Mental Health Proctored ATI, ATI MENTAL HEALTH PROCTORED, ATI proctored Mental Health; Solution Guide.

Wernicke-Korsakoff Expected Finding - Confusion Heroin Intoxication Expected Finding - Respiratory Depression Reaction of Terminal Cancer Diagnosis - Denial Valproic Acid Teaching - Teach the need to regularly monitor liver function levels due to the risk of hepatotoxicity When should Donapezil be taken? - Bedtime to reduce the risks for injury due to bradycardia and syncope Methadone is indicated for TX of.... - Opiate use disorder Phenelzine---Finding to report - Elevated BP: increases risk for hypertensive crisis This is an MAOI! Acute Main---Priority Goal - Maintain adequate hydration Binge-eating expected finding - Abdominal pain Stage 4 Alzheimers expected finding - Client is able to identify the names of family members Restricting type anorexia expected finding - Decreased caloric intake due to excessive fear of weight gain ECT Potential Complications - Cardiac arryhthmia Cocaine intoxication expected finding - Dilated pupils Benzo---finding that would indicate questioning the provider - Hypotension Alcohol Withdrawal Medication - Disulfram Can give____________with lithium - Valproic Acid Both treat bipolar Common adverse effect of Buspirone - Dizziness Confusion develops...... - SLOWLY with alzheimers What food type to avoid with Disulfram - Pure vanilla extract Conduct Disorder expected finding - Aggressive behavior toward others Heroin withdrawal expected findings - Muscle aches Alcohol withdrawal expected findings - Insomnia and restlessness Mematine is used to treat - Severe alzheimers ADHD teaching - Ignore child's attention seeking behaviors that are not dangerous Rape-Trauma Syndrome finding - Report of intense guilt Medication that is given during alcohol detox - Diazepam ECT expected findings - Memory loss Nausea Tachycardia ECT is given for - Bipolar with rapid cycling Vagus Nerve Stimulation adverse effects - Voice changes Dysphagia Neck pain Modeling - Allows client to see a demonstration of appropriate behaviors in a stressful situation. The goal is that the client will imitate the behaviors Systemic Desentization - Begins with mastering of relaxation techniques. Then a client is exposed to increasing levels of anxiety-producing stimulus. Flooding - Exposing the client to a great deal of undesirable stimulus in an attempt to turn off anxiety response. Most useful for phobias Thought Stopping - Teaches a client to say "stop" when a negative thought or compulsive behavior arises and substitute positive thought. The goal is that the client with time will use command silently Eye Movement Desentization and Reprocessing (EMDR) - Therapy for clients who have PTSD. Encourages eye focus on a separate stimuli while thinking of or talking about the traumatic event PTSD expected findings - Hallucinations Recurring nightmares How is seasonal depression treated? - Light therapy Dysthymic Disorder - Mild form of depression that usually has an early onset, such as in childhood and lasts at least 2 years in length St. John's Wort adverse effects - Photosensitivity Skin rash Rapid heart rate GI distress Abdominal pain Depressive disorders are most prevalent in... - Adults between ages of 15-40 Transpersonal Communication - Addresses an individual's spiritual needs and providers interventions to meet those needs Empathy - UNDERSTANDING of feelings Rapid Cycling - 4 or more episodes of acute mania within 1 year Bipolar I - Client has at least one episode of mania alternating with major depression More severe Bipolar II - Client has one or more hypomanic episodes alternating with MDD Bipolar Meds - Lithium=mood stabilizer Anticonvulsants such as Valproic Acid (Depakote), Clonazapam, Lamitcal, Gabapentin, and Topiramate Benzos such as Lorazepam used on a short term basis SSRIs such as Prozac A client in a true manic state will... - Not stop moving, and does not eat or drink, or sleep. This can become a medical emergency Alogia - Poverty of thought or speech; the client may sit with a visitor but may only mumble or respond vaguely to questions Avolition - Lack of motivation in activities and hygiene Grandeur - Believes that she is all powerful and important, like a god Somatic Delusionals - Believes that his body is changing in an unusual way, such as growing a third arm Depersonalization - Nonspecific feeling that a person has lose their identity, self is different or unreal Derealization - Perception that environment has changed Global Assessment of Functioning (GAF Scale) - Helps to determine a client's ability to perform ADLs and to function independently Mileu - Safe, structured environment that decreases anxiety and distracts the client from constant thinking and hallucinations Atypical Antipsychotics - Treat BOTH positive and negative symptoms of schizophrenia Abilify Geodon Zyprexa Seroquel Risperdal Clozaril (Clozapine) Conventional Antipsychotics - Treat positive symptoms of schizo Haloperidol (Haldol) Loxapine Chlorpromazine (Thorazine) Fluphenazine Benzos - Lorazepam (ativan) Clonazepam (Klonopin) Positive Symptoms of Schizo (obvious) - Hallucinations Delusions Use of clang association Constantly waving arms (bizarre movements) Spitting - Client tends to characterize people or things as all good or all bad at any particular moment For example, client might say, "You are the worse person in the world!" Later that day, she might say, "You are best, but the nurse from the last shift is terrible!" Seen in borderline personality disorder Cluster A Disorders - Odd or eccentric traits Paranoid: characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit or deceive the person Schizoid: characterized by emotional detachment, disinterest in close relationships and indifference to praise or criticism; often uncooperative Schizotypal: characterized by odd beliefs lead to interpersonal difficulties, an