Mental Health Final!!!

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an antidote for benxodiazepine overdose or toxicity?

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flumazenil (Romazicon)

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Buspirone is different from other anitanxiety medications in that it

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does not cause physical or psycological dependence

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measures that may be used to manage bruxism caused by paroxetine (Paxil)

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Concurrent administration of buspirone
Use of mouth guard
Changing to a different class of antianxiety medication

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The benzodiazepam anxiolytics:

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diazepam (Valium)
alprazolam (Xanax)
lorazepam (Ativan)
chlordiazepoxide (Librium)
oxazepam (Serax)
clonoazepam (Klonopin)

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therapeutic uses for diazepam (valium)

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Anxiety disorders
Seizure disorders
Insomina
Muscle Spasm
Alcohol withdrawal (for prevention and treatment of acute symptoms)
Induction of anesthesia

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Don't use diazepam (valium) with

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Alcohol
Barbiturates
Opioids

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Other classes of antianxiety medications include

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Antihistamine
Beta Blockers
Anticonvulsants

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Buspirone (Buspar) is a _______ and used for_______

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Nonbarbiturate Anxiolytic
Long term management of anxiety disorders...treatment of generalized anxiety disorder (GAD)

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paroxetine (Paxil) is a

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Nonbarbiturate Anxiolytic- SSRI

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now considered the first choice for depression

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Selective serotonin reuptake inhibitors (SSRIs)

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Names of SSRIs

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fluoxetine (Prosac)
citalpram (Celexa)
escitalopram oxalate (Lexapro)
paroxetine (Paxil)
sertralin (Zoloft)

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therapeutic uses for fluoxetine (Prozac)

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Depressive disorder
Anxiety disorders
Bulimia Nervosa

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oldest class of antidepressants but second line of choice

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Tricyclic antidepressants (TCAs)

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names of TCAs

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amitriptyline (Elavil)
imipramine (Tofranil)
doxepin (Sinequan)
nortriptyline (Parnate)

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now considered 2nd or 3rd choice medications for depression due to their adverse affects with food

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Monoamine oxidase inhibitors (MAOIs)

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Names of MAOIs

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phenelzine (Nardil)
isocarboxazid (Marplan)
tranylcypromine (Parnate)

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Therapeutic uses for amitriptyline (Elavil)

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Depressive disorders
Depressive episodes of bipolar disorder

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clients have symptoms that appear to be appear to be a mixture of schizophrenia and mood disorders

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schizoaffective disorder

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schizoaffective disorder is most likely a distinct syndrome resulting from

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high genetic liability to mood disorders and schizophrenia both

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has an episode lasts at least one day but less than one month, after which the person returns to the premorbid level of functioning

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brief psychotic disorder

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last at least one month but less than 6 months

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schizophreniform disorder

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a person who is in a close relationship with another person who is delusional comes to share the delusional beliefs

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shared psychotic disorder

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Behavorial aspects with positive symptoms in schizophrenia

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Hyperactivity
Bizarre behavior

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Affect of positive symptoms in schizophrenia

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inappropriate affect
overractive affect
Hostility

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Cognitive aspect of positive symptoms in schizoprenia

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Delusions
Disorganized thinking
loos associations
suspiciousness

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Social part of positive symptoms in schizophrenia

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aloof and stilted interactions

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Behavorial aspects with negative symptoms in schizophrenia

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Decreased activity level
limited speech; conversation difficult
minimal self-care

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affect of negative symptoms in schizophrenia

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Blunted or flat affect
Anhedonia

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Perceptual in positive symptoms in schizophrenia

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Hallucinations
Sensory overload

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Perceptual in negative symptoms in schizophrenia

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Inability to understand sensory information

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Cognitive part of negative symptoms in schizophrenia

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Concrete thinking
Attention impairment
Memory deficits
Impaired problem solving
Lack of motivation

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Social part of negative symptoms in schizophrenia

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Social withdrawal, isolation
Poor rapport with others
Inadequate social and occupational skills

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accounts for the majority of premature deaths among people with schizophrenia

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Suicide

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What type of delusion:
"my neighborhood wants me dead or alive. They think I hold all of their secrets. They have tapped my phone and peek through my windows 24 hrs a day"

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Persecution

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What type of delusion:
"You think this is me talking, but really it isn't. My husband keeps putting these thoughts in my head."

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Thought insertion

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What type of delusion:
"I have a hammer in my heart. It pounds daggers in it all day long. Dont you hear it? Someday soon it is going to pound so hard that my heart will come flying out of my chest onto the floor."

