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174 Cards in this Set
- Front
- Back
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Positive symptoms of schizophrenia include
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hallucinations, delusions
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Schizoaffective disorder is a combination of which 2 diseases
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schizophrenia and bipolar
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Traditional meds ________ dopamine
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decrease or block
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The biggest reason to change someone from a traditional psychotic med to a atypical is
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EPS
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A late symptom of EPS is
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tardive dyskinesia
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The treatment for EPS is
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anticholinergic (benadryl or cogentin)
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What do you do for a pt that develops neuromalignant syndrome
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It is an emergency, hold med, cooling measures and hydration
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Thorazine, Haldol, Mellaril and Prolixin are which type of antipsychotic
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Traditional
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Clozaril, Risperdal, Zyprexa, Geodon, Seroquel and abilify are what type of antipsychotic
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2nd generation
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A side effect of all atypical antipsycotics
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weight gain
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Clozaril, a atypical antipsychotic, can cause which emergency problem
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Agranulocytosis, if pt reports any s/s of illness or injury check WBC
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Akathesia is characterized by
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restlessness
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Antipsychotics are ______ to OD on
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not very easy
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EPS symptoms
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Parksonians, acute dystonia, tardive dyskinesia, akathesia
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What would you see in a pt with acute dystonia
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neck ridgitity
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This symptom of EPS does not go away once you have it
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Tardive dyskinesia
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If a pt presents with EPS symptoms what drug would you give?
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An anticholinergic such as cogentin or benadryl
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Symptoms of EPS depend on
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dose
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Old meds target _____ symptoms
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positive
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Z meds are the worst meds for
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weight gain (Zyprexa)
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New meds target ________ symptoms
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positive and negative
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What med would you give to a pt with neuro malignant syndrome
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A muscle relaxant- parlodel or dantrolene
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With Geodon what do you need to watch out for?
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Cardiac hx
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Which antidepressant is your 1st line therapy
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SSRI
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TCA's should not be given if the patient has
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cardiac hx
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TCA's work well but can be ___________
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deadly in OD
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Elderly pt taking a TCA should be taught that a common side effect is _____________ they are at higher risk of _______
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hypotension, fall
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Serotonin Syndrome is common in which antidepressant class
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SSRI
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S/S serotonin syndrome
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Agitation, tremorous, jittery, confusion, increase HR and BP, fever, sweating, muscle ridgitity, cardiovascular collapse
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SSRI's should not be give with which other drug?
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MAOI
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Common side effect in SSRI affecting 70%
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Sexual dysfunction
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Sexual dysfunction can also occur with which class of antidepressants
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SSNI
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This drug class is the 3rd choice due to danger of HTN crisis
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MAOI
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Which MAOI's which foods need to be avoided
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tyramine
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There are 2 mood stabilizers used for bipolar what are they
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Lithium and antiepileptic drugs
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How is lithium excreted
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by kidneys
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Pts taking lithium must be informed to do what with there diet
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maintain normal salt intake- the levels of sodium and lithium in the body must balance. They must also stay hydrated.