eccentric appearance and magical thinking or perceptual distortions that are not clear delusions or hallucinations Cluster B Personality Disorders (Dramatic, Emotional, or Erratic traits) - Antisocial: characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility Borderline: characterized by instability of affect, identity, and relationships as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often tries self-injury and may be suicidal Histrionic: characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious Narcissistic: characterized by arrogance, grandiose views of self-importance, the need for constant admiration Cluster C Personality Disorders (Anxious, fearful, traits. Insecurity and inadequacy) - Avoidant: characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations. Fear of abandonment Dependent: characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends Obsessive-Compulsive: characterized by perfectionism with a focus on orderliness and control of the extent that the individual may not be able to accomplish a given task Confabulation - Seen with cognitive disorders Client may make up stories when questioned about events or activities that she does not remember Perseveration: - Client avoids answering questions by repeating phrases or behaviors (Grandpa Mose!) Delirium Meds - Antipsychotics or antianxiety meds may be used Neurocognitive Disorder Meds - Medications such as Donepezil (Aricept), Rivastigmine (Exelon) and Galantamine (Razadyne) increase actetylcholine at cholinergic synapses by inhbiting its breakdown by acetylcholinterase, which increases the availability of acteylcholine at neurotransmitter receptor sites in the CNS Adverse effects: nausea & diarrhea which in occur in about 10% of patients Bradycardia Medication approved for moderate stages of alzheimers - Memantine (Namenda) Delirium expected findings - Family report of personality changes Hallucinations Restlessness Severity Scale for substance use disorder - 0-1=no diagnosis of substance abuse 2-3=mild substance abuse 4-5=moderate substance abuse 6 or more= severe substance abuse Common defense mechanism with substance abuse - Denial Nicotine Withdrawal med - Bupropion (Zyban) Anorexia - Voluntary refusal to eat Body weight less than 85% of expected normal weight for individual) Restricting Type: individual drastically restricts food intake and does not binge or purge Binge-eating/purging type: engages in binge-eating or purging behaviors Binge Eating Disorder - Client recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa Weight gain increases risk for: -diabetes -HTN -Cancer Overgeneralization - "Other girls don't like me because I'm fat" "All or Nothing" Thinking - "If I eat any dessert, I will gain 50 lbs" Catastrophizing - "My life is over if I gain weight" Personalization - "When I walk through the hallways, I know everyone is looking at me" Emotional Reasoning - "I know i look bad because I feel bloated" Eating Disorder Vitals - Low BP with possible orthostatic hypotension Decreased pulse and body temperature Hypertension may be present in clients who have binge eating disorder Anorexia Skin, Hair & Nails - Fine, downy hair (lanugo) on the face and back; yellowish skin, mottled, cool extremities and poor skin turgor Anorexia Reproductive status - Accompanied by amenorrhea for at least 3 consecutive cycles Electrolyte Imbalance: Bulimia - Hypokalemia Hyponatremia Hypochloremia Diet for individuals with eating disorders - Provide small, frequent meals which are better tolerated and will help prevent the client from feeling overwhelmed Provide a diet high in fiber to prevent constipation Provide a diet low in sodium to prevent fluid retention Limit high-fat, gassy foods during the start of treatment Administer a multivitamin and mineral supplement Refeeding Syndrome - Potentially fatal complication that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client A nurse is planning care for a client who has anorexia nervosa with binge-eating and purging behaviors. What should be included in the plan of care? - Implement one-on-one observation during meal time Benzo IV use include: - Diazepam Lorazepam Anterograde Amnesia - Difficulty recalling events that occur after dosing Flumazenil use - Administered to counteract sedation and reverse the adverse effects of benzos Benzo antidote Serotonin Syndrome - Agitation, confusion, disorientation, anxiety, hallucinations, fever, diaphoresis, tremors Nardil A/E - Orthostatic Hypotension Headache Mirtazaprine (Remeron) - This medication increases the release of serotonin and norepinephrine Dysfunctional Grief - Involves difficult progression through the expected stages of the grieving process Disenfranchised Grief - Entails an experienced loss that cannot be publicly shared or is not socially acceptable, such as suicide Autism expected finding - Repetitive counting Levels of Suicide Nursing Interventions - Primary: prevention strategies that include providing information and education to at-risk populations Secondary: management of the suicide crisis Tertiary: interventions with the family or friends of a person who committed suicide Overt Comment (Suicide) - "There is just no reason for me to go on" Covert Comment (Suicide) - "Everything is look pretty grim for me" Suicide indicator - A sudden change in mood from sad/depressed to happy and peaceful Individuals with highest risk of suicide - Adolescents Native American Clients with depressive disorder Medications for Anger Management - Olanzapine (Zyprexa) Ziprasidone (Geodon) These are atypical antipsychotics used to control aggressive behavior and impulsive behaviors. These are used more commonly than Haloperidol because of the severity of side effects of Haloperidol Haloperidol is often used...just not as often Preassaultive Stage of Violence - Defensive responses to questions Rapid breathing Facial grimacing Agitation