Mental health exam 2

Clozaril

baseline WBC first so we can follow when on this mediation bc it makes WBCs low

Serotonin syndrome

too much serotonin- diarrhea, agitation, muscle rigidity, insomnia, confusion, increased HR, hyperreflexia

Larmoyrigitate (Lamictal) adverse s/s-

sleepy, nausea, vomiting, severe rash, SJS, arrhythmias, suicidal ideation

MOAI foods to avoid

aged cheese, wine, beer, chocolate, coffee, tea, sour cream, yogurt, smoked and processed meats, beef or chicken liver, canned figs, caviar, raisins, pickled things, yeast products, broad beans, soy sauce, over the counter diet pills

Olanzapine( Zyprexa)

treatment for bipolar 1 and schizophrenia, alleviates delusions, hallucinations, mood disturbances

**Watch for weight gain

Lithium carbonate toxicity

1.5-2.0- blurred vision, ATAXIA, tinnitus, persistent nausea/ vomiting

2.0-2.5- excessive output of dilute urine, increasing tremors, muscular irritability. Psychomotor retardation, and mental confusion

>2/5- impaired consciousness, nystagmus, seizures, coma, oliguria, arrythmias, MI. Cardio disease

Lithium carbonate s/e

include mental confusion, tremors, muscle irritability, and dilute urine

Geodon (ziprasidone)- why is it important to get a baseline EKG?

Can cause QT syndrome which causes uncontrollable fast heart rhythm (need a baseline)

Benztropine (Cogentin)- when to administer?

Used with Haldol symptoms; stops muscle ridgity, restlessness, muscle spasms in eyes, back and neck

Propranolol (Inderal)- use and purpose of prescribing?

Calms somatic/physical symptoms of anxiety; treats physical symptoms of anxiety

Haloperidol (Haldol)- adverse effects?

Dystonia- movement disorder; uncontrollable movements, stiff muscles

Divalproex sodium (Depakote)- education

take the same time every day, do not stop taking medication without discussing with physician, monitor liver and pancreas, no alcohol or CNS depressants

Trifluoperazine (Stelazine)

antipsychotic risk for MNS

Paroxetine (Paxil)

SSRI can take weeks to work, never stop taking it suddenly, avoid alcohol; side effects can be transient, and seek help if you have suicidal thoughts

Antidepressants

always have a black box warning (especially in children and adolescents)

Describe how to connect with a depressed patient

Build a therapeutic relationship, be patient, reassuring, validating, encouraging and empathetic

Safety focuses and assessment for a depressed pt

Stay with pt, check patient regularly, suicide precautions, establish trusting relationshp

Diagnosis of major depressive disorder

Depressed symptoms for 2 weeks, most days of those 2 weeks, and most of each day

Signs and symptoms of premenstrual disorder

Depressive symptoms begin several days to weeks before menstruation and get better a few days after menstruation

Nursing focuses on establishing therapeutic relationships and connections

Genuine interest

Empathy

Trust

Persistent depressive (dysthymia) disorder signs and symptoms

Sad or down; no evidence of psychotic symptoms. Patient must have chronically depressed mood for most of the day, more days than not for at least 2 years

Why is a complete medical assessment required for a new admission for depression?

Increased risk for diseases and other conditions. A depressed person may not be taking care of themselves.

Anxiety- appropriate goal setting

Maintain anxiety at a manageable level

Short goals with anxiety

Descrease anxiety

Difference between generalized anxiety disorder and panic disorder

Symptoms can overlap

GAD- persistent worry that interfered with daily life

PD- recurrent panic attacks, physical and psychological distress. Sudden and intense

Medications for panic disorder- focuses on nursing education

Buspirone: SSRI takes weeks to work

Doxepin: tricyclic, used for insomnia

Clonazepam: benzodiazepine, works quickly

Clozapin: antipsychotic, schizophrenia

Benzodiazepine- what do you need to know about addiction

high risk for addiction

Severe panic attacks and interventions for care

Help patient feel safe, focus on physiological needs (keep warm, hydrated, rest), teach relaxation techniques, provide support, administer meds

Trichotillomania signs and symptoms

The irresistible urge to pull hair out

Patient presenting- warning signs-suicide

Withdraw, giving away items, taking dangerous risks, extreme mood swings, using drugs and alcohol more, making a plan

Bipolar- meals and nutritional considerations for pts in a manic state

High protein, high calorie

What's a nursing priority with aggressive bipolar patients?

Keep patient safe, keep others/ self safe

What are short term goals associated with manic behavior and aggressiveness?

No harm to self and others

Difference between bipolar 1 and 2:

1- the client is experiencing or has experienced a full syndrome of manic or mixed symptoms. May also have experienced episodes of depression

2- characterized by bouts of major depression with episode occurrence of hypomania. Has never met the criteria for a full manic episode

Lithium patient teaching

Monitoring blood levels, 6-8 glasses of water/day, notify MD if nausea and vomiting, no low sodium diet

OCD- nursing diagnosis and approaches to care: "ineffective impulse control"

Maintain anxiety at a manageable level

Focuses on nursing teaching and how to support patients in ritualistic behaviors

don't confront, argue, punish, distract patient

Schizophrenia- pt characteristics for dystonia, akathisia, Parkinsonism

Dystonia: stiff muscles, uncontrollable movements

Parkinsonism: tremors, ridgity, unstable gait

Akathisia: inability to remain still

Aggression safety of pts and staff- what should staff do to keep themselves and patients safe?

Calm demeanor, calm atmosphere, keep others and self-safe

Negative and positive symptoms of schizophrenia:

Positive: add to

Negative: taken away

Short-term goal for violence directed>>>>

Keeping them and others safe; no harm to self and others

Before stating antipsychotic medications- what should be assessed?

Cardiac status, blood sugar

Why is an EKG before starting antipsychotic?

Know if a cardiac issue develops- can cause prolonged QT intervals

Stages of schizophrenia

Prodromal: symptoms first appear, may be nonspecific difficult to diagnosis

Active: acute phase; immediate medical attention required

Residual: symptoms start to ease; some may still be present

Neuroleptic malignant syndrome signs and symptoms, including how to treat

MMS: high fever over 105- increased HR, muscle ridgity, confusion, breathing difficulty

What is the fear of water called?

Aquaphobia, natural environment type

Agoraphobia goal setting

Avoiding and fearing places that might cause feelings of being trapped, helpless or embarrassed. Fear of leaving home, crowds, enclosed places

goals of agoraphobia

Goals: manage symptoms, identify triggers, challenge fears, develop coping strategies

Signs and symptoms of delayed grief response:

Experience grief at a later time than is typical

Know Kubler-Ross stages or grief:

Denial, anger, bargaining, depression, acceptance

Dysmorphic disorder- what nursing diagnosis is associated with a preoccupation with imagined defects, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief.

Disturbed body image related to changes in appearance secondary to severe trauma

Disturbed body image related to surgery as evidence by fear of rejection

at what age does self injury begin?

12-14 years old