Exam 3: NSG3450/ NSG 3450 V1(2026/ 2027 Updated Edition) Nursing Practice – Mental Health Guide| Q&A| Grade A| 100% Correct (Accurate Solutions)- Galen

Exam 3: NSG3450/ NSG 3450 V1(2026/ 2027 Updated Edition) Nursing Practice – Mental Health Guide| Q&A| Grade A| 100% Correct (Accurate Solutions)- Galen Q. When considering an eating ds, what is a physical criterion for hospital admission? a. a daytime HR of 50bpm b. an oral temp of 100F or more c. 90% of ideal body weight d. systolic BP 130mmHg ANSWER A Q. When considering the need for monitoring, which intervention should the nurse implement for a pt w/ anorexia? Select all that apply: a. provide scheduled portion-contolled meals and snacks b. congratulate pt's for weight gain and behavior that promote weight gain c. limit time spent in bathroom during periods when not under direct supervision d. promote exercise as a method to increase appetite e. observe pt during and after meals/snacks to ensure that adequate intake is achieved and maintained ANSWER A, C, E Q. Which intervention will promote independence in a pt being treated for bulimia nervosa? a. have the pt monitor daily caloric intake and intake and output of fluids b. encourage the pt to use behavior modification techniques to promote weight gain behaviors c. ask the pt to use a daily log to record feelings and circumstances r/t urges to purge d. allow the pt to make limited choices about eating and exercise as weight gain progresses ANSWER D Q. Which pt statement supports the diagnosis of anorexia nervosa? a. "I'm terrified of gaining weight." b. "I wish I had a good friend to talk to" c. "I've been told I drink way too much alcohol" d. "I don't get much pleasure out of life anymore" ANSWER A Q. Obesity can be the end result of a binge-eating ds. The nurse understands that the best tx option in persons w/ a binge-eating ds promotes: a. bariatric surgery b. coping strategies d. avoidance of public eating d. appetite suppression meds ANSWER B Q. Taylor, a psych RN, orients Regina, a pt w/ anorexia nervosa, to the room where she will be assigned during her stay. after getting Regina settled, the nurse informs Regina: a. "I need to go through the belongings you have brought w/ you" b. "you can use the scale in the back room when you need to" c. "you will be eating 5x a day here" d. "the daily structure is based around your desire to eat" ANSWER A Q. Safety measures are of concern in eating-disorder treatments. Pt's w/ anorexia are supervised closely to monitor: Select all that apply: a. foods that are eaten b. attempts at self-induced vomiting c. relationships w/ other pt's d. weight ANSWER A, B, D Q. Malika has been overweight all her life. Now as an adult, she has health problems r/t her excessive weight. Seeking weight loss assistance at a primary care facility, Malika is surprised when the nurse practitioner suggests: a. a trial of SSRI antidepressant therapy b. mild exercise to start, increasing in intensity over time c. removing snack foods from the home d. medications x for HTN ANSWER A Q. Malika agrees to start losing weight according to the nurse practitioner's outlined plan. Additional teaching is warranted when Malika states: a. "I am willing to admit I am depressed" b. "psychotherapy will be part of my tx" c. "I prefer to have a gastric bypass rather than use this plan" d. "my comorbid conditions may improve w/ weight loss" ANSWER C Q. A pt w/ a hx of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the pt has relapsed? Select all that apply: a. intense nausea b. diaphoresis c. acute paranoia d. confusion e. dyspnea ANSWER A, B, D, E Q. Which assessment data confirms the suspicion that a pt is experiencing opioid withdrawal? Select all the apply? a. pupils are dilated b. Pulse rate is 62 beats/min c. slow movements d. extreme anxiety e. sleepy ANSWER A, D Q. The nurse diagnosis "ineffective denial" is especially useful when working w/ substance use disorders and gambling. Which statements describe the diagnosis? Select all that apply: a. reports inability to cope b. does not perceive danger of substance use or gambling c. minimizes sx d. refuses healthcare attention e. unable to admit impact of disease on life pattern ANSWER B, C, D, E Q. Which action should you take when a female staff member is demonstrating behaviors associated w/ a substance use disorder? a. accompany the staff member when she is giving pt care b. offer to attend rehab counseling w/ her c. refer her to a peer assistance program d. confront her about your concerns and/or report your concerns to a supervisor immediately ANSWER D Q. A pt diagnosed w/ opioid use disorder has expressed a desire to enter into a rehab program. What initial nursing intervention during the early days after admission will help ensure the pt's success? a. restrict visitors to family members only b. manage the pt's withdrawal sx well c. provide the pt a low stimulus environment d. advocate for at least 3 months of tx ANSWER B Q. Opioid use disorder is characterized by: a. lack of withdrawal sx b. intoxication sx of pupillary dilation, agitation, and insomnia c. tolerance d. rewiring smaller amounts of the drug to achieve a high over time ANSWER C Q. Terry is a young male in the chemical dependency program. Recently he has become increasingly distracted and disengaged. The nurse concludes that Terry is: a. bored b. depressed c. bipolar d. not ready to change ANSWER D Q. Maxwell is a 30 y/o male who arrives at the ER stating, "I feel like I am having a stroke." During the intake assessment, the nurse discovers that Maxwell has been working for 36 hours straight without eating and consumes eight double espresso drinks and 12 caffeinated sodas. The nurse suspects: a. fluid overload b. dehydration and caffeine OD c. benzodiazepine OD d. sleep deprivation syndrome ANSWER B Q. Donald, a 49 y/o male, is admitted for inpatient alcohol detoxification. He Is cachexic, has multiple scabs on his arms and legs, and has lower extremity edema. An appropriate nursing diagnosis for Donald, along w/ an expected outcome is: a. Risk for injury/Remains free from injury b. Ineffective denial/ Accept responsibility for behavior c. Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs D. Risk for suicide/ Expresses feelings plans for the future ANSWER C Q. Which response by a 15 y/o demonstrated a common sx observed in pt's diagnoses w/ major depressive disorder? a. "I'm so restless. I can't seem to sit still" b. "I spend most of my time studying. I have to get into a good college." c. "I'm not trying to diet, but i've lost about 5lbs in the past month" d. "I go to sleep around 11pm, but i'm always up by 3am and can't go back to sleep" ANSWER D Q. Which assessment question ask by the nurse demonstrated an understanding of comorbid mental health conditions associated w/ major depressive disorder? Select all that apply: a. "do rules apply to you" b. "what do you do to manage anxiety? c. "do you have a hx of disordered eating?" d. "have you every been arrested for committing a crime?" ANSWER B, C, D Q. Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated w/ the older population? a. conducting routine suicide screenings at a senior center b. identifying depression as a natural, but treatable result of aging c. identifying males as being at a greater risk for developing depression d. stressing that most individuals experience just a single episode of major depression in a lifetime ANSWER A Q. Which characteristic identifies during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply: a. female b. 7 y/o c. comorbid autism diagnosis d. outbursts occur at least once a week e. temper tantrum occur at home and in school ANSWER B, C, E Q. Which chronic medical condition is a common trigger for major depressive disorder? a. pain b. HTN c. hypothyroidism d. Crohn's disease ANSWER A Q. Tammy, a 28 y/o w/ major depressive disorder and bulimia nervosa is ready for d/c from the county hospital after 2 weeks of inpatient therapy. Tammy is taking Citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? a. Fluoxetine (Prozac) b. isocarboxazid (Marplan) c. amitriptyline d. Duloxetine (Cymbalta) ANSWER A Cabot has multiple sx of depression including mood reactivity, social phobia, anxiety, and overeating. With a hx of mild HTN, which classification of antidepressants dispensed as a transdermal patch would be a safe med? a. Tricyclic antidepressants b. Selective serotonin reuptake inhibitors c. Serotonin and norepinephrine reuptake inhibitors d. Monoamine oxidase inhibitor D When nurse uses therapeutic communication w/ a withdrawn pt who has major depression, an effective method of managing the silence is to: a. meditate in the quiet environment b. ask simple questions even if the pt will not answer c. use the technique of making observations d. simply sit quietly and leave when the pt falls asleep C The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be under-active in depression is: a. Transcranial magnetic stimulation b. deep brain stimulation c. vagus nerve stimulation d. electroconclusive therapy (ECT) B Two months ago, Natasha's husband died suddenly and she has been overwhelmed w/ grief. When Natasha is subsequently diagnosed w/ major depressive disorder, her daughter, Nadia, makes which true statement? a. "depression often begins after a major loss. Losing dad was a major loss" b. "bereavement and depression are the same problem: c. "mourning is pathological and not normal behavior" d. "antidepressant meds will not help this type of depression" A Which pt statement does not demonstrate an understanding of a suicide safety plan? a. "I know that when I start thinking about my dad, I'm going to start thinking about killing myself" b. "going for a really long, hard run helps clear my mind and stops the suicidal thoughts" c. "my sister is always there for me when I start getting suicidal" d. "I keep the suicide prevention phone number in my wallet" B Which interventions will help make the environment on the unit safer for suicidal pt's? Select all that apply: a. all windows are kept locked b. every shower has a breakaway shower rod c. eating utensils are counted when trays are collected d. pt doors are kept open e. staying within listening distance of the pt A, B, C, D What are the nursing responsibilities to a pt expressing suicidal thoughts? Select all that apply: a. instituting one-to-one observation b. documenting the pt's whereabouts and mood every 15-30mins c. ensuring that the pt has no contact w/ glass or metal utensils d. ensuring the pt has swallowed each individual dose of med e. discussing triggers of depression A, B, C, D When considering community suicide prevention programs, what population should the nurse plan to service w/ regular suicide screenings? Select all that apply: a. 10- to 34- y/o b. males c. college-educated adults d. rural population e. Native American A, B, E Research supports which intervention implemented on a long-term basis significantly reduces the incidence of suite and suicide attempts in a pt diagnosed w. bipolar ds? a. a SSRI b. ECT c. one-on-one observation d. lithium D Gladys is seeing a therapist bc her husband committed suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?" The therapist's best response would be: a. "he probably acted quickly on his impulse to kill himself" b. "he did not want to think about he pain he would cause you" c. "he was not able to think clearly due to his emotional pain" d. "he thought you may think it was an accident if there was no note" C Martin is a 23y/o male w/ a new diagnosis of schizophrenia, and his family is receiving info from a home health nurse. The topic of education is suicide prevention, and the nurse recognizes effective teaching when the mother says: a. "persons w/ schizophrenia rarely commit suicide" b. "suicide risk is greater in the first few years after diagnosis" c. "suicide is not common in schizophrenia due to confusion" d. "most persons diagnosed w/ schizophrenia die of suicide" B Sigmund Freud, Karl Menninger, and Aaron Beck theorized that hopelessness was an integral part of why a person commits suicide. A more recent theory suggest suicide results from: a. elevated serotonin levels b. the diathesis-stress model c. outward aggression turned inward d. a lack of perfectionism B Which person is at the highest risk for suicide? a. a 50 y/o married white male w/ depression who has a plan to OD if circumstances at work do not improve b. a 45 y/o married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teen c. a young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden d. an older Hispanic male who is Catholic, is living w/ a debilitating chronic illness, is recently widowed, and who states, "I wish that God would take me too" C Kara is a 23 y/o pt admitted w/ depression and suicide ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply: a. focus primarily on developing solutions to the problems leading the pt to feel suicidal b. assess the pt thoroughly and reassess the pt at regular intervals as levels of risk fluctuate c. avoid talking about the suicidal ideation as this may increase the pt's risk for suicidal behavior d. meet regularly w/ the pt to provide opportunities for the pt to express and explore feelings e. administer antidepressant meds cautiously and conservatively bc of their potential to increase the suicide risk in Kara's age group f. help the pt to identify positive self-attributes and to question negative self-perceptions that are unrealistic B, D, E, F Which statement made to the grieving pt demonstrates effective therapeutic communication? Select all that apply: a. "your loves one was irreplaceably special" b. "it must be comforting to know they are with God now" c. "you can very very grateful for the time you had together" d. "I would like to take the flowers from the funeral home to your house" e. "your loss must be devastating. I can't imagine how you must be feeling right now" A, D, E Considering the subject of medically assisted death, which statements identify the pros and cons of the argument associated w/ the issue of nonmaleficence? Select all that apply: a. from the pt's perspective, there is no different between ending life by providing a lethal prescription and by stopping treatment that prolongs life b. assisted death violates the oath to "do no harm" and destroys trust between pt and nurse c. there is equal protection under the law that allows the right to refuse or withdraw tx and to commit suicide d. every competent person has the right to make decisions based on personal convictions e. him beings are the stewards but not the absolute masters of the gift of life A, B Which statement made by a pt demonstrated acceptance of criteria required of hospice care? a. "I