one drowsy enough to fall asleep
Alcohol doesn’t help promote sleep
43
8. A client withdrawing from alcohol is given lorazepam (Ativan). The nurse teaches the client’s family about the drug. Which response by a family member indicates that the nurse’s teaching has been successful
1. “Short-term use of lorazepam can lead to dependence”
2. “The lorazepam will reduce the symptoms of withdrawl”
3. “The lorazepam will help him forget about symptoms of withdrawl”
4. The lorazepam will also help him with heart disease”
“The lorazepam will reduce the symptoms of withdrawl”
44
. A client who abuses alcohol tells a nurse everyone in his family has an alcohol problem and nothing can be done about it. Which response is most appropriate?
1. “You’re right. It’s much harder to become a recovering person”
2. “This is just an excuse for you so you don’t have to work on becoming sober”
3. “Sometimes nothing can be done but you may be the exception in the family”
4. “Alcohol problems can occur in families, but you can decide to take the steps to become and stay sober.”
4. “Alcohol problems can occur in families, but you can decide to take the steps to become and stay sober.”
45
10. A client with chronic alcoholism ma be predisposed to develop which of the following conditions?
1. Arteriosclerosis
2. Heart failure
3. Heart valve damage
4. Pericarditis
Heart failure
46
Study questions 45-46 (pg 238) in Substance disorder NCLEX handout posted on content page under Addiction section.
a. 45. A client experiencing amphetamine withdrawal may commonly experience which of the following symptoms?
1. Disturbed sleep
2. Increased yawning
3. Psychomotor agitation
4. Inability to concentrate
Disturbed sleep
47
Which condition can occur in a client who has just used cocaine?
1. Tachycardia
2. Hyperthermia
3. Hypotension
4. Bradypnea
Tachycardia
48
Which test might be ordered for a client with a hx of cocaine abuse who exibits behavior changes following a return from an inpatient treatment facility?
1. Antibody screen
2. Glucose screen
3. Hepatic screen
4. Urine screen
Urine screen
49
. A nurse is assessing a pt with a hx of substance abuse who has pinpoint pupils, a HR of 56 bpm, a RR of 6 breaths/min, a temp of 96.4. Which substance should the nurse determine is most likely cause of client’s symptoms?
1. Opiods
2. Amphetamines
3. Cannabis
4. Alcohol
Opiods
50
Which intervention is the highest priority in planning care for a pt recovering from cocaine use?
1. Skin care
2. Suicide precautions
3. Frequent orientation
4. Nurtrition consultation
Suicide precautions
51
Review Panic Disorder and use of Benzodiazepine Therapy
Benzodiazepines are tremendously useful in treating intensely distressed pts. Alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) widely used for panic disorders. Risk for withdrawal symptoms upon discontinuation. Still commonly used for panic disorders even though SSRI’s are recommended for first-line treatment of a panic disorder.
52
Review Panic Disorder and nursing interventions
?
53
Study the paragraph: Overview of Anxiety Disorders
Most common of psychiatric illnesses treated by HCP. Women experience more often than men. Strong relationship between depression and anxiety disorders. Anxiety disorders tend to be chronic and persistent illnesses with full recovery more likely among those w/ out comorbidities.
54
What is Arachnophobia
Fear of spiders
55
Understand compulsive behaviors in those with OCD. Review Human Response to OCD on page 474. Also, know the difference between obsessions and compulsions.
Obsessions create tremendous anxiety, and pt perform compulsions to relieve the anxiety temporarily. If ritual is not performed, the person feels increased anxiety and distress Compulsions are necessary, not pleasurable. They are often recognized as strange or odd by pt. Initially there are attempts to resist behavior but eventually resistance fails and behaviors are incorporated into daily routines. Most common obsession is fear of contamination and resulting compulsion is hand washing. Shame and disgust linked with embarrassment and guilt often experienced
56
What is Neurasthenia
Cultural bound syndrome (Asian American) characterized by fatigue, weakness, poor concentration, memory loss, irritability, aches, apins, sleep disturbances or hwa-byung “suppressed anger syndrome”
57
Review Psychosocial Aspects of Chronic Pain
Impacts one’s quality of life. Mood,j coping skills, interpersonal relations, and financial and social resources affected. Preoccupation with pain becomes a daily burden. Demoralization, sadness, loss of interest in life, feelings of worthlessness, self-reproach, excessive guilt, indecisiveness, and suicidal ideation associated w/ chronic pain.
