Mental Health Exam 1

Front 1

What are the general desired qualities of the nurse/therapist/clinician?

Back 1

o Most important quality: Communication
o Genuineness/authenticity: ability to be honest with Pt (Pt will be able to risk being more genuine themselves)
o Empathy: ability to understand and share the feelings of others (vs Sympathetic: condolence, agreement, pity)
o Compassionate neutrality, unconditional regard (for the Pt)
o Self reflective: → ↑ ability to empathize w/ Pt
o Respect for the patient: the Pt is an individual who deserves respect

Front 2

Discuss the difference between social vs therapeutic communication?

Back 2

o Social communication is less formal than therapeutic, so therapeutic is more appropriate in mental health milieu
o The Pt is the focus of the communication with therapeutic communication

Front 3

What are the phases of the Nurse-Patient relationship?

Back 3

1. Pre-Orientation/Pre-Interaction Phase
2. Orientation/Introductory Phase
3. Working Phase: (note: a ↓ working phase → ↓ depth of relationship w/ Pt)
4. Termination Phase

Front 4

What does the pre-orienation and pre-interaction phase consist of?

Back 4

- Gathering data about Pt (haven’t assessed Pt yet, so from ED, chart, written/oral reports, family/EMT/police)
- Self-reflection: ID own feelings; plan for first contact w/ Pt

Front 5

What does the orientation/introductory phase consist of?

Back 5

- Emphases: build trust, assess, ID Pt’s emotions, provide support, establish structure
- Establish contact and create environment conducive to trust and rapport
- Establish mutually-agreeable goals and own plan of action (care plans are vital to Tx of psych. Pt’s)
- ID Pt’s strengths and weaknesses
- Establish length of relationship (it’s OK to ID self as student and note that interactions will be max of 96 hours)
- Formulate nursing diagnoses

Front 6

What does the working phase consist of?

Back 6

- ID, explore, link, and modify behaviors, thoughts, attitudes relative to presenting issue(s)
- Establish short- and long-term goals (might be change or stabilization vs. “cure”)
- Solve problems
- Address resistance (Freudian: part of us that resists Δ)
- Exploring/Journaling/Confrontation: these help Pt to note reactions to events to help w/ their care; try not to
direct Pt, but help them come to realizations
- Redefining perceptions & interpretations with goal of more realistic conclusions
- Promoting Δ (Pt-initiated)

Front 7

What does the termination phase consist of?

Back 7

- therapeutic closure to relationship
- Reason(s): e.g.: d/c of Pt; end of nursing rotation
- Difficult phase, may try to avoid
- Review: goals met, + Δ’s, strategies for coping w/ future crises
- Referrals: MD, therapist
- ID resources for future needs of Pt
- D/C instructions: nurse is responsible for summarizing for the Pt the d/c instructions from several sources
- “Official good-bye”; encourage future therapeutic relationships and friendships

Front 8

What is transference?

Back 8

Pt reacting to clinician as if they were someone else

Front 9

What is countertransference?

Back 9

clinician transferring unconscious emotion onto the Pt

Front 10

What information is in a Mental Status Exam/Evaluation?

Back 10

o ID Data (e.g. name, age, S/O, occupation, religion, med. Dx’s, allergies, CC)
o Gen’l Description (appearance, grooming, dress, ht/wt, scars/tattoos, hair, motor activites, speech, gen’l attitude)
o Emotions (mood [subjective], affect [objective], appropriateness)
o Thought Processes (content of thought [how words are spoken] vs. form of thought [how words are assembled])
o Perceptual Disturbances (hallucinations, illusions, depersonalization, derealization)
o Sensorium and Cognitive Ability (A&O, memory, capacity for abstract thought, fund of knowledge)
o Impulse Control (r/t hostility, guilt, affection, sexuality)
o Judgment and Insight (solve problems, make decisions, knowledge of self, coping strategies)
o All terms discussed in conjunction with a mental status evaluation

Front 11

What is the purpose of Mini-Mental Status evaluation?