want my family to be with me" b. "there is no cure for my illness. I have accepted that" c. "it's important to me that I die in my own home" d. "I don't want my family to bear the burden of caring for me" B Which statement made by a widow demonstrates that her grief work has been effective? Select all that apply: a. "I can remember how much my deceased husband loved chocolate chip ice cream" b. "painting is my new passion, and I really enjoy learning the various strokes" c. "Jim could be very stubborn when he thought he was right" d. "I don't know why he had to die" e. "I just can't believe he's gone" A, B, C Which factor has the greatest influence on the hospice nurse's ability to provide respectful professional care? a. acceptance that death Is a natural part of life b. possession of excellent care giving nursing skills c. the existence of a healthy, well-balanced personal life d. the desire to work w/ both the pt and the family C There is conflict surrounding the dying experience in modern medicine. The medical model of treatment in the U.S. has traditionally been focused on the prolongation of life. What intrinsic factor plays into this medical model? a. healthcare workers do not want their pt's to die b. medicare is a fee-for-service model c. palliative care is expensive to administer d. keeping people alive as long as possible is the ethical thing to do D Holly is a 53 y/o female w/ terminal breast cancer. Holly's nurse int he hospital brings up the subject of hospice care, Holly becomes upset and states, "I am not ready to give up and die." You respond that hospice is: a. a model of healthcare that emphasizes quality of life for you and your family b. the end of curative treatments and pain management c. a multidisciplinary team providing curative and therapeutic treatment d. an aggressive medical plan to end suffering and hasten death A Guadalupe is the matriarch of. a large family. She is terminally ill and none of her family members know her end-of-life wishes. The best action for the nurse is to: a. discuss durable power of attorney b. organize a family meeting w/ Guadalupe's permission to discuss her goals and wishes c. have a family meeting without Guadalupe so as to not upset her d. ask the doctor to tell Guadalupe that she is dying B A bereavement group run by a local hospice includes a woman who is distraught over her supervisor's death. The woman appears severely distressed. She has trouble functioning with activities of daily living and making the simplest of decisions. The group facilitator recognizes that this woman is suffering from disenfranchised grief after learning: a. the woman was in love with her married supervisor b. she has not taken enough time off work to grieve properly c. the supervisor died over a year ago d. her family is not involved enough to support her A The dying patient w/ a neurocognitive disorder such as Alzheimer's dx is especially challenging to provide care for. They may have sx or pain that they are unable to adequately describe or define. Reversible conditions that respond to treatment that may affect level of consciousness, anxiety, or agitation include: a. inability to communicate b. distended bladder, constipation, or nausea c. reduced urinary output d. weakness due to the dying process B Which nursing response demonstrates accurate information that should be discussed with the female pt diagnosed w/ bipolar and her support system? Select all that apply: a. "remember that alcohol and caffeine can trigger a relapse of your symptoms" b. "due to the risk of your manic episode, antidepressant therapy is never used with bipolar disorder" c. "it's critical to let your healthcare provider know immediately if you aren't sleeping well" d. "Is your family prepare to be actively involved in helping manage this disorder?" e. "the sx then to come and go and so you need to be able to recognize the early signs" A, C, D, E Which statement made by the pt demonstrated an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply: a. "I have to keep reminding myself to consistently drink 6-12 oz glasses of fluid every day" b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider" c. "lithium may help me lose the few extra pounds I tend to carry around" d. "I take my lithium on an empty stomach to help w/ absorption" e. "I've already made arrangements for my monthly lab work" A, B, E The nurse is providing medication education to a pt who has be prescribed lithium to stabilize mood. Which early signs and sx of toxicity should the nurse stress to the pt? Select all that apply: a. increased attentiveness b. getting up at night to urinate c. improved vision d. an upset stomach for no apparent reason e. shaky hands that make holding a cup difficult D, E a male pt calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? a. reinforce that the level is considered therapeutic b. instruct the pt. to gold the next dose of medication and contact the prescriber c. have the pt go to the hospital ER immediately d. alert the pt to the possibility of seizures and appropriate precautions B Which intervention should the nurse implement when caring for a pt demonstrating a manic behavior? Select all that apply: a. monitor the pt's vital signs frequently b. keep the pt distracted w/ group-oriented activities c. provide the pt with frequent milkshakes and protein drinks d. reduce the volume on the television and dim bright lights in the environment e. use a firm but calm voice to give specific concise directions to the pt A, C, D, E Substance abuse is often present in people diagnosed w. bipolar disorder. Laura, a 28y/o with a diagnosis of bipolar, drinks alcohol instead of taking her prescribed meds. The nurse caring for this pt recognizes that: a. anxiety may be present b. alcohol ingestion is a form of self-medication c. the pt is lacking a sufficient number of neurotransmitters d. the pt is using alcohol bc she is depressed B Ted, the former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I eight years go. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania the psychiatric nurse practitioner recommends: a. Clonazepam (Klonopin) b. Fluoxetine (Prozac) c. Electroconclucisve therapy (ECT) d. Lurasidone (Latuda) C A 33 y/o female diagnosed with bipolar 1 has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, "You are ready to enter the maintenance therapy staff, so at this time I am goin to adjust your dosage by prescribing": a. a higher dosage b. once a week dosing c. a lower dosage d. a different drug C Tatiana has been hospitalized for an acute manic episode. On admission, the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct? a. SOB, GI distress, chronic cough b. ataxia, severe hypotension, large volume of dilute urine c. GI distress, thirst, nystagmus d. Electroencepaholigc changes, chest pain, dizziness B Luc's family comes home one evening to find him extremely agitated and they suspect he is in a full manic episode. The family called emergency medical services, While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting? a. hypodermic needles b. fast food wrappers c. empty soda cans d. energy drink containers D anorexia nervosa - pt. refused to maintain a minimally normal weight for height - expresses an intense fear of gaining weight - a chronic illness that waxes and wanes - the patient will require long term treatment subtypes