important points to study

what is clozapine and common complications

The first atypical antipsychotic developed. Despite its effectiveness for schizophrenia spectrum disorders, it is no longer considered a first-line medication because of its serious adverse effects.

FORMULATIONS: Tablets, orally disintegrating tablets

COMPLICATIONS

• Low risk of EPS

• High risk of weight gain, diabetes mellitus, dyslipidemia

• Agranulocytosis can occur. Obtain baseline WBC and monitor weekly, bi-weekly, to monthly per protocol.

• Monitor for indications of infection (fever, sore throat, lesions in mouth), and notify the provider if manifestations occur.

• Other adverse effects: sedation, hypersalivation, orthostatic hypotension, and anticholinergic effects

• Pregnancy Risk Category B

what are some common central nervous system stiumulants and common side effects

Methylphenidate, dexmethylphenidate, dextroamphetamine, ampheamine mixture and lisdexamfetamine

Complications:

• CNS stimulation(insomnia, restless)

• Decreased appetite, weight loss

• Cardio effects: dysrhythmias, chest pain, high bp

• hallucinations and paranoia

• hypersensitivity

what is Atomoxetine and common complications

Block reuptake of norepinephrine at synapses in the CNS.

Complication:

• Hepatotoxicity

• seizure activity

• Suicidal ideations

• GI effectss(N/V)

What is Anorexia Nervosa

• Persistent energy intake restriction leading to significantly low body weight in context of age, sex, developmental path, and physical health

• Fear of gaining weight or becoming overweight

• Disturbance in self-perceived weight or shape

Characteristics

• Clients are preoccupied with food and the rituals of eating, along with a voluntary refusal to eat.

• This condition occurs most often in female clients from adolescence to young adulthood.

• Onset can be associated with a stressful life event, such as college.

• Compared to clients who have restricting type, those who have binge-eating/purging type have higher rates of impulsivity and are more likely to abuse drugs and alcohol.

What are the two types of anorexia nervosa

Restricting type: The individual drastically restricts food intake and does not binge or purge.

Binge-eating/purging type: The individual engages in binge eating or purging behaviors.

What is Bulimia nervosa

• Binge eating: Large amount of food consumed in < 2 hours; amount is definitely larger than what most people eat.

• Loss of control: Client feels unable to stop eating during the binge.

• Compensatory behaviors: Self-induced vomiting, misuse of laxatives/diuretics, fasting, or excessive exercise.

• Frequency requirement: Binge eating + compensatory behaviors occur ≥ 1 time per week for 3 months.

what are the two types of Bulimia nervosa

Purging type: The client uses self-induced vomiting, laxatives, diuretics, and/or enemas to lose or maintain weight.

Nonpurging type: The client can compensate for binge eating through other means (excessive exercise and the misuse of laxatives, diuretics, and/or enemas).

What is binge eating disorder

• Clients recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa.

• Clients experience distress following the binge-eating episode.

• An excessive food consumption must be accompanied by a sense of lack of control.

• At least once per week for 3 months.

• Binge eating disorder affects men and women of all ages, but is most common in adults age 46 to 55.

• The weight gain associated with binge eating disorder increases the client’s risk for other disorders, including type 2 diabetes mellitus, hypertension, and cancer.

• Severity of the disorder depends on the number of binge-eating episodes each week.

what are some side effects of lamotrigine

• Double or blurred vision, dizziness, headache, nausea, and vomiting

• Serious skin rashes( Instruct clients to withhold medication and notify provider if rash occurs.)

What is Nonmaleficence

a commitment to do no harm.

What is veracity

a commitment to tell the truth

What is fidelity

fulfillment of promises.

What is beneficence

action that promotes good for others, without any self-interest.

What are some s/s of autism spectrum disorder

• Delays in at least one of the following

  • Social interaction

  • Social communication

  • Imaginative play prior to age 3 years 

• Distress when routines are changed

• Unusual attachments to objects

• Inability to start or continue conversation

• Using gestures instead of words

• Delayed or absent language development

• Grunting or humming

• Inability to adjust gaze to look at something else

What is Delirium

Impairments in memory, judgment, ability to focus, and ability to calculate, which can fluctuate throughout the day. Disorientation and confusion often worse at night and early morning.

Level of consciousness is usually altered and can rapidly fluctuate.

There are four types of delirium.

• Hyperactive with agitation and restlessness

• Hypoactive with apathy and quietness

• Mixed, having a combination of hyper and hypo manifestations

• Unclassified for those whose manifestations do not classify into the other categories

Restlessness, anxiety, motor agitation, and fluctuating moods are common. Personality change is rapid.

