N126 Exam 2 Set 1

Front 1

Men = genetic risk for depression is accompanied by a genetic risk for _______ and _____ disorders

Back 1

anxiety

conduct

Front 2

_________ is a key risk factor for suicide

Back 2

Depression

Front 3

4X more _____ than _____ complete suicide

Back 3

Men

women

Front 4

____ tend to develop heart disease earlier than _____

Back 4

Men

women

Front 5

Women = more susceptible to depression than men only during the _______ _______.

Back 5

childbearing years.

Front 6

Major depression

Back 6

Weeks to months- Low mood, low self esteem, loss of interest or pleasure in normally enjoyable activities

Front 7

Bipolar I

Back 7

at least one episode of mania alternates with major depression

Front 8

Bipolar II

Back 8

one or more periods of major depression with periods of hypomania.

Front 9

Dysthymia

Back 9

chronic depressive disorder present for most of day, more days than not, for MORE THAN 2 YRS

Front 10

What is the #1 therapy to use with patients that have depression?

Back 10

Cognitive Therapy- they need + experiences

Front 11

Secondary depression

Back 11

depression occurs as part of a physical illness or medical regime, or other non-mood mental illness.

Front 12

Primary depression

Back 12

depressions which occur which are not part of any other illness.This is what we are focusing on

Front 13

Types of primary depressions

Back 13

Major depression, Dysthymia, Subtypes- SAD, Post Partum

Front 14

SAD

Back 14

seasonal affective disorder- live in really northern climates, less sunlight (Alaska). Light therapy can help fix the problem.

Front 15

Post Partum

Back 15

risk for infant- hallucinations can cause one to harm their children- Andrea Yates

Front 16

Psychotic features with depression

Back 16

can be so depressed hallucinations or delusions can come on

Front 17

Depression- Psychodynamic Theory

Back 17

psychosocial stressors and interpersonal events trigger neurochemical and neurophysical changes in the brain. Early trauma may sensitize the brain causing an exaggerated stress response and predispose genetically vulnerable people to depression.

Front 18

Depression- Cognitive Theory

Back 18

these theorists believe that a triad of negative beliefs cause depression due to the reaction to the world these beliefs cause negative view of self and the world

Front 19

Depression- Learned helplessness Theory

Back 19

a person who believes that negative events are his/her fault and that nothing can be done to change them is prone to depression

Front 20

Depression- Psychophysiological Theory

Back 20

Genetic, Biochemical, stress- Seems clear that the cause is multi-factor (biology + stressors) = diathesis – stress model.

Front 21

Depression assessment- The Big 5

Back 21

1. Safety (suicidal thoughts, plan, etc.)
2. Key features of low mood (how long it is) anhedonia
3. thinking (slowed, poor conc?)
4. Feelings (anxiety, hopeless/helpless)
5. Physical behavior (psychomotor retardation, vegetative signs)

Front 22

Vegetative signs of depression

Back 22

changes in eating (anorexia), early morning wakening or hypersomnia, changes in elimination- constipation and/or sex patterns- libido- not interested in sex.

Front 23

Masked depression

Back 23

Truancy, underachievement, school phobias, drugs (amphetamines), sex, delinquent behavior, accident proneness

Front 24

Best combo of therapies for Depression?

Back 24

Talk and drug

Front 25

#1 med choice for pts with depression?

Back 25

SSRIs

Front 26

Bipolar disease theories

Back 26

neurotransmitter imbalance, genetics (strong heritability), neuroendocrine imbalance (low thyroid levels), diathesis stress model

Front 27

Teaching for pts on MAOIs

Back 27

do not eat food with high tyramine (soy sauce, avocado, miso, figs, meats (fermented/smoked/aged), cheese (all but soft), fermented sausages, beer and wine, dried/cured fish) to prevent hypertensive crisis

Front 28

Teaching for pts on Lithium

Back 28

levels must be checked regularly to prevent toxicity, water intake balance- rick of electrolyte imbalance

Front 29

SSRI actions, side effects, and nursing considerations

Back 29

Axn: selectively blocks reuptake of serotonin
S/E: Central Serotonin syndrome
Nsg consids: can increase suicidal ideations
Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft

Front 30

TCA actions, side effects, and nursing considerations

Back 30

Axn: blocks reuptake of norepinephrine and serotonin
S/E: cardio-toxicity, sedative, anticholinergic, toxic
Nsg consids: very toxic
Elavil and Tofranil

Front 31

MAOIs actions, side effects, and nursing considerations

Back 31

Axn: blocks action of monamine oxidase
S/E: hypertensive episode
Nsg consids: cannot eat low levels of tyramine
Nardil and Parnate

Front 32

Mood stabilizing drugs actions, side effects, and nursing considerations

Back 32

Axn: slows down conduction of neurons
S/E: lithium toxicity, tremors
Nsg consids: must have levels checked regularly
Lithium, Depakote/Depakene

Front 33

Describe the signs and symptoms of serotonin syndrome.... therapy?