of anorexia nervosa restricting and binge-eating/purging type characteristics of of anorexia nervosa - extreme weight loss - intense fear of loss of control and weight gain - involves a strong denial of the problem - typically well educated and economically secure - distorted body image - restricted calories with significantly low BMI - more common in females - perfectionist, competitive personality - dysfunctional family dynamics - overbearing mom clinical presentation of anorexia nervosa - low weight - amenorrhea - yellow skin - lanugo - cold extremities - peripheral edema - muscle weakness - very reluctant to get help - perfectionistic tendencies abnormal lab values of anorexia nervosa - hypokalemia 3.5 mEq/L - anemia pancytopenia - decreased bone density areas to cover when assessing anorexia patient (psychological) - perception of the problem - eating habits - history of dieting - methods to achieve weight control (restricting, extreme exercise, purging,) - value attached to a specific size and weight - interpersonal and social functioning - mental status and physiological parameters refeeding syndrome - metabolic alterations that may occur during nutritional repletion of starved patients - results in fluid balance abnormalities, abnormal glucose metabolism, hypophosphatemia, hypomagnesemia - complication may result in abnormalities of fluid balance and glucose metabolism as well as hypophosphatemia, hypomagnesemia, and hypokalemia - thiamine deficiency can also occur - nutrients are reintroduced slowly in order to avoid this syndrome interventions for anorexia nervosa patients - make sure that the patient has a one-to-one staff at all times - structured meal times - make the patient feel accepted in the milieu - restrict patient from doing any exercise - restrict bathroom use after meals - approach discussion about physical appearance carefully - weigh the patient after the first void with the same clothes on daily - the goal is 2-pound weight gain weekly - the patient must eat food ordered - provide additional calories - small frequent meals to avoid refeeding syndrome - the focus should be on eating behavior and underlying feelings of anxiety. bulimia nervosa - a disorder in which cycles of overeating are followed by some form of purging or clearing of the digestive tract either by vomiting or compensatory methods such as diuretics or laxatives, fasting, or excessive exercise DSM-5 criteria for bulimia nervosa - recurrent episodes of binge eating - recurrent compensatory behaviors to prevent weight gain, for example, vomiting - eating in a discrete period of time an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances - a sense of lack of control over eating during the episode - the binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months - self-evaluation is unduly influenced by body shape and weight clinical assessment of bulimia nervosa patient - at or close to ideal body weight - enlargement of parotid glands - dental erosion and caries - problems with impulsivity and compulsivity - gastric dilation, rupture - calluses, scars on hand (Russell's sign) - peripheral edema - muscle weakening - abnormal laboratory values (hypokalemia, hyponatremia) - cardiomyopathy - ECG changes - cardiac failure (due to cardiomyopathy from ipecac poisoning) - thyroid function levels - glucose level - CBC - ECG - assess triggers to cause binging psychological factors of bulimia nervosa development - poor body self-image - restrictive dieting - history of childhood sexual or physical abuse - feelings of significant shame - depressive signs and symptoms - problems with interpersonal relationships - more willing to engage in therapy and seek help interventions for a patient with bulimia nervosa - observation during and after meals - restriction on bathroom privileges after meals - normalizing eating patterns - maintaining appropriate exercise regimen - provide an accepting environment - promote self-care binge eating disorder - significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa - like bulimic patients, binge eating disorder patient are also more willing to seek help binge eating disorder treatment - similar to bulimia - CBT - fluoxetine (prozac)? - little known on aftermath - one study showed 1/3 still had it 12 years after treatment DSM-5 criteria for binge eating disorder - recurrent episodes of binge eating; on average, at least once a week for three months - binge eating episodes include at least three of the following: - eating more rapidly than normal - eating until uncomfortably full - eating large amounts when not hungry - eating alone due to embarrassment about large food quantity - feeling disgusted, guilty, or depressed after the binge - no compensatory behavior is present pharmacological interventions for binge-eating disorder - SSRIs - CNS stimulants (lisdexamfetamine dimesylate (vyvanse) - anorectic stimulants - benzphetamine (didrex) - lorcaserin (belviq) - naltrexone and bupropion extended-release (contrave) pharmacological/psychological interventions for bulimia nervosa SSRI (fluoxetine [prozac] is first-line) along with cognitive behavioral therapy (CBT) substance use disorder pattern of maladaptive behaviors and reactions brought about by repeated use of a substance, sometimes also including tolerance for the substance and withdrawal reactions substance use disorder four major groupings - impaired control - social impairment - risky use - physical effects (intoxication, tolerance, and withdrawal) addiction - a primary, chronic disease of brain reward, motivation, memory, and related circuitry - it is a disease of dysregulation in the hedonic (pleasure-seeking) or reward pathway of the brain - addicted individuals are unable to consistently abstain from the substance or activity intoxication the state in which a person's mental and physical abilities are impaired by alcohol or another substance tolerance the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect withdrawal the discomfort and distress that follow discontinuing the use of an addictive drug (physiological symptoms) opioids any drug or agent with actions similar to morphine (heroin, opium) stimulants drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, and ecstasy) that excite neural activity and speed up body functions club drugs illegal drugs that are found mostly in nightclubs or at all-night dance parties called raves (MDMA/ecstasy) opioid intoxication characterized by behavioral or psychological changes, pupillary constriction, and one or more: drowsiness or coma, slurred speech, and impairment and attention or memory opioid withdrawal symptoms - excessive sweating, restlessness, and dilated pupils - agitation, goosebumps, tremor, and violent yawning - increased heart rate and blood pressure - nausea/vomiting and abdominal cramps and pain - muscle spasms and weight loss opioid overdose triad 1. pinpoint pupils 2. unconsciousness 3. respiratory depression opioid overdose treatment establish airway, give naloxone (narcan) and monitor for rebound/acute withdrawal precipitation 1-2 hours post-administration opioid general treatment - methadone is a synthetic narcotic opioid. It is used to decrease the painful symptoms of opiate withdrawal - also block the euphoric effects of opiate drugs such as heroin, morphine, and codeine as well as oxycodone, and hydrocodone - methadone