Psych Exam 2: Suicide, Depression, Bipolar, Addiction

Describe what suicide is vs suicidal ideation

• Suicide is the intentional act of killing oneself

• Suicidal Ideation is having THOUGHTS of committing suicide.

What are risk factors of suicide: (5)

1. Older adults

• untreated depression

• no job/ finances

• feel isolated/powerless

• decline in physical health

• lose loved ones

2. fam hx suicide

3. poor relationships at home, school, work

4. hx trauma/ abuse

5. access to lethal methods (firearms)

Warning signs of Suicide: (7)

1. Withdrawing from fam and friends socially

2. Giving away possessions

3. Bidding goodbye to fam/friends

4. Feeling like "Burden” to others

5. Engaging in risky behavior

6. Obsessively thinking/talking abt death

7. Hx of suicidal attempts

Inpatient hospitalization safety: (2)

1. One-to-One line of sight surveillance or at least monitor q15 min

2. Monitor and take away harmful objects

How would a person act what they have Major Depressive Disorder? (11)

1. Depressed mood (almost everyday)

2. Can’t sleep or oversleeping

3. Indecisive

4. Can’t concentrate

5. Suicidal ideation (always ask upfront!)

6. Increased or decreased MOTOR activity 

7. Hard to feel pleasure

8. Increase or decreased weight

9. Unkempt appearance

10. Hard to complete ADLs

11. Depressed w/ psychosis

Those most at risk for depression: (7)

1. Females

2. Unmarried

3. Low socioeconomic class

4. Early childhood trauma

5. Fam hx of depression

6. Postpartum period

7. Medical Illness (Comorbidities→ DM, COPD, HF)

Nursing assessments for depression: (4)

1. Assess suicide risk ALWAYS!!

2. See if they have a plan/ method

3. Implement safety precautions

4. Assess severity

Plan of care for depressed client: (5)

1. Patient-Centered Holistic Care

• consider whole person (emotional, social, financial factors that’ll affect health)

2. Partnership:

• pts need to actively engage in tx process

  • go to follow up apps. 

  • attend therapy

  • med adherence

3. Respect and Dignity

4. Effective communication:

• clear and Empathetic!!

• active listening

• OEQs

• Silence

• Clarifying/Summarizing

• Frequent check ins

5. Assist w/ ADLs

Anti-depressant meds: (5)

1. SSRIs

2. SNRIs

3. Tricyclic Antidepressants

4. Atypicals

5. MAOIs

Whens ECT therapy used? (3)

When other treatments fail (aka medications)

• used for depression

• bipolar

• seizures

Side effects ECT: (3)

1. Temporary memory loss

2. HA

3. Confused

Patient education for ECT: (5)

1. Lasts 25 secs

2. NPO 4-8 hrs B4

3. Supine on tx table IV anesthesia and muscle relaxant

• maintain ventilation

4. Post-procudure: awake in 10-15 mins

5. May sleep for 1-2 hrs after proceudre

Bipolar I Disorder describe it:

→ has had at least one time when they felt extremely energetic or “on top of the world” (that’s a manic episode)

→ and at some other point, they’ve also felt either a smaller burst of energy or a deep sadness and loss of interest (a depressive episode).

Describe Bipolar II Disorder:

→ has had at least one really low period where they felt very sad or hopeless (a depressive episode)

→ and at least one period of feeling extra happy or energetic, but not as extreme as full mania (a hypomanic episode).

• may experience prolonged depression!!**********

What emotions would a person experiencing Mania show? (9)

1. Fellings of elation

2. Infalted self-esteem (cocky)

3. Delusions

4. Grandiosity (super powers)

5. Hyperactive

6. Agitated

7. Flight of Ideas

8. Accelerated speech

9. Easily distracted

How would a manic person ACT on a daily basis? (6)

1. Impulsive:

• spending money, or giving away stuff

2. Demanding and manipulative

3. Distracted and bad attention span

4. Seeks attention

• flashy dress and makeup

• inappropriate behavior

5. Decreased sleep

• 2-3 hrs/day or go days w/o sleep

6. Neglect ADLs

• nutrition (anorexia)

• hydration

  • leads to exhaustion or risk of death

Nursing Assessment of Mania progression:

stage 1 (4)

stage 2 (4)

stage 3 (3)

Stage 1: Hypomania

• Super happy, talks a lot, full of energy

• Easily distracted (“Ooh shiny!”)

• Gets irritated fast if interrupted

• Still kinda normal — just extra
  

Stage 2: Acute Mania

• Thinks they’re unstoppable — no guilt, no limits

• Acts wild or inappropriate (flirty, rude, spending sprees)

• Doesn’t sleep, blames everyone else

• Very labile
  

Stage 3: Delirious Mania

• Can’t think straight — confused, panicky, maybe hallucinating

• So hyper they’re exhausted, may collapse

• Dangerous — might hurt self or others

Nursing Diagnosis for mania: (7)

1. Risk for injury

• take away harmful stuff

• assess SI!!