Back 33

tachycardia, fever, hypertension, apnea, and death. Therapy: stop medication, serotonin receptor blockade medications, cooling blankets/ice packs, anticonvulsants, ventilator, paralysis

Front 34

Describe the signs and symptoms of hypertensive crisis.... therapy?

Back 34

headache, stiff neck, palpitations, and nausea/vomiting, fever. Therapy: calcium channel blockers (Antihypertensive medications)

Front 35

Describe the signs and symptoms of lithium toxicity.... therapy?

Back 35

hand tremor, nausea, slurred speech, GI upset, confusion, seizure,blurred vision, EEG changes coma/death... i. Gastric lavage with urea, mannitol, aminophylline, hemodialysis

Front 36

Identify indications for the use of electroconvulsant therapy.

Back 36

drug therapy failure, acutely suicidal client, depressed client experiencing psychotic symptoms.

Front 37

transcranial magnetic stimulation

Back 37

MRI like magnet put around head for treatment

Front 38

vagus nerve stimulation

Back 38

pacemaker placed in upper chest with wires wrapping around vagus nerve in left side of neck… constant pulse set for continuous treatment. Last ditch effort when nothing else has worked.

Front 39

Anergia

Back 39

lack of energy

Front 40

Anhedonia

Back 40

inability to feel pleasure

Front 41

Clang associations

Back 41

word choice based on rhyming more than meaning

Front 42

Cyclothymia

Back 42

hypomanic episodes alternate with minor depression for at least two years, mania is usually irritable type.

Front 43

Dysphoric mood

Back 43

distressed, characterized by anxiety, depression, or unease

Front 44

Elated mood

Back 44

proud and joyful

Front 45

Cyclothymia

Back 45

hypomanic episodes alternate with minor depression for at least two years, mania is usually irritable type.

Front 46

Euphoric mood

Back 46

exaggerated feelings of well-being

Front 47

Dysphoric mood

Back 47

distressed, characterized by anxiety, depression, or unease

Front 48

Euthymic mood

Back 48

normal, moderate mood state, neither depressed nor manic

Front 49

Elated mood

Back 49

proud and joyful

Front 50

Flight of ideas

Back 50

continuous flow of speech with many changes from topic to topic with some associations.

Front 51

Euphoric mood

Back 51

exaggerated feelings of well-being

Front 52

Hypomania

Back 52

just below mania, does not impair social, occupational, interpersonal, and reality testing

Front 53

Euthymic mood

Back 53

normal, moderate mood state, neither depressed nor manic

Front 54

Rapid cycling

Back 54

a variation of bipolar disorder and represents 4 or more episodes of mania of 2 weeks or more in 1 year.

Front 55

Flight of ideas

Back 55

continuous flow of speech with many changes from topic to topic with some associations.

Front 56

Labile mood

Back 56

up and down mood, all over the place

Front 57

Hypomania

Back 57

just below mania, does not impair social, occupational, interpersonal, and reality testing

Front 58

Mania

Back 58

unstable elevated mood- delusions, poor judgment, and impaired reality testing. Impaired social, occupational, interpersonal functions.

Front 59

Rapid cycling

Back 59

bipolar patient with many episodes of mood swings close together. Four or more in one year

Front 60

Labile mood

Back 60

up and down mood, all over the place

Front 61

Mania

Back 61

unstable elevated mood- delusions, poor judgment, and impaired reality testing. Impaired social, occupational, interpersonal functions.

Front 62

Pressured speech

Back 62

forceful energy manifested in frantic, jumbled speech, as when an individual with mania struggles to keep pace with thoughts

Front 63

Psychomotor retardation

Back 63

slow movements

Front 64

Ruminate

Back 64

to go over in mind over and over

Front 65

What are the pros and cons to ECT?