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The normal plasma level of Lithium is
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0.8 to 1.5 mEq/L
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Adverse effects of Lithium at therapeutic level include
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n/d/ abd pain (take with meals)
Weight gain, polyuria (need 800ml h20/day) Renal toxicity (monitor labs) Goiter and hypothyroidism (reversible) and Tetratogenesis (Category D-avoid in pregnancy) |
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Lithium toxicity occurs at levels around ________- and includes what s/s
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2.0 severe n/v/d, course tremors, neuro- slurred speech
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Lithium interacts with which drugs
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diuretics
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Antiepileptics used for bipolar include
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valproic acid, tegretol and lamictal
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Stevens Johnson Syndrome is a adverse reaction to which mood stabilizer
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Lamotrigine (Lamictal)
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What needs to be monitored and why when giving a pt valproic acid
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LFT- and PLT
can cause liver failure and thrombocytopenia |
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Side effect of Valproic acid and how to fix it
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N/V take with food
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Alcohol w/d s/s
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tachycardia, hypertension
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w/d assessment should last
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3-5 days
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Wernicke symptoms
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diplopia, ataxia, somnolence
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a pattern of substance use that has caused recurrent and significant consequences r/t repeated use of substance repeatedly during a 12 month period
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Substance Abuse
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must have 3 or more criteria over 12 months or longer but may or may not have physiological dependence on substance
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Substance Dependence
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A need for a substance in greater amounts to achive desired effect
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tolerance
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physiological and mental maladaptation occuring when a substance is stopped
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Withdrawl
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The cage questionare asks what questions
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C
A G E |
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A reversible substance specific syndrome due to recent ingestion defines what
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intoxication
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An immediate result at a low cost with a narrow window of assessment used to detect alcohol
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breath analysis
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Intoxication in most states is a BAL = to
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.08
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Etoh, sedative-hypnotics, benzo's and barbiturates belong to which class of substances
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Depressants
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Name 5 stimulant substances
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Amphetamine, cocaine, crack, nicotine, caffeine
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Name 3 Hallucinogens
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LSD, Ecstasy(MDMA), PCP
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Name the 4 classes of substances
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depressants, stimulants, hallucinogens, narcotic/analgesics
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tremor, restlessness, anorexia, insomnia, agitation, increased activity, increased alertness, elation, are symptoms of which substance class intoxication
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Stimulants
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Amphetamines effect
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increase BP, HR, relax bronchial smooth muscle and vasoconstrict
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Cocaine affects which organ of the body
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heart
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Priority nursing dx for a pt on hallucinogens is
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danger to self or safety
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Physical effects of hallucinogens include
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n/v, pupil dilation, increased temp, BP Pulse Decreased RR, loss of appetite, insomnia, sweating, elevated BS, seizure and coma
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With this substance class it is possible to have flashbacks years later
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Hallucinogens
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Wernicke's Encepalopathy s/s
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ataxia, mental status changes, paralysis of eye
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Wernickes is reversible with
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Thiamine
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Tremors, anorexia, insomnia, tachycardia, HTN, agitation, N/V, hallucinations are withdrawal signs of which substance
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ETOH
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DT's start ____ to _____ hours after last drink
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24-72
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anxiety, intolerance to brightness or loudness, muscle twitch, seizure are withdrawal signs of which substance
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Sedative/Hypnotics
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Opiod w/d causes which s/s
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muscle cramps, bone pain, diarrhea, piloerection, temperature fluctuation, craving, pupil dilation, dysphoria
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Which substances are at highest risk of having sucidal thoughts during w/d
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amphetamines and cocaine
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Fatigue, depression, vivid bad dreams, psychomotor and sleep disturbances, increased appetite are w/d symptoms of
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amphetamines/ cocaine
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When detoxing a pt from sedative/hypnotics do you stop the drug immediatly
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No , gradually decrease dose. May use tegretol
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Methadone decreases ________
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craving for opiods
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Benzos are used for labile violent behavior in which drug pt that is detoxing from
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hallucinogen/PCP
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What is the intervention for cocaine or amphetamine detox
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no physiologic
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A patient that is intoxicated from drinking too much is at risk for
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aspiration.
