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120 Cards in this Set

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What is the definition of schizophrenia?
A syndrome or disease process of the brain that causes distorted and bizarre thoughts, perceptions, emotions, movements and behavior.
When is schizophrenia usually diagnosed?
In late adolescence / early adulthood (15-25 years old in men; 25-35 years old in women)
What are the hard (positive) symptoms of schizophrenia?
Ambivalence
Associative looseness
Delusions
Echopraxia
Flight of ideas
Hallucinations
Ideas of reference
Preservation
What are the soft (negative) symptoms of schizophrenia?
Alogia (poverty of content)
Anhedonia
Apathy
Blunted affect
Catatonia
Flat affect
Lack of volition
Which cultural group requires a smaller dose of anti-psychotic medication?
Asians (they have more side effects if they take a normal dose)
Conventional anti-psychotic medications target which symptoms?
Only the positive symptoms
Give some examples of "conventional" anti-psychotic medications:
Thorazine
Prolixin
Mellaril
Haldol
Mobane
Stalazine
Atypical anti-psychotic medications target which symptoms?
Both the positive and negative symptoms
List some of the atypical antipsychotics:
Clozaril
Risperdal
Zyprexa
Seroquel
Geodon
Which anti-psychotics are available in a depot injection?
Fluphenazine (Prolixin) and
Haloperidol (Haldol)
List the extrapyramidal side effects caused by antipsychotics:
Dystonic reactions
Pseudoparkinsonism
Akathisia
Are the extrapyramidal side effects reversible? How are they treated?
Yes; they are treated with anticholinergic medications
What are the characteristics of tardive dyskinesia?
*Abnormal, involuntary movements (lip-smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet).
What is neuroleptic malignant syndrome?
A frequently fatal side effect characterized by muscle rigidity, high fever, elevated creatine phosphokinase (CPK)
What should the nurse do if neuroleptic malignant syndrome occurs?
Stop drug immediately
Which anti-psychotic commonly causes agranulocytosis?
Clozapine (Clozaril)
What is required to prevent agranulocytosis in patients who are taking clozapine?
Regular white blood cell counts
What is bipolar disorder?
Mood cycles of mania and/or depression and normalcy
List some of the SSRI antidepressant medications:
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil)
citalopram (Celexa)
List some of the common side effects of SSRI's:
insomnia
weight gain
sedation
constipation
nausea
For whom are the SSRI's usually prescribed?
Patients with mild to moderate depression
List some of the tricyclic antidepressants:
amitriptyline (Elavil)
imipramine (Tofranil)
desipramine (Norpramin)
nortriptyline (Pamelor)
doxepin (Sinequan)
When does effectiveness usually begin with tricyclic antidepressants?
4 to 6 weeks
For whom are tricyclic antidepressants usually prescribed?
Patients with moderate to severe depression
List the atypical antidepressants:
venlafaxine (Effexor)
bupropion (Wellbutrin)
nefazodone (Serzone)
What are the common side effects for the atypical antidepressants?
headache
dizziness
drowsiness
nausea
vomiting
What is trazodone commonly used for in depressed patients?
Used to treat insomnia due to sedation
List the MAOI antidepressant medications:
isocarboxazid (Marplan)
tranylcypromine (Parnate)
phenelzine (Nardil)
MAOI's are used infrequently because they interact with tyramine and cause what condition?
hypertensive crisis
True or False: Overdose on MAOI's is mild
False: these drugs are lethal in overdose
How long does it take to gain maximum effectiveness with MAOI's?
6 weeks
What are the common side effects of MAOI's?
dry mouth
blurred near vision
constipation
urinary retention
sedation
weight gain
orthostatic hypotension
nausea
What are the manifestations of a dystonic reaction?
*Spasms in discrete muscle groups such as neck muscles or eye muscles
*May be accompanied by protrusion of the tongue, dysphagia, and laryngeal/pharyngeal spasm that can compromise airway.
What is the treatment for dystonic reactions?
Benadryl (diphenhydramine)
or Cogentin (benztropine)
What are the manifestations of pseudoparkinsonism?
*Shuffling gait
*Mask-like face
*Continuous muscle stiffness
*Ratchet-like joint movements
*Drooling
*Akinesia (slow/difficult movements)
What are the manifestations of akathisia?
