Mental Final

Clozapine (Clozaril)

- Antipsychotic medication (SGA; helps diminish +- s/s of schizophrenia - Want to watch for tachycardia and seizures- May cause severe agranulocytosis (weekly blood draws)- Weight gain, high in cholesterol/triglyceride/blood glucose -lower risk of NMS than FGA

Neuroleptic Malignant Syndrome NMS

- Is a rare but life-threatening reaction that can occur in response to neuroleptic or antipsychotic meds-S/s: high fever. muscular rigidity, altered mental status, autonomic disturbance (high BP, sweating, HR)

Bulimia nervosa S/S

-Binge eating followed by purging -tooth erosion (caused by frequent exposure to gastric acid and vomiting) (predisposes the client's teeth to dental caries. -Need frequent dental check ups-binges eat and attempt to hide food in containers-Orthostatic hypotension-Bad breath

Anorexia Nervosa S/S

Refuse to eat/ restrict self from eating AmenorrheaFluid Electrolyte imbalanceLanugo (thin hair)Constipation weight loss of 25% below normalexcessive exercisecold intolerance

Restating (therapeutic)

repeating the main idea expressed

Reflecting (therapeutic)

directs questions or feelings back to client so that they may be recognized and accepted

Exploring (therapeutic)

delving further into a subject, idea, experience, or relationship

open-ended questions

encourage patients to share information about experiences, perceptions, or responses to a situation

Offer self

Offer to be with, to assure, or to console the client.

Offer General Leads

Gives encouragement to continue, leaves direction of discussion to client ("Go on.")

focus of therapeutic communication

this technique helps pt to concentrate on what is important

OCD

an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

OCD medications

SSRIsTricyclicsBenzodiazepines

Disulfiram

Daily oral medication to sustain abstinence of alcohol, type of aversion therapyCauses nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed

acetaldehyde syndrome

this is caused by using disulfiram and alcohol together, effects include nausea, vomiting, weakness, sweating, palpitations, and hypotension. This can progress to respiratory depression, cardiovascular suppression, seizures, and death.

Active listening skills

Observing the client's nonverbal behaviorsunderstanding and reflecting on the client's verbal message

bipolar disorder

A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.

manic phase of bipolar disorder

Periods of HIGH mood. Irritable & Hyper. May required hospitalization -Restless/ Decreased in sleeping/ Hallucinations -Flight of ideas, impulsivity-Grandiosity -Hyper mood, Elevated Activity -Poor judgement_Manipulative behavior

Nursing intervention for mania episode

Providing for safetymeeting physiologic needsproviding therapeutics communication promoting appropriate behavior managing medication

manic phase of bipolar disorder diet

offer energy/ protein dense foods that are easily consumed on the go (finger foods): hamburger, sandwiches, fruit juice, shakes

Depressant phase of bipolar disorder

Periods of LOW mood -Sad & Low energy levels- Sleep disturbances

Bipolar Meds

Lithium, Carbamazepine; Valproic Acid (antiepileptics) uses mostly used during manic episodesDO NOT TAKE CARBONATED BEVERAGES WITH THESE DRUGS

Valproic Acid (Depakote)

Antiseizure medPrecautions/interactions: contraindicated in liver disease, pregnancy. Side effects: hepatotoxicity, teratogenic effects, pancreatitis, Gi upset, PROLONGED BLEEDING TIME

Lithium Carbonate

a chemical used to counteract mood swings of bipolar disorder (tx bipolar)

Lithium toxicity

Tremors, Metallic taste, neuro symptoms, slurred speech, seizure, tinnitus besides parenthesis,

Suicide Risk assessment

Three elements: -is there a specific plan with details -how lethal is the proposed method. -does the client have access to the proposed method.When the proposed method is available, the situation is more serious.

Schizophrenia (positive symptoms)

DelusionsAnxiety/ agitationHallucinations AuditoryJumbled speechDisorganized Behavior

Schizophrenia (negative symptoms)

-flat affect: showing no emotion-lack of hygiene, lack of motivation, and social withdrawal, anhedonia (not capable of feeling joy or pleasure)

conventional antipsychotics

Chlorpromazine, Haloperidol First-Generation drug for Schizophrenia-Treats pos. symptoms ONLY (dopamine receptors)-Less expensive, more side effectsDisadvantages: Extrapyramidal side effects, Anticholinergic side effects, tardive dyskinesia, lower seizure threshold*

Extrapyramidal (EPS)

movement disturbances manifesting as abnormal oral-facial movements, sticking tongue out, grinding teeth, shuffling gait

atypical antipsychotics indications

Risperidone, clozapine, ziprasidone positive and negative symptoms of schizophreniaIncreased Weight/cholesterol/ triglyceride/ blood sugar

Delusion

Alterations in thought are false fixed beliefs that cannot be corrected by reasoning and are usually bizarre.