Some perceptual disturbances can be present, such as hallucinations and illusions.

Change in reality can cause fear, panic, and anger.

Can cause vital signs to become unstable requiring intervention.

Should be considered a medical emergency.

What are some communication stragies for pts with personality disorders

• A firm, yet supportive approach and consistent care will help build a therapeutic nurse-client relationship.

• Offer the client realistic choices to enhance the client’s sense of control.

• Limit-setting and consistency are essential with clients who are manipulative, especially those who have borderline or antisocial personality disorders.

• Clients who have dependent and histrionic personality disorders often benefit from assertiveness training and modeling as well as psychotherapy.

• Clients who have schizoid or schizotypal personality disorders tend to isolate themselves, and the nurse should respect this need. Psychotherapy can help improve the client’s ability to respond to social cues from others.

• For clients who have histrionic personality disorder, who can be flirtatious, it is important for the nurse to maintain professional boundaries and communication at all times.

• When caring for clients who exhibit dependent behavior, self-assess frequently for countertransference reactions.

what is complicated grief

• The client does not demonstrate the expected behaviors of the normal grief process.

• Cultural expectations can influence the development of delayed or inhibited grief.

• Clients can remain in the denial stage of grief for an extended period of time.

• Due to client’s inability to progress through the stages/tasks of grief, a subsequent minor loss (even years later) can trigger the grief response.

What is disorted grief

• The client experiences the feelings and somatic manifestations associated with normal grief but to an exaggerated level.

• The client is unable to perform activities of daily living.

• The client can remain in the anger stage of the grief process and can direct the anger towards themselves or others.

• The client can develop clinical depression.

What is chronic or prolonged grief

• This maladaptive response is difficult to identify due to the varying lengths of time required by clients to work through the stages/tasks of grief.

• Clients can remain in the denial stage of grief and remain unable to accept the reality of the loss.

• Chronic or prolonged grief can result in the client’s inability to perform activities of daily living.

What is disenfranchised grief

• This grief entails an experienced loss that cannot be publicly shared or is not socially accepted (suicide and abortion).

what are some important nursing care points for anxiety disorders

• Provide safety and comfort to the client during the crisis period of these disorders, as clients in severe- to panic-level anxiety are unable to problem solve and focus. Clients experiencing panic-level anxiety benefit from a calm, quiet environment.

• Remain with the client during the worst of the anxiety to provide reassurance.

• Perform a suicide risk assessment. QS

• Provide a safe environment for other clients and staff.

• Provide milieu therapy that employs the following:

  • A structured environment for physical safety and predictability

  • Monitoring for, and protection from, self-harm or suicide

  • Daily activities that encourage the client to share and be cooperative

  • Use of therapeutic communication skills (open-ended questions) to help the client express feelings of anxiety, and to validate and acknowledge those feelings

  • Client participation in decision making regarding care 

• Use relaxation techniques with the client as needed for relief of pain, muscle tension, and feelings of anxiety.

• Instill hope for positive outcomes (but avoid false reassurance). QPCC​​​​​​​

• Enhance client self-esteem by encouraging positive statements and discussing past achievements.

• Assist the client to identify defense mechanisms that interfere with recovery.

• Postpone health teaching until after acute anxiety subsides. Clients experiencing a panic attack or severe anxiety are unable to concentrate or learn.

• Identify counseling, group therapy, and other community resources for clients who have anxiety.

what are some risk factors for suicide

Older adult clients G

• Untreated depression

• Loss of employment and finances

• Feelings of isolation, powerlessness

• Prior attempts at suicide (older adult clients are more likely to succeed)

• Change in functional ability

• Declining physical health

• Alcohol or other substance use disorder

• Loss of loved ones

Biological factors

• Family history of suicide

• Physical disorders (AIDS, cancer, cardiovascular disease, stroke, chronic kidney disease, cirrhosis, dementia, epilepsy, head injury, Huntington’s disease, and multiple sclerosis).

Psychosocial factors

• Sense of hopelessness

• Intense emotions (rage, anger, or guilt)

• Poor interpersonal relationships at home, school, and work

• Developmental stressors, such as those experienced by adolescents

• History of trauma/abuse

Cultural factors

• American Indian and Alaskan Native ethnic groups have the highest rate of suicide.

Environmental factors

• Access to lethal methods, such as firearms

• Lack of access to adequate mental health care

• Unemployment

what are some serious warning signs of suicide

• Having sudden and extreme mood swings

• Developing a suicide plan, such as collecting pills, buying a gun, etc.