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# 1 priority for nursing care of a paranoid person
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Develop trust
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Paranoid patients often use ____________ as a defence mechanism
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projection-
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Tense, guarded, suspicious and argumentative (may hurt others) is the s/s of this
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paranoid
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These patients are consumed with delusion, have flat affect
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Paranoid
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To be diagnosed schizoaffective symptoms of schizophrenia and another mood disorder must be present for
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longer than 1 month
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positive schizophrenia symptoms are related to _________________ process
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hyperdopaminergic
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Negative symptoms of schizophrenia are related to
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structural changes in brain and hypodopaminergic process
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flat affect, withdrawl and low functioning are positive or negative types of schizophrenia
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negative
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Delusions are driven by
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fear
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Positive symptoms of schizophrenia include delusions, religiousity, paranoia, distorted ______________ and hallucinations
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sense of self such as echolalia, echopraxia, and depresonalization
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Objective signs of schizophrenia include
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alteration in personal relationships- isolation (spends 6-8 hrs in room), alteration of activity, agitation
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Delusional disorder includes 5 subtypes
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grandiose, jealousy, persecutory, somatic and erotomanic (criterion A -positive symptoms is never met)
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Brief psychotic disorder lasts
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less than 1 month
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How many positive symptoms (criterion a) must a patient have to be dx with brief psychotic disorder
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1 or more
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Schizophreniform disorder is also called
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1st break
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How long does schizophreniform disorder last
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1-6 months
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When you have a disruptive patient there are 6 things you must do, name them
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Set LIMITS, Decrease STIMULI, OBSERVE for escalating behavior, minimize potential WEAPONS, do invoke CONSEQUENCES when violations occur, SAFETY
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6 things you should do for a withdrawn patient
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provide non threatning activities, arrange furniture so patients sit together, assist with decision making, 1x1 with RN, grooming and hygeine, Resocialization
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Be matter of fact, dont laugh or whisper, clarify misperceptions, dont touch without warning, be consistant and maintain eye contact are all things you should do with a _____________ patient
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Suspicious
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A mental status where one struggles to distinguish the external world from internally generated perceptions is ______
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psychosis
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Common symptoms of psychosis include
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hallucinations, delusions, disorganized thinking
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This brain disease disrupts perceptions, thinking, feelings and behaviors
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schizophrenia
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Are males or females more at risk for developing schizophrenia? at what age?
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Female in their 20's
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To be diagnosed with schizophrenia you must have ___ symptoms which may include hallucinations, delusions, disorganized speech, disorganized/catatonic behavior, negative symptoms
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2
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Which drugs are effective in treating (not curing) schizophrenia
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neuroleptic
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What plays a major role in the onset/relapse of schizophrenia
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stress
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Patients with which disease often dont recognize their own illness (denial)
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schizophrenia- think its just stress
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What is echolalia
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repeating words
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What is echopraxia
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imitating behaviors
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What are the 4 A's
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Affective disturbance (flat affect) Ambivalence (lack of initiative) Associative looseness (tie things together that dont relate) and Autism
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Biologic causes of schizophrenia include
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genetics, neurostructure and perinatal risk factors
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Hebephrenic is also called
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disorganized
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Hebephrenics are ______ functioning
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low
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Mimic, don't make sense, flat affect, regressive, disorganized speech are all signs of
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hebephrenics
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Catatonics are _______ functioning
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low
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Catatonic symptoms are expressed by _______
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body (psychomotor)
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s/s of catatonic pt
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immobily, waxy, stupor, excessive motor activity, negativity or mute, echolalia, echopraxia, peculiar movements
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Highest nursing dx for a catatonic pt
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self care deficit
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Treatment for thought disorders includes
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inpt stay to stabilize, outpt for psychotherapy, group therapy and social skills training
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Name 2 mood disorders
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Depressive and Bipolar
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Depression is a ___________ of norepi, serotonin and dopamine
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deficiency
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Depression may also have diminished release of which hormone
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TSH
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Which age group doesnt have a sense of the finality of death
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adolecents- concrete to abstract
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Major depressive disorder must contain ____ symptoms
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4- sleep disturbance, psychomotor disturbance, fatigue, worthlessness, decreased concentration, thought of death
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Dysthymic disorder key element is
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CHRONICITY- it is less severe than MDD
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Pysical signs of depression include
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HA, fatigue, constipation and CP
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Bipolar disorders are characterized by
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mood swings from depression to euphoria (mania) with intervening periods of normalcy
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Mania is due to ______ norepi and dopamine
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excess
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Bipolar onset of symptoms may have a ____ pattern
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seasonal
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A patient that has never met the critera for mania or mixed but has hypomania may be diagnosed
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Bipolar 2
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Stage 1 bipolar has symptoms that
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are not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization (hypomania)
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Stage 2 of bipolar has symptoms that
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cause marked impairment in functioning of mood, cognition and perception
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This chronic mood disturbance must have numerous episodes of hypomania and depressed mood for 2 years but cannot meet criteria for bipolar 1 or 2
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Cyclothymic disorder
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#1 RN dx for mood disorders
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risk for injury (not suicidal but agitation and poor boundaries, hypersexual in bipolar) Risk for suicide in depression
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Low self esteem would be appropriate in which mood disorder
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depression
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Self care deficit would be appropriate in which mood disorder
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both
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high protein high calorie fingerfoods are good for __________ patients
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manic
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What type of therapy is used for depression but not mania?
