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Psych Nursing Test 2
| Question | Answer |
|---|---|
| What is the 4th leading cause of disability in the US? | Depression |
| When does pathological depression occur? | When adaptation to every day disappointments is ineffective. |
| What is major depressive disorder characterized by? | one or more episodes of major depression with or without full recover between episodes. |
| What are some of the things a person experiences during a bout of depression? | substantial pain and suffering, as well as psychological, social, and occupational disability |
| A severe form of mood disorder that is characterized by delusions or hallucinations | delusional or psychotic major depression |
| What is dysthymic disorder characterized by? | depressed mood and loss of interest or pleasure in activities of life, with some additional signs and symptoms of depression present most of the time for at least two years. |
| What are patients with dysthymic disorder at risk of developing? | major depressive mood |
| What are the characteristics of premenstrual dysphoric disorder? | depressed mood, marked anxiety, mood swings, and decreased interest in activities during the week prior to menses and subsides shortly after the onset of menstruation . |
| What are some risk factors of depression? | prior episodes of depression, family hx, prior suicide attempts, female gender, under 40 years old, postpartum period, medical comorbidity, lack of social support, stressful life situations, alcohol/substance abuse |
| Areas to assess in a depressed patient? | affect: facial expressions convey sadness, frequent sighing, bouts of weeping thought process: poor memory, concentration, judgement; indecisiveness feelings: anxiety, worthlessness, guilt, anger physical behavior: lethargy, fatigue,hygiene neglected |
| What is the highest priority in assessing depressed patients? | the presence of suicidal thoughts or potential |
| Nursing Interventions for depressed patients? | protect the client from self harm, enhance self-esteem, help the client determine ways to take control of life, ensure pt is meeting needs of nutrition, elimination, anxiety, rest, and personal hygiene |
| Three phases in the treatment and recovery of major depression? | Acute(6-12 wks), Continuation(4-9 months), and Maintenance (1+years) |
| How do MAOIs work? | prevent inactivation of norepinephrine, serotonin, dopamine, and tyramine |
| What does the increase in tyramine not broken down by MAO cause? | high blood pressure, hypertensive crisis, CVA |
| Foods with high amount of tyramine? | avocados, soybean, figs, pepperoni, dried and cured fish, almost all cheeses, foods with yeast, imported beer and chianti wines, protein dietary supplements, soy sauces, among others |
| What are some s/s of hypertensive crisis? | severe headache, tachycardia, palpitations, hypertension, nausea, vomiting |
| How do tricyclic's work? | inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS |
| How long may it take for the full effects of TCAs to be seen? | 4-8 weeks |
| Side effects of TCAs? | dry mouth, blurred vision, tachycardia, constipation, urinary retention, reflux, postural hypertension |
| Which side effects of TCAs require immediate medical attention>? | urinary retention and severe constipation |
| Serious side effects of TCAs | dysrhythmias, tachycardia, MI, heart blocks |
| What is the use of TCAs contraindicated with? | MI, other cardio problems, narrow-angle glaucoma, hx of seizures |
| What is the best predictor of future violence? | history of violence |
| s/s that precede violence: | pacing, restlessness, clenched jaw or fists, rigid posture, tense facial expressions, SOB, sweating, rapid pulse, profanity, argumentative, loud voice, very soft voice |
| Milieu characteristics that are conducive to violence: | overcrowding, staff inexperience, provocative or controlling staff, poor limit setting, arbitrary revocation of privileges |
| What is mania? | the euphoric mood associated with bipolar illness that is unstable, can quickly change to irritation and anger |
| What are the characteristics of a manic person? | laugh, joke, and talk in a continuous stream; demonstrate boundless enthusiasm; treat everyone with confidential friendliness; incorporate everyone into their plans and activities |
| What are some pleasurable activities people with mania become involved in that have painful consequences? | sexual indiscretion, too busy to eat or sleep causing exhaustion, manipulative behavior, gambling, stealing, spending money freely |
| What is a primary nursing intervention for someone with mania? | prevention of exhaustion and death from cardiac arrest |
| What are some nursing diagnoses related to mania? | risk for injury is probably the most important |
| What is the med usually given for mania? | Lithium |
| What is lithium effective in reducing? | elations, grandiosity, flight of ideas, irritability, manipulations, anxiety |
| what is the therapeutic level of lithium? | 0.4-1.3 |
| What type of diet should a person taking lithium maintain? | regular diet with normal sodium and fluid intake |
| Why is it important to eat a normal amount of sodium? | lithium decreases sodium re-absorption in the kidneys which can lead to sodium deficiency. Low sodium level can lead to lithium toxicity |
| What type of patients is seclusion useful for? | patients who can no longer control their behavior. |