is addictive also and - suboxone (buprenorphine and naloxone) - naltrexone, an opioid antagonist indicated for the prevention of relapse to opioid dependence following opioid detoxification methadone side effects that should be reported to the health care provider - respiratory depression, shallow breathing, feeling light-headed, fainting, chest pain, fast or pounding heartbeat, hives, rash, swelling of the face, lips, tongue, and hallucinations. benzodiazepine and barbiturate use disorder (sedative, hypnotic, and antianxiety medication use disorder) criteria for intoxication: slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking benzodiazepine and barbiturate withdrawal symptoms rebound hyperactivity (autonomic) tremor, insomnia, psychomotor agitation, anxiety, grand mal seizures. stimulant use disorder - involves regular use of either cocaine or amphetamine - may lead to gradual domination of individual's life - can result in tolerance and withdrawal reactions stimulant intoxication symptoms - high feeling - pupillary dilation - euphoria - gregariousness - grandiosity - repetitive behavior - anger - impaired judgement - cardiac arrhythmias - high or low bp - chest pain - tachycardia or bradycardia - chills - perspiration - nausea or vomiting - weight loss - weakness - confusion - seizures alcohol use disorder (the most dangerous substance to withdraw from) alcohol use marked by tolerance, withdrawal, and a drive to continue problematic use DSM-5 criteria for alcohol use disorder - alcohol is often taken in larger amounts or over a longer period than was intended - there is a persistent desire or unsuccessful efforts to cut down or control the alcohol use - a great deal of time is spent in activities necessary to obtain, use or recover from the effects of alcohol - craving or a strong desire or urge to use alcohol Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home - continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. - important social, occupational, and or recreational activities are given up or reduced because of alcohol use - recurrent use in situations in which it is physically hazardous - alcohols use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. alcohol withdrawal (mild to moderate) - begins about 6-8 hours after last drink with jitters or shakes - mild-moderate withdrawal (agitation, lack of appetite, nausea, vomiting, insomnia, impaired cognition, mild perceptual changes, increase in systolic and diastolic blood pressure, pulse and temperature. (Librium is useful for tremulousness and mild to moderate agitation) alcohol withdrawal (severe) - psychotic and perceptual symptoms (hallucinations, illusions) may begin in 8-10 hours - this is a medical emergency because the patient is at risk for unconsciousness, seizures, and delirium (benzodiazepines, lorazepam [ativan] or librium can be given orally or IM alcohol withdrawal seizures - may occur within 12-24 hours after the last drink - the seizures are generalized and tonic-clonic and can reoccur within hours (diazepam [valium] given IV) alcohol withdrawal delirium - acute delirium (also known as DTs) associated with withdrawal from alcohol after prolonged heavy consumption - it is a medical emergency that can result in death of 20% of the untreated patients - can happen any time within the first 72 hours after the last drink - characterized by autonomic hyperactivity ( intense anxiety, tremors, fever and sweating, hallucinations, insomnia, hypertension - delusions can result in unpredictable and dangerous behavior - prevention is the goal - diazepam (valium) may be given for tremors, agitation, impending or acute delirium Wernicke-Korsakoff syndrome - organic brain syndrome resulting from prolonged heavy alcohol use, involving confusion, unintelligible speech, and loss of motor coordination, ocular motility abnormalities - it may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers. Wernicke's may clear up within a few weeks or may progress into Korsakoff's syndrome Korsakoff's syndrome - an alcohol related disorder marked by extreme confusion, memory impairment, and other neurological symptoms - treatment of Korsakoff's syndrome is also thiamine for 3 to 12 months - most patients with Korsakoff's syndrome never fully recover alcoholic cardiomyopathy effect of alcohol can weaken and thin muscles of the heart leading to enlargement and eventual heart failure inhalent use disorder - volatile hydrocarbons are toxic gases inhaled through the nose or mouth to enter the blood stream - solvents for glues and adhesives - propellants found in aerosol paint sprays, hair sprays, and shaving cream - thinners such as paint products and correction fluids - fuels such as gasoline and propane rehabilitation from substance use - the goal of treatment is to assist in the development of awareness and a commitment - patients must be ready to change and be aware that they are powerless over the disorder and need help. bipolar I disorder - the most severe type of bipolar disorder - it is marked by shifts in mood, energy, and ability to function - periods of normal functioning may alternate with periods of illness (highs, lows, or a combination of both) - many people continue to experience chronic interpersonal or occupational difficulties even during remission. bipolar 1 DSM-5 criteria - one or more manic episodes and one or more depressive episodes - additionally, the presence of 3 of the following constitutes mania. - extreme drive and energy - inflated sense of self-importance - decreased need of sleep (ex. feels rested after 3 hours of sleep) - excessive talking combined with pressured speech. - personal feeling of racing thoughts - distractibility by environmental events - unusually obsessed with and overfocused on goals. - purposeless arousal and movement - dangerous activities such as indiscriminate spending, reckless sexual encounters, or risky investments mania - a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extreme goal-directed activity or energy - these periods last at least 1 week for most of the day every day - symptoms of mania are so severe that this state is a psychiatric emergency - manic episodes usually alternate with depression or a mixed state of anxiety and depression manic episode symptoms - distractibility, irritability, grandiosity, flight of ideas, activity increased, sleep decreased, talkative (food needs also decrease) - patients may not eat or drink for days at a time DIGFAST grandiosity an overvaluation of one's significance or importance bipolar II DSM-5 (picture) bipolar II disorder criteria one must have at least 1 hypomanic (for 4 DAYS) and at least 1 major depressive (for 2 WEEKS) episode hypomania - a low-level and less dramatic mania - the hypomania of bipolar II disorder tends to be euphoric and often increases functioning - like mania, hypomania is accompanied by excessive activity and energy for at least four days and involves at least three of the behaviors listed under criterion B in the DSM-5. - hypomania is not usually severe enough to cause serious impairment in occupational or social functioning; however, the major depressive symptoms can be quite profound and may put those who suffer from it at particular risk for suicide criterion B in DSM-5 signs of mania - inflated self-esteem or grandiosity - decreased need for sleep - more talkative than usual