Exam 1 Study Guide PDF - Nursing Exam Notes

**Exam 1** - Emergency, start with CPR first - CJAM: collect data, action pla, identify outcomes. - DSM5 is not a nursing care plan, It is a resource with clinical manifestations related to mental health disorders. - Suicidal precautions, have them close to nurse's station - Neuro...

**Exam 1** - Emergency, start with CPR first - CJAM: collect data, action pla, identify outcomes. - DSM5 is not a nursing care plan, It is a resource with clinical manifestations related to mental health disorders. - Suicidal precautions, have them close to nurse's station - Neurotransmitters: 1. Histamine: alertness and wakefulness ( regulates glutamate, GABA and serotonin) 2. serotonin: sexual behaviors, temperature, emotional regulations, sleep and pain. 3. Dopamine: regulates motor, cognitive and affective functions - Know medication regimes for each disease. - **Catecholamines:** hormones produced by adrenal glands, plays an important role on the body's stress response. - Lithium therapeutic range: 0.6-1.2 - Sleep hypnotics (Lunesta or Ambien): for insomnia. A/E: HA, fatigue, dizziness, nausea, sleepwalking, amnesia. These meds **[don't]** improve memory, concentration, and they **[increase]** risk of accidents. - GABA: INHIBITORY neurotransmitter that blocks excitatory signals -- associated with **anxiety and panic.** - Glutamate: EXCITATORY neurotransmitter that stimulates cell activity and is associated with **memory and learning**. - Suicide attempt: INTENT to die but doesn't. Intends to kill self. - Self-harm: hurts oneself and creates physical pain. Does not intend to kill self. - DUTY TO WARN: Pt. threaten to harm another, nurse has to let the person know - Antipsychotic meds: **HALOPERIDOL and RISPERIDONE.** - Signs of psychosis: delusions, hallucinations, alterations in speech, not in touch with reality. - ADHD: hyperactivity, impulsivity, and inattentiveness - ADHD meds: methylphenidate and risperidone ( antipsychotic but for ADHD if aggression is present) - Provider discusses treatment plan, s/e, risks, and alternative treatments, NOT NURSE! Nurse will only witness signing consent. Nurse has to call provider to explain further details and additional questions - Implied consent can be legally assumed in EMERGENCY SITUATION. Client has to give nonverbal permission. - Documentation: use quotation marks, and document EXACT statement. Nurse should not use judgement, opinion, or diagnose the action. - **LOTS OF QUESTIONS IN SEROTONIN SYNDROME!** - Serotonin syndrome s/s: shivering, diarrhea, tachycardia, hypertension, muscle rigidity, fever and seizures, restlessness, insomnia, confusion, - Serotonin syndrome: SSRIS, SNRIS, bupropion, tricyclic antidepressants, MAOIS - Can happen when mixing MAOIs and serotonin, valproic acid - Serotonin synd.: consider airway, may have apnea, delirium, be prepared to give anticonvulsant (bc of SEIZURES), pad side rails, and protect head from injury - SSRIS: med for suicide ideation. This med will increase interest in suicide and will give energy to the pt. to do it. Provide a watchful eye for mood changes. Take with food. Avoid tyramine (hypertensive crisis) - Neuroleptic malignant syndrome: a/e of **antipsychotic**. Changes LOC, seizures, stupor, **high fever!**!! **Muscle rigidity**, hypertension, elevated creatine - **Agranulocytosis-** do not learn labs but know it's like flu. A/e of antipsychotics. Fever, chills, tachycardia, tachypnea, fatigue, muscle weakness, sore throat, **mouth sore** - **Stages of stress:** 1. Alarm: fight or flight 2. Resistance: tries to cope 3. Exhaustions: can no longer maintain normal function if the stressor is not relived - Be sure to identify anxiety level: Panic -- extreme physical symptoms, chest \[pain, palpitations, SOB - Compassion fatigue: how a nurse feels. It is important to have self-care so they don't feel burnout. - Stress response: positive responses- exercise, adequate sleep, healthy diet, adequate hydration and spirituality bc it gives HOPE and lessens stress - Journaling helps pt. to identify stressor but should not substitute therapy or meds - **Zones of mental health