Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

83 Cards in this Set

  • Front
  • Back
consists of 1 or more manic or mixied episodes usually accompanied by major depressive episodes?
bipolar 1
consists of 1 or more major depressive episodes accompanied by at least 1 hypomanic episode?
bipolar II
elevated,irritable mood
lasts 1 week
impairment in social/occupational functioning
requiring hospitalization?
Manic episodes
What should the nurse assess for when receiving a manic patient?
-self-destructive behavior
-assaultive behavior
Name the signs of Mania?
-grandiosity:inflated self esteem(delusions of grandeur)
-decrease need for sleep
-pressured speech,hyperverbal
(reports racing thoughts)
-flight of ideas:
-increased involvement in goal-directed activities
-Excessive involvement in pleasurable activities(sex spending,travel,)
-intrusive & demanding
-denial & non-compliance
-usually a + DST test
Intervention for Mania:

When pt is hyperactive?
-walk with pt and ask them how they are doing, assess mental status.
intervention for mania:

How should the nurse ensure proper nutrition?
-provide foods which can be eaten on the run: finger foods
intervention for Mania:

other interventions for client who is hyperactive?
-reduce stimuli
-offer quiet time/open seclus
-use short/simple sentences
-use consistent staff of same sex
-anger mgmt:count 10 slowly
-allow to discuss feelings in trusting rltnsp,in order to accept them selves and past behaviors
-be strict with rules:no special favors or priviledges:set limits:
less extreme form of mania,less impairment of functioning,does not require hospitalization, may feel on top of the world, take on huge projects, do not see themselves sick?
hypomanic episodes
Symptoms over a 2yr period with chronic fluctuating mood disturbance(hypomanic with periods of depression).Moody temperamental and unpredictable.Must be free manic episodes,major depressive episodes or mixed episodes for 2 yrs before dx?
Medications for bipolar d/o?
-All atypical antipsychotics
-Gabaentin (Neurontin)
-Paroxetine (Paxil)
-Combination therapy: for those on Li and depakote become depressed
Nursing implications for client on Lithium?
-adequate water & salt intake
-No diuretics
-check levels prior to admis
-long term may dvlp thyroid/kidney problems
-Monitor TSH & creatine
can stabilize mood, do not stop abruptly b/c may cause seizure,Topamax can cause wt loss,Tegretol good for rapid cycling, Now approved as Equetro?
the spaces b/w the nurses power and the clients vulnerability.Nurses power from professional position and access to private knowledge about pt?
professional boundaries
brief excursions across boundaries that may be inadvertent thoughtless or even purposeful if done to meet a special therapeutic need?
boundary crossing
can result when their is confusion b/w the needs of the nurse and those of the client?
boundary violation
is an extreme form of boundary violation and includes any behavior that is seductive,sexually demeaning,harassing or reasonably interpreted as sexual by the client?
professional sexual misconduct
What to do if your pt makes sexual advances?
-clarify your role as nurse
-set appr.verbal boundaries("I am uncomfortable when you speak or touch me that way.Please dont")
-set physical boundaries:as a colleage to assist with pt care if needed
-consult your supervisor:wether situation warrents reassignment
-treat your pt respectfully when redirecting inappropriate behavior
organic etiology of schizophrenia:adopted twin studies?
-monozygotc twins had 50% greater risk than general pop
-genetic predispostion
-being raised by schizophrenic parent had little effect on becoming schizophrenic
dopamine hypothesis of schizophrenic?
-chroni administration of D-amphetamine produces a schizophrenic like symptoms.Effective antipsychotic drugs blocked DA receptors in vivo and inhibited the effect of D-amphetamine
comorbidities and schizophrenia?
-male life span 10yrs
-female life span 9 yrs shorter
-reduce pain sensitivity
-deny symptoms
-socially withdrawn/do not seek medical care
-difficulty to eval.b/c of comm and cognitive difficulties
-poor health habits(diet smoking ,lack of exercise)
-morbid obese/increase wt gain
-reduced insulin sensitivity
-elevated triglycerides
Serotonin hypothesis for schizophrenia?
-complex interaction b/w 5HT and DA:low DA & high 5HT=psychosis:high energy
-newer antipsychotics are potent antagonists of the 5-HT2A and D2 receptors:1sr generation cause robot people
-low DA:takes care of pos sx
-high 5HT:takes care of neg s
Neurodevelopmental hypothesis:schizophrenia?
-Possible ob and perinatal complications
-ct scans show cerebral ventricular enlargmnt
-postmortem studies show 5% tissue loss & decrease vol of limbic and temporal structures
In a pet scan what does it measure reg.glucose:?
-glucose uptake indicates increase metabolism leading to decrease in activity
Pathological communication,its split,hostile,critical,done in overinvolved family.The sender of the comm.demands a response to a msg.containing contradicting signals while the receiver is unable to comment or escape?
double bind communication
blockage.ex.if you cry i'll give you something to cry about?
expressed emotion
course of schizo illness?
course of the illness:
often introverted,shy,few friends,often ill with a lot of somatic complaints?
premorbid stage
change in behavior, more withdrawal,poor academic performance,decreased in enjoyable activities,rituals,magical thinking,agressive,poor hygiene?
prodromal stage
positive signs occur with peculiar affect and psychosis?
acute stage
not a return to premorbid level,decreased social and occupational functioning,negative signs,not always psychotic?
residual stage
When is a pt given the diagnosis of schizophrenia?
if <2weeks?
if >2weeks but <6months? least 6 months,begins late teens/early adulthood
2.brief reactive psychosis