• Complaining about feeling great guilt or shame

• Increasing use of drugs or alcohol

• Behaving anxious or agitated

• Changing eating or sleeping habits

• Displaying rage or talking about seeking revenge

what are manic and depressive symptoms of bipolar disorder

Manic:

• Elevated/labile mood, euphoria

• Agitation, irritability, restlessness

• ↑ Activity, pressured speech, flight of ideas

• Grandiosity

• Impulsivity (spending/giving away items)

• Distractible, poor judgment

• Attention-seeking; inappropriate behavior

• ↓ Sleep, neglect of ADLs

• Possible delusions/hallucinations

• Denies illness

Depressive:

• Flat/blunted affect, tearfulness

• Low energy, anhedonia

• Difficulty concentrating

• Appetite/sleep changes

• Poor hygiene

• Psychomotor retardation or agitation

• Possible suicidal ideation

what are s/s of PTSD

• Intrusive findings (presence of memories, flashbacks, dreams about the traumatic event)

• Memories of the event recur involuntarily and are distressing to the client

• Flashbacks (dissociative reactions where the client feels the traumatic event is recurring in the present), such as a military veteran feeling that they are reliving a combat situation after hearing a harmless loud noise

• Night-time dreams related to the traumatic event

• Avoidance of people, places, events, or situations that bring back reminders of the traumatic event

• Trying to avoid thinking of the event

Mood and Cognitive Alterations

• Anxiety or depressive disorders

• Anger, irritability frequently present

• Decreased interest in current activities

• Guilt, negative self-beliefs, and cognitive distortions, such as, “I am responsible for everything bad that happens.”

• Detachment from others, including friends and family members

• Inability to experience positive emotional experiences, such as love and tenderness

• Dissociative manifestations (amnesia, derealization, depersonalization)

What is selective serotonin reuptake inhibitors complications

• First few days/weeks: Nausea, diaphoresis, tremor, fatigue, drowsiness

• After 5 to 6 weeks of therapy: Insomnia, headache, and sexual dysfunction (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest)

• GI bleeding

• hyponatremia

• serotonin syndrome

What is serotonin syndrome

Signs/Symptoms:

• Mental status changes: agitation, confusion, anxiety, delirium, hallucinations

• Neuromuscular: myoclonus, hyperreflexia, tremors, incoordination

• Autonomic: fever, diaphoresis, tachycardia, labile BP

• GI: nausea, vomiting, diarrhea, abdominal pain

• Severe: seizures, coma, apnea, death

Nursing Actions:

• Onset 2–72 hr after starting medication

• Discontinue med → symptoms resolve

• Teach clients to withhold dose and report symptoms immediately

what is Dialectical behavior therapy

a cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior. This therapy focuses on gradual behavior changes and provides acceptance and validation for these clients.

What is Eye movement desensitization reprocessing (EMDR)

a focused approach that encourages the client to reconnect traumatizing memories and emotions in a safe structured environment that allows the client to reprocess their emotions and feelings through the use of adaptive defense mechanisms. EMDR is effective in treating anxiety and trauma related disorders.

what are Cholinesterase inhibitor meds

(donepezil, rivastigmine, and galantamine) increase acetylcholine at cholinergic synapses by inhibiting its breakdown by acetylcholinesterase, which increases the availability of acetylcholine at neurotransmitter receptor sites in the CNS.

• In some clients, these medications improve the ability to perform self-care and slow cognitive deterioration of Alzheimer’s disease in the mild to moderate stages. 

what are SSRIs used to treat

• Major depression

• Obsessive-compulsive disorders

• Bulimia nervosa

• Premenstrual dysphoric disorders

• Panic disorders

• Posttraumatic stress disorder

• Social anxiety disorder

• Generalized anxiety disorder

• Bipolar disorder

What is Systematic desensitization

This therapy is the planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situations, or by imagining events that cause anxiety. During exposure, the client uses relaxation techniques to suppress anxiety response.

• Systematic desensitization begins with the client mastering relaxation techniques. Then, the client is exposed to increasing levels of the anxiety-producing stimulus (either imagined or real) and uses relaxation to overcome anxiety. The client is then able to tolerate a greater and greater level of the stimulus until anxiety no longer interferes with functioning. Used to assist clients who have phobias that are anxiety producing.

What is Validation therapy

Useful for clients with neurocognitive disorders. It is a process of communication with a disoriented older adult client by respecting and validating their feelings in a time or place that is real to them, even though it does not relate to actual reality.

What is Catatonia

Pronounced decrease or increase in the amount of movement. Muscular rigidity, or catalepsy, may be so severe that limbs may be so severe that the limbs remain in whatever position they are placed.