Setting limits with aggressive clients - Tell the client calmly and directly what he must do in a particular situation "I need you to stop yelling and walk with me outside where we can talk." Risk factors of family & community violence - Victims are the greatest risk of violence when they try to leave the relationship Pregnancy tends to increase the likelihood of violence toward the intimate partner Child under 3 years of age Family violence other name - Maltreatment Tension Phase (Violence) - Abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence Acute Battering Phase - The tension becomes too much to bear and serious abuse takes place Victim may try to cover up injuries or may get help Honeymoon Phase - Abuser becomes loving, promises to change, and is sorry for behavior Shaken Baby Syndrome findings - May cause intercranial hemorrhage Assess for respiratory distress, bulging fontanelles, increase in head circumference Acute Phase of rape - Occurs immediately following the attack. Lasts for about 2 weeks and consists of initial emotional or impact reaction Emotional outbursts: crying, laughing, hysteria, anger, and incoherence Somatic Reaction of rape - Occurs later and lasts about 2 weeks Bruising and soreness from attack Muscle tension, headaches, sleep disturbances, GI symptoms, genitourinary symptoms, a variety of emotional reactions: embarrassment, guilt, revenge, anger, anxiety, fear. primary prevention - preventing mental problems. teaching stress reduction techinques secondary prevention - early detection - screening the community tertiary prevention - rehab and prevention of further problems - support groups partial hospitalization - an approach in which patients receive treatment at a hospital during the day but return home at night. includes detox programs assertive community treatment - aimed at helping severely mentally ill wherever they are in the community, each assigned a team member available any time of the day, visited twice a week by that member. interprofessional team to reduce rehospitializations and relapses community mental health centers. education groups medication dispensing prgrams individual and family counseling psychosocial rehabilitation programs - Residential services, day programs for older adults classical psychoanalysis - therapeutic process of assessing unconscious thoughts and feelings and resolving conflict by talking to a psychoanalyst - focuse on eawrly life psychodynamic psychotherapy - therapy aimed at uncovering the unconscious motives that underlie psychological problems - emphasis on current state interpersonal psychotherapy - focuses on helping clients improve current relationships and specific problems CBT - focusing on individual thoughts and behaviors cognitive reframing - replacing negative thoughts priority restructuring - ID what requires priority, such as pleasurable activities journaling - ID stressors assertive training - helps clients express feelings in a socially acceptable manner behavioral therapy - decreasing anxiety and avoidant behavior DBT - dialectical behavior therapy for personality disorders systematic desensitization - planned, progressive exposure to an anxiety provoking stimuli examples of CBT - DBT systematic desensitization aversion therapy meditation guided imagery diaphragmatic breathing muscle relaxation biofeedback biofeedback - increasing awareness and gaining control of reactiosn to a trigger response prevention - preventing a client from performing a compulsive behavior with the intent that anxiety will diminish thought stopping - use of aversive stimuli to interrupt or prevent upsetting thoughts prolonged exposure therapy - combines relaxation techniques with exposure to the traumatic situation through repeated discussion or in real world situations - results in decreased anxiety EDMR - eye movement desensitization and reprocessing - a therapy using rapid eye movement during desensitization techniques for PTSD contraindications of EDMR - active SI psychosis severe dissociative disorders detached retina glaucoma severe substance abuse disorder crisis intervention - emergency counseling for crime victims somatic therapy - used for dissociative disorders - increasing awareness of the present, decreases dissociative episodes hypnotherapy - used for dissociative disorders risk with TMS - seizures transcranial magnetic stimulation - a treatment that involves placing a powerful pulsed magnet over a person's scalp, which alters neuronal activity in the brain risk for ECT - confusion retrograde amnesia short term memory loss SADPERSONS - sex age depression past attempts excessive drug use rational thinking loss social supports lacking organized plan no spouse sickness bleuler's As for psychosis - affect disturbance autism associative looseness ambivalence SIGECAPS - - for depression sleep - lack of quality of sleep interests - apathy and loss guilt - hopelessness energy - anergia concentration - indecision, inability, alterations appetite - decreases psychomotor retardation suicide DIGFAST - - for bipolar mania Distractibility Indiscretion - esp about sex Grandiosity Flight of Ideas Activity - increase Sleep - decrease Talkative DELIRIUM mnemonic - Dementia Electrolyte imbalance, dehydration Liver lungs kidney heart disease Infection Rx - drugs Injury pain stress surgery Unfamiliar environment Metabolic reasons A's for Alzheimers - amnesia aphasia apraxia agnosia expressive amnesia - broca's area - know what you want to say but mouth does not work receptive amnesia - Wernickes - gibberish and lack of content apraxia - repetitive movement agnosia - the inability to recognize familiar objects. SHIVERS - - serotonin syndrome Shivering Hyperreflexia Increased temp Vital sign instability Encephalopathy Resltessness Sweating TRAUMA - - PTSD Trauma Rexperiencing - flashbacks Avoidance Unable to function Restlessness Arousal MOA of benzos - work on GABA inhibits electrical activity in the brain. sedation. not used for minor stressors side effects of benzos - - interfere with motor ability attention and judgement - drowsy fatigue confusion slow reflexes - abuse potential - do not stop abruptly drug interactions with benzos - OTC drugs kava valerian alcohol antidote for benzos - flumazenil examples of benzos - diazepam clonazepam alprazolam lorazepam MOA of first generation antipsychotics - lowers dopamine, causing negative symptoms and adverse effects from each pathway - more negative symptoms adverse effects of first generation antipsychotics - anticholinergic antiadrenergic antihistamine what med must be given with first generation antipsychotics - benztropine for EPS thioridazine - first generation low potency antipsychotic - more sedating, more anticholinergic, less EPS, tachycardia haloperidol - first generation high potency antipsychotic - less sedation less anticholinergic - more EPS risperidone - second generation antipsychotic. least sedating orthostatic hypotension appetite stimulation can be used as a mod stabilizer clozapine - last choice second generation antipsychotic. helps with SI agranulocytosis - check CBC every 2 weeks for 6 months olanzapine - second generation weight gain and can be used as a mood stabilizer ziprasidone - second generation antipsychotic that needs to be taken with food QT prolongation what are second generation antipsychotics notorious for - weight gain - monitor for metabolic syndrome aripiprazole - third generation antipsychotic that is best for weight gain, best for CV, improves both positive and negative symptoms and cognitive function - dopamine system stabilizer - adjunct therapy for depression examples of MAOIs - phenelzine isocaboxazid tranylcyrpomide selegiline MOA of MAOIs - raise SE NE DA and tyramine by preventing destruction adverse effects of MAOIs - hypertensive crisis CVI HA NV hyperthermia palpitations stiff sore neck contraindications of MAOIs - CVD HTN CHF liver disease foods with tyramine - aged cheese cured meats fava beans chocolate wine beer caffeine figs yeast MSG soybeans shrimp paste ginseng protein supplements avocados examples of TCAs - amitriptyline imipramine doxepin nortriptyline amoxapine trimipramine clomipramine MOA of TCAs - raise SE and NE by stopping their reuptake adverse effects of TCAs - anticholinergic antiadrenergic antihistamine sedation ataxia confusion insomnia lethal in overdose** antiadrenergic effects - orthostatic hypotension reflex tachycardia dizziness fainting antihistamine effects - weight gain examples of SSRIs - fluoxetine citalopram escitalopram paroxetine sertraline how does it take for SSRIs to work - 4-6 weeks adverse effects of SSRIs - HA - early Stomach nausea - early weight change - paroxetine sexual side effects hyponatremia bruxism increased suicide risk MOA with SNRIs - low dose - increase SE high dose - increase NE higher dose - increase DA used for panic attacks anxiety and ADHD side effects of SNRIs - less weight gain less poop out sleep disturbance dry mouth HTN - terrible discontinuation syndrome! examples of SNRIs - venlafaxine duloxetine desvenlafaxine MOA of buproprion - NE/DA reuptake inhibitor may increase anxiety side effects of bupropion - no sexual side effects lowers seizure threshold - TBI what can bupropion be used for - smoking cessation what to avoid with bupropion - eating disorders addictive behaviors abuse potential what can bupropion be combined with and why - SSRIs to reduce sexual side effects mirtazapine - antidepressant that works fast, no sexual side effects but has huge weight gain trazodone - poor antidepressant that aids in sleep and has priaprism as side effect what are all anticonvulsants - teratogenic who to use valproic acid and divalproex sodium for - rapid cyclers side effects of divalproex soidum and valproic acid - hepatoxicity GI symptoms thrombocytopenia decrease effectiveness of BC side effects of carbamazepine - blurred vision - nystagmus leukopenia agranulocytosis SJS what decreases the effectivess of carbamezpine - grapefruit juice side effects of lamotrigine - SJS blurred vision nystagmus pharmacokinetics of lithium - absorbed in GI tract excreted through the kidneys takes 1-2 weeks to work therapeutic index of lithium - 0.8-1.4 lithium toxicity 2.0-2.5 - required emetic or gastric lavage. blurry vision ataxia twitching hypotension polyuria coarse hand tremor vomiting lithium toxicity above 2.5 - hemodialysis symptoms of lithium toxicity - Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea coarse hand tremor - projectile vomiting diuretics and lithium - increase LI NSAIDS andlithium - increase LI when causes decrease in NA - sweating diarrhea vomiting use of diuretics mild adverse effects of lithium - fine hand tremors polyuria thirst nausea weight gain nursing interventions with lithium - take at the same time daily with meals maintain salt intake monitor sweating, fever draw lithium level in the morning 8-12 hours after last dose drink 10-12 glasses water avoid conception reduce caffeine amphetamines - Adderall Dexedrine examples of methyphenidates - Ritalin concerta Vyvanse focalin daytrana contraindications with stimulants - caffeine cocaine cold meds examples of non-stimulants ADHD - NE reuptake inhibitors atomoxetine (Strattera) bupropion venlafaxine alpha 2 agonists - clonidine guanfacine helps with impulsivity drugs for Alzheimers mild to moderate - donepezil Exelon razadine adverse effects of donepezil Exelon razadyne - GI symptoms bradycardia facial flushing leg crampsl contraindications with donepezil Exelon razadyne - COPD Memantine - NMDA antagonist for alheizmer improves cognitive function, slow the rate of decline in severe stages drug of choice with OCD - clomipramine drugs to treat delirium tremens - carbamazepine opioids drugs for alcohol abuse - disulfiram naltrexone