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Somatic

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What type of delusion:
"I can have any guy I want. Matt Damon called me last night but I couldn't go out because I already had a date with Tom Cruise"

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Erotomanic

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when verbal ideas shift form one topic to another, and there is no apparent relationship between the thoughts, and the person speaking is unaware there in no connection

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Loose association

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Appropriate goals for people with schizophrenia

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Communicate clearly
Completes ADLs appropriately
Exhibits increased attention span
Makes appropriate decisions
Displays affect appropriate for the situation
Denies hallucinations
Verbalizes logical thought processes
Develops occupational skills

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Priorites of care for a client with schizophrenia

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Prevention of violence
Altered cognition
Compromised social relationships

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One of the most effective nursing interventions with a client with schizophrenia is

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the nature of the nurse-client relationship

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Based on the assessment data, the nurse selects outcomes appropriate to the nursing diagnoses of substance abuse. Broad outcomes are:

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Reduce or eliminate alcohol or drug use
Improve quality of life through abstinence
Improve quality of family life

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Prioprities of care for clients with substance use disorders are:

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Maintain safety of clients and others
Maintain abstinence
Assume responsibility for own behavior

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are a form of amnesia for events that occurred during the drinking period

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Blackouts

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Based on the assessment data on eating disorders, the nurse selects outcomes appropriate to the nursing diagnosis. Broad outcomes include:

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Weight stabilizers within normal parameters
Abnormal eating patterns decrease or cease
Verbalizes an improved quality of life

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Goals appropriate to people with eating disorders

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Verbalizes increase satisfaction with self
Demonstrates more flexible daily routines
Decreases frequency of binge eating and purging
Verbalizes fewer fears
Achieves target weight
Identifies secondary gains
Verbalizes fewer cognitive distortions
Family problem-solves together

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Priorities of care for clients with eating disorder are

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Critical physical alterations
Imbalanced nutrion
Excessive exercise
Delusional body image
Impaired cognition

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part of the cycle of life; anticipated but still may be intensely felt

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Necessary loss

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any loss of a valued person or item that can no longer be experienced

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actual loss

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any loss defined by the client but not obvious to others

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perceived loss

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losses normally expected due to the developmental processes of life

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maturational loss

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unanticipated loss caused by an external event

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situational loss

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Kubler-ross five stages of dying

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denial
anger
bargaining
depression
acceptance

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Bowlby four stages of mourning

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numbing
yearning and searching
disorganization and despair
reorganization

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directive documents for medical treatment per the client's wishes

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living will

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for health care- an agent appointed by the client or the courts to make medical decisions when the client is no longer able to do so

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durable power of attorney

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Grief is defined as

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an individuals response to a significant loss

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Rape-trauma syndromes acute phase

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occurs immediately following the rape and lasts for about 2 weeks

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Somatic reactions such as bruising and soreness, muscle tension, headaches, sleep disturbances, GI symptoms, Genitournary symptoms, and a variety of emotional reactions including embarrassment in Rape-trauma syndrome occur later and last about

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2 weeks

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pressured or forced sexual contact, including sexually stimulated talk or actions, inappropriate touching or intercourse, incest, and rape

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Sexual assault

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With a rape victum you want to assess the client's

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level of anxiety
coping mechanisms
support systems, including both personal and community supports, such as an attorney

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counseling for a rape victum begins in the

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Emergency department

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Rape-trauma syndrome is comparable to

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posttraumatic stress disorder

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haveing thoughts about committing suicide

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suicide ideation

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inflicting a nonlethal injury to oneself with the intent to die or commit bodily harm

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parasuicide

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Pharmacotheraoy to prevent suicide includes

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antidepressants
lithium therapy for the client with bipolar disorder
Antipsychotic medications for the clients with schizophrenia or bipolar disorder
Antianxiety medications for clients with panic disorder and/or sleep deprevation

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primary intervention for suicide

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activities that provide support, information, and education to prevent suicide, such as speaking in a high school health class

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alcohol withdrawal s/s

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possible life-threatening increase in vital signs, psychotic behavior, seizures

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crystal meth withdrawal s/s

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depression, prolonged sleeping

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cigarettes withdrawal s/s

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craving, nervousness, anxiety, irritability, increased appetite

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Heroin withdrawal s/s

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yawning, piloerection, abdominal cramps, muscle pain

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LSD withdrawal s/s

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no withdrawal symptoms

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antidote for opioid toxicity is

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intravenous naloxone (Narcan)

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alcohol and benzodiazepines are

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cross-tolerant