NUR 351 Final Test Review- Psych PDF

1 NUR 351 Final Test Review- Psych Mental Status Examination ○ Sections of MSE, know what belongs in each section and the terms used (review MSE form!). General Observations Appearance Grooming Dres...

1 NUR 351 Final Test Review- Psych Mental Status Examination ○ Sections of MSE, know what belongs in each section and the terms used (review MSE form!). General Observations Appearance Grooming Dress Motor Behavior/Activity Physical Condition Rapport/Reaction Sensorium Memory Orientation Semantic/Intellectual Functioning Concentration Abstraction Calculation Affect/Mood Affect Mood Congruency Thought Processes Thought Content Thought Form Insight and Judgment Chemical Dependence ○ Nursing Process (ADPIE) Assessment- MSE is done in this stage Diagnosis Planning Implementation Evaluation  2 Mood Disorders ○ Depression ○ Bipolar Disorder Mania characteristics Abnormally upbeat, jumpy or wired Increased activity, energy or agitation Exaggerated sense of well-being and self-confidence Decreased need for sleep Unusual talkativeness Racing thoughts Distractibility Mania interventions (least restrictive first) Prevent physical harm Can use manic symptoms (such as distractibility) to manage care Redirect patient Support patient to maintain self-control Meds- Mood stabilizers & anticonvulsants (see pharm section below). If a mood stabilizer doesn’t work will switch to an anticonvulsant. ○ Suicide Questions to ask Does the client have thoughts and ideas of suicide? Does the client have a plan? Are there means to act upon the plan? Does the client express intent to act on the plan? How lethal is the plan? Safety is main priority  3 Substance Use Disorders ○ Alcohol Patients with substance use disorder first need to acknowledge the consequences of their substance use and then recognize that they need to have abstinence. Will not be able to handle drinking anymore. ○ Cocaine Withdrawal symptoms- depression, drowsiness/sedation, cravings/urges ○ Impaired Professionals Signs- Increased use of the bathroom, patients who are always in pain, working nights, adding extra shifts, calling out, volunteer to always be med nurse, narcotic count off when they work Eating Disorders ○ Anorexia Physical symptoms- low body weight, amenorrhea, muscle weakness, yellow skin, dehydration, nutritional deficiencies, does not feel hungry Emotional/cognitive symptoms- depression, anxiety, perfectionism, obsessiveness, fear of gaining weight Interventions Outcomes Educate patient that perfection is unattainable Patient will gain weight ○ Bulimia Physical symptoms- normal or overweight, fluctuations in weight, irregular bowel function Emotional/cognitive symptoms- depression, anxiety, low self esteem Interventions Outcomes Will be binge and purge free Maintain weight- Bulimic patients DO NOT need to lose weight, they are usually normal weight or overweight  4 Pharmacology- know which med belongs to which med class! ○ Antianxiety Medications Benzodiazepines Diazepam, alprazolam, lorazepam Side effects- sedation, drowsiness Patient teaching- do not drive or operate heavy machinery while taking Non-Benzodiazepines buspirone ○ Antidepressant Medications TCAs amitriptyline, imipramine, nortriptyline SSRIs fluoxetine, paroxetine, citalopram, escitalopram, sertraline SNRIs venlafaxine, duloxetine MAOIs tranylcypromine, phenelzine Avoid tyramine-containing foods Can cause hypertensive crisis Atypical Antidepressants bupropion, trazodone ○ Antimanic Medications Mood Stabilizers lithium Anticonvulsants valproic acid, carbamazepine, gabapentin, lamotrigine ○ Antipsychotic Medications Typical Antipsychotics chlorpromazine, haloperidol, fluphenazine, thioridazine, thiothixene Can cause dystonia (involuntary muscle contractions, stiff neck, thickened speech)- needs intervention Atypical Antipsychotics risperidone, olanzapine, clozapine, quetiapine Atypical antipsychotics have less EPS side effects, used for newly diagnosed patients Depot is a medication form that is longer acting (weeks-months) than oral or regular IM medications. For  5 patients who have difficulty with compliance, this provides a great alternative. Examples: risperidone depot IM ○ Antiparkinson Medications Dopaminergic Agent carbidopa/levodopa Dopamine Agonist pramipexole Anticholinergic benztropine Antihistamine diphenhydramine