| What makes seclusion effective? | reduces overwhelming stimuli and protects the client from injuring self or others |
| When is seclusion warranted? | substantial risk to self or others, client is unable to control actions, problematic behavior has been sustained, other measures have failed |
| What is electroconvulsive therapy? | brief seizures induced by electric current through electrodes attached to one or both sides of the head. requires informed consent or court ordered in involuntary therapy |
| Are people sedated before ECT? | yes, they are given general anesthesia |
| Indications for ECT | most commonly used for depression. also used for psychotic illnesses, can be used in combination with drug therapy |
| ECT is a primary treatment in what cases: | when a patient is suicidal or homicidal and need rapid response, if previous medication trials have failed, when there is marked agitation, vegetative symptoms, or catatonia; major depression with psychotic features |
| adverse reactions of ECT | memory deficits for the first few weeks after treatment; memory usually returns but not always; after treatment the patient might be confused or disoriented |
| What is schizophrenia? | derived from greek words schizo (split) and phren (mind). brain disease that affects a person's thinking, language, emotions, social behavior, and ability to perceive reality accurately. |
| What is schizophrenia caused by? | a combination of genetic predisposition, biochemical dysfunction, brain structure abnormality, and psychosocial stress |
| What is the leading cause of premature death in the schizophrenic population? | suicide |
| What are the categories of symptoms? | positive- the presence of something that isn't normally there (hallucinations and delusions) negative- the absence of something normally there (apathy, lack of motivation) |
| What are the 4 A's of schizophrenia? | Affect: flat, blunted, inappropriate, bizarre Associative looseness: jumbled and illogical speech,impaired reasoning Autism:delusions, hallucinations,neologisms ambivalence: simultaneously holding two opposing emotions, attitudes, wishes about a person |
| Nursing Interventions related to schizophrenia: | safety, reduce stimulation, address paranoia, teaching coping skills, provide constructive outlets for energy, limit setting, etc |
| What symptoms do first generation antipsychotics treat? | positive symptoms |
| what are some symptoms of first generation antipsychotics? | extrapyramidal such as acute dystonia, akathisia, and pseudoparkinsonism; urinary retention; constipation; dry mucus membranes; tardive dyskinesia; weight gain; sexual dysfunction; etc. |
| What symptoms do second generation antipsychotics treat? | positive and negative. these meds are often chosen as first line. produced minimal EPS or tardive dyskinesia. |
| What are some issues with second generation antipsychotics? | Clozaril (isn't used much anymore) it can cause agranulocytosis and the person would need WBC counts every week for the first 6 months. others include Zyprexa, Seroquel, and Geodon and these cause significant weight gain and metabolic syndrome |
| What symptoms do third generation antipsychotics treat? | Abilify is the only drug in this class. it is safer but may be less effective. It improves positive and negative symptoms and cognitive function. |
| What is Neuroleptic malignant syndrome? | toxic side effect of first-generation and second generation antipsychotics. caused by excessive dopamine receptor blockage. life threatening. can show up years after starting medications |
| What is neuroleptic malignant syndrome characterized by? | reduced consciousness, increased muscle tone, autonomic dysfunction (hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling) |
| What are the four cardinal signs of neuroleptic malignant syndrome? | severe muscle rigidity, hyperthermia, disturbances of consciousness, and autonomic dysfunction |
| How is neuroleptic malignant syndrome treated? | Mild cases- Parlodel; severe cases- Dantrium |
| What is the number one priority with anger and aggression? | de-escalation |
| What occurs in the pre-assaultive stage? | encourage the patient to move to a safe and quiet place, reassure you are interested and willing to help, state your expectations for behavior, demonstrate respect (sit eye level, personal space, do not end conversations, do not respond to verbal abuse) |
| How do you assure your safety when dealing with aggressive patients? | avoid dangly jewelry, have enough staff, know the layout of the unit, do not stand directly in front of client or doorway, provide feedback to patient whose behavior escalates, avoid confrontation |
| What occurs in the assaultive stage? | staff must respond quickly! use of physical restraints or seclusion may be warranted if other means didn't work |
| What are the different types of hallucinations? | auditory- hearing voices or sounds (60% of schizo patients) visual- seeing persons or things olfactory- smelling odors gustatory- experiencing tastes tactile- feeling bodily sensations |
| What are command hallucinations? | voices that direct the person to take an action. These need to be assessed very carefully because they could direct the person to cause harm to self or others |
| What is boundary impairment? | the impaired ability to sense where one's body ends and other's body begins. (a patient may drink another patients drink believing because it is near them it is theirs) |
Created by:
mcguirex3
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