Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
95 Cards in this Set
- Front
- Back
|
Benzodiazapines work on which Neurotransmitter
|
GABA
|
|
|
3 Common types of medications for anxiety
|
1. benzo
2. Buspar - no "ah" let down feeling. 3. SSRI |
|
|
Benzo's general info
|
Dependence both physical and psych.
Not likely to interact with other meds hard to die from an Overdose ideal time frame 2-4 weeks, PRN |
|
|
EX of benzos
|
Xanax- pm
Ativan- alcohol (ETOH) withdrawal Klonopin- scheduled long term treatment Librium- ETOH withdrawal Valium |
|
|
Benzo Side effects
|
Dizziness
Drowsiness Lethargy "morning hangover" |
|
|
Nsg considerations for benzos
|
1. Do not give to elderly with delirium
2. monitor CBC, LFT, RFT 3. Monitor BP, HR, RR 4. Check for dizziness 5. Do not take with ETOH or CNS stimulants 6. Watch for yellow skin 7. Maintain Safety |
|
|
Examples of MAOI
|
1. Nardil
2. Parnate Works on dopamine, serotonin, and norepi. |
|
|
MAOI Side effects
|
Orthostatic Hypotension
dizziness drowsiness fatigue anticholinergic effect "drying" seizure HTN crisis |
|
|
HTN crisis:
|
Occurs when on MAOI and a person eats foods with Tyramine.
|
|
|
Foods containing Tyramine
|
Ripe Cheese, Yeast extract, red wine, pickled herring, sauerkraut, overripe bananas, figs, avocados, chicken liver, beer, fava beans, coffee, tea, cola, chocolate
|
|
|
MAOI drug interactions
|
Interacts with many meds, always check with PCP before taking any meds.
DO NOT take with "St. John's Wort" or "SAMe" as it will lead to serotonin syndrome |
|
|
NSG Considerations- MAOI
|
1. Can the person afford/remember the diet.
2. monitor for suicidal Ideation (SI) 3. Monitor LFT/RFT 4. Monitor BMI 5. Monitor for metabolic/serotonin syndromes |
|
|
Tricyclic ex:
|
1. Elavil
2. Pamelor 3. Anafranil 4. Sinequan 5. Tofranil Works on serotonin, dopamine, and norepi |
|
|
Tricyclic se
|
lethargy
sedation anticholinergic hypotension arrhythmias |
|
|
NSG considerations- tricyclics
|
increased falls in elderly
not for kids < 12 yo EKG baseline and periodically thru therapy Monitor BP and SI Monitor for serotonin syndrome |
|
|
SSRI examples
|
Zoloft
Paxil Prozac- Bulemia esp. Lexapro Celexa- Symbyax Zyprexa - Bipolar depression |
|
|
SSRI side effects
|
N/V/D
dizziness drowsiness HA Dry mouth sexual dysfunction (males esp) |
|
|
NSG considerations- SSRI
|
1. Caution with elderly r/t dizziness and hyponatremia
2. not for kids, except for use with OCD 3. Monitor LFT/RFT 4. monitor for SI 5. Do not stop abruptly 6. Monitor for serotonin syndrome |
|
|
SSNRI ex:
|
Cymbalta
Effexor Pristiq Used when SSRI didn't work or wasn't tolerated. |
|
|
Conditions SSRIs are used:
|
Anxiety
OCD Anorexia Bulemia Autism Dementia Conduct disorder |
|
|
SSNRI side effects
|
Anxiety
Drowsiness/dizziness Abnormal dreams HA Anorexia/ABD pain Nausea/constipation/diarrhea seizures |
|
|
NSG Considerations- SSNRI
|
Use with caution if pt has hx of: 1. CVD 2. HTN 3. Hepatic/renal impairment
Check BP Check for serontonin syndrome monitor for SI |
|
|
Serotonin syndrome
|
Confusion
agitation tachycardia HTN Nausea/Abd. pain Fever diaphoresis tremor muscle rigidity (possible) Slow progression to death without treatment |
|
|
Treatment (Tx) for serotonin syndrome
|
STAT d/c of medication thats causing it.
Anticonvulsants- PRN for seizure Ativan Thorazine- for the hyperthermia Diazepam |
|
|
Mood stabilizers
|
Increase GABA
Depakote Topamax- nightmares Neurontin Tegretol Lithium |
|
|
Mood stabilizer side effects
|
WEIGHT GAIN!!!
agitation dizziness insomnia/sedation anorexia abd. pain HA diarrhea hepatotoxicity pancreatitis |
|
|
Depakote
|
Therapeutic blood level: 50-100 mcg.
