Mental Health Final practice #2

Borderline Personality Disorder (BPD)

A personality disorder marked by instability in relationships, self-image, mood, and behavior. Includes fear of abandonment, impulsivity, anger, and self-harm.

How should a nurse respond to verbal abuse in BPD?

Set firm, consistent boundaries. Stay calm and do not tolerate abusive behavior.

What do firm boundaries look like in BPD?

Clear expectations, consistent enforcement, calm tone, no arguing or rescuing.

What is splitting?

Viewing people as all good or all bad and attempting to divide staff.

Priority for BPD

Safety, consistency, limit-setting, and coping skills.

What is lithium used for?

Mood stabilizer for bipolar disorder, especially mania.

Lithium labs

Serum lithium, BUN, creatinine, TSH, sodium.

Why monitor lithium level?

Prevent toxicity and ensure therapeutic range.

Why monitor kidney function?

Lithium is excreted by kidneys.

Why monitor thyroid?

Lithium can cause hypothyroidism.

Why is sodium important?

Low sodium increases lithium levels.

Lithium toxicity risk factors

Dehydration, vomiting, diarrhea, low sodium, kidney issues.

What should patients avoid on lithium?

Dehydration and drastic salt changes.

Signs of lithium toxicity

GI upset, tremor, confusion, ataxia.

Lithium memory trick

Low sodium + low fluid = high lithium.

Positive symptoms of schizophrenia

Hallucinations, delusions, disorganized speech, bizarre behavior.

Negative symptoms of schizophrenia

Loss of normal function like flat affect and low motivation.

5 A’s of negative symptoms

Affective flattening, alogia, avolition, anhedonia, asociality.

Flight of ideas

Rapid topic changes, seen in mania.

Grandiosity

Inflated self-importance.

Derealization

Environment feels unreal.

Depersonalization

Feeling detached from self.

Types of depression

MDD, persistent depressive disorder, seasonal affective disorder, perinatal depression, PMDD.

Which depression has highest suicide risk?

Major depressive disorder.

Depression in cold/dark climates

Seasonal affective disorder.

Highest suicide risk (BPD vs anorexia vs bulimia vs dependent)

Borderline personality disorder.

Highest medical risk among those

Anorexia nervosa.

Dependent personality disorder

Excessive need to be taken care of, difficulty making decisions.

Treatment for dependent PD

CBT, encourage independence, assertiveness training.

What to avoid in dependent PD

Avoid fostering dependency.

Strongest suicide risk factor

Past suicide attempt.

Suicide risk factors

Plan, intent, access to means, depression, substance use, isolation.

Depression risk factors

Trauma, stress, chronic illness, family history.

Important questions after suicide attempt

Method, timing, intent, lethality.

Home health nurse sees patient with gun

Do not approach, leave area, ensure safety, notify authorities.

Priority in unsafe situation

Scene safety first.

Voices telling patient what to do

Command hallucinations.

Priority question for hallucinations

Are they telling you to harm yourself or others?

Antidepressants and suicide risk

Risk increases early in treatment due to increased energy before mood improves.

Culture vs ethnicity

Culture = beliefs/practices, ethnicity = background.

Which to prioritize?

Culture, because it affects care decisions.

Crisis types

Situational, maturational, adventitious.

Situational crisis

Sudden external event.

Maturational crisis

Life stage transition.

Adventitious crisis

Catastrophic event.

Dementia vs delirium

Dementia = chronic and progressive. Delirium = acute and reversible.

Which is permanent?

Dementia.

Which is reversible?

Delirium.

Mania environment

Low stimulation, structured setting.

Activities for mania

Simple, solitary, noncompetitive.

Avoid in mania

Group games, debates, overstimulation.

Alzheimer’s care

One step at a time, routine, simple choices.

Should you rush Alzheimer’s patients?

No, give extra time.

If patient is lost

Redirect calmly and guide them.

Travel amnesia

Dissociative fugue.

Psych diagnosis tool

DSM-5-TR.

Neurotransmitters

Serotonin, norepinephrine, dopamine, GABA, acetylcholine, histamine.

Low serotonin/norepi

Depression.

High dopamine

Psychosis.

Low GABA

Anxiety.

Low acetylcholine

Memory loss.

Why females higher dementia risk

Longer lifespan.

Best antipsychotic type for mixed symptoms

Atypical (second-generation).

ECT purpose

Induces controlled seizure to improve severe mental illness.

ECT use

Severe depression, suicidality, catatonia.

5150

72-hour involuntary hold.

5250

14-day hold after 5150.

Order of holds

5150 → 5250 → conservatorship.

EPS

Side effects from antipsychotics.

4 EPS

Dystonia, parkinsonism, akathisia, tardive dyskinesia.

Denial in grief

Disbelief and numbness.

Leadership styles

Autocratic, democratic, laissez-faire.

Best in crisis

Autocratic.

Ethical principles

Autonomy, beneficence, nonmaleficence, justice, fidelity, veracity.

Dysfunctional communication types

Generalizing, manipulation, placating, distracting.

MAOIs avoid

Tyramine foods.

Examples of Tyramine foods

Aged cheese, cured meats, fermented foods.

Anorexia findings

Lanugo, bradycardia, hypotension, amenorrhea.

Antipsychotic with WBC risk

Clozapine.

When can HIPAA be broken

When there is serious and imminent danger.

Restraint time adult

4 hours.

Restraint time age 9–17

2 hours.

Restraint time under 9

1 hour.

OCD components

Obsessions and compulsions.

Obsessions

Intrusive thoughts causing anxiety.

Compulsions

Behaviors to reduce anxiety.