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psychotherapy
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ADHD is the most common dx with
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depression and mania
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Postpartum depression begins within ________ hours after delivery, peaks at ________ days and lasts _____ weeks
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48, 3-5, 2
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What is the drug of choice for maaintenance of bipolar pts?
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Lithium
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What does lithium do in bipolar?
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decreases hyperactivity
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Traits become inflexible and maladaptive in what
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personality disorders
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Egosyntonic means (this is a symptom of a personality disorder)
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-behaviors are disturbing to others
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This personality disorder is characterized by exaggerated sense of self worth, lack of empathy, lack of humility, overly sensitive, project invulnerability, fantasizes about success
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Narcissistic
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This personality disorder is characterized by always being in a state of crisis, sense of inner rage, fear of abandonment, splitting, impulsivity
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borderline
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This group of personality disorders are in the ER more than others
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borderline
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This group of personality disorders may get into abusive relationships
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dependent
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This personality disorder is characterized by shyness, overly sensitive to rejection, awkward in social setting, timid,
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avoidant personality do
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This personality disorder is characterized by pervasive needs cared for, fear of separation, allows others to make decisions, feels helpless, lack self confidence
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dependent P.D
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Splitting occurs when
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internal perception is black and white
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After a suicide attempt when is the greatest risk of another attempt
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3months to 2 years
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in constant 1:1 care how close must you be to the patient
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within arms reach
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After antidepressants are started in a suicidal patient they may
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have enough energy and clarity to follow thru with plan
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Antidepressants start working in
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2 wks
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Cluster A includes
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Paranoid, schizoid or schizotypial
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This personality disorder is characterized by distrust, suspiciousness, tence, cold, oversensitive, blames others
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Paranoid
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When dealing with a paranoid patient you should
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Be matter of fact, tell them what you are doing
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This personality disorder is characterized by defect in ability to form relationship or respond to others, often withdrawl, decreased intrest in sex, cold, constrictive affect
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schizoid
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This personality disorder is characterized by desiring relationships but cant carry thru, magical thinking, illusions, depersonalization, bland
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schizotypal
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This personality disorder is characterized by irresponsibility, disregard for rights of others, charming initially, cannot sustain job, manipulative, impulsive,
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antisocial
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This personality disorder is characterized by colorful, dramatic behavior, party people, drama queens, attention seeking, manipulative, center of attention
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Historonic
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When dealing with a borderline personality pt they need
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consistency- DBT works well too
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When dealing with a dependent personality disorder pt you should use this therapeutic technique
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reflecting
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This personality disorder is characterized by serious, difficulty expressing emotions, rigid, cold, perfectionist, controlling, most common in oldest child
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Obsessive Compulsive
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This personality disorder is characterized by procrastination, stubborn, forgetful, pessimistic, seek retribution in subtle passive ways
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passive aggressive
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Cluster A includes
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paranoid, schizoid, schizotypal
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Cluster A RN dx include
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social isolation, altered thought process, loneliness
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Cluster B includes
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Antisocial, borderline, histronic, narcissitic
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Borderline pt is at risk for violence directed at
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self
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Antisocial people are a risk for violence to
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others
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Cluster B RN dx
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risk for violence (need to set limits), disturbed self esteem, Ineffective coping, impaired social fx
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Cluster C includes
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avoidant, dependent, OCD, passive aggressive
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Cluster C focus on
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anxiety
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Cluster C RN dx
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social isolation, altered communication, altered mood
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