Back 65

Pro: effective Con: can cause memory loss and headache for a couple weeks after the procedures are done.

Front 66

SSRIs- How do they work? Name 6 drugs.

Back 66

Inhibiting Serotonin's re-uptake.
Celexa, Lexapro, Luvox, Proxac, zoloft, paxil

Front 67

SNRIs- How do they work? Name 2 drugs.

Back 67

Inhibiting Serotonin and Norepinephrine's re-uptake.
Effexor, Cymbalta

Front 68

NDRIs- How do they work? Name 1 drug.

Back 68

Inhibiting Norepinephrine and Dopamine's re-uptake.
Wellbutrin

Front 69

SNDIs- How do they work? Name 1 drug.

Back 69

Disinhibits serotonin and norepinephrine (blocks alpha1 rec. that inhibit S and N)
Remeron

Front 70

TCAs- How do they work? Name 2 drugs.

Back 70

Inhibits S and Norepi's re-uptake- just like SNRIs.
Elavil and Tofranil

Front 71

What foods contain tyramine?

Back 71

Avocado, figs, bananas, all cheeses, imported beers, protein supps, soups, shrimp paste, soy sauce, anything that is fermented, smoked, dried, or aged (meats, fish, etc.)

Front 72

What kind of foods should we try to give clients with mania?

Back 72

Frequent high calorie snacks- finger foods that they can carry, walk with, and eat

Front 73

How should rest be approached with clients with mania?

Back 73

frequent rest periods

Front 74

What type of environment should be provided for clients with mania?

Back 74

Low level stimuli environ, provide structured, solitary activities with mild physical exertion

Front 75

How should we communicate with clients with mania?

Back 75

Use short and concise explanations/statements. Avoid getting caught up in jokes. Tell clients limits in simple terms, including the consequences. Be consistent with limits.

Front 76

How should we approach hygiene and wardrobe for clients with mania?

Back 76

Give simple step by step reminders for hygiene. Supervise clothes, we do not want flamboyant dress (they may be embarrassed when they come down).

Front 77

#1 Nursing diagnoses for pts with depression?

Back 77

Risk for suicide or self-harm R/T suicidal ideation, past attempts, and/or hopelessness

Front 78

Other Nursing diagnoses for pts with depression?

Back 78

Impaired social interaction, Disturbed self-esteem, Ineffective individual coping, Self-care deficit

Front 79

Secondary gains

Back 79

additional benefits the person experiences from being sick such as getting attention and being excused from responsibilities.

Front 80

S/S of central serotonin syndrome

Back 80

hyperactivity, tachycardia, hyperpyrexia, hypertension (essentially everything hyper) lead to delirium, then seizures, then possibly death.

Front 81

Common and Serious S/E of TCAs

Back 81

common side effects: sedation, anticholinergic, tachycardia, postural hypotension
serious side effects: dysrthymias, MI, heart block

Front 82

MAOI’s: used less due to dangerous side effect of ________

Back 82

hypertension

Front 83

What is something VERY IMPORTANT to remember about MAOIs?

Back 83

AVOID OTHER DRUGS UNLESS APPROVED BY MD – especially other anti-depressants

Front 84

What is a very effective treatment for depression that a client can do on their own?

Back 84

Exercise- nearly as effective as talking therapy in some cases: empowering, involves action (non-ruminative), goal oriented, and positively reinforcing.

Front 85

Light therapy

Back 85

used in SAD and seems to lessen depression.

Front 86

Vagus nerve stimulation

Back 86

pacemaker for the brain), surgically implanted device sends mild signals to vagus nerve to stimulate areas of brain involved with mood. 40% significant relief in experiments

Front 87

Transcranial magnetic stimulation

Back 87

halo of magnets used to modify electrical activity of cerebral cortex. 50% effective in experiments

Front 88

What disorders fall under the category- Mood Disorders?

Back 88

Depression and Bipolar

Front 89

_________ is less severe than mania. It usually doesn’t impair the person’s grasp on reality.

Back 89

Hypomania

Front 90

Mixed episodes

Back 90

both manic & depressive symptoms within one day.

Front 91

Is Bipolar inheritable?

Back 91

Highly inheritable (80-90%). Many genetic similarities to schizophrenia.

Front 92

What may precipitate a bipolar episode?

Back 92

Psychological stress may precipitate episodes.