Back 11

for eval of organic problems if not enough time to perform complete Mental Status Exam

Front 12

What is the general information about the DSM-IV, such as what diagnoses might be found on Axis I, for example, the
main diagnoses that we’ve discussed class?

Back 12

o Axis I Psychiatric, clinical syndromes: acute problems – problem is treated successfully and Pt is released
Note: no one can be admitted to psych dept. without an Axis I condition
o Axis II Personality Disorders and Mental Retardation: chronic / ongoing problems
o Axis III Medical Diagnoses: e.g. COPD, HF, DM; whether or not r/t psych. Problem
Note: Dx’s such as wrist lac’s, ↓ mentation, etc. should be recognized as possibly r/t psych. problems
o Axis IV Stressors
o Axis V Global Assessment of Functioning (GAF)
Examples of Axis I (“Parity Diagnoses”: covered by insurance the same as medical issues; “non-parity” Dx’s also):
Major Depression … Bipolar Disorder … Schizophrenia … Schizoaffective … PTSD … OCD … Anxiety Disorder

Front 13

What is Axis I?

Back 13

Psychiatric, clinical syndromes: acute problems – problem is treated successfully and Pt is released
Note: no one can be admitted to psych dept. without an Axis I condition

Examples of Axis I (“Parity Diagnoses”: covered by insurance the same as medical issues; “non-parity” Dx’s also):
Major Depression … Bipolar Disorder … Schizophrenia … Schizoaffective … PTSD … OCD … Anxiety Disorder

Front 14

What is Axis II?

Back 14

Personality Disorders and Mental Retardation: chronic / ongoing problems

Front 15

What is Axis III?

Back 15

Medical Diagnoses: e.g. COPD, HF, DM; whether or not r/t psych. Problem
Note: Dx’s such as wrist lac’s, ↓ mentation, etc. should be recognized as possibly r/t psych. problems

Front 16

What is Axis IV?

Back 16

Stressors

Front 17

What is Axis V?

Back 17

Global Assessment of Functioning (GAF)

Front 18

What is the purpose of a defense mechanism?

Back 18

Primary function is to reduce anxiety and to protect the ego

Front 19

What are defense mechanisms?

Back 19

Defense mechanisms are psychological strategies to cope with reality and maintain self-image

Front 20

What is repression (involuntary) as a defense mechanism?

Back 20

involuntary exclusion of a painful or conflictual thought, impulse, or memory from
awareness. Performed by ego as attempt to allow for ~normal functioning

Front 21

What is suppression (voluntary) as a defense mechanism?

Back 21

Being vaguely aware of the thought or feeling but try to hide it

Front 22

What is sublimation as a defense mechanism?

Back 22

Redirecting a feeling into a socially productive activity

Front 23

What is reaction formation as a defense mechanism?

Back 23

Turn a feeling into its opposite (overcompensation for unacceptable impulses)

Front 24

What is displacement as a defense mechanism?

Back 24

Redirecting feelings to another target; discharging feelings on people less dangerous
than who aroused the emotion

Front 25

What is intellectualization as a defense mechanism?

Back 25

Dealing with emotional conflict through excessive use of abstract thinking or making
generalizations (more intellectualized type of rationalization)

Front 26

What is devaluation as a defense mechanism?

Back 26

Dealing with conflict by attributing exaggerated negative qualities to self or others

Front 27

What is idealization as a defense mechanism?

Back 27

Overestimation of desirable qualities / underestimation of limitations (of desired object
or person)

Front 28

What is rationalization as a defense mechanism?

Back 28

Various explanations to justify a situation while denying feelings

Front 29

What is projection as a defense mechanism?

Back 29

Thinking someone else has your thoughts or feelings

Front 30

What is passive aggression as a defense mechanism?