What is waxy flexability

Maintaining a specific position for an extended period of time

what is stupor

Motionless for long periods of time, coma-like

What is exhopraxia

Purposeful imitation of movements made by others

what is motor retardation

Pronounced slowing of movement

what are poz and neg symptoms for psychotic disorders

Positive symptoms related to behavior, thought, perception, and speech: Agitation, bizarre behavior, delusions, hallucinations, flight of ideas, loose associations

Negative symptoms: Social withdrawal, lack of emotion, lack of energy, flattened affect, decreased motivation, decreased pleasure in activities

What is associative looseness

Unconscious inability to concentrate on a single thought. Can progress to flight of ideas in which the client’s speech moves so rapidly from one thought to another that it is incoherent.

what are Neologisms

Made-up words that have meaning only to the client (“I tranged and flittled”).

What is echolaila

The client repeats the words spoken to them.

what is clang association

Meaningless rhyming of words, often forceful, such as, “Oh fox, box, and lox.”

what is a word salad

Words jumbled together with little meaning or significance to the listener (“Hip hooray, the flip is cast and wide-sprinting in the forest.”).

what is Circumstantiality

Including multiple and unneeded details during a conversation, such as describing in great detail the weather and clothes they are wearing when asked what their plans are for the day.

What is Tangentiality

Starts talking about trivial information rather than focusing on the main topic of conversation, such as talking about what they will have for lunch when the discussion is about discharge medications.

what is alogia

Poverty of thought or speech. The client might sit with a visitor but only mumble or respond vaguely to questions.

What is anhedonia

Lack of pleasure or joy. The client is indifferent to things that often make others happy, such as looking at beautiful scenery.

What is avolition

Lack of motivation in activities and hygiene. For example, the client completes an assigned task, such as making their bed, but is unable to start the next common chore without prompting.

What can tyramines do to MAOI

Risk: Tyramine-rich foods → hypertensive crisis
Symptoms: Headache, nausea, ↑ HR, ↑ BP

Foods to Avoid:
Aged cheeses, pepperoni/salami, avocados, figs, bananas, smoked fish, protein supplements, soups, soy sauce, some beers, red wine

Note: Low-dose MAOI patch = minimal tyramine sensitivity; high doses require tyramine restriction.

What is atypical anxiolytic action

The exact antianxiety mechanism of this medication is unknown. This medication binds to serotonin and dopamine receptors. Dependency is much less likely than with other anxiolytics, and use of buspirone does not result in sedation or potentiate the effects of other CNS depressants. It carries no risk of misuse.

What rae some important points for seclusion

• A client can voluntarily request a temporary timeout in cases in which the environment is disturbing or seems too stimulating. A timeout is different from prescribed seclusion because a timeout is by the request of the client.

• In general, the provider should prescribe seclusion and/or restraint for the shortest duration necessary, and only if less restrictive measures are not sufficient. They are for the physical protection of the client and/or the protection of other clients and staff. QS

Safety Rules:

• Never leave client alone, locked, or in prone/supine position

• Requires continuous in-person or remote supervision

Q15–30 min Assess & Document:

• Client behavior & precipitating events

• Alternatives attempted before restraint/seclusion

• Time initiated

• Current behavior, vitals, cardiac/resp/skin status

• Food/fluid offered & taken

• Toileting, physical needs, pain

• Medications given

• Time released

Prescriptions:

• May apply restraints/seclusion without order in emergency → obtain written order within 15–30 min

• Must discontinue once behavior is safe/calm

• Need new order each time restraints are restarted

What is Olanzapine and complications

an atypical antipsychotic used to treat schizophrenia, bipolar disorder, and sometimes adjunctive treatment for depression. It works by blocking dopamine and serotonin receptors.

COMPLICATIONS

• Low risk of EPS

• High risk for diabetes mellitus, weight gain, and dyslipidemia

• Other adverse effects: sedation, orthostatic hypotension, anticholinergic effects

what is tertiary prevention

actions taken after a disease or injury has occurred to reduce complications, improve quality of life, and prevent further disability.

Examples:

• Rehabilitation (physical therapy after a stroke)

• Support groups for chronic illness

What is primary prevention

actions taken to stop a disease or injury before it ever occurs.

Examples:

• Vaccinations

• Health education (nutrition, exercise, safe sex)

what is adjustment disorder

a stress-related mental health condition that occurs when someone has difficulty coping with or adapting to a major life change or stressor (e.g., breakup, job loss, illness, moving, divorce).

what is apraxia

What is methadone a treatment for 

Opiates