Psychiatric Nursing Final Study Guide PDF

NRSB 331 Psychiatric Nursing Study Guide (Comprehensive Final) 1. Signs and symptoms of anxiety Mild – happens to the average person and occurs in normal experience of everyday living Moderate – hears and grasps less information and may have selective inattention, sympathetic NS o S...

NRSB 331 Psychiatric Nursing Study Guide (Comprehensive Final) 1. Signs and symptoms of anxiety Mild – happens to the average person and occurs in normal experience of everyday living Moderate – hears and grasps less information and may have selective inattention, sympathetic NS o Shaking o Little diaphoretic o Tremulous voice o Vital signs OK, HR might be up Severe – may focus on one particular detail or many scattered details and has difficulty understanding what is going on in the environment o Chest pain o Stomach pain o Jerking o Tachycardia o Hyperventilation o Nausea o Dizziness Panic – EXTREME level; unable to process what is going on in the environment and may lose touch with reality // Unable to function Treatment of anxiety, including medications Medications: Diazepam (Valium; benzos) Lorazepam (Ativan; benzos) Alprazolam (Xanax; benzos) Chlordiazepoxide (Librium; benzos) Buspirone (Buspar; atypical antidepressant) Do assessment of patient’s anxiety, their H&P, their medication history, substance abuse Benzodiazepines are usually the #1 line for anti-anxiety meds Side effects: Drowsiness/ Sedations/Dizziness CNS depression (assess RR; flumenazil if less than 12bpm) Dependency risk Withdrawal Lowered blood glucose Slowed breathing Possible memory problems Fatigue Nausea Sexual dysfunction Anticholinergic effects ▪ Dry mouth  ▪ Hot ▪ Blind/blurred vision Teaching: Avoid grapefruit juice if taking Buspirone (Buspar) Avoid driving or moving a lot right after administration Med can be addictive Assess cortisol levels?? AVOID alcohol, added sugar, aged foods, coffee, soda Don’t combine with other benzo’s 2. Signs and symptoms of bipolar disorder Bipolar I (most severe; at least one manic episode) Episodes of mood swings ranging from depressive Bipolar II (at least one hypomanic and at least one major depressive episode) lows to manic highs There is NO CURE; frequently inherited There might be some factor of epigenetics (stress-induced) Signs and Symptoms: Pressured speech (under pressure) Tangential speech (their story is cyclic but often comes back to that one point) Flight of ideas Circumstantial speech (individual never gets to their story) Loose associations Clang associations (grouping of usually rhyming words) Treatment of bipolar disorder, including medications Lithium (Eskalith, lithobid) o The first line of defense for bipolar disorder because it stays in the body long enough o Take with food o Watch fluid intake AND increased/decreased based on sodium levels o Normal range = 0 – 1.5 Valproate and Carbamazepine o Ensure to get lab values o Monitor liver function and platelet values o Valproate normal range = 50 – 125 mcg/mL o Carbamazepine normal range = 4 – 12 mg/L SSRI’s o Example: Paroxetine, Sertraline, Citalopram o Block the reuptake (availability) of serotonin → making more of the serotonin available o Be mindful of serotonin syndrome (SHITS and SHIVERS) o Monitor for suicidal ideations, headaches, sleep changes, may decrease libido o Therapeutic range is 4 weeks 3. Signs and symptoms of schizophrenia schizo = “split” // phren = “mind”  Causes more lengthy hospitalizations, chaos in family life, expensive costs and fears It is also a combined group of disorders that expresses specific dysfunctional symptoms Psychotic (lose some contact with reality) + delusional (existent of prominent false and fixed beliefs) + schizoaffective (symptomatology with mood disorders – mania or depression) They have at least one psychotic symptoms (listed below) Signs and Symptoms: Loose associations (cannot connect sentences and thoughts together) Ideas of reference (false beliefs about some people being against you) Persecution (believing you are being persecuted against) Grandeur (wealth of belief; believing you are all that so that’s why people don’t like you) Somatic (significant focus on physical symptoms – pain, SOB) Thought broadcasting (thinking people can hear them) Thought insertions (believing that people are putting thoughts inside your head) Religiosity (believe that they are religiously being persecuted against – ex. jews are on to him) Magical thinking (believing that your thoughts and action will cause something magically – ex. wearing pajamas inside out will make it snow) Treatment of