Mental Health Exam 2 Study Guide

Mental Health Exam 2 Study Guide In class review 1) What medications are examples of MAOI’s ● Phenelzine (Nardil) ● Selegiline (Emsam) 2) Your patient is about to start taking Phenelzine (Nardil), you as a nurse should include in your education plan (SATA) ● Aviodance of foods high in tyramine ● Check with the pharmacist before taking any OTC (examples are cold medications) 3) What is the risk of taking an SSRI and MAOI inhibitor together (SATA)? ● Serotonin syndrome ● Hypertensive crisis 4) Your bipolar patient is making demands and disrupting the unit, how do you respond (SATA) ● Set clear limits ● Distraction techniques ● Use a firm calm approach 5) High level suicide precautions for inpatients include SATA ● 1:1 staff within arm’s length of patient at all times ● Removal of any hard objects at meal times ● Removal of anything that the patient potentially uses to harm themselves 6) When can a patient stop taking their mood stabilizer? ● NEVER! They should not stop taking their mood stabilizer. 7) Inpatient, you are accessing your patient for depression 3 days after starting medication treatment, your client is in a cheerful mood and says “I feel great”, you should change his care plan to include which of the following ● Keep a closer eye on the patient, consider asking for an order for staff view at all times. 8) Your patient is experiencing acute mania, what type of environment should you put the patient in? ● A neutral-colored room with minimal furnishing 9) Your patient with acute mania now seems to be responding well to treatment, how are you able to tell. ● Participating in groups, taking turns speaking, appropriately dressed. 10) Pick healthy coping strategies, ● Exercise ● Journaling ● Using learned coping strategies 11) Your patient tells you “They are after me, they want to kill me”, what is your best response? ● That must make you scared, how does that make you feel? 12) Your patient is experiencing auditory hallucinations, what is your next step? ● Ask your patient what the voices are saying. 13) Should you assess for depression and suicidal ideation in a schizophrenic patient ● Yes Concept Guide 1. Anhedonia ● Anhedonia is the inability to feel pleasure. It's a common symptom of depression as well as other mental health disorders. Most people understand what pleasure feels like. 2. Anergia ● Abnormal lack of energy is among the negative symptoms common to schizophrenia and depression. 3. SSRI patient/family teaching points ● Medications of any kind — prescribed, over-the-counter, or herbal supplements — should never be mixed without consulting the doctor ● Alcohol (wine, beer and hard liquor) or street drugs, may reduce the effectiveness of antidepressants ● Avoid consuming certain foods that contain high levels of tyramine, such as many cheeses, wines and pickles. 4. Lithium adverse reactions ● Excessive urination and thirst (polyuria and polydipsia) are consistently found to be among the most common side effects associated with lithium ● Hives; difficulty breathing; swelling of face, lips, tongue, or throat. ● Too much lithium in the body can cause death. 5. What activities can put someone at risk for lithium toxicity? ● Lithium toxicity can occur if you take only slightly more than a recommended dose. Risk factors for lithium toxicity include older age and factors that lead to disturbances in renal blood flow and water-salt homeostasis, such as fever, diarrhea or vomiting, and use of nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, and renin- angiotensin-aldosterone system (RAAS) inhibitors. Female sex has also been associated with a higher risk of lithium toxicity 6. Lithium patient education – teaching points ● Stop using lithium and call the doctor for symptoms of lithium toxicity: muscle weakness, twitching, drowsiness, feeling light-headed, mood changes, blurred vision, ringing in the ears, irregular heartbeats, confusion, slurred speech, clumsiness, trouble breathing, or seizures. ● Some medicines can interact with lithium and cause a serious condition called serotonin syndrome 7. Assessment of Suicide, what would be considered a high-risk assessment? ● Communicating suicidal thought ● Verbally or in writing; seeking access to lethal means such as firearms or medications; and demonstrating ● Preparatory behaviors such as putting affairs in order. 8. St. John’s wort considerations ● St. John's wort might cause serious interactions with some medications. ● St. John's wort is most commonly used for "the blues" or depression and symptoms that sometimes go along with mood such as nervousness, tiredness, poor appetite, and trouble sleeping. ● It can cause some side effects such as trouble sleeping, vivid dreams, difficulty sitting still, nervousness, irritability, stomach upset, tiredness, dry mouth, dizziness, headache, skin rash, diarrhea, and skin tingling. 9. Symptoms of Bipolar manic episode ● An individual with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. ● Abnormally upbeat, jumpy or wired. ● Increased activity, energy or agitation. ● Exaggerated sense of well-being and self-confidence (euphoria) ● Decreased need for sleep. ● Unusual talkativeness. ● Racing thoughts. ● Distractibility. 10. Symptoms that could be attributed to child/adolescent depression ● Feeling sad, hopeless, or irritable a lot of the time ● Not wanting to do or enjoy doing fun things ● Showing changes in eating patterns – eating a lot more or a lot less than usual ● Showing changes in sleep patterns – sleeping a lot more or a lot less than normal ● Showing changes in energy – being tired and sluggish or tense and restless a lot of the time ● Having a hard time paying attention ● Feeling worthless, useless, or guilty ● Showing self-injury and self-destructive behavior 11. Nursing interventions for a patient suffering with severe anxiety ● Encourage the client's participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth. Relaxation exercises are effective nonchemical ways to reduce anxiety ● Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.) ● PRN medications may be indicated for high levels of anxiety. ● Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep- breathing exercises, physical exercises, brisk walks, jogging, meditation). 