Acamprosate drugs for nicotine addiction - Chantix bupropion drug to reverse anticholinergic toxicity in older adults - stop antipsychotic and start physostigmine anticholinergic toxicity - fluctuating vital signs dilated pupils older adults Neuromalignant syndrome - excessive dopamine blockage and increased muscle tone. autonomic dysfunction agitation confusion high fever drug treatment for NMS - stop antipsychotic and start dantrolene mild anxiety - normal and adaptive good eye contact may be tense but energetic low irritability more alert and concentrating wide visual field can talk to the patient moderate anxiety - increase in vitals but pulse is normal sporadic eye contact good startle reflex protective mode more irritable overly sensitized treatment for moderate anxiety - oral medication needs relaxation deep breathing and visualization severe anxiety - sweating pacing tense poor eye contact dread defensive strike first verbally disortions in effective reasoning closed visual field only thinking about the problem mild delusions or paranoia out of range VS treatment with severe anxiety - firm simple directions remove from stimuli IM or oral panic anxiety - flight fight or freeze fixed eyes out of control overwhelmed cannot articulate emotions disorganized thinking treatment of panic anxiety - guiding patient IM possibility of restraints quickly intervene maturational crisis - leaving home marriage birth of a child retirement death of a parent internal situational crisis - loss of job divorce severe illness external adventitious crisis - unplanned accidental natural disaster crime of violence immature types of defense mechanisms - denial dissociation intellectualization projection regression denial - UC refusal or ignoring I can quit at any time Dissociation - UC separating feelings from situation or object an out of body experience intellectualization - UC overuse of logic without reason being overly analytical about death introjection - UC incorporating other's values dressing like your therapist projection - UC blaming of others for unacceptable thoughts or feelings my ex is so unreasonable regression - UC return to earlier development sucking thumb intermediate defense mechanisms - repression reaction formation undoing displacement rationalization repression - UC forgetting to painful events I can't remember undoing - behaviors that make up for an unacceptable thought or behavior gift giving after abuse reaction formation - overcompensation saying you love someone even though you hate them displacement - UC taking out anger on a less threatening object kicking the dog punching a wall rationalization - UC justifying illogical feelings I was going to quit my job anyway mature defense mechanisms - altruism sublimation suppression transference countertransference altruism - helping others to suppress drives voluntary sublimation - substituting an acceptable activity for an unacceptable drive example of sublimation - A man with aggressive urges becomes a surgeon suppression - conscious denial of an event not ready to talk about it transference - the feelings that a patient has and puts on the nurse countertransference - feelings that a nurse has and puts ont eh patient erikson's infant stage - 0-18 months trust vs. mistrust attachment and bonding eriksons toddler stage - 18mont-3 years autonomy vs. shame sense of self control and adequacy eriksons preschool stage - 3-6 years initiative vs. guilt ability to be a self starter eriskson's school stage - 6-12 years industry vs. inferiority ability to learn how things work erikson's adolescence stage - 12-18 years ID vs. role diffusion unique, integrated person erikson's young adult stage - 18-30 years Intimacy vs. isolation commitment to another person erikson's middle adulthood stage - 30-65 years generativity vs. stagnation family and society erikson's senrio stage - 65+ years integrity vs. despair sense of fulfillment What are cognitive symptoms of psychotic disorders - -disordered thinking -inability to make decisions -poor problem solving ability -difficult concentrating to perform tasks -Memory deficits Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about them - ideas of reference Feels singled out for harm by others (being hunted down by FBI) - Persecution Believes that she is all powerful and important like a god - grandeur believes that his body is changing in an unusual way, scubas growing a third arm - somatic delusions May feel that her spouse is sexually involved with another individual - Jealousy Believes that a force outside his body is controlling him - being controlled believes that her thoughts are heard by others - thought broacasting believes that others thoughts are being inserted into his mind - thought insertion Believe that her thoughts have been removed form her mind by an outside agency - thought withdrawal is obsessed with religious beliefs - religiosity The client may say sentence after sentence but each sentence may relate to another topic and the listeniner is bale to follow the clients thoughts - flight of ideas Made up words that have meaning only to the client such as i tranged and flitted. - neologisms What are the standardized screen tools for psychotic disorders - -Global assessment of functioning scale -scale for assessment of negative symptoms -brief psychiatric rating scale -Brief psychiatric rating scale -abnormal involuntary movement scale (AIMS) What antidepressants are prescribed for psychotic disorders - Paxil (Peroxetine) -monitor for SI -Notify for deepened depression -Do not stop abruptly What are the anxiolytics/ benzo's used for psychotic disorders? - -Ativan (Lorazepam) -Klonopin -sedative effects -need to get blood tests for ANC -use caution in older adults What are the personality disorders in cluster A - (Odd and eccentric traits) -Paranoid -Schizoid -Schizotypal Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations - schizotypal Dealing with anxiety by reaching out to others. Ex: a nurse who lost a family member in a fire is a volunteer firefighter - Altruism Dealing with unacceptable feelings or impulses by unconsciously substitute acceptable forms of expression. Ex: a person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously a the gym during his lunch period - Sublimation Voluntarily denying unpleasant thoughts and feelings. Ex: A person who has lost his job states he will worry about paying his bills next week - Suppression Putting unacceptable ideas, thoughts, and emotions out of conscious awareness. Ex: a person who has a fear of the dentist's drill continually "forgets" his dental appointments. - Repression What are healthy defense mechanisms? - alturism and sublimation what are intermediate defenses - repression reaction formation displacement rationalization undoing What are immature defenses - projection dissociation splitting denial Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation Ex: A person who is angry about losing his job destroys his child's favorite toy - displacement Overcompensating or demonstrating the opposite behavior of what is felt. Ex: a person who dislikes her sisters daughter offers to babysit so that her sister can go out of town - reaction formation Performing an act to make up for prior behavior. Ex; An adolescent completes his chores without being prompted to after having an argument with his parents. - undoing creating reasonable and acceptable explanations for unacceptable behavior Ex: A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog. - rationalization temporarily blocking memories and perceptions from consciousness Ex: an adolescent witnesses a shooting and is unable to recall any details of the event - dissociation demonstrating an inability to reconcile negative and positive attributes of self or others Ex:a client tells a nurse that she is the only one who cares about her, yet the following day the same client refuses to talk to the nurse - splitting Blaming others for unacceptable thoughts and feelings Ex: a young adult blames his substance use disorder on his parents refusal to buy him a new car - projection pretending the truth is no reality to manage the anxiety of acknowledging what is real. Ex: A parent who is informed that his son was killed in combat tells everyone he is coming home for the holidays. - denial Orientation phase of a therapeutic relationship includes what? - -Introduction to client and state purpose -Set the contract: meeting time, place, frequency, duration and date of termination -discuss confidentiality -build trust by establishing expectations and boundaries -set goals with the client -explore the clients ideas, issues, and needs -explore the meaning got testing behaviors -enforce limits on testing or other inappropriate behaviors Working phase of a therapeutic relationship includes what? - -maintain contract -perform ongoing assessment -facilitate the clients expression of needs and issues -encourage pt to problem solve -promote self esteem -foster positive behavioral change -explore and deal with resistance and other defense mechanisms -recognize transference and countertransference -reassess goals and plan -remind client of termination date Termination phase of a therapeutic relationship includes what? - -provide pt tine to discuss thoughts and feelings about termination -discuss the clients experience with separation and loss summarize goals and achievements -review memories of work in the sessions -express own feelings -discuss ways to incorporate new healthy behaviors matinaing limits of final termination What is included in cognitive reframing - -priority restructuring -journal keeping -assertiveness training -monitoring thoughts. A therapist or others serve as a role models for a client, who imitates this modeling to improve behavior - Modeling The client receives positive rewards for positive behavior positive reinforcement - operant conditioning This therapy is the planned, progressive, or graduate exposure to anxiety providing stimuli in relief situation, or by imagining events that case anxiety during exposure the client uses relaxation - systematic desensitization Pairing of a maladaptive behavior with a punishment or unpleasant stimui such as a bitter taste or mild electric shock as punishment for behaviors such as alcohol use disorder violence self mutilation and thumb sucking - aversion therapy This therapy uses various techniques to control pain tension and anxiety - meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedbacks exposing a client while in the company of a therapist to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response - flooding preventing a client from performing a compulsive behavior with the intent that anxiety will diminish - response prevention teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout, "stop" and substitute a positive thought. this goal over time is for the client to use the command silently - thought stopping This style supports group interacting and decision making to solve problems - democratic the group process progresses without any attempt by the leader to control the direction - laissez-faire The leader completely controls the direction and structure of the group without allowing group interaction or decision making to solve problems - autocratic some group members or the leader may have goals different from the stated group goals that may disrupt group processes - hidden agenda Initial phase of group development includes: - define the purpose and goals of the group -leader sets tone of respect, trust and confidentiality -members get to know each other and the group leader -there is a discussion about termination Working phase of group development includes: - promote problem solving skills to facilitate behavior changes. Power and control issues