Back 30

Dealing with conflict by indirectly and unassertively expressing aggression

Front 31

What is regression as a defense mechanism?

Back 31

Reverting to an old (usually immature) behavior to ventilate feelings

Front 32

What is compensation as a defense mechanism?

Back 32

Encountering failure of frustration in some activity and overemphasizing another activity

Front 33

What is denial as a defense mechanism?

Back 33

Completely rejecting a thought or feeling

Front 34

What are the general concepts regarding all forms of Brief Therapy?

Back 34

o Future-focused, goal-directed: focuses on solutions & recovery, rather than problem that brought client to therapy
o Used in diverse fields of practice: business, social policy, education, criminal justice systems, child welfare
o Optimistic assumption – Pt has strengths and abilities, resources and skills that they bring with them
• may not be in touch with these
o Client is expert regarding their own difficulty/problem
o Attempt to reconnect Pt’s with their own intrinsic abilities: client has ability to get well; just guide and help them
o Change is inevitable and client wants change
o Identify what is already working; Pt may already have solutions to problem & may simple need confidence boost
o Understanding past not necessary to develop possibility for future
o Keep concepts / solutions simple and meaningful
• complex problems don’t always need complex solutions” (Steve de Shazer)

Front 35

What is positive reinforcement and give an example?

Back 35

Adding favorable event after desired behavior

Rewarding a child who gets good grades

Front 36

What is negative reinforcement and give an example?

Back 36

Removing unfavorable event after desired behavior

Noise stopped when rat hits correct lever

Front 37

What is positive punishment and give an example?

Back 37

Adding unfavorable event after undesired behavior

Time out (for toddlers)

Front 38

What is negative punishment and give an example?

Back 38

Removing favorable event after undesired behavior

Withholding privileges after misbehavior

Front 39

What is extinction and give an example?

Back 39

Ignoring behavior

Ignoring a tantrum

Front 40

What is response cost?

Back 40

Weaken a behavior by removing positive stimulus

(similar to negative punishment)

Front 41

What is reciprocal inhibition and give an example?

Back 41

Inhibit one response by the occurrence of another incompatible response

Conditioning a relaxation response to stimuli that used to provoke anxiety

Front 42

What is systematic desensitization and give an example?

Back 42

Less-to-more distressing stimuli to desensitive to feared situation (ends w/ In Vivo exposure)

Pt w/ fear of heights gradually being exposed to higher and higher places

Front 43

What is flooding and give an example?

Back 43

Accelerated systematic desensitization

Pt w/ fear of heights taken to top floor 1st

Front 44

What is the definition of overgeneralization from cognitive therapy?

Back 44

Drawing conclusions about a wide variety of things based on one event

Front 45

What is the definition of arbitrary inferences from cognitive therapy?

Back 45

Making a negative conclusion about something without supporting evidence

Front 46

What is the definition of selective abstraction from cognitive therapy?

Back 46

Forming conclusions based on an isolated detail of an event; other information is ignored and
the significance of the total context is missed

Front 47

What is the definition of magnification/minimization from cognitive therapy?

Back 47

Perceiving a case or situation in a greater or lesser light than it truly deserves
(exaggerating or trivializing)

Front 48

What is the definition of personalization from cognitive therapy?

Back 48

Tendency to relate external events to oneself, even when no basis for making a connection

Front 49

What is the definition of catastrophizing from cognitive therapy?

Back 49

Thinking worst-case scenario will be outcome for all situations

Front 50

What is the definition of Dichotomous (Polarized) Thinking from cognitive therapy?

Back 50

Thinking in extremes, that things are either all good or all bad

Front 51

What is the definition of perfectionism from cognitive therapy?

Back 51

Needing to do everything perfectly to feel good about oneself

Front 52

What is the definition of mind reading from cognitive therapy?

Back 52

Believing that one knows the thought of another without validation

Front 53

What is the definition of externalization of self-worth from cognitive therapy?