schizophrenia, including medications Antipsychotics: ▪ Haloperidol (Haldol) 1st gen Most effect on the positive symptoms of schizophrenia More EPS s/s ▪ Clozapine (Clozaril) 2nd gen Targets both negative and positive Less EPS s/s ▪ Risperidone (Risperdal) 2nd gen Targets both negative and positive ▪ Olanzapine (Zyprexa) 2nd gen Targets both negative and positive ▪ Ziprasidone (Geodon) 2nd gen Targets both negative and positive ▪ Aripiprazole (Abilify) 2nd gen Targets both negative and positive 1st gen VS More neurological S/S More EPS s/s Sedation and weight gain 2nd gen antipsychotics  More metabolic s/s Less EPS s/s Increase BG Weight gain Know the positive and negative symptoms of schizophrenia Positive: **things that are being ADDED to the person’s thoughts/behaviors/actions Speech and perception disturbances o Flight of ideas (their thought process does not make sense) o Neologisms (made up words by the patient – ex. “His mannerolgies are poor) o Echolalia (repeating of another’s words that are being said to them, repeating mostly you) o Clang association (rhyming words) o Word salad (jumble of words) Hallucinations (audio, visual, command, tactile, olfactory) o AUDITORY are the most common! Hostility Bizarre behavior Negative: **things that are being TAKEN AWAY from the person’s thoughts/behaviors/actions Anergia (deficiency of energy) Waxy flexibility (ex. you move their above their head and they just keep it there – no effort to reposition it) Posturing (taking away their posture/movement – ex. hands fisted together) Affect – the feeling state or emotional tone (ex. inappropriate, bland, flat, apathy so not interested in the environment) Poverty of thought 4. What is culture-bound syndrome? Signs and symptoms. Exist when clusters of symptoms occur in specific groups and are recognized by these groups as a known pattern of experienc Running a muck Hwa-byung o Korean o Similarities to depression o Characterized by epigastric pain, anorexia, palpitations Neurasthenia o Chinese o Similarities to depression o Characterized by somatic symptoms, feelings of sadness Ataque de nervios o Latin American o Characterizing by a sudden attack of trembling Ghost sickness  o Navajo o Characterized by being out of one’s mind, o Thought to be caused by an evil spirit Jin possession o Somalian o Symptoms of psychological distress and anxiety o Treatment consists of exorcism Susto o Latin American o Characterized by a broad range of somatic and psychological symptoms similar to posttraumatic stress disorder (PTSD) Wild illness o Chinese, Vietnamese o Characterized by a fear of cold, wind or drafts 5. Ericksons stages Life Stage Year Developmental Stage Infancy Birth to 18 months Trust vs. Mistrust (TM) Early Childhood/ Toddler 18 months to 3 years Autonomy vs. Shame (AS) Preschool 3 years to 6 years Initiative vs. Guilt (IG) School Age 6 years to 12 years Industry vs. Inferiority (II) Adolescent 12 years to 20 years Identity vs. Role Confusion (IR) Early Adulthood 20 years to 35 years Intimacy vs. Isolation (II) Middle Adulthood 35 years to 65 years Generativity vs. Self-absorption Older Adulthood/Later years 65 years + Ego Integrity vs. Despair (ED) 6. Define Id, Ego, and Superego **Freud (Psychoanalytical Theory) says the first thing we do is TRUST → interactive systems of the personality Conscious (what you see) Preconscious aka. Subconscious (just below the surface of the water) Unconscious (the feelings, thoughts, memories) Id (part of unconscious): At birth UNCONSCIOUS and IMPULSIVE The source of all drives, instincts, reflexes and needs Ex. a hungry, screaming infant Ego (part of preconscious): Withing the first few years of life as the child begins to interact with other Resides in all (preconscious, conscious and unconscious) The problem solver and reality tester; navigate the outside world Superego (part of ego and Id): Develops between the ages of 3 and 5 Resides in all levels of awareness  It is the moral component of personality The sense of right/wrong, we perfect our civilized behavior 7. Who is Peplau, what is her theory, how might she employ it? Hildegard Peplau has a profound role in shaping the specialty of psychiatric mental health nursing. She identified ANXIETY has a key element in her theory interpersonal relationships: ▪ Mild – normal, everyday living ▪ Moderate – person hears and grasps more information ▪ Severe – not being able to be in reality ▪ Panic – can’t comprehend much of anything Preorientation, orientation, working, , termination phases 8. Know primary, secondary, and tertiary intervention as it relates