NUR 255 Mental Health Exam 2 Study Guide/NUR 255 Mental Health Exam 2 Study Guide.

NUR 255 Mental Health Exam 2 Study Guide

Substance Related/Addictive Disorders (Chapter 22)

Substances that Lead to Use Disorders:
• Alcohol
• Caffeine
• Cannabis
• Hallucinogen
• Inhalant
• Opioid
• Sedative-hypnotics
• Stimulants
• Tobacco

Addiction – you need it; if you don’t have it, you may go into withdrawal
Intoxication – high or drunk
Tolerance – need more of the substance to get the same effect as when you first started
Withdrawal – physiological effects as a result of not having the substance in your system.

Alcohol: Signs of Intoxication and Withdrawal:
• Intoxication – manifest differently in each person but includes:
o Staggering, slurred speech, repeating self, lack of coordination, etc.
• Withdrawal:
o Hyper alert
o Irritable
o Startles easily
o Possible seizures
o Elevated Vital Signs

• Delirium Tremors (DT’s):
o Signs and Symptoms:
 Anxiety, Insomnia, Anorexia, Delirium, Elevated VS, Diaphoresis,
Disorientation, Psychosis, Elevated temperature.
o Treatment:
 Fluids, Antianxiety medications, Thiamine and B vitamins to prevent
seizures, and possibly antihypertensive.
o Questions to ask patient:
 How much have you had to drink?
 When was your last drink?
 DT’s occur 24-72 hours after last drink
o Can be life threatening

, o Patient has to go through DT’s before recovery can begin

Opiates Signs of Intoxication and Withdrawal:
• CNS depressants
• Slows down Respiratory Rate
• Includes:
o Heroin
o Morphine
o Fentanyl
o Methadone
o Meperidine

• Intoxication:
o Constricted pupils, Drowsiness, Slurred speech, Decreased RR and BP,
psychomotor retardation.
• Withdrawal:
o Pain, N/V, Psychomotor agitation, Loss of appetite, Cravings for drug,
Diaphoresis.
 Can be fatal if symptoms are not treated!

Cocaine:
• CNS Stimulant
• Blocks pain
• Increases sexual arousal and may increase violence.

• Intoxication:
o Pupil dilation, Dryness of oral and nasal cavity, Excessive motor activity
• Withdrawal:
o Depression, Paranoia, Lethargy, Anxiousness, Insomnia, N/V, Sweating chills.

HESI HINT:
• What medications can the nurse expect to administer to chemically dependent clients?
o In treating alcohol withdrawal, chlordiazepoxide (Librium) or lorazepam (Ativan)
is commonly used.
o Disulfiram (Antabuse) is often used as a deterrent to drinking alcohol.

HESI HINT:
• Know what defense mechanisms are used by chemically dependent clients. Denial and
rationalization are the two most common coping styles used. Their use must be
confronted so the client’s accountability for his or her own behavior can be developed.

HESI HINT:
• What basic needs take priority when working with chemically dependent clients?

, o Alcohol and other substance intake has superseded the intake of food for these
clients. Nutrition is a priority.
o This results in an inadequate intake of thiamine and niacin. This is why Thiamine
is used to treat a patient going through DT’s to prevent seizures.

HESI HINT:
• What behaviors are expected during alcohol withdrawal?
o In the alcoholic, DTs occur 12-48 hours after the last intake of alcohol
 Anxiety, Insomnia, Anorexia, Delirium, Elevated VS, Diaphoresis,
Disorientation, Psychosis, Elevated temperature.

HESI HINT:
• What type of therapy is used with chemically dependent clients?
o Group therapy is effective, as are support groups such as AA and NA.

Schizophrenia Spectrum Disorders (Chapter 12)

Substance abuse disorders:
• Schizophrenia and substance abuse often are seen together
• Majority of schizophrenic’s have Nicotine Dependence
• Polydipsia – excessive thirst
o Leads to electrolyte imbalances

1st Degree biologic relative with schizophrenia
• Increases chances of developing schizophrenia by 10%

Course of the Disorder:
• Prodromal – signs leading up to the initial psychotic break into schizophrenia
o Awkward, obsessive, phobias, anxiety, mind-wandering

Phases of Schizophrenia:
• Phase 1 – Acute
o Onset or exacerbation of symptoms
• Phase 2 – Stabilization
o Symptoms diminishing
o Movement toward previous level of functioning
o Stabilization comes from adherence of medication regimen
 This can be hard because they may not be willing to take medications out
of fear or not trusting the person giving them the meds.
• Phase 3 – Maintenance
o At or near baseline functioning

, Symptoms of Schizophrenia:
Positive Symptoms – Presence of Problematic behavior
• Alterations in Thinking:
o Delusions
 False fixed beliefs
o Concrete Thinking
 Inability to think abstractly
• Alterations in Speech – Associative looseness:
o Clang associations
 Saying a series of words that rhyme; don’t make sense
o Word Salad
 Saying random words; has meaning to them, but make no sense
o Neologisms
 Make up words or phrases
o Echolalia
 Repeating what you say or what they hear
• Other disorders of thought or speech:
o Religiosity
o Magical Thinking
 Belief that they can make something happen based on thoughts or action
o Paranoia
o Circumstantiality
o Tangentially
o Cognitive retardation
o Alogia, or poverty of speech
o Flight of ideas
o Thought blocking
o Thought insertion
o Thought deletion
• Alterations in Perception:
o Depersonalization - focus on self
 Extremely uncomfortable feeling of being an observer of one’s own body
or mental process
o Derealization – focus on outside world
 Recurring feeling that one’s surroundings are unreal or distant. The
person may feel mechanical, dreamy, or detached from the body
o Hallucinations
 Seeing, hearing, tasting false things
 6 types of hallucination:
 Auditory, Visual, Olfactory, Tactile, Gustatory, Command
o Illusions
 Real object that gets misinterpreted