Back 53

Self-determining one’s value based on the approval of others

Front 54

What are the basic functions of lobes of the brain connected to psychiatric symptoms (frontal lobe)?

Back 54

primary and supplemental motor, eye movement, language, cognition, personality, social judgment,
attention, volition

Front 55

What are the basic functions of lobes of the brain connected to psychiatric symptoms (parietal lobe)?

Back 55

sensation, taste, reading, writing, facilitates spatial orientation

Front 56

What are the basic functions of lobes of the brain connected to psychiatric symptoms (temporal lobe)?

Back 56

hearing, sense of smell, speech center (language comprehension), emotions, memory

Front 57

What are the basic functions of lobes of the brain connected to psychiatric symptoms (occipital lobe)?

Back 57

visual discrimination, some aspects of visual memory

Front 58

What are the basic functions of lobes of the brain connected to psychiatric symptoms (limbic system)?

Back 58

(instincts, drives, needs and emotions)
o Amygdala – regulates emotional responses – misfiring of neurons here may be involved in Bipolar
• Overstim of amygdala r/t PTSD
o Thalamus – filters incoming information regarding emotions, moods and memories
o Hypothalamus – eating, temperature regulation, emotion, autonomics, water balance, circadian rhythm,
pituitary function
o Hippocampus – major role in encoding, consolidation, and retrieval of memories

Front 59

What neurotransmitters are involved with schizophrenia?

Back 59

• ↑ DA in limbic system → + s/s of schizophrenia
• ↓ DA in frontal cortex → – s/s of schizophrenia
o Serotonin blocked by atypical antipsychotics in cortical areas liberates DA ;
liberated DA alleviates – s/s of schizophrenia (e.g. ↑ DA → negative s/s)

Front 60

What neurotransmitters are involved with depression?

Back 60

↓ serotonin and ↓ NE

Front 61

What neurotransmitters are involved with mania?

Back 61

↑ serotonin and ↑ NE

Front 62

What neurotransmitters are involved with anxiety?

Back 62

↑ NE and ↓ GABA

Front 63

What neurotransmitters are involved with Alzheimer's?

Back 63

↓ ACh

Front 64

What are the positive symptoms of schizophrenia?

Back 64

o Positive (r/t ↑ DA; excess or distortion of normal function)
• Hallucinations
• Delusions
• Formal Thought Disorder

Front 65

What are the negative symptoms of schizophrenia?

Back 65

• Decreased eye contact
• Decline in grooming and hygiene
• Flattened affective responses
• Thought blocking
• Inattentiveness
• Diminished volition (avolition – ↓motivation . . . to get out and participate in life)
• Decreased expressive gestures
• Diminished recreational interests
• Decrease in relationships (tend to be isolative)
• Diminished content speech – poverty of thought
• Knowledge/cognitive deficits

Front 66

What is the etiology of schizophrenia – how much genetic, how much cultural, how much family dynamics?

Back 66

• Biologic theories
- Biochemical: Dopamine – too much in some parts of brain; not enough in others
• Neurostructural
- Changes in ventricular brain ratios
- Brain Atrophy
- ↓ Blood Flow in Pre-Frontal Cortex
• Genetic (10% of 1st-degree relatives of schizophrenia get it)
• Perinatal Risk Factors: flu epidemics → % schizophrenia in offspring of mothers who had the flu

Front 67

What are the risk factors of schizophrenia?

Back 67

• 46% lifetime risk if identical twin has schizophrenia
• 10% lifetime risk if sibling has schizophrenia
o Lasts a lifetime for 95%
• 1/3 of all homeless have schizophrenia
• 20-50% attempt suicide, 10% (?) completed suicide (probably higher)
• 20% shorter life expectancy (r/t less inclination to seek help from family friends, healthcare)

Front 68

What are some common nursing dx for Schizophrenia?