*Restless movement
*Pacing
*Inability to remain still
*Report of inner restlessness
What are some treatments used for akathisia?
Beta-blockers
Benzodiazepines
What are the hallmark symptoms of schizophrenia?
*Hallucinations
*Disorientation
*Concrete or literal thinking
What is the most common form of hallucination in schizophrenic patients?
Auditory hallucinations
What is the 2nd most common form of hallucination in schizophrenic patients?
Visual hallucinations
What are nursing interventions for hallucinations?
*Focusing on reality
*Presenting reality
*Helping pt. identify feelings
*Reality-based activities
*Engaging pt. in environment
*Relaxation techniques
What are the major symptoms of mania?
*Grandiose mood
*Agitation
*Exaggerated self-esteem
*Sleeplessness
*Pressured speech
*Flight of ideas
*Easily distracted
*Intrusive behavior
*High-risk activities
*Poor judgment
What is required to avoid lithium toxicity in patients who are taking lithium?
Regular monitoring of serum lithium levels
What are common side effects of lithium?
*Mild nausea/diarrhea
*Anorexia
*Fine hand tremor
*Fatigue
*Metallic taste in mouth
*Polydipsia
*Polyuria
What are the signs of lithium toxicity?
*Severe nausea/vomiting/diar.
*Severe mental confusion
When is the onset of action for lithium?
2-3 weeks
Which drugs are used for their mood-stabilizing effects in patients with bipolar disorder?
Anticonvulsant drugs (Tegretol, Depakote, Lamictal, Topamax, Trileptal, Neurontin)
Which benzodiazepine is used for its mood-stabilizing effect in patients with bipolar disorder?
Klonopin
What are the side effects of anticonvulsants?
drowsiness
sedation
dry mouth
blurred near vision
weight gain
What form of treatment is useful in mildly depressive patients?
psychotherapy
Describe "limit-setting:"
*State behaviors that are acceptable and unacceptible
*Identify consequences
*State expected behavior
How should the nurse communicate with a bipolar patient?
Use very short sentences
What types of foods should be offered to the bipolar patient to ensure good nutrition?
Finger foods (can be carried from place to place)
What should the nurse do to promote sleep in a bipolar patient?
Decrease environmental stimuli
Where should the nurse channel a bipolar patient's energy?
Into an activity that is socially acceptable
What should be assessed in regards to safety with bipolar patients?
Suicide risk
What is a toxic level of lithium?
1.5 mEq or greater
What symptoms of lithium toxicity are exhibited in patients with a lithium level of 1.5-2 mEq/L?
*Nausea/vomiting/diarrhea
*Reduced coordination
*Drowsiness
*Slurred speech
*Muscle weakness
What should the nurse do if the patient has a lithium level of 1.5 - 2 mEq/L?
Withhold next dose; call physician. Serum lithium levels are ordered and doses of lithium are usually suspended for a few days or the dose is reduced.
What symptoms of lithium toxicity are exhibited in patients with a lithium level of 2 - 3 mEq/L?
*Ataxia
*Agitation
*Blurred vision
*Tinnitus
*Giddiness
*Choreoathetoid movements
*Confusion
*Muscle fasciculation
*Hyperreflexia
*Hypertonic muscles
*Myoclonic twitches
*Pruritus
*Maculopapular rash
*Movement of limbs
*Slurred speech
*Large output of dilute urine
*Incontinence (bladder/bowel)
*Vertigo
What is the nurses action if a patients serum lithium level is 2 - 3 mEq/L?
Withhold future doses, call physician, stat serum lithium level. Gastric lavage may be used to remove oral lithium; IV containing saline and electrolytes used to ensure fluid and electrolyte function and maintain renal function.
What are the symptoms of lithium toxicity in a patient whose serum lithium level is 3.0 mEq/L and above?
*Cardiac arrhythmia
*Hypotension
*Peripheral vascular collapse
*Focal or generalized seizure
*Reduced LOC (stupor to coma)
*Myoclonic jerks of muscle groups
*Spasticity of muscles
What is the nurses action if a patients serum lithium level is 3 mEq/L or above?
All of preceding interventions plus lithium excretion is augmented with use of aminophylline, mannitol or urea. Hemodialysis may also be used to remove lithium from the body. Respiratory, circulatory, thyroid and immune systems are monitored and assisted as needed.