ideas of reference delusion

Misconstrues trivial events andattaches personal significance to them (believes others are talking about him)

persecution delusion

Feels singled out for harm by others (being hunted by FBI)

grandeur delusion

Believes that they are all powerful andimportant, like a god

somatic delusions

Believes that their body is changing inan unusual way (growing a third arm)

Jealousy Delusions

Believes that her partner is sexually involved with another individual even though there is not any factual basis for this belief

being controlled delusion

A delusion in which feelings, impulses, thoughts, or actions are experienced as being under the control of some external force rather than being under one's own control.

thought broadcasting delusion

belief that someone's thoughts can be heard by others

thought withdrawal delusion

believes that her thoughts have been removed from her mind by an outside agency

Religiosity Delusions

is obsessed with religious beliefs

magical thinking delusion

believes his actions or thoughts are able to control a situation or affect others, such as wearing a certain that makes him invisible to others

Best way to help patients with different delusions

1. establish a trusting, interpersonal relationship2. identify the content and/or type of delusion 3. investigate how the delusion is affecting the person's life4. assess the intensity, frequency, and duration of the delusion 5. attempt to redirect or distract the person from their delusion

Anxiety

The condition of feeling uneasy or worried about what may happen

separation anxiety

patient experiences excessive fear or anxiety when separated from an individual to which the client is emotionally attached

specific phobia

fear of objects or specific situations or events

agoraphobia

An abnormal fear of open or public places

Social Anxiety Disorder (Social Phobia)

fear of interacting with others or being in social situations that might lead to a negative evaluation

panic disorder

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.

Generalized Anxiety Disorder (GAD)

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal

antianxiety drugs

Benzodiazepine, atypical anxiolytic, SSRI.

Involuntary holds

Formerly known as a "Legal Hold" or "Legal 2000", 5150 hold, mental health crisis holds are used when a person appears to be in a mental health crisis. This means that they meet criteria for "substantial likelihood of serious harm" to themselves or others due to mental illness. In this situation they may be held involuntarily in a healthcare facility for evaluation, observation, and treatment for up to 72 hours

electroconvulsive therapy indication

MDDAcute manic episode Schizophrenia Spectrum Disorder "Clients whose manifestations are not responsive to pharmacological tx

Extrapyramidal (EPS) Treatment

anticholinergics

Altruism defense mechanism

meeting the needs of others in order to discharge drives, conflicts or stressorsEX: a nurse who lost a family member in a fire is a volunteer firefighter

sublimation (defense mechanism)

- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive.EX: Mom of son killed by drunk driver, president of MADD.

Suppression: Defense Mechanism

- The voluntary blocking of unpleasant feelings and experiences from one's awareness.ADAPTIVE USE: A Student put off thinking about a fight they have with their friend to focus on the testMALADAPTIVE USE: a person who has lost their job states they will not worry about paying the bills next week

Repression (defense mechanism)

- Involuntary blocking of unpleasant feelings and experiences from one's awareness.EX: An accident victim can remember nothing about the accidentmaladaptive use: a person who has a fear of the dentist continually forgets to go to their dentist appointment

Regression (defense mechanism)

A person goes back to an earlier or less mature state or behavior

displacement (defense mechanism)

- The transfer of feelings from one target to another that is considered less threatening or that is neutral.EX: A client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse.

Reaction (Defense Mechanism)

overcompensating or demonstrating the opposite behavior of what is felt EX: a person who is trying to quit smoking repeatedly talk to adolescents about the dangers of nicotine

Undoing: Defense Mechanism

- Symbolically negating or canceling out an experience that one finds intolerable.EX: Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her flowers.

Rationalization (defense mechanism)

- Attempting to make excuses or formulate logical reasons to justifying unacceptable feelings or behaviors.EX: John tells the rehab nurse, "I drink because its the only way I can deal with my bad marriage and awful job.

Dissociation defense mechanism

process that enables a person to split mental functions in a manner that allows them to express forbidden or unconscious impulses without taking responsibility for the action; unable to remember the disowned behavior (fugue states, amnesia)

Denial (defense mechanism)

- Refusing to acknowledge the existence of a real situation or the feelings associated with it.EX: A women drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem.

Compensation : Defense Mechanism

- Covering up a real or perceived weakness by emphasizing a trait one considers more desirable.EX: A handicapped boy is unable to participate in football, so he compensates by becoming a great scholar.

identification

conscious or unconscious assumption of the characteristics of another individual or groupex: a child who has a chronic illness pretends to be a nurse for their dolls

Intellextualization

separation of emotions and logical facts when analyzing or coping with a situation or eventex: a law enforcement officer blocks out the emotional aspect of a crime so they can objectively focus on the investigation

conversion

Responding to stress through the unconscious development of physical manifestations not caused by a physical illness

splitting

demonstrating an inability to reconcile negative and positive attributes of self or others

projection (defense mechanism)

- Attributing feelings or impulses unacceptable to ones self to another person.EX: Sue feels a strong sexual attraction to her track coach and tells her friend, "Hes coming on to me!