58
51) Review Mental Health Consequences of Violence, specifically what symptoms should be assessed for in someone who has been physically neglected
Victims of emotional Intimate Partner Violence (IPV) and alcohol abuse increases the risk for depressive symptoms and being a victim of sexual abuse increases risk of depression and PTSD. Abused children experience intrusion, abandonment, devaluation or pain in the relationship with the abuser instead of closeness and nurturing that are normal for intimate relationships. Intimacy is associated with shame and fear rather than warmth and caring and concerns about dominance and submission rather than mutuality Shame is associated with submissive, feeling devalued, and desire to retaliate against person seen as source of humiliation
59
Study providing education and leaving an abusive relationship
Education is a key nursing intervention for survivors. Survivors understand cycles of violence and dangers of homicide that increases as violence escalates or survivor attempts to leave relationship. Survivors need information about resources (shelters, legal services, government benefit, and support networks). Before giving survivor written info, discuss possibility of perpetrator finding possessions and may use as excuse for battering. Need education appropriate for age and cognitive ability about symptoms of anxiety, depression, dissociation and PTSD. First step is developing a plan to help survivor recognize danger. Next step is devise escape route
60
Study Intimate Partner Violence, knowing the gender difference
Approximately 70% victims killed by intimate partner violence are women. On average, more than 3 women are murdered each day. In cases of murder suicide, women are more likely to be vicims. African American women are twice as likely as white women to be killed by spouses and 4 times as likely to be murdered by boyfriends. Exposed to higher and more severe levels of violent trauma. Women are sometimes so used to being in abusive situations that they do not recognize degree of danger they are facing. IPV is highly associated with suicide. Also develop PTSD, which increases suicide risk. Also higher risk for HIV infection. Abused women 4 times more likely to have sex with risky partners.
61
Stalking is a crime of what
Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency. Crime of intimidation. Stalkers harass and terrorize victims through behaviors that cause fear or substantial emotional distress.
62
Study the paragraph related to CSSD and comorbidity
Complex Somatic Symptom disorder, pts perceive themselves as being “sicker than sick” and report all aspects of health as poor. CCSD frequently coexists with other psychiatric disorders, commonly depression and anxiety. Others include: panic disorders (OCD), psychotic disorders, and personality disorders. Older adults particularly high for comorbid depression. Numerous unexplained medical problems also coexist with this disorder (because ptsrecieve medical/surgical treatments unnecessarily). Disproportionate number women are treated with IBS, polycystic ovary disease, and chronic pain.
63
What are the indications that someone may be experiencing CSSD, review
the clinical course paragraph
May perceive themselves as sicker than sick and report all aspects of their health as poor. Many eventually become diabled and cannot work. Typically visit HCP multiple times an month and become frustrated when HCP doesn’t appreciate level of suffering. People with CCSD often provider shop until given new meds, hospitalized, or surgery performed. Source of physical symptoms can’t be seen through medical or lab tests.
64
```
For women diagnosed with CSSD, what should the focus of group therapy
be on (p. 548-group interventions)?
```
Pts benefit from cognitive behavior groups that focus of coping skills. Most pts are women, so treatment addresses feminist issues and should e encouraged to strengthen their assertiveness skills and improve low-self esteem. Redirection helps pt from giving too much information.
65
58) Know the definition of Body Dysmorphic Disorder
Pts focus on real (but slightly) or imagined defects in appearance, such as large nose, thinning hair, or small genitals. Preoccupation causes significant distress and interferes with ability to function socially. Feel self-conscious and fear ugly body part will malfunction. Surgical procedure to correct problem doesn’t correct distress or preoccupation.
