NUR 114 PSYCH EXAM 1 STUDY GUIDE 2022/2023 UPDATE
Special Situations
-a crisis occurs when pt uses all coping strategies and fails; self-limiting and can last 4-6 weeks
-types of loses: physiologic, safety, loss of security and sense of belonging, self-esteem, and loss r/t self-
actualization (pt may never find soulmate)
-grief and loss are what the pt says they are
-Kubler-Ross stages of grief: denial, anger, bargaining, depression, acceptance (these can occur in any
order and for however long)
-risk factors for complicated grief: death of a spouse or child, death by suicide, and sudden or
unexpected death
-physiologic responses of complicated grief: impaired immune system, increased serum prolactin level,
and increased mortality rate from heart disease
-choose a quiet, but not isolated room when interviewing psychotic pt (pt may become threatening)
-ask direct questions, “how many hours did you sleep”, not “how did you sleep” with psychotic pts
Depression
-single and divorced people are most at risk for developing major depressive disorder
-the degree of depression is comparable to pts sense of helplessness and hopelessness
-meds used in depressive disorders interfere with the neurotransmitters in the brain
-norepinephrine and serotonin levels are decreased with depression; drugs increase the sensitivity of
the postsynaptic receptor sites
-antidepressant meds shouldn’t be used over 3-6 months
-4 C’s of anticholinergic effects: dry eyes, can’t pee, dry mouth, constipation (can’t see, can’t pee, can’t
spit, can’t shit)
-psychotherapy must be included in the treatment of pts with depression; interpersonal therapy
-anergia: lack of energy
-anhedonia: loss of pleasure from activities
-depressed pts often slouch when seated, avoid eye contact, slow with everything, and tend to ruminate
thoughts
-depression often results in “ineffective coping”
,NUR 114 PSYCH EXAM 1 STUDY GUIDE 2022/2023 UPDATE
-when talking with depressed pt, avoid pt ruminating, avoid being overly cheerful, allow and encourage
crying, do not probe for info, and talk about coping strategies from the past
-the nurse may need to prompt activities for pt with depression; promote autonomy in ADL’s; don’t ask
pt to do something, simply state for the pt to do it (“here are your pants; put them on”)
-depression among older adults may exhibit as fatigue, diminished memory and concentration, feelings
of worthlessness, sleep disturbances, appetite disturbances with excessive weight loss or gain,
restlessness, impaired attention span, and suicidal ideation
-during antidepressant admin with older adults, and waiting 4-6 weeks to become effective, offer
support and encouragement, change positions slowly, and maintain adequate hydration
-postpartum psychosis is an emergency condition; the mother becomes delusional and has thoughts of
hurting herself and the infant; mother should not be left alone with infant
-SSRI’s are good for depression, anxiety, and OCD; also safer in older adults bc they produce few
sedative, anticholinergic, and cardiovascular side effects
-tricyclic antidepressants have a lag period of 10-14 days (up to 1-4 weeks) before decreasing depressive
symptoms; 6 weeks for full effect; use in caution with pts who have glaucoma, BPH, urinary
retention/obstruction, DM, hyperthyroidism, cardiovascular disease, renal impairment, or respiratory
disorders
-an overdose of tricyclics occurs over a period of a few days; symptoms include: confusion, agitation,
hallucinations, hyperprexia, and increased reflexes
-symptoms of hypertensive crisis: occipital headache, hypertension, n/v, chills, sweating, restlessness,
nuchal rigidity, dilated pupils, fever, and motor agitation (these can lead to hyperprexia, ceberal
hemorrhage, and death); phentolamine mesylate can be given to reverse hypertensive crisis (dilates
blood vessels and decreases vascular resistance)
-serotonin syndrome occurs when taking MAOI with SSRI
-ECT can be used in pts who aren’t responsive to antidepressants or experience adverse effects;
electrodes are placed to the head that cause a seizure; NPO after midnight, no fingernail polish on, and
pt voids before procedure; O2 given to pt during; IV med of short-acting anesthetic and muscle
relaxant (succinylcholine) given before
-TMS can be most effective treatment for mild-moderate depression when used alone
-MAOI-tyramine reaction produces symptoms within 20-60 minutes after ingestion
-for pts who are discharging home, assess for suicide potential; SSRI’s are rarely fatal, but cyclic and
MAOI’s are potentially fatal
-major depressive disorder more commonly found in women
-worldwide disabilities: 1st major depression and 2nd bipolar disorder
Bipolar Disorder
, NUR 114 PSYCH EXAM 1 STUDY GUIDE 2022/2023 UPDATE
-bipolar disorder: extreme episodes of mania and depression
-mood disorders: depression, mania, or both
-during manic episodes, pt is: euphoric, grandiose, energetic, and sleepless; poor judgement and rapid
