Psychiatric and Mental Health Nursing: Exam 1

neurocognitive disorders

involve a decline in one or more areas of cognition, such as executive function, learning and memory, judgment or social cognition that represents a significant change from an individual’s previous level of functioning

delirium

• Acute onset

• Fluctuating course

• Impaired attention

• Altered level of consciousness

• Usually reversible

• Medical emergency

dementia

• Insidious onset

• Progressive decline

• Memory impairment

• LOC not altered

• Usually irreversible

• Chronic condition

delirium is acute, fluctuating, w impaired attention and an altered LOC, dementia is insidious, progressive, not altered LOC with memory impairment

What is the difference between delirium and dementia?

neurodevelopmental disorders (NDD)

A group of conditions with onset during childhood and adolescent years

cholinesterase inhibitors, NMDA receptor antagonists, antipsychotics, antidepressants, statins, anticoagulants, aspirin

Name medications for pharmacologic disorders.

attention deficit-hyperactivity disorder (ADHD)

Persistent patterns of include developmentally inappropriate degrees of inattention, hyperactivity, and/or impulsiveness.

(3) SUBTYPES

1. Predominantly inattentive presentation

2. Predominantly hyperactive/ impulsive presentation

3. Combined presentation (*most common)

autism spectrum disorder

• Persistent deficits in social communication and social interaction

• Restricted, repetitive patterns of behavior, interests, or activities

• Symptoms begin in childhood, must cause significant impairment with social, occupational, academic, or other important areas of functioning and are not better explained by an intellectual disability or global developmental delay.

social functioning, verbal communication, personal identity

What do you seek to improve in autism spectrum disorder?

risperidone (risperdal) and aripiprazole (abilify)

In autism spectrum disorder, what are medications for severe irritability and self-harming behaviors?

behavioral and communication therapies, education therapies, family therapy, providing a sensory friendly environment

Name other interventions for autism spectrum disorder.

intellectual disabilities

• Disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains

• May be mild, moderate, severe, or profound

fragile X and down syndrome

Name genetic intellectual disabilities.

pre/postnatal infections, exposure toxins, nutritional deficiencies

Name environmental factors to intellectual disabilities.

tics

quick, repetitive, nonrhythmic movements or vocalizations not caused by medications, substances, or another disorder

echopraxia

copying movements of others

copropraxia

involuntary obscene socially inappropriate gestures

echolalia

repeating words or phrases from others

palilalia

repeating one’s own words

coprolalia

the involuntary and uncontrollable utterance of obscene, taboo, or socially inappropriate words and phrases.

provisional tic disorder

One or more motor and/or vocal tics for less than 1 year prior to 18 years old

persistent tic disorder

Single or multiple motor and vocal tics must be present for 1 year and prior to 18 years old

tourette syndrome

Most severe tic disorder, Multiple motor tics and a vocal tic, must persist for one year and must be present prior to age 18

antipsychotics, alpha agonists, and botox injections

What are pharmacologic treatments to Tourette’s?

habit reversal training, stress management and relaxation training

What does cognitive behavioral therapy do for Tourette’s?

excessive worry, separation anxiety, somatic complaints, school avoidance

What are common manifestations of anxiety?

persistent sadness/irritability, loss of interest, appetite/sleep changes, declining academic performance

What are common manifestations of depression?

PHQ-9A, SCARED

What are screening tools for pediatric depression and anxiety?

safety assessment

_____________ is always a priority with depressive symptoms.

ongoing comprehensive risk assessment, CBT, coping skills, encourage healthy sleep/activity, collaborate with family and school, support medication adherence when prescribed

What are interventions for pediatric depression and anxiety?

anorexia nervosa, bulimia nervosa, binge eating, obesity

Name eating disorders.

physical assessment, eating and exercise behaviors, psychological assessment, mental status exam, eating attitudes test, self-concept

What do you assess for in an eating disorder?

anorexia nervosa

• Significantly low body weight due to restrictive eating

• Intense fear of weight gain and/or behaviors that prevent weight gain

• Disturbance in body image or lack of recognition of the seriousness of low weight.

bradycardia, hypotension, hypothermia

What do you find in the vital signs of a patient with anorexia nervosa?

low BMI, weight loss, malnutrition

What do you find in the nutritional status of a patient with anorexia nervosa?