If > 100 at risk for hepatotoxicity monitor LFTs! |
|
|
NSG considerations- Mood stabilizers
|
Elderly is at high risk for dizziness/sedation
Monitor LFT/RFT Monitor for SI Lithium Level- 0.4-1.5 |
|
|
Antipsychotics used for
|
Works on dopamine levels
dementia autism conduct disorder mental retardation delirium |
|
|
Examples of antipsychotics
|
Typical:
thorazine stelazine Atypical: Haldol Clozaril Risperidal Abilify Seroquel Zyprexa |
|
|
Clozaril
|
WEEKLY monitor CBC
Because: 1. side effect of agranulocytosis 2. risk for infection 3. infection symptoms with a decrease WBC instead of increased WBC. |
|
|
Antipsychotic side effects
|
ANTICHOLINERGIC
orthostatic hypotension WT LOSS/GAIN Lethargy SEDATION HA weakness EPS |
|
|
EPS side effects and treatments
|
Dystonia: rigid muscles tx: benadryl of cogentin
Pseudoparkison's- Cogentin or symmetrel Akathisia- "restlessness": Benzos |
|
|
Neuroleptic Malignant syndrome (NMS)
|
within first week of tx
rapid development (24-48 hr) r/t depletion of dopamine |
|
|
Neuroleptic Malignant syndrome symptoms
|
Fever (HIGH)
Tachycardia Labile HTN (all over the place) Diaphoresis Altered LOC Incontinent "Lead Pipe" rigidity (Whole body) |
|
|
Tx for NMS
|
Parlodel
Symmetrel Muscle Relaxers- for dystonia |
|
|
Sedatives examples
|
Barbiturates: "amytal"
Benzo: ativan, xanax Maintain safety, NO ETOH or cns depressants/stimulants |
|
|
Hypnotics
|
Benzo: Tamazepam, Triazolam
MISC: Ambien, Lunesta, Rozerem |
|
|
NSG considerations- hypnotics
|
Give immediately before sleep
need to expect at least 8 hours of sleep minimum Ambien can cause sleep walking do not take after 2400 |
|
|
Hypnotic Side effect
|
"MORNING HANGOVER"
orthostatic hypotension impaired coordination blurred vision |
|
|
CNS stimulants
|
Ritalin
Adderal Concerta Strattera- not a controlled substance Focalin Wakes up the "sleepy" part of brain responsible for impulsivity, inattention, hyperactivity |
|
|
CNS Stimulant side effects
|
Agitation/anxiety
Paranoia Loss of appetite wt. loss increased HR and BP insomnia stunted growth- most concerning for parents |
|
|
Primary Prevention of mental health issues in community
|
Definition: reduce the INCIDENCE of mental disorders in community
Prevention of crisis early identify stressors teach coping skills |
|
|
Primary prevention nursing focus
|
maturational/developmental ages.
EX: adolescence, marriage, parenthood, retirement. Target education on the age groups |
|
|
Secondary prevention
|
Definition: SHORTEN DURATION of illness.
Detect early and treat early on-going assessment of high risk people providing meds and care Give referrals to support groups/centers etc. |
|
|
Tertiary Prevention
|
Definition: REDUCE DEFECTS associated with chronic mental illness.
"REHAB" Goal- keep them out of hospital Help with ADLs, shopping, budgets, crisis intervention etc. Referrals |
|
|
Domestic Violence
|
A learned behavior
women not required to report on kids are required to report on |
|
|
Cycle of violence
|
1. tension building
2. acute explosion 3. honeymoon |
|
|
Child abuse- Physical
|
Bruises- all stages of healing
Bite Marks/welts- Adult size Burns |
|
|
Child Abuse- Emotional
|
Not paying attn in class
bedwetting/thumb sucking regressive behaviors |
|
|
Child Abuse- Sexual
|
Frequent UTI's -esp girls
Genital/throat sores/STD Prob's/pain walking/sitting Foreign Objects in bladder/vag/rectum Genital pain/rash/bruising/bleeding Sleep disturbances |
|
|
Child neglect- physical
|
Denied healthcare
leaving child home alone not changing diapers not bathing not providing enough food |
|
|
Child neglect- emotional
|
not showing:
love affection positive regard education socialization with kids their age |
|
|
Elder abuse- victim profile
|
70 + year old female, white
decreased cognitive ability unable to do ADLs on own Caregiver isn't able to meet needs |
|
|
Elder abuse- vicitimzer
|
Lives with them
the primary caregiver abused themselves abuses substances tight finances high stress |
|
|
Delirium s/sx
|
Change in cognition over short time.