Back 68

 Altered Thought Process (most common)
 Impaired communication
 Self-care Deficits
 Activity Intolerance
 Social Isolation
 Decisional Conflict
 Disturbed Sensory Perception
 Disturbed Body Image
 Excess Fluid Volume (r/t excess fluid intake/water intoxication → hyponatremia)
 Disturbed Thought Process
 Dysfunctional Family Processes
 Interrupted Family Processes

Front 69

What are some nursing interventions for Schizophrenia?

Back 69

 Preventing relapse
 Promoting adequate communication
 Promoting adherence to medication regimen
 Assisting with grooming and hygiene
 Promoting organized behavior
 Promoting social interaction and activity
 Promoting social skills and activities
 Intervening with hallucinations and delusions
 Promoting congruent emotional responses
 Promoting family understanding and involvement
 Promoting community contacts

Front 70

Describe the 1st generation of antipsychotic medications?

Back 70

Completely block D2 receptors
greater impact on + symptoms (which are r/t ↑ DA)
Significant side effects
Examples: Thorazine (Chlorpromazine), Haldol (Haloperidol)
Absorption rate: 1-6 hours
Tranquilization begins in 1 hour
Half life: 10-30 hours
Continued improvement for 6-8 weeks
Accumulate in fatty tissues; highly protein bound
Metabolized by cytochrome P450 system in liver

Front 71

Describe the 2nd generation of antipsychotic medications?

Back 71

Weak blocking of D2; strong blocking of D1 and D4
Blocks 5HT2 serotonin receptors; serotonin inhibits DA, so serotonin → ↑ DA in cortical region of brain
Greater impact on + symptoms (r/t ↑ DA) but treat – symptoms and cognitive s/s
↓ EPSE compared with 1st gen
↑ risk of metabolic changes: diabetes, weight gain, hyperlipidemia
Examples: Clozaril, Riperdal, Zyprexa, Seroquel, Geodon, Abilify
Many 2nd Gen’s used across diagnostic categories (e.g., Zyprexa as a mood stabilizer)

Front 72

What are the possible side effects of antipsychotic medications?

Back 72

• Anticholinergic side effects
o Dry mouth, blurred vision, constipation, urinary retention
• Salivation (esp. w/ Clozaril) (even though most side effects are anticholinergic)
• Nausea/GI upset (recommend taking with food)
• Rash
• Sedation
• Orthostatic Hypotension
• Photosensitivity
• Hormonal
o Decreased libido
o Amenorrhea
o Weight Gain
• Reduction of Seizure Threshold
• Extrapyramidal (EPSEs)
o Akathisia
o Akinesia
o Dystonia
o Tardive Dyskinesia

Front 73

What will extrapyramidal (EPSEs) look like in your patient?

Back 73

Extrapyramidal (EPSEs) – r/t blockage of D2 receptors in mid-brain (i.e. not enough DA)
o Pseudoparkinsonism
- Tremor, shuffling, drooling, pill-rolling, rigidity
- Good response to anticholinergics (e.g. Benadryl, Cogentin, Artane)

Front 74

What will akathisia look like in your patient?

Back 74

o Akathisia (continuous restlessness and fidgeting – very uncomfortable to the Pt)
- Restless legs, jittery feelings
- Occurs early in treatment
- Differentiate from agitation
- Poor response to anticholinergics

Front 75

What will akinesia look like in your patient?

Back 75

o Akinesia
- Slowed movements (bradykinesia) or absence of movement
- Weakness
- Fatigue or no energy
- Responds to anticholinergics

Front 76

What will dystonia look like in your patient?

Back 76

o Dystonia
- Involuntary muscular movements of face, arms, legs, and neck
- Abnormal sustained contracted postures
- Appears early in tx
- Responds to anticholinergics
- Oculogyric crisis may occur: uncontrolled rolling back of the eyes (unable to see; can be painful)

Front 77

What will tardive dyskinesia look like in your patient?