electrolyte abnormalities, anemia, leukopenia

What do you find in the laboratory values of a patient with anorexia nervosa?

cardiac dysrhythmias, prolonged QT interval

What do you find in the cardiovascular status of a patient with anorexia nervosa?

constipation, abdominal discomfort

What do you find in the gastrointestinal status of a patient with anorexia nervosa?

amenorrhea, hormonal disturbances

What do you find in the endocrine status of a patient with anorexia nervosa?

body image distortion, fear of weight gain, obsessive thoughts about food

What do you find in the psychological status of a patient with anorexia nervosa?

multidisciplinary approach, daily weights, behavioral modification (contacts and privileges), initiate refeeding, transition to a day treatment program

How do you manage anorexia nervosa?

weight <75% of IBW, dehydration or electrolyte disturbances, HR<40, SBP<70, T<35C(95F), orthostatic hypotension, EKG abnormalities, medical emergencies- syncope, seizures, cardiac failure, psychiatric emergencies- Suicidal ideation

In anorexia nervosa, what are the indications for admission to acute care facility?

refeeding syndrome

• Potentially life-threatening metabolic complication of nutritional rehabilitation

• Hypophosphatemia is the hallmark finding

• Monitor potassium, magnesium, glucose, fluid balance, and cardiac status

• Gradual caloric advancement and close monitoring are essential

• Nursing priority: recognize early signs and report changes promptly

hypophosphatemia

What is the hallmark finding of refeeding syndrome?

bulimia nervosa

• Recurrent episodes of binge eating

• Lack of control overeating during episodes

• A regular cycle of compensatory behaviors such as self-induced vomiting, laxatives, diuretics, exercise or dieting

• Binge eating and compensatory behaviors occur, at least once a week for 3 months.

usually normal or slightly above/below normal

What do you find in the weight of a patient with bulimia nervosa?

dental erosion, cavities, sore throat

What do you find in the oral assessment of a patient with bulimia nervosa?

Russell’s sign, painless enlargement of parotid glands, broken blood vessels in eyes and/or face

What do you find in the physical findings of a patient with bulimia nervosa?

abdominal discomfort, reflux, constipation

What do you find in the gastrointestinal status of a patient with bulimia nervosa?

dysrhythmias secondary to electrolyte imbalances

What do you find in the cardiovascular status of a patient with bulimia nervosa?

shame, guilt, body dissatisfaction

What do you find in the psychosocial assessment of a patient with bulimia nervosa?

individual and family therapy, do not emphasize purging but rather binging, avoid trigger foods, dental evaluation

What are interventions to bulimia nervosa?

prozac (fluoxetine)

What are medications for bulimia nervosa?

binge eating disorder

• Recurrent and persistent episodes of this disorder with (3) or more of the following:

  • Eating much more rapidly than normal

  • Eating until feeling uncomfortably full or when not hungry

  • Eating alone because embarrassment

  • Feeling disgusted with oneself, depressed, or very guilty after overeating

• Marked distress regarding binge eating

• Absence of regular compensatory behaviors (such as purging).

often overweight or obese, elevated BMI

What do you find in the weight status of binge eating disorder?

recurrent binge eating episodes

What do you find in the eating patterns of binge eating disorder?

shame, guilt, depression, anxiety

What do you find in the emotional assessment of binge eating disorder?

hypertension, dyslipidemia, type 2 diabetes

What do you find in the metabolic health of binge eating disorder?

isolation, avoidance of social eating situations

What do you find in the social functioning of binge eating disorder?

secretive eating, loss of control while eating

What do you find in the _______ of binge eating disorder?

lisdexamfetamine (vyvanse), SSRIs, topamax (topiramate), GLP-1 medications

What are medications for binge eating disorder?

being seen as “the enemy” if nurse must ensure the client eats, dealing with own issues about body image and dieting

What are self-awareness issues of eating disorders?

schizophrenia

syndrome or disease process causing:

• Disturbances in thought processes, perception, and affect

• Severe deterioration in social and occupational function

delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms

What are the 5 key symptoms of psychotic disorders?

schizophreniform disorder

Similar to schizophrenia lasting only 1–6 months.