• give frequent rest periods

2. Risk for violence

3. Imbalance nutrition

4. Disturbed Thought process

5. Disturbed Sensory Perception (hallucinate)

6. Impaired Social Interaction

7. Insomnia

Nursing care for Impaired social interaction in MANIC pt: (4)

1. Set limits on manipulative behavior/expectations of rules on unit

2. Dont argue****

3. Dont bargain/ reason w/ pt****

4. Decrease stimulation w/o isolating pt*****

5. Give positive reinforcement!

Nursing care—Mania and risk for violence: (5)

1. Take away harmful objects

2. Calm attitude

3. Address inappropriate behavior ASAP 

• first offer options then consequences follow

4. If restraints needed, make sure staff is nearby to help

5. Goal is to help pt verbalize inappropriate behaviors and demonstrate appropriate interaction skills and self-awareness

Nursing implementation for those at risk for imbalanced nutrition in MANIC pt (6)

1. Give high-protein, high cal foods****

• bc pt is hyperactive and will neglect nutrition

2. Finger foods

3. Protein drinks

4. Record I/O and calorie count

5. No caffeinated drinks!

6. Help achieve 6-8 hrs of sleep w/o interruption

Meds for Mania: (3)

• lithium

anticonvulsants:

• lamotrigine

• valproate

What do u assess/monitor for when pt is on Valproic Acid?

LIVER function!!!

• LFTs q2 months

Alcohol s/s intoxication: (6)

1. Slurred speech

2. Poor coordination (stumbling, can’t walk straight)

3. Slow reaction time

4. Mood changes (happy, angry, silly, etc.)

5. Drowsiness or confusion

6. N/V

“everything slows down”

Alcohol Withdrawal s/s: (8)

1. Tremors or shaking (especially hands)

2. Sweating (high temp)

3. Restlessness

4. Fast heart rate

5. Seizures

6. HTN

7. Trouble sleeping

8. Delusions/Hallucinations

9. Delirium

“speeds up”

tx alcohol withdrawal (4) vs maintenance (2)

1. Withdrawal:

   1. give benzos

   • lorazepam

   2. anticonvulsants

   • valproic acid

   3. Abstinence

   4. N-acetylcysteine (OTC)

   Maintenance:

   1. Naltrexone: decrease alc craving

   2. Disulfiram (Antabuse): causes unpleasant physical effects when you drink

Stimulant s/s abuse: (7)

1. DILATED pupils

2. DRY oronasal cavity

3. Excessive MOTOR activity

4. hyperactive

5. hypervigilance (super aware of surroundings, fight or flight mode constantly

6. interpersonal sensitivity

• someone is easily hurt, worried, or anxious about how others see them

7. euphoric

-coke/crack**

Stimulant withdrawal s/s: (8)

“Crashing”

1. depressed/fatigue

2. agitated

3. cramps

4. HA

5. Nightmares

6. disoriented

7. cravings

8. lethargic

Opioid abuse s/s: (7)

1. “Pinpoint” pupils

2. Decreased RR, BP

3. Slurred speech

4. Drowsy

5. Psychomotor retardation (everything slowww asf)

6. euphoric then dysphoria

• feeling great at first, then crashing afterward.

7. Impaired concentration, Judgement, Memory

• slows down

Opioid Withdrawal effects: (9)

1. Yawning

2. Insomnia

3. Panic

4. Rhinorrhea

5. Diaphoresis

6. Lacrimation

7. Cramps

8. Muscle Aches

9. Chills/Fever

speeds up

Hallucinogens-what are the types? (3)

1. LSD

2. Psilocybin (magic mushroom)

3. Phencyclidine Piperidine (PCP, Angle dust, horse tranquilizer, peace pill)

• “mind expanding drugs”

• visual

• flashbacks

Hallucinogen abuse s/s physical effects: (7)

1. Chills

2. Pupils DILATED-like stimulants

3. Increased HR, RR, BP, Temp, Blood sugar

4. Dizzy

5. Trembling/ Sweating

6. No Appetite

7. Insomnia

Hallucinogen abuse Mental effects s/s:

1. Heightened response to color, sounds, texture, body awareness

2. Distorted vision

3. Sense of slowed time

4. Magnified feelings

5. Fear of control loss

6. Paranoid

7. Serenity, Euphoria

8. Depersonalization

9. Derealization

10. Increased Libido

Self-Help groups for substance abuse:

1. Alcoholics Anonymous

• 12 step program

  • steps include things like admitting there’s a problem

  • asking for help

  • making amends to people they’ve hurt

  • committing to stay sober.

• need a sponsor

  • personal mentor who’s been through it before.

2. NA basically same as AA