Back 77

o Tardive Dyskinesia
- Bizarre facial and tongue movements (lip smacking, teeth grinding, tongue thrusting or writhing), stiff
neck, difficulty swallowing
- Occurs after long term use of antipsychotics (long-term use of antipsychotics → damage)
- Symptoms stop with sleep, worsen with anticholinergics (i.e. ↑ tardive dyskinesia with Benadryl)
- Assess using AIMS (abnormal involuntary movement scale) – pp. 856-857 in text
- May be irreversible
- Treatment (attempt): change antipsychotic medications (no anticholinergics – worsen s/sx)

Front 78

What are special considerations with a patient taking clozaril (clozapine)?

Back 78

agranulocytosis: CBC’s to monitor WBCs

Front 79

What are special considerations with a patient taking thorazine (chlorpromazine) & Haldol (haloperidol)?

Back 79

aplastic anemia (pancytopenia): CBCs to monitor RBC/WBC/platelets
Renally excreted: monitor BUN/creatinine for ↓ renal sufficiency

Front 80

What are special considerations with a patient taking risperdal (risperidone)?

Back 80

Do not take with cola or tea (coffee OK)

Front 81

What is Neuroleptic Malignant Syndrome (NMS)?

Back 81

NMS is a complete blockage of DA and can → death

Front 82

What are special considerations with a patient taking seroquel (quetiapine)?

Back 82

Risk of DM – monitor for s/sx
CNS depression → ↓ thirst response: monitor for dehydration

Front 83

What symptoms might the patient exhibit Neuroleptic Malignant Syndrome?

Back 83

severe parkinsonian muscle rigidity, hyperpyrexia (107° +), tachycardia, tachypnea, fluctuations in BP,
diaphoresis, deterioration of mental status to stupor and coma

Front 84

What actions might you take as the nurse with a patient exhibiting signs of possible Neuroleptic Malignant Syndrome?

Back 84

o Treat with DA agonists (Dantrolene or Bromocriptine)
o Treat s/sx with cooling blankets and antipyretics (e.g. ibuprofen)

Front 85

What medications are used to treat side effects of antipsychotics?

Back 85

 Anticholinergic (dryness, constipation): [ n/a re: med’s ] encourage fluid intake and use of stool softeners
 EPSEs: anticholinergics (Cogentin, Benadryl, Artane) to ↓ DA breakdown (i.e. ↑DA), buspirone (BuSpar – an
axiolytic) for two weeks prior to start of antipsychotics

Front 86

What are the symptoms of major depression?

Back 86

• Depressed mood for more than 2 weeks
• Loss of interest in pleasurable activities
• Impaired social functioning
• Change in appetite/weight
• Change in sleep / fatigue
• Sense of worthlessness, thoughts of death
• Decreased concentration

Front 87

What are the risk factors of major depression?

Back 87

gender (women twice as likely), divorce, age (20 – 50 first time; > 65), prev. episode, heredity

Front 88

What are some Nursing Dx for major depression?

Back 88

• Risk for Self-Directed Violence
• Situational/Chronic Low Self-Esteem
• Hopelessness
• Ineffective Coping

Front 89

What are some nursing interventions for major depression?

Back 89

• Preventing suicide/promoting safety
• Promoting self-esteem
• Instilling hope
• Enhancing socialization
• Medications
• ECT

Front 90

What are some Psychobiologic treatments other than meds to treat major depression?

Back 90

• Symptom alleviation (not necessarily eliminating root cause)
• Therapy/ies (individual, group, family, cognitive
• Teaching (coping strategies)
• ECT

Front 91

What medication might be used to help a patient stop smoking?

Back 91

o Nicotine replacement therapy (patch, lozenge, gum, inhaler) – ↓ cravings by maintaining blood nicotine
o Bupropion (Zyban) – antidepressant that assists with smoking abstenance
o Welbutrin

Front 92

What might an ER/ED do for a patient who is suspected of overdosing on an opiate?