• Duration: 1-6 months

brief psychotic disorder

Sudden onset psychosis, often after stressor

• Duration: 1 day to <1 month

schizoaffective disorder

psychotic disorder where mood + psychotic symptoms present

• Duration: Varies

substance/medication-induced psychotic disorder

Psychosis resulting from substance use, intoxication, withdrawal, or medications

• Duration: soon after exposure

false belief

A delusion is nothing more than a ________.

psychotic disorder due to another medical condition

symptoms of psychosis lasting depending on medical condition

delusional disorder

Delusions most prominent, does not meet criteria for schizophrenia

• Duration: At least 1 month

1-1-6 Rule

Mnemonic:

• brief psychotic = 1 day to <1 month

• schizophreniform = 1 to 6 months

• schizophrenia = 6+ months

hallucinations, delusions, grossly disorganized thinking, ideas of reference, alterations in speech

What are positive symptoms of schizophrenia?

echolalia

automatic repetition of words, phrases, or sounds that a person hears from someone else.

clang association

a disorganized speech pattern where a person chooses and groups words based on how they sound—such as rhyming or alliteration—rather than their actual meaning or logical connection.

word salad

also known as schizophasia, is a symptom of Schizophrenia where a person speaks in a jumble of random, unrelated words and phrases that have no clear meaning to the listener.

neologisms

newly invented words or phrases that have a clear, specific meaning to the speaker but no understandable meaning to anyone else. They are classified as a positive symptom of psychosis and a form of disorganized speech.

apathy, avolition, anhedonia, flat/blunted affect, social withdrawal, poverty of speech

What are negative symptoms of schizophrenia?

to obtain maximum efficacy with minimal toxicity

What is psychopharmacology’s goal?

apathy

a lack of motivation, interest, or emotional expression, defined as a general absence of goal-directed activity rather than a simple choice or laziness.

avolition

is a psychological symptom defined as a severe, debilitating decrease in the ability to initiate and persist in self-directed, purposeful activities

anhedonia

the inability to feel pleasure or joy from activities that you once found enjoyable.

schizophrenia, acute mania, depression with psychotic features, episodes of psychosis in personality disorders, other psychotic disorders, agitation

What are indications of antipsychotics?

1st generation/typical antipsychotics (haldol, thorazine, prolixin)

Primarily dopamine receptor blocker (D2)

2nd generation/atypical antipsychotics (clozapine, risperdal, zyprexa, geodon)

• Serotonin and dopamine receptor blocker

• Seem more effective in treating (-) symptoms

3rd generation/novel antipsychotics (abilify, rexulti)

partial dopamine agonist

long-acting injectable antipsychotics

• Administered every 2–26 weeks depending on product

• Improve adherence compared with daily oral therapy

• Associated with lower relapse and hospitalization risk

• Support continuity of care in psychotic disorders

  • Risperidone (Risperdal), Aripiprazole (Abilify), Olanzapine pamoate (Zyprexa), Haloperidol decanoate (Haldol), Paliperidone palmitate (Invega)

Akathisia, Dystonia, Akinesia, Permanent Tardive dyskinesia

What is the ADAPT mnemonic of anti-psychotic induced movement disorders?

oculogyric crisis

an acute dystonic reaction causing the involuntary, prolonged upward or sideward deviation of the eyes.

cogentin, benadryl, valbenazine (ingrezza)

what medications can be used to treat antipsychotic-induced movement disorders?

metabolic syndrome, EPS, anticholinergic side effects, low blood pressure, sedation

What is the MEALS mnemonic for antipsychotic side effects?

fever, encephalopathy, vital sign instability, elevated CK level, rigidity

What is the FEVER mnemonic for neuroleptic malignant syndrome?

neuroleptive malignant syndrome

a rare, life-threatening reaction to dopamine-blocking medications like antipsychotics.

stop (causative) medication, provide supportive care, cooling measures, vital signs stabilization, hydration, monitor labs

How to treat neuroleptic malignant syndrome?

the mental status examination (MSE)

• Fundamental component of the assessment

• Structured way to evaluate the patient’s current status

• Evaluates the patient’s level of functioning

• Identifies the patient’s psychiatric needs

• Serves as a basis for future exams to assess the patient’s progress

Asking what brought them to the hospital

How do I assess my patient’s insights?

abstract thinking

What are you assessing for when you tell metaphors and idioms?

rapport, trust, respect/positive regard, genuineness, empathy

What are characteristics of a therapeutic relationship?

transference

when the patient unconsciously and inappropriately displaces (transfers) feelings of behaviors related to significant people in the patient’s life onto the nurse