3.shizophreniform d/o
which type of schizophrenia is characterized by paranoid delusions in which the client falsely believes that others are out to harm him/her.The pt may be hostile,argumentative,aggressive?
paranoid schizophrenia
characterized by bizarre behavior that does not meet the criteria of other types of schizophrenia.H&Ds are prominent?
undifferentiated schizophrenia
characterized by flat or inappropriate affect(such as silliness,irrationality,or giggling)bizarre behavior and social impairment?
disorganized schizophrenia
term used to describe the client who has had one major episode of schizophrenia with prominent psychotic symptoms and who has lingering symptoms?
residual schizophrenia
characterized by reduced movement,immobile,remains in same position,waxy flexibility(limb remains in the same position for prolonged period),may have echolalia:repeats what others say,echopraxia(copy movements of others).
catatonic schizophrenia
two sets of symptoms,schizophrenia and mood d/o,either major depression or mania in the same illness episode?
schizoaffective d/o
one or more non bizarre delusions for a period of at least one month,. Most not ever meet criteria a symptoms. arise in middle and late adulthood.person will function well in area not affected by the delusion?
delusional d/o
risk factors of schizophrenia?
-biochemical:neurochemical/neruoanatomical alterations
-fam genetics:id. twins 50% risk than fraternal twins
-psychological influences:stressful life events,low self-esteem,poor social skills,demoralization
-envir influences:poverty,lack of social support,hostile home,isolation,disruption in interpsnl rltnsp(divorce),job pressure,unemployment
specific biological factors:
2.modulates level of DA,affects mood
3.decrease in brain vol,enlarged ventricles,deeper fissures,loss or underdevelopment of brain tissue.
belief that others are hostile or trying to harm the individual:
delusions of persecution
false belief that public events or people are directly related to the individual?
delusions of reference:"the music is being played just for me"
belief that onel body is altered from normal structure or functin?
somatic elderly woman believes that her bowel is filled with cement and refuses to eat.
belief that ones unspoken thoughts can be heard?
thought broadcasting:ex.a youngpt believes that everyone around him knows hes attracted to a nurse although he has not said nothing.
ideas of influence?
i can make him call
idea of divine mission?
i can save the world
grandiose delusion?
i am very rich
the client has trouble expressing a response or will stop in midsentence as if he was stuck?
words that rhyme or sound alike are distributed throughout conversations without necessarily making sense?
clang associations
phrases,sentences,or entire conversations said to the client are repeated back to the client?
words or meanings are invented by the client.this can include multisyllabic,pseudo-scientific words or simple words?
maintaining a particular idea regardless of the topic being discussed or attempts to change the subject?
an incoherent medley of words emitted in conversation as if it was a sensible and articulate phrase?
work salad
represent an excess or distortion or normal functioning: Name the positive signs of schizophrenia?
Hallucination:most common auditory
diordered speech and behavior
an eccentricity of language:going off on a tangent like outer space when the subject of the conversation was reality based?
tangential thought
which delusions are the hallmarks of schizophrenia?
1.idea of reference:music playing just for me
2.thought broadcasting:"are you trying to read my mind"pts thoughts transmitted to others but not directly by pt
3.thought insertion:aliens put thoughts in my mind
4.thought withdrawal:took thought away
What are the negative sx assoc with schizophrenia:
alogia:lack of words
ambivalence:conflicting ideas
anhedonia:lack of interest
associational disturbances:loose assocition
avoltion:lack of motivation
causes of acute exacerbation?
-non-compliance with psychotrophic medications:suspicious of meds,synonymous with antibiotics,denial
-social isolation:no support
-lack of positive support:pt removed from home
Name some psychosocial therapeutic treatments /settings for individuals and their families?
day tx
home health
partial hospitalization
alliance for the mentally ill
emotions anonymous 12 step program
dual dx program
community health centers
social security disability ins
vocational rehab
community colleges
which drugs affect the CNS?
major tranquilizers
typical and atypical
antipsychotics how they work:
1.mesolimbic system?
2.nigrostriatal tract?
3.tuberoinfundibular tract?
4.mesocortical system in typicals?
1.decrease + sx of schizo
2.increase EPS sx
3.increase hyperprolactinemia
4.increase negative sx
the effects of 5HT-2A receptor blockade?
atypicals antagonize several subtypes of 5HT in mesocortical which liberates DA in that area & decrease negative sx
1.use to tx?
2.reaction to skin due to ?
3.whats the half life and why
4.half life can lead to what problems?
2.photosensitivity:do indoor activities
3.long half life,due to highly protein bound,
4.compliance,pt stop meds have no S.E think they dont need meds
D2 antagonism?
5HT2A antangonism?
5HT1A agonism?
5HT2c antagonism? efficacy,eps endocrine effects
2.neg sx efficacy,less eps
3.antidepressant & anxiolitic,improved cognition
4.antidepressant & anxiolytic
adverse and allergic effects of 1st generation antipsychotics or typicals?
1.blood dyscrasias:prolong sore throat,flu like sx
2.cholestatic hepatitis:jaundice b/c bile duct clogged with metabolites
3.NMS:high fever & high CPK(CK)levels
4.acute dystonic reactions:severe EPS
EPS is controlled with what medications?
Traditional/FGAs blockage of D2:
often classified as high potency? or low potency?
high:low sedative effects,high EPS,little hypotension ex.haldol