Continuum:** 1. Excelling: estoy en mi peak! No concerns 2. Thriving: Coping with stressors and minimal concerns ( stress but I'm okay) 3. Surviving: unhappy, worried about stressors, distracted, angry, annoyed 4. In crisis: paralyzed with fear, often requires hospitalization. - Coping with stress: adequate sleep, support group, nutritious diet, spending time with friends, yoga/meditations, spending time with Chabe/omer, avoid disappointment by being HUMBLE with expectations. - WAYS NOT TO HELP STRESS: daydreaming, pondering past, revenge, overeating, binge shopping, alcohol/smoking/drugs. - Milieu therapy: Review physical environment and the psychosocial factors. Creating the environment is an **IMPLEMENTATION**. Quiet environment, warm lighting, music should not be used during initial interview. Craft room. Exercise room - Coordinating care: Including others in the implementation of best care standards for patient. Include a whole team of professionals in order to optimize care for patient. The team will advocate for the patient. - Erickson's stages not really on test, Just know elderly and kids won't be able to digest this meds so well. - Social determinants: economic status, education, and access to health care. - **SYMPATHETIC**: Flight of fight -- anxiety, preparation for an exam, driving - **PARA SYMPATHETIC**: Relaxation response -- after stimulus is over -- relax, exhausted, not occurring anxiety - **Mental Health**: state of well-being in which a person can cope with daily stressors. - **Mental Illness:** A disruption in a person's ability to adapt- maladaptive stress response. - **Causes of mental Illness:** Stress (adolescents), genetics, not contagious - **Therapy:** a person can refuse it, not everyone needs it, not required by insurance, can be used along with meds. - **Behavioral therapy:** Modifying maladaptive behaviors, patterns, and responses. Behaviors are learned and and can have negative consequences. Focused on changing patterns. It focuses on the use of positive rewards to promote desired behaviors. - **Med administration:** Meds are given with an explanation, HOLD med and contact provider for clarification in case patient refuses. - **Cognitive therapy:** Problems are rooted in a person's past, goal is to challenge the negative thought patterns that contribute to the feelings of sadness, patients are challenged to confront and overcome anxiety-provoking situations. It also challenges patients to not avoid thinking about negative situation but to approach problems, memories head-on. - **Psychoanalytic therapy:** The unconscious mind influences a person's thoughts and feelings and behaviors. Learn adaptive coping skills. Studies the unconscious mind. One-to-one with a counselor. - **Group therapy**: a small group with similar diagnoses and share insight into using coping skills. They are encouraged to share feelings and develop strategies for coping with their condition. Begin to show more confidence, verbalize and communicate with others. Nurse leader facilitates discussion, but people in group do the most talking. - **Family therapy**: meet the family's needs. Work together to solve problems. May have induvial meetings first and then add family members. - **Telehealth therapy**: virtually from home via phone or computer - **Talk therapy**: Talk about feelings and ideas 1 in 1 with a therapist. - **Sigmund Freud**: Psychodynamic theory - **Abraham Maslow**: Maslow's hierarchy of needs - **Erik Erickson:** Psychosocial stages of development - **John Watson:** Developed behavioral Theory - **Restraints:** Provider must prescribe with written documentation as to why. Safety: tightness, time, food and drink, watchful supervision, and therapeutic communication. Remove ASAP, maintaining supervision and slow removal. Provider must be present for initial application. Least restrictive to severe. Give them "time out" after an outburst. Seclusion ( leave room and go to quiet restricted area). Physical restraints (last resort) after violence shown. **Clozapine** after violent behavior. - **Dangers of physical restraints:** 1. Positional asphyxia: slip down and cut off airway 2. Aspiration: issues with swallowing when restraints are applied to torso 3. Cardia arrest: stress and neurotransmitters, psycho and physio stressor cause MI - **Cues when pt. is experiencing loss:** affect changed, disinterest in previous activities, notable change in mood and coping, lack/increase of sleep, low appetite, decreased energy. - **Stages of grief Kubler-Ross:** denial, anger, bargaining, acceptance - **Complicated prolonged grief:** create a safe and quiet environment, confidential setting, discuss feelings and facts about loss, special edu. and support for pt. Certified nurses only. - Bargaining and negotiation should not be tolerated. Redirect and remind boundaries. Provide positive rewards. - **MAOIs (phenelzine) :** avoid tyramine, like pickles, pepperoni, cheese, chocolates, avocados, soybean or fermented. - **Tardive dyskinesia:** Haloperidol (psycho). Abnormal involuntary movement scale is used to determine severity. S/s: tongue thrusting, lip smacking, facial grimacing, eye blinking, hip thrusting. Irregular and repetitive. - **Clinical Opiate Withdrawal Scale (COWS):** Identify the treatment of opiate withdrawal with benzodiazepine therapy. - **Fluoxetine:** SSRI, antidepressant, bulimia, OCD, panic disorder, premenstrual dysphoric disorder. Increases serotonin. Do not abruptly. Antidepressant discontinuation syndrome occurs, flu like ( N/V, difficulty sleeping and achy. - **Initial interview:** Introductions are made, boundaries are established, therapeutic milieu created[, identify the patient's own perception of their mental status. Priority!!!] - **Bias:** Prejudice, stereotyping - **Justice:** [ ] caring for clients equally - **Beneficence:** benefit others, for the good - **Non maleficence:** Do no harm and have beneficial outcome. - **Autonomy:** Allow client to make their own decisions - **Assault:** Person is threatened and fearful of harm - **Battery:** Physical harm. - **False imprisonment:** Restraints, guarded and imprisoned - **Negligence**: Most common **UNINTENTIONAL** tort. - **Cognitive ability exam**: Counting backwards by 5's - **Affects**: Facial appearance, expressions, reactions - **Language ability:** Ask client to read, write statement of book. - **Remote memory:** List 3 objects, repeat list in 15 min - **Abstract thinking:** give situation with problem solving - **Sleep basics:** Have sleep diary with routines and patterns, avoud alcohol before bed, limit to 2 drinks of caffeine in the morning, naps for 20 min, if unable to sleep read or write, same schedule, not TV - **Lithium therapeutic range:** 0.8-1.4 - **Lithium toxicity (\>1.5):** dehydration, thirst, diarrhea, blurry vision, hand tremor, nausea and vomiting, confusion, muscle weakness, slurred speech and ataxia. - **Duty to warn:** Nurse has to let the person know if a client is threatening them. Do not break confidentiality of patient want to do suicide ( not even primary physician) - **Premenstrual Dysphoric Disorder:** week before period, bloated and full, fuzzy brain feeling, moody and sad. SBE after 4^th^ day bc breast is not as tender and masses are easily detected. - **Suicide attempt:** Take care of physical injuries, medicate for sleep, give nutrition and fluids - **Sudden Change in moods:** need visit from provider. Not normal!!! - **MOOD ZONES:** 1. **Excelling zone:** happiness in life and hope of the future assist in dealing with the stress 2. **Healthy zone:** stressor and anxiety, but it is handled 3. **Reacting zone:** Reversible anxiety and stress and person can continue activities. 4. **Surviving zone:** Stress if interfering with life and sleep but there is boundaries. 5. **Struggling zone:** insomnia, cannot concentrate, too much to worry 6. **Ill zone:** Mental paralysis and inability to cop, sever panic attacks and stress. Immediate medical attention. - Norepinephrine regulates learning and memory. - Naps are recommended to be approx. 20 mins - The root of problems in cognitive therapy: a person's past - Epinephrine: adrenaline - Post partum psychosis requires emergency care. Mothers feel hopeless and could hurt their infant. - After electroconvulsive therapy, apply oxygen