or pressure to keep talking - flight if ideas or subjective experience that thoughts are racing - distractibility (ex. inattention, too easily drawn to unimportant or irrelevant external stimuli) as reported or observed - increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (ex. purposeless non-goal directed activity) - excessive involvement in activities that have a high potential for painful consequences (ex. engaging in unrestrained buy sprees, sexual indiscretions, or foolish business investments) cyclothymic disorder - cyclothymic disorder, symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children - hypomania and depression symptoms do not meet the criteria for either bipolar II or major depression, yet the symptoms are disturbing enough to cause social and occupational impairment assessment guidelines for bipolar disorder 1. assess whether the pt is a danger to self or others: - pts experiencing mania can exhaust themselves to the point of death - pts may not eat or sleep, often for days at a time - poor impulse control may result in harm to others or self - uncontrolled spending may occur 2. assess the need for protection from uninhibited behaviors - external control may be needed to protect the pt from such consequences as bankruptcy, b/c pts experiencing mania may give away all of their money or possessions 3. assess the need for hospitalization to safeguard and stabilize the pt 4. assess medical status - a thorough medical examination helps to determine whether mania is primary (a mood disorder - bipolar disorder or cyclothymic disorder) or secondary to another condition - mania may be secondary to a general medical condition - mania may be substance-induced (caused by use or abuse of a drug or substance or by toxin exposure) lithium - has FDA approval for both acute mania and maintenance treatment - the onset of action is usually within 10-21 days - because the onset of action is so slow, it is usually supplemented in the early phases of treatment by atypical antipsychotics, anticonvulsants, or antianxiety medications lithium is effective in reducing - elation, grandiosity, and expansiveness - flight of ideas - irritability and manipulation - anxiety - self-injurious behavior expected side effects of lithium - fine hand tremor, polyuria (producing too much urine), mild thirst, mild nausea, general discomfort, sedation, lethargy weight gain - long term use can cause renal toxicity, goiter, and hypothyroidism. early signs of lithium toxicity 1.5 mEq/L - 2.0 mEq/L - gastrointestinal upset - course hand tremors - confusion - hyper-irritability of muscles - EEG changes - sedation - incoordination advanced signs of lithium toxicity 2.0 - 2.5 mEq/L - ataxia (many symptoms of ataxia mimic being drunk, such as slurred speech, stumbling, falling, and incoordination) - giddiness - serious EEG changes - blurred vision - clonic movements - large output of diluted urine - seizures - stupor - severe hypotension - coma patient and family teaching: bipolar disorder 1. patients with bipolar and their families need to know the chronic nature of the disease. 2. long term maintenance of treatment 3. side effects of medications as well as toxic effects. 4. signs and symptoms of relapse. 5. phone numbers to emergency contact people. 6. ETOH, substance abuse, caffeine, sleep deprivation, and over-the-counter medications could produce relapse. 7. good sleep and hygiene are CRITICAL to stability major depressive disorder (MDD) - depressed mood most of the day nearly every day - markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day - significant weight loss when not dieting or weight gain or a decrease or increase in appetite nearly every day - insomnia or hypersomnia nearly every day - fatigue or loss of energy nearly every day - psychomotor agitation or retardation nearly every day - the feeling of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day - diminished ability to think or concentrate or indecisiveness nearly every day - recurrent thoughts of death (not just fear of dying) recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. - the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. suicidal ideation thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones affect the outward representation of a person's internal state of being serotonin syndrome - with any drug that increases 5-HT (ex. MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. - treatment: cyproheptadine (5-HT2 receptor antagonist) serotonin syndrome symptoms - hypertension - tachycardia - myoclonic jerking - tremors - nausea - diarrhea - sweating - hyperthermia - agitation - confusion SSRIs (selective serotonin reuptake inhibitors) - fluoxetine, paroxetine, sertraline, and citalopram - first line of treatment for major depression SSRI side effects B - body weight increase (nausea & vomiting) A - anxiety/agitation D - dizziness and dry mouth (headache) S - serotonin syndrome S - stimulated CNS R - reproductive/sexual dysfunction I - insomnia BAD SSRI SNRIs (serotonin-norepinephrine reuptake inhibitors) (may help reduce neuropathic pain) Venlafaxine (Effexor) Duloxetine (Cymbalta) Desvenlafaxine (Pristiq) SNRI side effects B - body weight increase A - anorexia D - dizziness S - suicidal thoughts N - N/V R - reproductive/sexual dysfunction I - insomnia also monitor for LIVER toxicity *BAD SNRI* TCAs (tricyclic antidepressants) (inhibits the synaptic reuptake of serotonin and norepinephrine antagonized adrenergic histaminergic muscarinic and dopaminergic receptors) Amitriptyline (Elavil) Amoxapine Desipramine Doxepin Imipramine Nortriptyline TCA side effects - anticholinergic side effects (dry mouth, constipation, urinary retention, blurred vision, paralytic ileus, hypotension), ataxia, tremors, paresthesias/tingling, mental clouding, dizziness, drowsiness, can be cardiotoxic (lethal in overdose, use cautiously in elderly patients with cardiac disorders - drowsiness, dizziness, and hypotension should subside in a few weeks MAOIs (monoamine oxidase inhibitors) - antidepressants that inhibit the action of an enzyme (monoamine oxidase) that is responsible for breakdown of NE and serotonin (5-HT) - can have fatal side effects if foods rich in amino acid TYRAMINE are consumed - thus, not used unless other classes of medication have failed - depression with ATYPICAL features respond well to MAOIs MAOIs Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (Emsam) Tranylcypromine (Parnate) MAOI side effects HAHA H - hypotension (orthostatic) A - anticholinergic side effects H - hypertensive crisis (if taken w/certain foods) A - anxiety, agitation, anorexia - no pseudoephedrine [sudafed]; - antihypertensives can cause severe hypotension - S/S of hypertensive crisis: severe headache, nausea, sudden episode of epistaxis - if hypertensive crisis, administer phentolamine, nitroprusside, or labetalol - a fast-acting antihypertensive that directly vasodilates electroconvulsive therapy (ECT) - a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient - the procedure can cause confusion and disorientation for several hours after procedure and can cause retrograde amnesia (loss of memory of events leading up to and including the treatment) - passes an electric current through the brain - most used with patients who have bipolar disorder with severe levels of depression - one major advantage of ECT