Back 92

Naloxone (Narcan): fast-acting opioid antagonist to counteract respiratory depression

Front 93

What do you need to educate your patient about using Antabuse (disulfiram)?

Back 93

No alcohol in any form (watch cough syrups, cough drops, mouthwashes)

Front 94

How is withdrawal from alcohol most commonly treated?

Back 94

 Early detection
 Monitor fluid status (can be overhydrated or dehydrated)
 Magnesium sulfate to ↓ irritability and prevent seizures
 Vitamins (alcohol interferes with absorption of B vitamins)
 Benzos to prevent Dts
 Disulfiram (Antabuse) or natrexone (ReVia, Trexan)

Front 95

What are symptoms of alcohol withdrawal?

Back 95

 Minor withdrawal (onset 6-12 hours; duration 48-72 hours):
• early – anxiety, agitation, irritabity
• later – tremor, tachycardia, HTN, diaphoresis, hallucinations
 Major withdrawal (Dts; onset 2-3 days; duration 3-5 days):
• ↑ temp, tachycardia, HTN, severe diaphoresis

Front 96

How would you know that someone has developed tolerance to alcohol?

Back 96

Tolerance is a reduction in receptor sensitivity, so an ↑ amount of alcohol req’d to intoxicate

Front 97

Blood alcohol levels – what’s the legal level in Colorado?

Back 97

 DUI: > 0.08%
 DWAI: > 0.05% (0.02% for < 21 yoa)

Front 98

What are medications used for bipolar?

Back 98

-antipsychotics
-antidepressants
-mood stabilizers

Front 99

How are antipsychotics used to treat bipolar?

Back 99

Antipsychotics (for hyperactive and agitated behavior)
(used when starting lithium to control s/sx since lithium takes 1-3 weeks to become effective)
• risperidone (Risperdal)
• olanzapine (Zyprexa)

Front 100

How and what antidepressants are used to treat bipolar?

Back 100

Antidepressants (during depressive swings)
• TCAs, MAOIs, SSRIs

Front 101

How and what mood stabilizers are used to treat bipolar?

Back 101

 Lithium
• Li helps stabilize K+ and Na+ to reduce over-excitement at cellular level
• blood levels indicating therapeutic vs toxic levels
- therapeutic range: 0.8 – 1.4 mEq/L
- toxic at 1.5 – 2 mEq/L
• side effects r/t toxic levels (no known antidote, so Tx is lavage and dialysis)
- tremors (persist throughout therapy)
- N/V/D (probably subside if taken with food)
- thirst (probably subside with adequate fluids)
- confusion
- blurred vision
- hypotension (fluid imbalance r/t K+ and Na+ imbalances)
- arrhythmias (interrupted cardiac activity r/t K+ and Na+ imbalances)
• nursing implications, such as water and salt intake
- teach Pt to eat a normal diet with normal salt intake and maintain adequate fluid intake (2.5 L/day)
- assess for renal function, cardiovascular disease
- remind women to use contraception
- warn Pt re: side effects
 Anticonvulsants (e.g. valproic acid)
• seem to work off-label
• Side effects: sedation, tremor, depression, psychosis, weakness; N/V/D, indigestion, cramps,
constipation; ~↑ AST/ALT/LDH/bilirubin

Front 102

What are the SE of lithium?

Back 102

- tremors (persist throughout therapy)
- N/V/D (probably subside if taken with food)
- thirst (probably subside with adequate fluids)
- confusion
- blurred vision
- hypotension (fluid imbalance r/t K+ and Na+ imbalances)
- arrhythmias (interrupted cardiac activity r/t K+ and Na+ imbalances)

Front 103

What are the nursing implications for lithium?