Lack of focus anxiety inattentiveness rambling speech reasoning- impaired rapid onset short duration with tx. disorganized thinking sleep disturbances emotionally unstable sleep/wake cycle reversed |
|
|
Causes of delirium
|
Infection
Hypoxia Med changes ETOH Anesthesia |
|
|
Dementia causes
|
Primary: Alzheimers
Secondary: Vascular dementia (r/t many TIA) AIDS/HIV Parkinson's Huntingtons chorea Head Trauma |
|
|
Dementia Sx
|
Gradual/insidious
Complex memory loss neglect personal appearance big personality changes wanders (late stages) inappropriate behaviors incontinent no speaking (later stages) Regressive behavior (late stage) |
|
|
Amnesic disorder
|
Memory loss
inability to learn new info A&O X 1 confabulation (make up stories to fill holes in memory) lack of initiative blunted affect apathy no impairment in abstract thought (balance checkbook) no impairment in judgement no personality change |
|
|
NSG process for amnesic disorders
|
Assess: safety, neuro status, mental status
Diagnoses: R/t safety and knowledge Goals should be short term |
|
|
Mild mental retardation
|
IQ: 50-70
Academic ability at about 6th grade able to minimally self support |
|
|
Moderate mental retardation
|
IQ: 35-50
"trainable" in a vocation academic skill @ 2nd grade can't live alone |
|
|
Severe Mental Retardation
|
" Ex: toilet, eat
Need close supervision |
|
|
Profound mental retardation
|
IQ: <20
Need consisten care/caregiver Possible concurrent neuro prob exists |
|
|
Autism
|
Abnormal/impaired development in social interaction and communication. Markedly restricted repertoire of activity and interests
|
|
|
Autism sx:
|
decreased social interaction
decreased eye contact indifferent "loner" slower to interpret meanings of gestures/looks labile emotions self-inflicted wounds |
|
|
Red flags for autism
|
No big smile/joyful expression when little
no speech or bably at appropriate ages probs with textures, sounds and other sensory information |
|
|
ADHD 3 features
|
Impulsivity
Hyperactivity Inattentiveness |
|
|
Neurotransmitter changes in ADHD
|
Decreased Dopamine and norepi.
Dopamie: responsible for impulsivity and risk taking Norepi: attention, arousal, mood |
|
|
Teaching for parents regarding meds:
|
DO NOT abruptly stop
a drug holiday should be tried occasionally, PER MD ORDER ONLY |
|
|
Strattera
|
a nonstimulant, give when increased dose of stimulants not working or side effects not tolerable. SE: nausea
|
|
|
If nothing else is working for ADHD
|
Try Wellbutrin or Effexor
|
|
|
Conduct disorder
|
Interferes with the basic rights of others and societal rules are violated
|
|
|
Symptoms/personality
|
"aggressive and rough"
stealing breaking into houses/cars bullying end up in juvenile detention frequently |
|
|
Oppositional defiant disorder
|
disobedient to elders, hostile.
not interfering with rights of others |
|
|
Adjustment disorder
|
maladaptive reaction that occurs 3 months after a stressor and no longer than 6 months. coping skills not working
|
|
|
Adjustment disorder symptoms
|
anxiety/worry
lack of interest appetite changes insomnia/too much sleep like conduct disorder just for a shorter period |
|
|
Impulse control disorders
|
Needs immediate gratification; must teach how to delay gratification.
|
|
|
Intermittent explosive disorder
|
no build up of anger; just BAM explodes and causes serious assult or destruction.
Gets worse as person ages |
|
|
Kleptomania
|
Stealing
item is cheap and small may be anxious/depressed feel no remorse TX: anxiolytics and SSRI |
|
|
Pyromania
|
set fires. pull fire alarms to watch reactions
stay and watch the fire plan!!! watch the people see when the building is full/empty |
|
|
Trichotillomania
|
"pulls own hair out"
females more often childhood prob other self mutalative behaviors TX: cognitive/behavioral therapy, de-sensitization, delayed gratification |
|
|
Anorexia
|
1. Close with parents not really with friends.
2. feels like theyre not perfect 3. Thin is "good", Thinner "better" and thinest "best." 4. do not feel sexual. 5. hide in baggy clothes or flaunt it. 6. 200 cal/day intake... (they dont feel hunger pain) 7. weight loss >15% of ideal BMI 8. no menses 9. lenugo (thin hair all over body) |
|
|
Bulemia:
|
1. Over controlling parents, aggressive behavior, looking for love.
2. binge/purge cycle 3. extreme exercise 4. laxative/diurectic use 5. vomiting |
|
|
BMI
|
Morbid obese >40
Obese >30 Norm 20-24 |
|
|
# 1 cause of death for eating disorders?
|
Heart failure
|
|
|
Binger eaters
|
Eat all day
usually high calorie snacks history of numerous diet failures use lap band commonly |
|
|
Warning signs of an eating disorder- Food behaviors
|
skipping meals
excuses to skip meals tiny portions wont eat in front of others have "safe" and "nonsafe" foods |
|
|
Warning signs of an eating disorder- body image
|
"too fat" r/t media, family msgs, etc..
big clothes to cover thin/fat body |
|
|
Warning signs of eating disorder: exercise
|
Compulsive
Extensive |
|
|
Warning signs of eating disorder: feelings
|
Repressed Anger
Passive/aggressive behavior Binge/purge/Starving r/t lack of control feels not measuring up to expectations needs to be perfect |
|
|
Eating disorder treatment team
|
1. PCP
2. Therapist 3. Nutritionist/dietician |
|
|
Crisis intervention
|
Phase 1: try to use previous problem solving skills
Phase 2: increase anxiety, feeling helpless, confusion, disorganized Phase 3: Prob solving skill/resources could resolve prob. Phase 4: ER/Psych Hospital, major disorganziation, anxiety increases to panic, emotionally labile, behavior reflects psychotic thinking. |
|
|
Nurse role in crisis
|
Assess: 1. hx of stressor, physical, mental state, suicide/homicide ideations, support system, coping skills
Plan: SAFETY, coping skills Interventions: reality based "here and now" stay with them at this stage |