is that it works more quickly than medication in improving depressive symptoms - usually within a week transcranial magnetic stimulation (TMS) - a treatment that involves placing a powerful pulsed magnet over a person's scalp, which alters neuronal activity in the brain - the only absolute contradiction to this procedure is the presence of metal in the area of stimulation such as cochlear implants - FDA approval for treatment-resistant major depressive disorder, but has not been approved for bipolar depression - research has been conducted that provides support for rTMS in patients with bipolar disorder - in fact, rTMS has been found to improve cognitive function in patients with bipolar disorder, so it may just be a matter of time before this use is approved suicide the act of intentionally taking one's own life suicide attempt when a person engages in potentially harmful behavior with some intention of dying completed suicide a term used to describe a suicide attempt that results in death suicide risk factors - depression - family disruption - substance abuse problems - relationship problems outside the family - result of a series of difficulties over time - being Native American/Alaska Native - male gender - a history of suicide in the family - access to lethal means - chronic physical illness or chronic pain - exposure to the suicidal behavior of others - history of trauma or abuse - previous suicide attempts primary risk factors for depression - female - unmarried - low socioeconomic class - early childhood trauma - presence of negative life event - family history of depression - ineffective coping ability - postpartum time period - medical illness (chronic or disabling medical conditions) - absence of social support - alcohol or substance abuse environmental guidelines for minimizing suicidal behavior on the psychiatric unit - use plastic utensils and count utensils when the tray is collected - do not assign patient to a private room and ensure the door remains open at all times - jump proof and hang-proof the bathrooms by installing breakaway shower rods and recessed shower nozzles. - keep electrical cords to a minimal length - install unbreakable glass - take all potentially harmful gifts from visitors before allowing them to see patients. - go through personal belongings with patient present and remove all potentially harmful objects. - ensure that visitors do not bring in or leave potentially harmful objects in patient's rooms. - search patient for harmful objects if they are allowed to leave the unit on a pass. case management for suicide potential patients - reconnect patient with family and friends - information on treatment providers, substance treatment centers, crisis hotlines, support groups for patients and families and recreational activities to enhance socialization and self-esteem suicide precautions within the facility - initiate one‑on‑one constant supervision around the clock, always having the client AT ARM'S LENGTH AWAY - document the client's location, mood, quoted statements, and behavior every 15 min or per facility protocol (suicide observation) - search the client's belongings with the client present. - remove all potentially harmful items from the client's room and vicinity - allow the client to use only plastic eating utensils. - count utensils when brought into and out of the client's room - check the environment for possible hazards (such as windows that open, overhead pipes that are easily accessible, non‑breakaway shower rods, non‑recessed shower nozzles) - ensure that the client's hands are always visible, even when sleeping. - do not assign to a private room and keep door open at all times - ensure that the client swallows all medications - clients can try to hoard medication until there is enough for a suicide attempt - identify whether the client's current medications can be lethal with overdose - if so, collaborate with the provider to have less dangerous medications substituted if possible - restrict visitors from bringing possibly harmful items to the client end of life care - the support and care given during the time surrounding death - the priority is to enhance the quality of life of the patient through: - honoring the experiences of the patient and family - respecting autonomy and informed choice - allowing care to be directed by the patient and family - honoring the dignity of the patient and family stages of grief (Kubler-Ross) - denial, anger, bargaining, depression, acceptance - states may not occur in order and may be repeated hospice admission criteria - physician must write an order for hospice care (also must sign the death certificate). - physician certifies that patient has a life expectancy of less than 6 months. - patient gives consent to be admitted to a hospice program. - in addition, the patient agrees not to use life-sustaining equipment if a life-threatening event occurs during the hospice time period - depending on the insurance benefits, patients who need a physical therapist and speech rehab are allowed to continue in hospice - if a terminal patient's family wants the patient admitted to hospice, but the patient is not willing, then the patient does not meet hospice admission criteria arguments surrounding physician-assisted suicide - individual liberty (the patients liberties may be violated because of governmental power - autonomy (the patients right to autonomy may be violated if they are forced to live against their wishes) - the quality of care (removal of legal bans on assisted suicide would likely enhance the opportunity for excellent end-of-life care for all patients - nonmaleficence - is helping to end life harmful? (nursing consideration) - beneficence (patients could benefit from relief that is now legally available to people who have physicians who are wiling to risk assisting them to die) complicated grief - a person has a prolonged or significantly difficult time moving forward after a loss - symptoms include preoccupation with thoughts of the deceased person, feelings of emptiness, anger, depression, disbelief, detachment, and rumination. disenfranchised grief - a situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions. (example: grieving the loss of a patient or a pet) pharmacological interventions for binge eating disorder? what are the side effects of this medication? - combination medication of naltrexone and bupropion (contrary) - side effects include nausea, headache, constipation, dizziness, and vomiting mood disorders are a risk factor for suicide mood disorders are a risk factor for suicide naltrexone opioid antagonist; curbs craving bupropion (wellbutrin) atypical antidepressant who is at the highest risk for suicide? - impulsive - recent loss - has access - alcohol or drugs when someone thinks about suicide for a long time but hasn't done it considered a high risk the patient at MOST risk is the one with a plan that can be done NOW or very soon and has the means easily available the patient at MOST risk is the one with a plan that can be done NOW or very soon and has the means easily available 1:1 observation - hands seen at all times - plastic silverware - door open to room - search everything in room and around the unit - no privacy if someone you know committed suicide assess the survivor for intent mild, moderate, severe, extreme anorexia nervosa - mild with a bmi