12. Know the different defense mechanisms, what they mean, how they can be used ● In psychoanalytic theory, a defense mechanism is an unconscious psychological mechanism that reduces anxiety arising from unacceptable or potentially harmful stimuli. Defense mechanisms may result in healthy or unhealthy consequences depending on the circumstances and frequency with which the mechanism is used. ● Five main mechanisms: repression, regression, projection, reaction formation, and sublimation. All defense mechanisms are responses to anxiety and how the consciousness and unconscious manage the stress of a social situation. 13. Which medications can be used for anxiety? Which can be used PRN for immediate relief? Which one cause dependance? Which ones do not cause dependance? ● Benzodiazepines (typically prescribed for short-term use) and newer options like SSRI antidepressants. Benzodiazepines cause dependance. ● Buspirone, also known by the brand name BuSpar, is a newer anti-anxiety drug that acts as a mild tranquilizer. ● Beta blockers—including drugs such as propranolol (Inderal) and atenolol (Tenormin)—are a type of medication used to treat high blood pressure and heart problems. However, they are also prescribed off-label for anxiety. 14. OCD – what is considered a compulsion? What is an obsession? ● Compulsions, sometimes known as rituals, are behaviors that people feel pressured to do to reduce anxiety, guilt and distress, or to prevent harm from occurring. Compulsions are often repeated, conducted according to strict rules, and time consuming. ● Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or urges that cause anxiety or distress. People with OCD attempt to ignore or suppress obsessions, or have to neutralize them by performing a compulsion 15. Agoraphobia ● Agoraphobia is an anxiety disorder that makes people very fearful of certain places and situations. 16. Symptoms one can experience in a panic attack ● A panic attack is an intense wave of fear characterized by its unexpectedness and debilitating, immobilizing intensity. Your heart pounds, you can't breathe, and you may feel like you're dying or going crazy. Panic attacks often strike out of the blue, without any warning, and sometimes with no clear trigger 17. PTSD ● A disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event. 18. Be familiar with Maslow’s hierarchy of needs ● Maslow's hierarchy of needs is a theory of motivation which states that five categories of human needs dictate an individual's behavior. Those needs are physiological needs, safety needs, love and belonging needs, esteem needs, and self-actualization needs. ● 19. Schizophrenia – be familiar with individual disorganized speech patterns ● Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. ● Neologisms – Made-up words or phrases that only have meaning to you. ● Perseveration – Repetition of words and statements; saying the same thing over and over. ● Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head”). 20. Positive and Negative Symptoms of Schizophrenia Positive symptoms are highly exaggerated ideas, perceptions, or actions that show the person can’t tell what’s real from what isn’t. ● Hallucinations – Auditory, Visual, Olfactory and gustatory, tactile ● Delusions ● Confused thoughts and disorganized speech. ● Trouble concentrating ● Movement disorders Negative symptoms refer to an absence or lack of normal mental function involving thinking, behavior, and perception. You might notice: ● Lack of pleasure ● Trouble with speech. ● Withdrawal 21. What types of side effects can antipsychotic medications have? ● Drowsiness. ● Dizziness. ● Restlessness. ● Weight gain (the risk is higher with some atypical antipsychotic medicines) ● Dry mouth. ● Constipation. ● Nausea. ● Vomiting. 22. What is neuroleptic malignant syndrome? What does this look like in a patient experiencing this? ● Neuroleptic malignant syndrome (NMS) is a rare reaction to antipsychotic drugs that treat schizophrenia, bipolar disorder, and other mental health conditions. It affects the nervous system and causes symptoms like a high fever and muscle stiffness. The condition is serious, but it's treatable. 23. What are extrapyramidal side effects? What do they look like? ● Akathisia - With akathisia, you may feel very restless or tense and have a constant desire to move. ● Parkinsonism - describes symptoms that resemble those of Parkinson’s disease. The most common symptom is rigid muscles in your limbs. You could also have a tremor, increased salivation, slow movement, or changes in your posture or gait. ● Neuroleptic malignant syndrome (NMS) - This reaction is rare, but very serious. Generally, the first signs are rigid muscles and fever, then drowsiness or confusion. You could also experience seizures, and your nervous system function may be affected. 24. Disturbed thought process vs Disturbed Sensory Perception ● The diagnosis Disturbed Thought Processes describes an individual with altered perception and cognition that interferes with daily living. Causes are biochemical or psychological disturbances like depression and personality disorders. The focus of nursing is to reduce disturbed thinking and promote reality orientation. ● Disturbed sensory perception is a change in the amount of patterning of incoming stimuli, accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli. 25. Clozaril patient teaching ● Clozapine affects your immune system. You may get infections more easily, even serious or fatal infections. Call your doctor if you have a fever, sore throat, weakness, or lack of energy. ● Clozapine can increase your risk of seizure, especially at high doses. Avoid any activity that could be dangerous if you have a seizure or lose consciousness. ● Clozapine can cause serious heart problems. Call your doctor right away if you have chest pain, trouble breathing, fast or pounding heartbeats or sudden dizziness. ● Clozapine is not approved for use in older adults with dementia-related psychosis. 26. Medication compliance in a schizophrenic patient ● Non-adherence is a major problem in the treatment of schizophrenia. ● non-adherence is a frequent cause of impairment, hospitalization, higher risk of suicide, longer time to remission, ● Poorer prognosis, loss of job, ● Dangerous behavior, arrest, violence, drug and alcohol consumption, ● Psychiatric emergences ● poor mental performance and low satisfaction with life. 27. How can you tell if someone is having auditory hallucinations? ● You might hear someone speaking to you or telling you to do certain things. The voice may be angry, neutral, or warm. Other examples of this type of hallucination include hearing sounds, like someone walking in the attic or repeated clicking or tapping noises.