low:high sedative effects,low EPS,and hypotension ex.Thorazine
Name Atypical antipsychotics/2nd generation
Name serotonin dompamine antagonists?
name dopamine system stabilizer?
3.olanzapine(Zyprexa)less suicidal more wt gain

a. Aripiprazole(Abilify)
5HT-2A antagonism in nigrostriatal tract how does it make a difference in atypical/SGAz?
-keeps D2 blockage to aprox.80% b/c or reciprocal relationship b/w 5HT & DA
-less EPS , no TD
an increase DA in mesocortical tract may lead to ?
decrease in the neg SS b/c 5HT antagonism may result in DA release thus reducing negative signs and pos depressions and sucide
adverse side effects of SGAs?
decrease sexual dysfunction,less with atypicals esp.(Geodon (Ziprasidone) and Abilify (aripiprazole) most with risperidone (Risperdal)
Adverse side effects of SGAs
alpha 1 blockade can lead to ?
-postural hypotension
esp.with clozapine (clozaril)
adverse side effects of SGAs
histamine 1 blocking can lead to ?
-sedation and increase wt gain(clozapine & olanzapine most wt gain)
-check bsl with olanzapine for possible NIDDM
adverse side effects of SGAs
anticholinergic effects can occur with?
-all atypicals except abilify(aripiprazole)Most often with clozapine (clozaril)
EPS less with atypicals and very low report with what meds?
-low with ziprasidone(Geodon) and aripriprazole(Abilify)
-most with risperidone (risperdal)>6mg QD
prolongation of QT interval seen with what meds?
What should nurse check ?
When should you not give it?
-Geondon or combo of neuroleptics
-EKG for safety
-prediposed to QT prolongation
Drug interations with p450 system?
-Paxil(paroxetine)SSRI=a potent CP2D6 inhibitor(liver cytochrome enzyme)takes out dissolves.
-risperidone x4 increases EPS
which meds decrease the seizure threshold?
clozapine (clozaril)most atypical SGAs
agranulocytosis is seen when taken which meds? nrsg implications?
-check WBC or CBC weekly for 6months then bi-weekly.
-check V/s
-assist with drooling HS
are most atypical highly sedative at first?
what can you combine atypicals with?
often help what kind of pts?
-tradiotionl neuroleptics
-unresponsive to tradtl neuroleptics
Geondon(Ziprasidone)has a high serotonin dopamine antagonism ration this means?
-reduced incidence of EPS & no TD.
-low incidence of orthostasis,sedation,anticholinergic effects
-no evidence of compromised hematologic function
-prolactin levels normal
-Mood elevating/decreases neg.symptoms of schizo
-no weight gain
-preffered over geodon why?
-partial agonist of D2,5HT1A and antagonist activity at 5HT2A receptors
-no reported TD or EPS
-antidepressant effect b/c moderate affinity for 5HT reuptake positive increase in DA in mesocortical areas to decrease
-little wt gain
-little or no increase in prolactin