to psychiatry. Primary – The prevention of problems before they occur Done with education, assessing for health risks, health promotion Secondary – Early detection and interventions Screenings (mammograms, vision, dental) Tertiary – Correction and prevention of DETERIORATION of disease state Done with mental health counseling, exercise therapy AFTER stroke occurs 9. How do we communicate therapeutically? Therapeutic touch Understanding the patient’s cultural values Paying attention to your non-verbal and verbal cues 10. What is muscarinic receptor blockade? A muscarinic receptor blockade IS a way that there is a destruction of neurotransmitters (refer to page 113 on book) What are the side effects of the medications that cause muscarinic receptor blockage? ~~Antagonists of muscarinic receptors are acetylcholine, norepinephrine and histamine Dry mouth → dry as a bone” Dry eyes → “dry as a bone” Anticholinergic side effects from Increased temp → “hot as a hare” Haloperidol, Fluphenazine, Dilated pupils → “blind as a bat” Chlorpromazine (first generation drug SO Flushed face, flushed neck → “red as a beet” more neurological effects) ****Tinnitus SIGNIFICANT SIDE EFFECTS = extrapyramidal side effects (EPS) → acute dystonia (muscles contract involuntarily), muscle spasms of the jaw/eyes/neck/sometimes whole body 11. What are the side effects of antipsychotics such as haloperidol and Geodon? Haloperidol (Haldol)  1st gen More EPS ▪ Acute dystonic reactions, ▪ Parkinsonism, ▪ Akathisia ▪ Tardive dyskinesia Neurological symptoms ▪ Sedation Weight gain Olanzapine (Geodon) 2nd gen Few EPS More metabolic s/s ▪ Weight gain/loss Increase blood sugar Antipsychotics → NMS (hyperpyrexia) 12. Define Acute dystonic reaction An involuntary contraction of muscles in the extremities, face, neck … etc that leads to abnormal movements or postures 13. Define Tardive Dyskinesia Is a SIDE EFFECT of antipsychotics; involving involuntary rhythmic movement which begins in the oral and facial muscles → progresses in the fingers, toes, neck, trunk or pelvis. Repetitive, involuntary movement; lip- smacking and grimacing 14. Know the purpose of GABA Gamma-aminobutyric acid (GABA) is an inhibitory NT that puts a brake on excitatory NTs to better focus on the pharmacological therapy for anxiety symptoms → slows neuron activity SO lowers anxiety levels Too much: Drowsiness Lightheadedness Too little: May cause people to suffer from anxiety disorders Depression Insomnia **GABA is a natural brain relaxant 15. Know the purpose of acetylcholine A NT that attaches to muscarinic receptors to help regulate internal function; works in the CNS and PNS Too much: Cholinergic crisis → blurred vision, cramps, increased salvation Too little: Linked to Alzheimer’s disease Myasthenia gravis Parkinson’s disease Memory problems!! 16. Know the purpose of serotonin A brain catecholamine that plays an important role in mood, sleep, sexuality, appetite and metabolism. Main NT implicated in depression Too much: Serotonin Syndrome (SHITS and SHIVERS) → shivering, diarrhea Too little: Depression **Serotonin is the body’s natural “feel good” hormone 17. Know the purpose of dopamine Dopamine is the “pleasure neurotransmitter” – it is reward that can be triggered by pleasurable activities (ex. eating, sex, drugs, sleeping). It acts as the hypothalamic factor that inhibits the release of prolactin from the anterior pituitary gland Too much: exceeds the number of receptors there are so the it has nowhere to go → eventually flooding the GAP! o Being aggressive, excessive energy, very impulsive o Anxiety o Insomnia, hallucinations, delusions o ADHD o Some symptoms of schizophrenia Too little: o Less motivation o Increased pituitary secretion of prolactin → Women: amenorrhea (irregular menses) and galactorrhea (excessive breast milk production). Men: gynecomastia (development of mammary glands) and galactorrhea o Depression 18. Know normal lithium levels LESS than 1.5 mEq/L Normal side effects → N & V, polydipsia, polyuria, lethargy, tremors 1.5 – 2.0 mEq/L Early signs of toxicity Coarse tremor Impairment in coordination/gait Vomiting  Diarrhea Drowsiness Confusion 2.0 – 2.5 mEq/L Advanced signs of toxicity MORE than 2.5 mEq/L SEVERE toxicity → may need hemodialysis Seizures Cardiac arrythmias Lack of coordination Altered mental status Kidney Damage 19. Which types of individuals are at highest risk for suicide? HIGHEST rates in Caucasians (85% to 90%) and sometimes Native Americans, ADOLESCENTS (white or native Americans) may be also a part of the cultural group and OLDER INDIVIDUALS LOWER