may dominate in this phase. -group leader uses therapeutic communication to encourage group work toward meeting goals. -members take informal roles within the group, which may interfere with or favor group progress toward goals. Termination phase of group development includes: - This makes the end of group sessions -group members discuss termination issues -the leader summarizes work of the group and individual contributions. one member takes responsibility for problems to keep peace at all costs - placating a member of the family with little power is blamed for problems within the family - scapegoating a third party is drawn into the relationship with two members whose relationship is unstable - triangulation These are emotional issues or themes within a family that continue for atlas three generations such as a pattern of substance use or addictive behavior when the families is under stress, dysfunctional grief pattern triangulation patterns and divorce - multigenerational issues The body's response to an increased demand. The first stage is initial adaptive response aka fight or flight mechanism. If it is prolonged maladaptive responses can occur - General adaptation syndrome What are the fight or flight responses or adaptive responses? - -Apprehension -unhappiness or sorrow -decreased appetite -increased respiratory rate, HR, CO, BP -depressed immune system What are the prolonged stress or maladaptive responses? - -chronic anxiety -depression, chronic pain, sleep disturbances -weight gain or loss -increased risk for MI/ Stroke -poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate -increased risk for infection What screen tools do you use for Stress management? - life changing events questionnaire -Holmes -Rahe scale -Lazarus Cognitive Appraisal who can ECT be used on? - - MDD - pt that has rapid cycling of acute manic episodes - schizophrenia spectrum disorders that are less responsive to neuroleptic meds such as schizoaffective disorder High risk pt with ECT - -recent MI - hx of CVA -Cerebrovascular malformation -intracranial mass lesion -increased intracranial pressure What is ECT not successful in? - substance use personality disorder dysthymic disorder What meds should be discontinued before ECT - MAOI Seizure med Lithium usually 2 weeks ahead of time What is injected before ECT to decrease secretions and counteract any vagal stimulation? - atropine sulfate or robinul what short acting anesthetic is used for ECT - brevital (methohexital) IV bolus What muscle relaxant is used - succinylcholine (anectine) Electrical stimulus time vs seizure time - 0.2-0.8 for electrical stimulus 25-60 for seizure activity complications of TMS (transcranial M stimulation) - -mild discomfort -tingling sensation at the site of the electromagnet -lightheadness -seizures are rare but a potential complications of VNS - -voice changes -hoarsness -throat or neck pain -dysphagia -dyspnea with exertion What standardized screen tools would be used for anxiety disorders? - -Hamilton rating scale for anxiety -modified speilberger state anxiety scale -Yale brown obsessive compulsive scale -hoarding scale self report -national stressful events survey What is the first line of treatment for anxiety disorders? - -SSRI such as zoloft (sertraline) Then they can also benefit from antidepressants, sedative hypnotic anxiolytics such as valium, non barbiturate anxiolytics such as buspar, beta blockers, antihistamines. What are the standardized screen tools for depressive disorders? - -Hamilton depression scale -beck depression inventory -geriatirc depression scale (short form) -zung self rating depression scale What SSRI's (selective serotonin reuptake inhibitor) are used for depression? - -celexa (citalopram) -prozac (fluoxetine) -zoloft (Sertraline) What TCA's(tricyclic antidepressants) are used for depression? - -Elavil(amitriptyline) What MAOI's are used for depression - -Nardil (phenelzine) What Atypical antidepressants are used for depression? - -Wellbutrin (bupropion) What SNRI's(serotonin norepinephrine reuptake inhibitor) are used for depression? - -Effexor (venlafaxine) -Cymbalta (duloxetine) When patient is taking SSRI for depression what client teaching needs to be done? - -may cause nausea, headache and CNS stimulation (agitation, insomnia, anxiety) -sexual dysfunciton may occur -observe for serotonn syndrome -No st. Johns wort -watch diet What are affective symptoms - hopelessness suicidal ideation What client teaching is needed with a depressive patient when they are taking TCA? - -Change positions slowly -Chew sugarless gum, eat foods high in fiber, increase fluids to reduce anticholinergic effects What client teaching is need with a depressive patient taking MAOI's - - avoid tyramine foods -avoid all medications including OTC talk to DR first What client teaching is needed with a depressive patient that is taking atypical antidepressants - - watch for HA, dry mouth, GI distress, constipation, increased HR, nausea restlessness or insomnia. Notify DR -monitor diet -dont give to seizure patients What client teaching is needed with a depressive patient that is taking SNRI's - -adverse effects include nausea, weight gain, and sexual dysfunction the client has at least one episode of mania alternating with major depression - Bipolar I The client has one or more hypomanic episodes alternating with major depressive episodes - Bipolar II The client has atlas 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomania episodes alternating with minor depressive episodes. - cyclothymia Risk factors of Bipolar - -Genetics having an immediate family member who has a bipolar disorder -psychological such as a stressful event or major life event -physiological such as neurobiological or neuroendocrine disorder. -substance use disorder What are the standardized screening tools for Bipolar disorders? - -The mood disorders questionnaire. What