66
Know the definition of Factitious Disorder
Pts intentionally cause illness or injury to receive attention or health care workers. Motivated soley by desire to become a pt and develop dependent relationship with HCP.
67
What is Munchausen’s syndrome by proxy
Involves a person who inflicts injury on another person. Commonly a mother who inflicts injuries on child to gain attention of HCP through child.
68
Review the section related to pain under review of systems, focusing on
how to perceive someone who has Somatic Disorder and is having pain,
Pain is the most common problem in people with CSSD. Pain is usually r/t symptoms of all major body systems, it is unlikely that a somatic intervention (like analgesic) will be effective on long-term basis. No medical explanation for the pain. But pain is real and has serious psychosocial implications. Ask the following questions:
• What is the pain like?
• What is the extent of the pain?
• What helps the pain get better?
• When is the pain at its worst?
• What has worked in the past to relieve pain?
69
62) Review Body Dysmorphic Disorder as it relates to depression and suicide
The risk for depression, suicide ideation, and suicide is high. The lifetime suicide attempt rate is estimated at 22-24%
70
63) What is the most difficult aspect of providing care to a patient with CSSD
The most difficult aspect is developing a sound, positive nurse-patient relationship. Yet this relationship is crucial.
71
64) What nursing diagnosis would most likely by identified as a priority for
someone with Body Dysmorphic Disorder
Disturbed Body Image
72
Review the effects of the medication, Naltrexone
It can reduce cravings, help maintain abstinence and interfere with tendency to want to drink. It can cause seiures, ventricular tachycardia, fibrillation, hypo/hypertension, cardiac arrest, sinus tachycardia, hepatotoxicity, pulmonary edema
73
Know the long-term effects from inhalant use (p. 603-Long-term
Complications).
Long-term inhalant use is linked to widespread brain damage and cognitive abnormalities. More inhalant users than cocaine uses had brain abnormalities and damage more extensive. Also performed worse on working memory and ability to focus attention, plan and solve problems. Withdrawal syndrome is similar to alcohol but primary symptoms include anxiety, tremors, hallucinations, and sleep disturbances.
74
What does successful smoking cessation usually require
Usually requires more than one type of intervention including social support and education. Two meds approved for cessation. The antidepressant bupropion helps people with smoking cessation. Auricular therapy is a potential adjunctive treatment for nicotine addiction.
75
What is Korsakoff’s syndrome (p.593)? (How does it differ from Wernickes)
Involves the hart, vascular and nervous system but primary problem is acquiring new information and retrieving memories. Wernickes is a degernerative brain disorder caused by thiamine deficiency.
76
68) What is invincibility fable
An aspect of egocentric thinking in adolescence that causes teens to view themselves as immune to dancgerous situations, such as unprotected sex, fast driving, and drug abuse.
77
For a child that has been sexually abused, what is the priority for the nurse
(p.676-Evaluation of childhood sexual abuse)?
Nurse must establish a safe and supportive environment in which to conduct the evaluation. Second, nrse needs to understand forensic implications of court hearing
78
How does Asperger Syndrome differ from Autism Disorder
Also characterized by sever and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities. Have social deficits with inappropriate initiation of social interactiosn. (Autism: makred impairment in reciprocal social interaction and verbal and nonverbal communication with restrictive and repetivie activities and interests.
79
71) Review the definition of Dyslexia
Reading disability defined as significantly lower score for mental age on standardized tests in reading that is not the result of low intelligence or inadequate schooling.
80
What is cultural identity
Set of cultural beliefs with which one looks for standards of behavior.
81
73) What medications are used to treat Attention Deficit Hyperactivity Disorder (p. 688-Using Pharmacologic Interventions)?
The first-line recommended medications for ADHD symptoms are the psychostimulants and atomoxetine (Strattera). It is not unusual for two psychostimulants or a psychostimulant and atomoxetine to be prescribed together for maximum response. Second-line medications include bupropion (Wellbutrin) and other antidepressants (tricyclic antidepressants [TCAs]). Then, if symptoms are not improved, alpha agonists (guanfacine or clonidine) are usually used
82
Conduct Disorders are sometimes referred to as (p. 696- Disruptive
Behavior Disorders)?