Back 103

nursing implications, such as water and salt intake
- teach Pt to eat a normal diet with normal salt intake and maintain adequate fluid intake (2.5 L/day)
- assess for renal function, cardiovascular disease
- remind women to use contraception
- warn Pt re: side effects

Front 104

What are the symptoms of a manic episode of someone with bipolar disorder?

Back 104

o Symptoms of a manic episode (persistent expansive mood for > 1 week)
• may or may not have psychotic features (altered realities)
• inflated self esteem, grandiose
• ↓ need for sleep; constant motor activity
• pressured speech; flight of ideas
• racing thoughts
• easily distracted
• expansive involvement in pleasure-seeking activities … to the expense of well-being (money, social, physical)

Front 105

What are nursing interventions for bipolar disorder?

Back 105

• Promote client safety: provide safe env., monitor activities, set and enforce limits
• Administer medications: antipsychotics, lithium carbonate
• Promote reality-based thinking
• Enhance socialization
• Promote self-care
• Enhance rest and sleep

Front 106

What are the symptoms that someone is suicidal?

Back 106

they tell you; depression, hopelessness, helplessness, hostility, anger, guarded, tense, worried, labile;
impulsive change in appearance, write a will, say “good-bye,” give away possessions, begin using substances;
withdraw from friends, loses interest in activities, preoccupied with death and dying

Front 107

What are the risk factors of someone who is suicidal?

Back 107

older white male, or younger black male; unemployed; ↑ stressors; possession of weapon; family
history; prior suicide attempt; significant illness; current or former psychiatric Pt; alcoholic

Front 108

What might you ask or
what action might you take to assess the pt’s risk and help increase the pt’s safety?

Back 108

o What you might ask: Do they have a plan and will they it to you? Have they figured out ways to keep someone
from stopping them?
o What action you might take: offer hope that alternatives are available (don’t offer glib reassurance); remove
weapons; get help (ER, 911, National Hopeline Network)

Front 109

What population is most at risk for suicide?

Back 109

Non-hispanic white men >= 65 yoa

Front 110

What are the symptoms and patient education for Serotonin Storm or Serotonin Syndrome?

Back 110

 Symptoms: agitation, ↑ BP, ↑ temp
 Patient education: watch medication combinations that ↑ serotonin levels

Front 111

What are the symptoms and patient education for Serotonin Discontinuation Syndrome?

Back 111

 Symptoms: dizziness, fatigue, light-headedness, anxiety, nausea, HA, ↑ aggression, ↓ mood
 Patient education: Taper down SSRIs (vs. abrupt stop)

Front 112

What do you need to educate your patient about taking MAOIs?

Back 112

Watch intake of tyramine (e.g. in foods such as aged cheeses). Tyramine is a NE agonist; can → hypertensive crisis
Must wait 5 weeks between SSRIs and MAOIs or ↑ risk of hypertensive crisis

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What do you need to educate your patient about taking Tricyclics?

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May not like side effects

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What do you need to educate your patients about taking SSRIs?

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If going to start on another antidepressant, should not do it right away

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Discuss SSRIs used for antidepressants?

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SSRIs
Action: Prevents reabsorption of serotonin → ↑ serotonin in synaptic cleft
Medications: Celexa, Prozac, Luvox, Paxil, Zoloft
S/Es: GI upset, sexual dysfunction, HA, Serotonin Syndrome

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Discuss TCAs used for antidepressants?

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Action: Block reuptake of serotonin and norepinephrine (but also block other receptors)
Medications: Elavil, Norpramin, Sinequan, Tofranil, Vivactil, Ludiomil
SEs: anticholinergic side effects: dry mouth, wt gain, sedation,
hypotension, dizznes, cardiac

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Discuss MAOIs used for antidepressants?

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MAOIs
Action: Inhibits metabolizing enzyme of serotonin and NE
Medications: Nardil, Marplan, Parnate
SEs: lightheadedness, drowsiness,
insomnia, stiff/sore neck,
palpations, N/V, flushing,
nose bleeds