Is tardive dyskinesia reversible?
No; however, decreasing or discontinuing the medication can arrest the progression.
Which drug has NOT been found to cause tardive dyskinesia?
Clozaril (clozapine)
Define personality:
An ingrained, enduring pattern of behaving and relating to oneself and others that includes perceptions, attitudes, and emotions regarding oneself and the world. It is consistent over time and does not change easily or rapidly.
Personality traits are formed by what age?
By age 2 - 3
When are personality disorders diagnosed?
*When personality traits become inflexible or maladaptive and interfere with how one functions in society or when they cause emotional distress.
Personality disorders are diagnosed when the person deviates from cultural expectations in two or more of which categories?
*Cognition
*Affect
*Interpersonal functioning
*Impulse control
Define cognition:
Ways of perceiving and interpreting self, other people, and events
Define affect:
Range, intensity, lability, and appropriateness of emotional response
Define "impulse control:"
Ability to control impulses or express behavior at the appropriate time and place
What are the personality types that make up "Cluster A" personality disorders?
People whose behavior is odd or eccentric (paranoid, schizoid, schizotypal)
What are the personality types that make up "Cluster B" personality disorders?
People who appear dramatic, emotional, or erratic (antisocial, borderlind, histrionic, narcissistic)
What are the personality types that make up "Cluster C" personality disorders?
People who are anxious or fearful (avoidant, dependent, obsessive-compulsive)
Why is it that many people with personality disorders do not seek treatment?
They don't believe they have a problem
Out of all the people who have personality disorders, which ones usually DO seek treatment?
Those who experience emotional distress
List some of the cognitive-behavioral techniques that can be effective in clients with personality disorders:
*Thought stopping
*Positive self-talk
*Decatastrophizing
Upon what is pharmacologic treatment based for patients with personality disorders?
The type and severity of symptoms, rather than the particular personality disorder itself.
What is a drug commonly prescribed for personality disorder clients who experience mood dysregulation?
*Lithium
*Other mood stabilizers
What is a drug commonly prescribed for personality disorder clients who experience anxiety?
*SSRI's
*MAOI's
What is a drug commonly prescribed for personality disorder clients who experience depression
*SSRI's
*MAOI's
Is paranoid personality disorder more common in men or women?
Men
What characterizes paranoid personality disorder?
*Mistrust and suspicion of others
*Guarded, restricted affect
*Aloof, withdrawn, hypersensitive
What coping mechanism is often displayed by clients with paranoid personality disorder?
Projection
The condition known as anti-social personality disorder in adults is diagnosed as _____________ in children
Conduct disorder
Discribe anti-social personality disorder:
*Pervasive pattern of disregard for and violation of rights of others
*Deceit/manipulation
*Poor judgment
*Thrill-seeking
*Poor work history
*Impulsive
Describe the general appearance/motor behavior of a client with anti-social personality disorder:
*Appears "normal"
*May be charming/engaging
*Tries to manipulate
Describe the mood/affect of a client with anti-social personality disorder:
*Shallow emotions
*Chooses emotions to work to their advantage
*No genuine feelings of empathy
*No guilt
*Only remorseful if caught
List some nursing diagnoses for clients with anti-social personality disorder:
*Ineffective coping
*Ineffective role performance
*Risk for other-directed violence
List some nursing outcomes for clients with anti-social personality disorder:
The client will:
*Demonstrate nondestructive ways to express feelings and frustration
*Identify ways to meet own needs without infringing on the rights of others
*Achieve satisfactory role performance
List some nursing interventions for clients with anti-social personality disorder:
*Forming a therapeutic relationship (includes limit-setting & confrontations)
*Promoting responsible behavior
*Helping client solve problems and control emotions
*Enhancing role performance
What characterizes borderline personality disorder?
A pervasive pattern of unstable interpersonal relationships, self-image and affect, and marked impulsivity
True or False: Persons with borderline personality disorder have higher rates of suicide and may have recurrent self-mutilation
True
What is common in the history of a person with borderline personality disorder?