thoughts, actions, and speech
-bipolar disorder ranks 2nd as a cause of worldwide disability (major depressive disorder is 1st)
-young men early in the course of bipolar disorder are at highest risk of suicide (previous suicide
attempts, alcohol abuse, and recently discharged from hospital)
-bipolar disorder occurs equally among men and women
-highest risk for developing bipolar disorder: highly educated people
-first manic episode usually occurs in teens, 20’s, or 30’s
-treatment for bipolar disorder requires lifelong medication regimen (lithium or anticonvulsant)
-the only psychiatric disorder in which meds can prevent acute cycles of bipolar behavior
-lithium is a salt contained in the human body; it is not metabolized; it reduces frequency of cycling
between manic episodes; peaks in 30 min to 4 hours (regular form) and 4-6 hours in slow-release form;
crosses blood-brain barrier (not recommended during pregnancy); lag period of 5-14 days for onset of
action (pt may need to take antipsychotic or antidepressant along with lithium until lithium works); avoid
lithium in pt with renal disease
-since lithium is a salt competitor, monitor for appropriate levels of sodium and water; no high sodium
diets, excessive water intake, or excessive sweating w/o compensation
-carbamazepine (anticonvulsant) need regular serum levels drawn bc of risk of toxic levels and to
monitor for suppression of WBC’s (4-12 ug/ml)
-valproic acid (Depakote) is used for simple absence and mixed seizures, migraine prophylaxis, and
mania; frequent liver function, serum ammonia, platelet, and bleeding time tests (50-125 ug/ml)
-psychotherapy is not useful during acute manic episodes (pt can’t focus)
-assessment of pt in manic state may need to collect info in intervals and include family
-hallmark symptom of mania: pressured speech (rapid and often loud speech w/o pauses; pt likely
interrupts and cannot listen to others)
-pts in manic episode have high self-esteem, limited insight, can rarely fulfill role responsibilities
(having a job or going to school), and may experience hallucinations; they may become hostile towards
those they see as getting in the way of their desired goals
-labile emotions: emotions are unstable and can fluctuate
-when caring for the pt with mania: set and maintain limits on behavior, decrease environmental
stimuli when possible, reorient pt as needed, limit size and frequency of group activities (avoid highly
competitive activities)
Special Situations
-a crisis occurs when pt uses all coping strategies and fails; self-limiting and can last 4-6 weeks
-types of loses: physiologic, safety, loss of security and sense of belonging, self-esteem, and loss r/t self-
actualization (pt may never find soulmate)
-grief and loss are what the pt says they are
-Kubler-Ross stages of grief: denial, anger, bargaining, depression, acceptance (these can occur in any
order and for however long)
-risk factors for complicated grief: death of a spouse or child, death by suicide, and sudden or
unexpected death
-physiologic responses of complicated grief: impaired immune system, increased serum prolactin level,
and increased mortality rate from heart disease
-choose a quiet, but not isolated room when interviewing psychotic pt (pt may become threatening)
-ask direct questions, “how many hours did you sleep”, not “how did you sleep” with psychotic pts
Depression
-single and divorced people are most at risk for developing major depressive disorder
-the degree of depression is comparable to pts sense of helplessness and hopelessness
-meds used in depressive disorders interfere with the neurotransmitters in the brain
-norepinephrine and serotonin levels are decreased with depression; drugs increase the sensitivity of
the postsynaptic receptor sites
-antidepressant meds shouldn’t be used over 3-6 months
-4 C’s of anticholinergic effects: dry eyes, can’t pee, dry mouth, constipation (can’t see, can’t pee, can’t
spit, can’t shit)
-psychotherapy must be included in the treatment of pts with depression; interpersonal therapy
-anergia: lack of energy
-anhedonia: loss of pleasure from activities
-depressed pts often slouch when seated, avoid eye contact, slow with everything, and tend to ruminate
thoughts
-depression often results in “ineffective coping”
,NUR 114 PSYCH EXAM 1 STUDY GUIDE 2022/2023 UPDATE
-when talking with depressed pt, avoid pt ruminating, avoid being overly cheerful, allow and encourage
crying, do not probe for info, and talk about coping strategies from the past
-the nurse may need to prompt activities for pt with depression; promote autonomy in ADL’s; don’t ask
pt to do something, simply state for the pt to do it (“here are your pants; put them on”)
-depression among older adults may exhibit as fatigue, diminished memory and concentration, feelings
of worthlessness, sleep disturbances, appetite disturbances with excessive weight loss or gain,