rates in African American (role of extended family), Hispanic Americans (role of extended family) and Asian Americans (shaming avoidance) Native Americans and Chinese look at suicide as if there was an imbalance between the person, tribe and family (elders believe that it will heal) 20. Define situational and maturational crisis. Situational: A crisis is a disturbance caused by a stressful event or threat, disrupting HOMEOSTASIS (the “stable state”) Arises from events that are extraordinary; external; often unanticipated o Examples: loss or change of a job, death of a loved one, abortion, change in financial status, divorce, severe physical/mental illness Maturational: Each developmental stage represents a development or maturational crisis; when a person reaches a new stage, coping styles are no longer effect and new coping mechanisms have yet to be developed Are you meeting the development goals? o Examples that can PERCIPITATE: leaving home for the first time, marriage, birth of a child, retirement, death of a parent 21. Signs and symptoms of bulimia nervosa Binging (binge eating) and purging (vomiting) behaviors; they engage in repeated episodes of binge eating followed by inappropriate compensatory behaviors of self-induced vomiting (misuse of laxatives/diuretics) **characterized by a significant disturbance in the perception of body shape and weight S/S: Eating in a discrete period of time (within any 2-hour period) or an amount of food LARGER than what most individuals would eat  Excessive fasting Excessive eating Burning in the chest (chest pain) 22. Signs and symptoms of anorexia nervosa A morbid fear of obesity, preoccupation with food and severe body image disturbances which results in a refusal to maintain minimally normally weight or height and express intense fear of gaining weight S/S: Intense fear of gaining weight or becoming fat Disturbance in the way the patient views their body weight Family dynamics (ex. boys = “star-pitcher” // girls = “cheerleader”) Child feels loss of control – domineering mothers and passive fathers Preoccupation with food Peculiar handling of food and pushing food around their plate Low weight Amenorrhea Lanugo on face/back (very thin, soft unpigmented hair → usually found in fetus/newborn) Cold extremities Hypothermia Muscle weakening Cardiovascular abnormalities (decreased potassium) Impaired renal function Hypokalemia Decreased bone density → very fragile WEARS BAGGY CLOTHING 23. What is borderline personality disorder? **Cluster A (eccentric), Cluster B (erratic), Cluster C (anxious) Under Cluster B category Behaviors described as dramatic, emotional, or erratic They have an inability to control their behaviors; rapidly shifting excessive emotions “Drama queens”; the “Karens” → more common in women}histrionic Little bipolar Use of splitting (only see black and white thought process) Impulsivity Emotional lability (rapidly moving from one emotion to another) **provide clear and consistent boundaries and avoid manipulative behaviors What medications would be prescribed? NO CURRENT MEDICATIONS APPROVED Often respond to antidepressants (such as SSRIs, anticonvulsants and lithium—for mood dysregulation related problems) Naltrexone (opioid receptor antagonist) used for reduction of self-inflected injuries  TREATMENT – psychotherapy (to promote clarification of inner feelings and appropriate expression), psychotropic meds 24. Define PTSD Occur in people who have re-experiencing of the trauma (most experiences through the providers/family Tragically, children are expose to many traumatic events without the strength or coping skills to adequately defend themselves Nightmares Prone to depression 25. What is required to restraint a client? Obtain a physician’s verbal/written order!! ***in emergencies, the nurse may place patient in restrains/seclusion BUT must obtain a written order as soon as possible thereafter What are the different types of restraints? ▪ Chemical restraint: medication or doses that are not being used for the patient’s condition; less restrictive ▪ Mechanical restraint: belts ▪ Seclusion: confining a patient alone in an area or room and preventing the patient from leaving. Only used when patient is demonstrating violence or self-destructive behavior that jeopardizes the safety of others ▪ Side rails 26. Define Neuroleptic malignant syndrome (NMS) ▪ Occurs in patients who have take first-generation antipsychotics (ex. Haldol) ▪ Life threatening medical emergency ▪ Caused by excessive dopamine receptor blockade → overfilling of dopamine ▪ Characterized by: o Hyperpyrexia (