Front 93

Bipolar Assessment-
Three most important initial symptoms:

Back 93

Elated mood
Increased activity
Decreased sleep

Front 94

Is Major depression a bipolar or unipolar disease?

Back 94

Unipolar Disease

Front 95

What are some nursing diagnoses for bipolar disorder?

Back 95

Risk for injury, risk for other-directed violence, disturbed thought processes, impaired social interaction

Front 96

What is the #1 advantage a nurse has over a client with bipolar disorder?

Back 96

Distraction- they are easily distracted

Front 97

What is the #1 reason to use seclusion with a bipolar client?

Back 97

To reduce environmental stimuli- for pts safety

Front 98

Acute mania- Risk for Injury

Back 98

In acute mania the key problem is prevention of exhaustion & death from cardiac collapse = Risk for injury

Front 99

Acute mania- Risk for violence directed at others

Back 99

tend to be irritable and intrusive = Risk for violence directed at others

Front 100

Acute mania- disturbed thought processes

Back 100

The grandiosity, poor insight & judgment, poor concentration = disturbed thought processes

Front 101

Acute mania- ineffective individual coping

Back 101

Schemes and shady deals = ineffective individual coping

Front 102

Acute mania- Impaired social interaction

Back 102

Restlessness, rapid speech, irritability, intrusiveness = Impaired social interaction

Front 103

Manic clients frustrate and tire nurses. They also try to ____ _____ to keep everything unsettled. They have more freedom when staff is not united.

Back 103

split staff

Front 104

When setting limits, _________ among the staff is the key to success.

Back 104

consistency

Front 105

Large motor activities and writing are great activities for _____ clients. They don’t have the concentration for precise activities.

Back 105

manic

Front 106

Seclusion and/or restraint charting

Back 106

Maintain usual procedures staff within reach to help pt, chart q 15 min, check for elimnation, comfort, food q 2 hrs

Front 107

drug of choice for mania

Back 107

Lithium

Front 108

Lithium therapeutic level

Back 108

(0.6-1.2 mEq/L is an average range and easy to remember). Takes 7-14 days to reach therapeutic level.

Front 109

When to check blood levels when for pts on lithium?

Back 109

weekly at first, then monthly, then every 3 months

Front 110

Nervous and muscular- s/e, early toxicity, advanced toxicity, and severe toxicity of lithium

Back 110

S/E- fine hand tremor (FHT)
EARLY- slur speech, muscle weak, FHT
ADV- Coarse HT, cnfus, muscle hyperirritability
SEVERE- Ataxia, cnfus, blur vis, seizures, clonic mvmts, coma, convulsions, death

Front 111

Digestive- s/e, early toxicity, advanced toxicity, and severe toxicity of lithium

Back 111

S/E- mild nausea, wt gain
EARLY- D/N/V
ADV- persistant GI upset
SEVERE-

Front 112

Cardiac- s/e, early toxicity, advanced toxicity, and severe toxicity of lithium

Back 112

S/E-
EARLY-
ADV- EEG changes- arrhythmias
SEVERE- Serious EEG changes, severe hypotension,

Front 113

Fluid and electrolyte- s/e, early toxicity, advanced toxicity, and severe toxicity of lithium

Back 113

S/E- polyuria and mild thirst
EARLY- thirst, polyuria
ADV-
SEVERE- Lg output of dilute urine, oliguria

Front 114

In acute mania, ______ use to control hyperactivity and aggression

Back 114

antipsychotics

Front 115

3 antipsychotics are approved for mood stabilization

Back 115

Zyprexa, Seroquel, Abilify approved for maintanance with bipolar

Front 116

medications for mood stabilization are anticonvulsants:

Back 116

Tegretol, Depakene/Depakote, Lamictal, Neurontin & Topamax, Klonopin/Ativan

Front 117

Possible side effect of Lamictal

Back 117

Life threatening rash -need to seek treatment for all rashes because they may indicate Stevens-Johnson Syndrome. Skin will just fall off.

