Study guide exam 2
NURS 3772
Bipolar
Know maintenance lithium levels (range of 0.5 to 1.5)
Difference between Bipolar I and Bipolar II (which is more likely to be hospitalized and more serious) criteria for each
What is rapid cycling?
When and why do we add an antipsychotic to med regimen for a bipolar pt? (know Zyrexa, Seroquel, Abilify, Risperdal)
What organs are adversely affected by lithium use? What labs need to be done?
Teaching for bipolar ptKnow the terms on slide 37
Interruption/disorganization of thought process in bipolar lead to flight of ideas, pressured speech, mania
How can the nurse manage intrusive and manipulative behaviors of the manic patient on a unit?
Remember it is always “safety first” in dealing with manic patients
Nursing diagnosis and nursing interventions with manic patients
Drug of choice for bipolar? Other classification is anticonvulsants. Know Tegretol, Depakote, Lamictal and Topamax are in this class
What is cyclothymia?
Schizophrenia
Even though we covered some content in the case study assignment, it is such an important mental health disorder, I am adding a few questions on the test.
Difference between positive and negative symptoms
Schizoaffective D/O is having schizophrenia symptoms plus a mood disorder like bipolar or depression.
Responses to a paranoid or fearful patient with schizophrenia should first be to acknowledge the patient’s fear. “It must be scary to see those images on the ceiling” or “to think people are trying to kill you”. It does not mean we are saying it is real, it is gaining their trust. But them we should reassure they are in a safe place . Also, try to learn what they are their experiencing.
Again, know that second generation (atypical) antispychotics are for patients who have both positive and negative symptoms (and most all patients have both). So, Haldol and Thorazine would not be the appropriate maintenance drug for them.
Depression
Difference between mood and affect
Dangerous result of taking and MAOI and TCA too closely together
Best response by the nurse to the depressed patient with poor self esteem
Know anhedonia, anergia
Teaching by the nurse to pt and family when starting pt on SSRIs.
Foods to avoid if on tyramine- restricted diet
What can occur if tyramine foods are eaten while taking MAOIs?
Focus of nursing interventions for the period after ECT
Ketamine for depression (receptors affected, route of delivery, how quickly it works, SE)
The suicide questioning ladder
Risk for suicide (two concepts involved) HOPELESSNESS and IMPULSIVITY (HOPELESSNESS is main one)
Best treatment or combination of treatments for Depression
Symptoms of depression
Risk factors for developing depression
Neurotransmitters implicated in depression
Other classifications of depressive D/O
Cognitive theory and learned helplessness of depression (remember cognitive has to do with thoughts). We need to stop the “stinkin thinkin” that a person has when they think they are worthless, or inadequate. Read the ppts to learn the difference between learned helplessness and cognitive theory
Remember empathy-empathy-empathy
Why do we become worried and watch the depressed client closely when they suddenly have a lift in their mood? (they have the energy to actually carry out a suicide plan)
How long does it take SSRIs to workSigns of Serotonin syndrome
Substance Use
Know definition of withdrawal, addiction, intoxication, tolerance
4 C.A.G.E. questions
Etiology of alcohol addiction
Signs of initial alcohol withdrawal
Factors that lead to successful and sustained recovery from alcohol and drug addiction
Primary med used to treat opioid addiction is Suboxone (combination of naloxone and buprenorphine). How does it work?
Overall concept of 12 step treatment approach
What classification of meds is primarily used to prevent DT’s in alcohol withdrawal?
Why is folic acid and vitamin B1 (thiamine) given to patients with Alcohol Use D/O?
What are DTs?
Areas measured when doing CIWA assessment: visual, tactile and auditory hallucinations, N/V, tremors, sweating, Headache, confusion, agitation. Also, vital signs.
Symptoms of opiate overdose
Know these 2 meds for alcohol treatment: Campral (acamprosate) and Antabuse (disulfiram). How do they work?