Disruptive behavior disorders, which include oppositional defiant disorder and conduct disorder, are a group of syndromes marked by significant problems of conduct. Because these disorders are characterized by “acting out” behaviors, they are sometimes referred to as externalizing disorders.
83
75) Know the neurological symptoms of conversion disorder
Conversion disorder, a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms, be renamed functional neurologic symptoms. Patients have neurologic symptoms that include impaired coordination or balance, paralysis, aphonia (inability to produce sound), difficulty swallowing or a sensation of a lump in the throat, and urinary retention. They also may have loss of touch, vision problems, blindness, deafness, and hallucinations. In some instances, they may have seizures.
84
76) Review definition of Hypochondriasis
Individuals are fearful of developing a serious ill-ness based on their misinterpretation of body sensations. The fear of having an illness continues despite medical reassurance and interferes with psychosocial functioning. They spend time and money on repeated examinations looking for feared illnesses. For example, an occasional cough or the appearance of a small sore results in the person making an appointment with an oncologist.
85
Review the Fight or Flight Response and sympathetic nervous stimulation on page 270-271.
The riskier the situation, the more intense is the physiologic response. When the brain (amygdala and hippocampus) interprets an event as a threat, the hypothalamus and autonomic nervous system are signaled to secrete adrenaline, cortisol, and epinephrine. These hormones activate the sympathetic nervous system, physiological stability is challenged, and a “flight or fight” response occurs. Heart rate, blood pressure, and blood sugar increase. Energy is mobilized for survival. As the sympathetic system is activated, the parasympathic is. After there is no longer a need for more energy and the threat is over, the body returns to a state of homeostasis.
86
Describe uncomplicated grief
Uncomplicated Grief: painful and disruptive. Person may have physical response (tightening throat, SOB, empty feeling in abdomen). A sense of unreality sets in and there is increased emotional distance. Gradually accept sense of loss as reality.
87
79) `What is another name for Antisocial Personality Disorder (p. 516)?
Term psychopath or sociopath is used when describing a person with ASPD.
88
Review priority-nursing intervention for patients entering detoxification
(593).
Observing for signs of seizure activity is a priority nursing intervention
89
Know what medication to use in an Opioid Intoxication or Overdose
Emergency treatment of individuals with opioid intoxication is initiated with an assessment of central nervous functioning, specifically arousal and respiratory functioning. Naloxone (Narcan), an opioid antagonist, is given to reverse the respiratory depression, sedation, and hypertension. In the presence of physical dependence on opioids, Narcan produces withdrawal symptoms that are related to the dose of Narcan and the degree and type of opioid dependence. When administered intravenously, the effect is generally apparent within 2 minutes. When administered intramuscularly, the effect is more prolonged
90
Review Nursing Diagnosis for Depressive Disorder
Risk for Suicide. Other nursing diagnoses include Hopelessness, Low Self-Esteem, Ineffective Individual Coping, Decisional Conflict, Spiritual Distress, and Dysfunctional Grieving.
91
Review how to interact with individuals with Depression
Interacting with depressed individuals is challenging because they tend to be withdrawn and have difficulty expressing feelings and engaging in interpersonal inter-actions. The therapeutic relationship can be strengthened through the use of cognitive interventions as well as the nurse’s ability to win the patient’s trust through the use of culturally competent strategies in the context of empathy. Cheerleading, or being overly cheerful to a person who is depressed, blocks communication and can be quite irritating. Nurses should avoid approaching patients with depression with an overly cheerful attitude. Instead, a calm, supportive empathic approach helps keep communication open.
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Review Dystonic Reactions and what medication is used to treat (p. 356-357).