of 17 or more - moderate with a bmi of 16 to 17 - severe with a bmi of 15 to 16 - extreme when the bmi is less than 15 anorexia nervosa - body mass index the gauge used to determine the severity of this disorder lanugo fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn (and those with anorexia nervosa) PICA compulsive eating of nonnutritive substances (feeding disorder) - defined as the ingestion of substances that have no nutritional value, such as dirt or paint - substance ingestion - no nutrients two criteria for hospitalization with eating disorders extreme electrolyte imbalance or weights below 75% of ideal body weight taste, appetite, and satiety changes with anorexia nervosa - evidence suggests that people with anorexia experience significant differences in sensation of taste, appetite, and satiety, which help to perpetuate the disorder - an individual coping with anorexia may experience fear, anxiety, panic, or depression healthy controls (taste, appetite, and satiety) healthy controls experience great satisfaction or comfort following the consumption of foods and in the presence of fullness, an individual coping with anorexia may experience fear, anxiety, panic, or depression anorexia nervosa DSM-5 - restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of the age, sex, developmental trajectory, and physical health (less than minimally normal/expected) - intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain - disturbed by one's body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight anorexia nervosa refusal to maintain a minimally normal weight for height - express intense fear of gaining weight - chronic illness that waxes and wanes - patients require long-term treatment that might include periodic hospitalizations - distorted body image - has feelings of powerlessness and seeks control - restricted calories with significantly low BMI diathesis stress model a diagnostic model that proposes that a disorder may develop when an underlying vulnerability is coupled with a precipitating event epidemiology anorexia nervosa - lifetime prevalence of 0.5% does not represent the actual prevalence - fewer than half seek help - individuals tend to conceal symptoms - commonly begins during adolescence or in young adults methods of weight control may often include control restricting, purging, and/or exercising lab values anorexia - electrolyte levels - glucose level - thyroid function test - complete blood count - electrocardiogram (ecg) - dual energy x-ray absorptiometry (dexa) to measure bone density - erythrocyte sedimentation rate (esr) - creatine phosphokinase (cpk) signs and symptoms of anorexia nervosa (picture) signs and symptoms of anorexia nervosa (chart) (picture of chart) when to weigh patients with anorexia - weigh each morning after 1st void with the same amount of clothing on each morning acute care anorexia nervosa - medical intervention - what has to be treated? - psychosocial interventions - what are the considerations? - pharmacological interventions - what might be ordered for this client? - integrative medicine - what does integrative mean? - health teaching and health promotion - topics to discuss? - safety and teamwork - national patient safety goals (improve patient safety) Anorexia lab findings - hypokalemia - K loss with purging - dehydration which leads to Na and water retention and K excretion - anemia (low hemoglobin) - leukopenia (low WBC) - possible elevated liver functions - possible elevated cholesterol - abnormal thyroid functions, blood glucose - decreased bone density - ECG changes (liver) - low calcium (hypocalcemia) bulimia general - engage in repeated episodes of binge eating followed by inappropriate compensatory behaviors - self-induced vomiting - misuse of laxatives, diuretics, or other medications - fasting or excessive exercise - disorder characterized by a significant disturbance in the perception of body shape and weight - excessive eating - dental erosion - shaky and weak - muscle weakness - low self-esteem - back of hand calluses (Russel's sign) - parotid swelling - gastric dilation/rupture - normal to slightly low weight abnormal lab values with bulimia - electrolyte imbalance - hypokalemia - hyponatremia first-line treatment for bulimia cognitive-behavioral therapy (CBT) - psychiatric-mental health advanced practice registered nurses are qualified to use the evidence-based cognitive-behavioral therapy (CBT), which is considered a first-line of treatment for bulimia CBT with bulimia - when patients eliminate bulimic behaviors, issues of self-worth and interpersonal functioning become more prominent - restructuring faulty perceptions and helping individuals develop accepting attitudes toward themselves and their bodies are the primary focus of therapy - if early improvement is not seen with CBT, an antidepressant should be added nursing interventions with bulimia - accompany to bathroom after meals for at least one hour - participation in the milieu - cognitive-behavioral therapy - individual and group counseling - monitor eating behaviors - allow time for exercise - health teaching and promotion - oral care anorexia nervosa can affect these labs... it is important to monitor these labs weekly for any deterioration in the patient’s condition CBC, CMP, TSH, MG, phosphorus, pre-albumin, amylase, direct bilirubin, urine drug test, urinalysis, urine pregnancy test, estradiol rapid cycling - bipolar I or II can experience - at least 4 episodes in a year - can happen within a month or even a day - more severe symptoms general adapatation syndrome 1. alarm stage (resistance slighly increases) 2. resistance stage (highest) 3. exhaustion (bad stress, burnout, panic zone) anticonvulsants - acute mania/acute bipolar depression/bipolar maintenance - superior for continuously cycling patients - effective at diminishing impulsive and aggressive behavior in some nonpsychotic patients - helpful in cases of alcohol and benzodiazepine withdrawal - beneficial in controlling mania (within 2 weeks) and depression (within 3 weeks or longer) second generation antipsychotics - sedative properties during the early phase of treatment (help with insomnia, anxiety, agitation) - have mood-stabilizing properties - Olanzapine (Zyprexa) - Risperidone (Risperdal) - Quetiapine (Seroquel) - Ziprasidone (Geodon) - Aripiprazole (Abilify) - Asenapine (Saphris) - Cariprazine (Vraylar) three main elements must be considered when evaluating lethality - is there a specific plan with detail? - how lethal is the proposed method? - is there access to the planned method? outcomes identification - maintenance phase of mania - obtain knowledge of the disorder, management, and medication - ex. identify three risk factors for the development of acute mania; identify preventive strategies - identify sources of support - ex. attend group therapy on a daily basis - problem solve - ex. identify new coping skills - planning: maintenance phase - preventing relapse - limiting severity and duration of future episodes - patients with bipolar disorders require medications over long periods of time/over entire lifetime - support patients in repairing their lives from the hardships that came out of the acute phase of illness implementation - bipolar disorders - unfortunately, lack of adherence to mood-stabilizing meds - hospitalization provides safety for a person ex