restlessness, impaired attention span, and suicidal ideation
-during antidepressant admin with older adults, and waiting 4-6 weeks to become effective, offer
support and encouragement, change positions slowly, and maintain adequate hydration
-postpartum psychosis is an emergency condition; the mother becomes delusional and has thoughts of
hurting herself and the infant; mother should not be left alone with infant
-SSRI’s are good for depression, anxiety, and OCD; also safer in older adults bc they produce few
sedative, anticholinergic, and cardiovascular side effects
-tricyclic antidepressants have a lag period of 10-14 days (up to 1-4 weeks) before decreasing depressive
symptoms; 6 weeks for full effect; use in caution with pts who have glaucoma, BPH, urinary
retention/obstruction, DM, hyperthyroidism, cardiovascular disease, renal impairment, or respiratory
disorders
-an overdose of tricyclics occurs over a period of a few days; symptoms include: confusion, agitation,
hallucinations, hyperprexia, and increased reflexes
-symptoms of hypertensive crisis: occipital headache, hypertension, n/v, chills, sweating, restlessness,
nuchal rigidity, dilated pupils, fever, and motor agitation (these can lead to hyperprexia, ceberal
hemorrhage, and death); phentolamine mesylate can be given to reverse hypertensive crisis (dilates
blood vessels and decreases vascular resistance)
-serotonin syndrome occurs when taking MAOI with SSRI
-ECT can be used in pts who aren’t responsive to antidepressants or experience adverse effects;
electrodes are placed to the head that cause a seizure; NPO after midnight, no fingernail polish on, and
pt voids before procedure; O2 given to pt during; IV med of short-acting anesthetic and muscle
relaxant (succinylcholine) given before
-TMS can be most effective treatment for mild-moderate depression when used alone
-MAOI-tyramine reaction produces symptoms within 20-60 minutes after ingestion
-for pts who are discharging home, assess for suicide potential; SSRI’s are rarely fatal, but cyclic and
MAOI’s are potentially fatal
-major depressive disorder more commonly found in women
-worldwide disabilities: 1st major depression and 2nd bipolar disorder
Bipolar Disorder
, NUR 114 PSYCH EXAM 1 STUDY GUIDE 2022/2023 UPDATE
-bipolar disorder: extreme episodes of mania and depression
-mood disorders: depression, mania, or both
-during manic episodes, pt is: euphoric, grandiose, energetic, and sleepless; poor judgement and rapid
thoughts, actions, and speech
-bipolar disorder ranks 2nd as a cause of worldwide disability (major depressive disorder is 1st)
-young men early in the course of bipolar disorder are at highest risk of suicide (previous suicide
attempts, alcohol abuse, and recently discharged from hospital)
-bipolar disorder occurs equally among men and women
-highest risk for developing bipolar disorder: highly educated people
-first manic episode usually occurs in teens, 20’s, or 30’s
-treatment for bipolar disorder requires lifelong medication regimen (lithium or anticonvulsant)
-the only psychiatric disorder in which meds can prevent acute cycles of bipolar behavior
-lithium is a salt contained in the human body; it is not metabolized; it reduces frequency of cycling
between manic episodes; peaks in 30 min to 4 hours (regular form) and 4-6 hours in slow-release form;
crosses blood-brain barrier (not recommended during pregnancy); lag period of 5-14 days for onset of
action (pt may need to take antipsychotic or antidepressant along with lithium until lithium works); avoid
lithium in pt with renal disease
-since lithium is a salt competitor, monitor for appropriate levels of sodium and water; no high sodium
diets, excessive water intake, or excessive sweating w/o compensation
-carbamazepine (anticonvulsant) need regular serum levels drawn bc of risk of toxic levels and to
monitor for suppression of WBC’s (4-12 ug/ml)
-valproic acid (Depakote) is used for simple absence and mixed seizures, migraine prophylaxis, and
mania; frequent liver function, serum ammonia, platelet, and bleeding time tests (50-125 ug/ml)
-psychotherapy is not useful during acute manic episodes (pt can’t focus)
-assessment of pt in manic state may need to collect info in intervals and include family
-hallmark symptom of mania: pressured speech (rapid and often loud speech w/o pauses; pt likely
interrupts and cannot listen to others)
-pts in manic episode have high self-esteem, limited insight, can rarely fulfill role responsibilities
(having a job or going to school), and may experience hallucinations; they may become hostile towards
those they see as getting in the way of their desired goals
-labile emotions: emotions are unstable and can fluctuate
-when caring for the pt with mania: set and maintain limits on behavior, decrease environmental
stimuli when possible, reorient pt as needed, limit size and frequency of group activities (avoid highly
competitive activities)