Remember, withdrawal from opioids, benzos, and amphetamines will make people feel like they are dying, but they likely they will not from the effect on the body itself. But withdrawal from alcohol can kill a person. They must be monitored and use of a protocol to prevent W/D is needed
Personality D/O
What makes one’s personality a “disorder”?
Difference between Schizophrenia and Schizotypal Personality D/O
Characteristics of Obsessive Compulsive Personality (OCPD) D/O (Not the same as OCD)
Do not get OCD confused with OCPD (Obsessive Compulsive Personality Disorder). I wish they had not used similar terminology in the DSM 5
Main characteristics of each cluster A, B, and C and each individual personality disorder
Which cluster causes the most harm to other people?
With cluster B patients, give example of staff demonstrating consistency with limit setting and expectations due to patient manipulative behaviors
Criteria for and treatment of Borderline Personality (BPD) D/O
What is the reason individuals often give for self-mutiliation
Signs the BPD patient is gaining insight?
Splitting that is done by the BPD patient— clients with BPD either idealize or devalue the nurse and others. Attempt to get the nurses mad at one another.
Important areas to address during assessment of patients with personality disorders
Suicide, self-harm
Risk factors
Biological, psychosocial and cultural, societal
Assessment using SAD PERSONS scale (this is an acronym for the 10 risk factors for suicide)
Nursing Interventions and goal setting for the patient
Affect may lift when the client has made a decision to complete suicide
Self-injury — profile
Stated reasons why clients cut/harm themselves
Lethality of methods
Ms Hale’s Suicide assessment ladder (in proper sequence)
Therapeutic statements by the nurse to suicidal clients
What is the “ripple effect” after a person completes suicide? As in the video
Veteran’s issues
Common behaviors and symptoms upon returning from combat
Symptoms of TBI and PTSD
Impact of multiple cycles of deployment
Common behaviors and symptoms experienced by veterans
Outcomes/goals for the veteran and family with mental illness
Nursing interventions for TBI/PTSD
Sexual D/O
Why is it difficult to define a sexual disorder?
How is “paraphilia” defined?
Why is it important for the nurse to do a self-assessment before taking a sexual history ( we need to remain objective and not judge. Unless someone is being harmed)
How to conduct a sexual history (privacy and avoid judgement during the interview) May have to report if someone is being harmed or laws broken
What is Gender Dysphoria
Cisgender vs transgender definition
Genito-pelvic pain D/O
Eating D/O
Physical signs of eating D/O
Different DSM diagnoses of eating D/O
Psychological signs of eating disorder
Profile of person with eating D/O
Risk factors for eating disorders
Nursing Assessment of patient with eating D/O
Personality traits of persons with Anorexia Nervosa (AN)
Symptoms of AN and nursing diagnosis for AN
When to hospitalized a client with AN
Most common causes of death in AN
Acute interventions in eating disorders
3 components of treatment in hospital
Intervention for clients with Bulimia Nervosa
Sleep D/O It is in DSM 5, not sure why
Why is sleep important to mental health?
What is the diagnostic test to measure sleep fragmentationDanger of inadequate sleep
Teaching by the nurse about sleep (safety—teach to avoid falling asleep while driving)
Recommended amount of sleep for adults
Forensics
Various roles and functions of the forensic psychiatric nurse
SANE-A and SANE-P
Grief
Difference between normal bereavement and major depressive episode following a loss
Terms: loss, grief, bereavement, mourning
Tasks of mourning a loss
Example of disenfranchised grief
Nursing interventions for the grieving
What to say and what not to say to acutely grieving persons
Serious and Persistent Mental Illness
Who are the seriously mentally ill?(SMI)
What is the (ACT) assertive community program?
How do case managers serve the SMI?
What programs and services are beneficial for the SMI?
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And finally:
What is the sequence of the “Pathway to prison” per Ms Hale? (from poor bonding to prison)