medications are given for patients that have bipolar disorder? - -Mood stabilizers: Lithium -Anticonvulsants that act as mood stabilizers: Depakote(valproic acid), Klonopin(clonazepam), Lamictal(lamotrigine), nuerontin(gabapentin), Topaz(topiramate) -Benzo's: Ativan(lorazepam) , for sleep -Antidepressants such as Prozac(fluoxetine) to manage depression The client has psychotic thinking or behavior present for atlas 6 months. Areas of functions including school or work, self care, and interpersonal realties are significantly impaired - schizophrenia the client has impairments of personality functioning. However impairment is no as severe as with schizophrenia - Schizotypal personality disorder The client experiences delusional timing for atlas 1 month. Self or interpersonal function is not markedly impaired - delusional disorder What atypical antipsychotics would be prescribed for patients with psychotic disorders? - -risperdal (Risperidone) -zyprexa (Olanzapine) -seroquel(Quetiapine) -Geodon (ziprasidone) -Abilify (aripiprazole) -Clozaril (clozapine) These treat both negative and positive symptoms watch diet Report agitation, dizziness, sedation, and sleep disruption may occur. What are the conventional antipsychotics for psychotic disorders - -Haldol (haloperidol) -Loxitane (Loxapine) -Thorazine (chlorpromazine) -Prolixin (Fluphenazine) Minimize anticholinergic effects get up slowly the client has psychotic manifestations that last between 1 day to 1 mont in duration - brief psychotic disorder The client has manifestation similar to those of schizophrenia, the but duration is from 1 to 6 months and social occupation dysfunction may or may not be present - schizophrenifrom disorder What are the risk factors of personality disorders? - -comorbid substance use disorders -hx or nonviolent and violent crime -sex offenses -childhood abuse or trauma -development factors with a direct link to parenting -Genetic and Biochemical factors What are the common pathological personality characteristics in a personality disorders - -Inflexibility/maladaptive responses to stress -compulsiveness and lack of social restraint -inability to emotionally connect in social and professional relationship -tendency to provoke interpersonal conflict -ability to merge personal boundaries with others. the clients disorder meets both the criteria for schizophrenia and depressive or bipolar disorder - schizoeffective disorder The client experiences psychosis within 1 month of substance intoxication or withdrawal. May be caused by medications intend for therapeutic use - Substance induced psychotic disorder Characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person - Paranoid Characterized by emotional detachment, disinterest in close relationships and indifference to praise or criticism; often uncooperative - Schizoid What are the personality disorders in Cluster B - -antisocial -borderline -histrionic -Narcissistic Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulations, impulsiveness, and fear of abandonment; often tries self injury - borderline Characterized by arrogance, grandiose views of self importance, the need for consistent admiration and a lack of empathy for others that strains most relationships; often sensitive to criticism - narcissistic characterized by emotional attention-seeking behavior in which the person needs to be the center of attention often seductive and flirtations - Histrionic Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility - Antisocial What personality disorders are in cluster C - -Avoidant -Dependent -Obsessive compulsive Characterized by perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task - Obsessive compulsive Characterized by extreme dependency in a close relationship with a n urgent search to find a replacement when one relationship ends - Dependent Characterized by social inhibition and avoidance of all situations that rear interpersonal contact, despite wanting close relationships due to extreme fear of rejection;often very anxious in social situations - Avoidant clients who have dependent and histrionic personality disorders often benefit from - assertiveness training and modeling Clients who have schizoid or schizotypal personality disorders ten to - isolate themselves the nurse should respect this need What medications maybe used for personality disorders - Antidepressant anxiolytic antipsychotic mood stabilizers What is dialectical behavior therapy used on what type of patient - self injurious risk factors for cognitive disorders - -parkinson's disease -huntington's disease -hepatic or renal failure -fluid and elctrolyte imbalances -nutritional deficiencys -cardiovascular diseases -infections (HIV/AIDS) -Substance use or withdrawal *More communion older adult clients and clients in and intensive care unit. Ris factors for neurocognitive disorder and Alzheimer's disease - -disorder of the neurological system -advanced age -prior head trauma -genetic factors -family history of Alzheimer's disease and or down syndrome Standardized screening tools for cognitive disorders - -Functional Dementia Scale -Mental or Mini Mental staus Examination -Functional Assessment Screening tool -Global Deterioration Scale -Blessed dementia Scale What medications would you give for a patient that has Delirium - Antipsychotic Antianxiety What medications would you give for a patient that has a neurocognitive disorder - Aricept Exelon Razadyne What are the adverse effects of neurocognitive disorder medications - nausea diarrhea bradycardia What are the medications for anxiety disorder (Benzo) - -xanax (alprazolam) -Valium (Diazapam) -Ativan (lorazepam) -Librium (chlordiazepoxide) -Tranxene ( -Serax (oxazepam) -Kolonopin (clonazepam) What are the atypical anxiolytic - buspar (buspirone) SSRI - Paxil (Paroxetine) Zoloft (sertraline) Lexapro(escitalopram) Prozac(fluoxetine) Luvox (fluvoxamine)