Dystonic reactions are also believed to result from the imbalance of dopamine and acetylcholine. The immediate treatment is to administer benztropine (Cogentin), 1 to 2 mg, or diphenhydramine (Benadryl), 25 to 50 mg, intramuscularly or intravenously. This is followed by daily administration of anticholinergic drugs and, possibly, by a decrease in antipsychotic medication. with the latter dominant. Young men seem to be more vulnerable to this particular extrapyramidal side effect. This side effect, which develops rapidly and dramatically, can be very fright¬ening for patients as their muscles tense and their body contorts.
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For Bulimia Nervosa Disorder: Review the pharmacologic interventions, what is the most important concern
Combination of CBT and medication has had the best results. Fluoxetine (Prozac) has been the most studied for bulimia nervosa in clinical trials. Effective doses are usually 60 mg per day, a higher dosage than that used to treat individuals with depression. Sertraline (Zoloft) has also been used effectively as have other SSRIs. These medications, prescribed for binge eating and purging, are effective, decreasing both binge eating and purging episodes even when depression is not present. The most important concern in using these medications is decreased appetite and weight loss during the first few weeks of administration. Weight should be monitored, especially during this period. The intake of medication must be monitored for possible purging after administration. The effect of the medication depends on whether it has had time to absorb.
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Review a client with CSSD Mood patterns in Assessment
The individual’s mood is usually labile, often shifting from extremely excited or anxious to being depressed and hopeless. Response to physical symptoms is usually magnified, such as interpreting a simple cold as pneumonia or a brief chest pain as a heart attack. Family members may not believe the physical symptoms are real and may view them as attention-getting behavior because symptoms often improve when the patient receives attention. For example, a woman who has been in bed for 3 weeks with severe back pain may suddenly feel much better when her children visit her.
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What is agoraphobia
Fear of open spaces
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88) Review Generalized Anxiety Disorder and medications used to provide the quickest relief from anxiety symptoms: pg 481.
The physical symptoms of anxiety and the neurotransmitter systems involved suggest that several medications can be effective in treating GAD. Benzodiazepines are most commonly used, but antidepressants (paroxetine, imipramine, and venlafaxine), buspirone, and β -blockers have all proved effective. Benzodiazepines offer quick relief from anxiety symptoms until the antidepressant therapeutic effects are felt, which may take a few weeks.
97
What is Alexithmia
It’s associated with somatic symptoms disorders. Individuals with alexithymia have difficulty identifying and expressing their emotions. They have a preoccupation with external events and are described as concrete externally oriented thinkers
98
Know the definition of Tourette’s Disorder
Tourette’s disorder, the most severe tic disorder, is defined by multiple motor and phonic tics for at least 1 year. Because no diagnostic tests are used for this disorder, the diagnosis is based on the type and duration of tics. The typical age of onset for tics is about 7 years, and motor tics generally precede phonic tics. Parents often describe the seeming replacement of one tic with another. In addition to this changing repertoire of motor and phonic tics. The child can suppress the tics for brief periods, child has more frequent tics at home than at school. Older children and adults may describe an urge or a physical sensation before having a tic. The general trend is for tic symptoms to decline by early adulthood
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91) What class of drugs would be prescribed for someone experiencing hallucinations and delusions
Antipsychotic drugs have the general effect of blocking dopamine transmission in the brain by blocking D 2 receptors to some degree. Some also block other dopamine receptors and receptors of other neurotransmitters to varying degrees. The second-generation antipsychotic drugs risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), paliperidone (Invega), ziprasidone (Geodon), aripiprazole (Abilify), iloperidone (Fanapt), asenapine (Saphris), and Lurasidone (Latuda) are available in a variety of formulations. They are effective in treating negative and positive symptoms. These newer drugs also affect several other neurotransmitter systems, including serotonin. This is believed to contribute to their antipsychotic effectiveness
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92) Know the Negative and Positive symptoms of Schizophrenia
Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening or loss of normal functions, such as restriction or flattening in the range and intensity of emotion (affective, flattening or blunting ), reduced fluency and productivity of thought and speech (alogia), withdrawal and inability to initiate and persist in goal-directed activity (avolition), and inability to experience pleasure (anhedonia).