*Family problems, especially alcoholism and sexual abuse
Describe the general appearance/motor behavior of a person with borderline personality disorder:
*Mildly dysfunctional clients appear normal
*Severely affected clients may be disheveled, unable to sit still, crying, and out of control
Describe the mood and affect of a person with borderline personality disorder:
*Dysphoric mood
*Unhappy
*Restless
*Malaise
*Intense feeling of loneliness
*Boredom
*Frustration
*Abandonment by others
*Labile mood/intense feelings
*Hypersensitive to how others feel about them
Describe the sensorium and intellectual processes of a person with borderline personality disorder:
*Oriented
*Intellectual functions intact
*May experience transient psychotic symptoms, such as hallucinations, under severe stress
Describe the judgment and insight of a person with borderline personality disorder:
*Poor judgment
*Impulsive/reckless behavior (lying, shoplifting, gambling, etc.)
*Limited insight: believes problems are due to others "failing" them
List nursing outcomes for a person with borderline personality disorder:
The client will:
*Be safe and free of significant injury
*Not harm others
*Not destroy property
*Demonstrate increased control of impulsive behavior
*Take apropriate steps to meet own needs
*Demonstrate problem-solving skills
*Verbalize greater satisfaction with relationships
List ways to incorporate the nursing intervention of "promoting client's safety" for clients with borderline personality disorder:
*Have client sign a "no self-harm" contract
*Focus on triggers for abnormal behavior
List nursing interventions for clients with borderline personality disorder:
*Promote the client's safety
*Promote the therapeutic relationship
*Establish boundaries in relationships
*Teach effective communication skills
*Help the client to cope and control emotions
*Reshape thinking patterns
*Structure daily activities
Evaluation of outcomes in clients with borderline personality disorder is based on what?
*Being safe
*Having fewer crises
*Forming effective relationships
*Maintaining employment
Define somatization:
The transference of mental experiences into bodily symptoms
What characterizes somatiform disorders?
The presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for the symptoms
What are the three central features of somatiform disorders?
*Physical complaints that suggest medical illness but have no demonstrable organic basis
*Psychological factors and conflicts that seem important in initiating, exacerbating, and maintaining the symptoms
*Symptoms or magnified health concerns that are not under the client's conscious control
What are the five specific somatiform disorders?
*Somatization disorder
*Conversion disorder
*Pain disorder
*Hypochondriasis
*Body dysmorphic disorder
Describe somatization disorder:
*Multiple physical symptoms
*Combination of pain, GI, sexual and pseudoneurologic symptoms
Describe conversion disorder:
*Unexplained deficits in sensory or motor function, such as blindness or paralysis, associated with psychological factors
*Attitude of la belle indifference (lack of concern or distress
Describe pain disorder:
*Pain unrelieved by analgesics
*Psychological factors influence onset, severity, exacerbation and maintenance
Describe hypochondriasis:
Preoccupation with fear that one has or will get a serious disease
Describe body dysmorphic disorder:
Preoccupation with imagined or exaggerated defect in physical appearance
List treatment options for patients with somatiform disorders:
*Treatment is focused on managing symptoms, improving quality of life, and improving coping skills
*Antidepressants are sometimes used for accompanying depression (SSRI's, etc.)
*Referral to a pain clinic is helpful in pain disorder (narcotics to be avoided)
*Involvement in therapy groups to improve coping and express emotions verbally has shown some benefit, but typically these disorders recur or are chronic for many clients
What is important to assess in clients with somatiform disorders?
The client's physical health status
Clients who somatize may have legitimate health concerns, such as:
*Disturbed sleep patterns
*Poor nutrition
*Lack of exercise
*Overuse of prescription medications
List some nursing diagnoses for clients with somatiform disorders:
*Ineffective coping
*Ineffective denial
*Impaired social interaction
*Anxiety
*Disturbed sleep pattern
*Fatigue
*Pain
List some nursing outcomes for clients with somatiform disorders:
The client will:
*Identify the relationship between stress and physical symptoms
*Verbally express emotional feelings
*Follow an established daily routine
*Demonstrate alternative ways to deal with stress, anxiety, and other feelings
*Demonstrate healthier behavior regarding rest, activity and nutrition
List some nursing interventions for clients with somatiform disorders:
*Provide health teaching
*Assist client to express emotions
*Teach coping strategies
List some emotion-focused coping strategies for clients with somatiform disorders:
*Progressive relaxation
*Deep breathing
*Guided imagery
*Distractions
List some problem-focused coping strategies for clients with somatiform disorders:
*Learn problem-solving methods and apply the process to identified problems
*Role-playing interactions with others