Front 118

STEP-BD

Back 118

study of most effective treatment- Intensive psychotherapy plus medications = most effective.
No specific type of psychotherapy found to be statistically more effective

Front 119

Completed suicide

Back 119

pt died from attempt

Front 120

Completed suicide

Back 120

pt died from attempt

Front 121

Copy cat suicide

Back 121

happens when a friend or famous person dies and the other person copies the act

Front 122

Copy cat suicide

Back 122

happens when a friend or famous person dies and the other person copies the act

Front 123

No-suicide contract

Back 123

contract with staff that pt will talk to someone if they are having suicidal ideations

Front 124

No-suicide contract

Back 124

contract with staff that pt will talk to someone if they are having suicidal ideations

Front 125

SAD PERSONS scale

Back 125

Scale used to calculate risk for suicide

Front 126

SAD PERSONS scale

Back 126

Scale used to calculate risk for suicide

Front 127

Suicide attempts

Back 127

person does not die from the attempt

Front 128

Suicide attempts

Back 128

person does not die from the attempt

Front 129

Suicidal ideation

Back 129

thoughts of committing suicide/hurting self.

Front 130

Suicidal ideation

Back 130

thoughts of committing suicide/hurting self.

Front 131

Suicide is the _____ leading cause of death in the U.S.

Back 131

11th

Front 132

Suicide is the _____ leading cause of death in the U.S.

Back 132

11th

Front 133

________ most common method for women

Back 133

Poison

Front 134

________ most common method for women

Back 134

Poison

Front 135

________ most common method for both men and women

Back 135

Firearms

Front 136

________ most common method for both men and women

Back 136

Firearms

Front 137

More men than women die by suicide by a ____ratio

Back 137

4:1

Front 138

More men than women die by suicide by a ____ratio

Back 138

4:1

Front 139

Highest suicide rate = ________

Back 139

white men over age 75.

Front 140

Occupations with the highest risk are _____ and ______. Nurses and social workers have an elevated risk compared to other jobs.

Back 140

physicians and dentists

Front 141

Psychological factors with suicide

Back 141

Hopelessness is a central factor, other motivations may be revenge, reunion with loved one, copy-cat suicide. People who cannot see different options to solve problems at risk.

Front 142

Biochemical-genetic factors with suicide

Back 142

Genetic link shown in twin studies, low levels or serotonin (5-HT), physical illnesses considered an important factor in many suicides.

Front 143

Example of an overt statement

Back 143

“Everyone would be better off if I died.”

Front 144

Example of a covert statement

Back 144

“I won’t be a problem much longer.”

Front 145

High Risk methods/plan for suicide

Back 145

gun, jumping off a high place, hanging, carbon monoxide poisoning, staging a car crash

Front 146

Lower risk methods/plan for suicide

Back 146

slashing wrists, inhaling natural gas, ingesting pills

Front 147

Sad Persons Scale

Back 147

Sex, Age, Depression, Previous attempts, ETOH, Rational thinking lost, Social supports lacking, Organized plan, No spouse, Sickness

Front 148

Risk for Suicide

Back 148

Overt or covert clues, high risk category

Front 149

Ineffective Coping

Back 149

Overwhelmed with situational crises, decreased support, ETOH/drugs

Front 150

Hopelessness

Back 150

Lacks hope for future

Front 151

Powerlessness

Back 151

Believes nothing can change situation

Front 152

Situational Low Self-esteem

Back 152

Feels worthless, is a burden to others, “no good”

Front 153

The DSM V has reclassified the group of disorders previously known as cognitive disorders. The new classification is called ________ disorders.

Back 153

neurocognitive

Front 154

cognitive disorders include....

Back 154

Delirium and Dementia

Front 155

Delirium is characterized by

Back 155

sudden changes in consciousness and cognition that develop over a short time span.

Front 156

Delirium is always...

Back 156

secondary to another condition such as a medical condition.

Front 157

Dementia is characterized by

Back 157

multiple cognitive deficits, including memory, and develops over a long period of time. (major neurocognitive disorder)

Front 158

There are a number of diseases causing primary _______.

Back 158

dementia

Front 159

Since delirium is always secondary to another condition, a rapid and accurate diagnosis is essential to start treatment of the underlying condition. If the underlying condition is not treated promptly, the delirium may become _________.

Back 159

irreversible

Front 160

When a mild delirium becomes more severe in the evening, the term ________ is used.

Back 160

Sundowning

Front 161

_______ clients frequently have hallucinations, illusions, and delusions.

Back 161

delirious

Front 162

ASSESSMENT GUIDELINES FOR DELIRIUM

Back 162

Acute onset & fluctuating course, Inattention
Disorganized thinking Disturbances of consciousness
Sundowning