Nursing I Exam 3

out of all mental illnesses which is more likely to cuase longer hospital stays, greater fasmily chaos, more costs to individual and governemnt, and more fear

schizophrenia

those with schizophrenia have a shoter life spans of

26

four phases of schizophrenia

premorbid- more withdrawn, grades drop, declien in self care

prodromal-unusual thoguths or beleifs, innaprotriate or absent emotions

active-hallucinations, delusions, or illusion are present

residual-negative symptoms remain, but positive symptoms such as hallucinations subside. flat affect and role impairment are common 

antiphsycotic medications 

first gen(typical)- phenothiazines Haloperidol

second gen(atypical)-benztropine, risperidone

hallunications

false sneory perceptions not assoicated with realn external stimuli

delusions

fized flase beelifs

positive symptoms of physcosis

delusions, hallucinations, disorganized thoughts, disorganized mobile behavior 

negative symptoms of psychosis 

lack of emotional expression, decreased or lack of motivation to complete purpoeful actitives(avolition), decresed verbal communication (algoia), decreased intrst in social interactions or reltionships, dimishined ability for abstract thinking

anergia

defeceny of energy

anhedonia

inability to experienc

waxy

when placed in a poition they stay ther

postruing 

stay in bizarre position

clang assoication

rhyming phrases

circumstainality

inability to reach the point due t incluions of details

tangentsbility

going off topic

perservation 

perisstent repetiion of the same word or idea in repsonse to digfferent uestion 

difference between first gena dn secodn gen antiphsychotic medications

first gen-strong dopamine blockage, more likely to cause EPSa dn NMS, more side effects, fewer withdrawl symptoms, effective against positive symptoms 

second gen-weaker dopamine blockage, effects serotonin, less liekly to cause EPS, less side effects, more withdrawl symptoms, effective agsinst positive and negative symptoms 

EPS

Pseudo-parkinsonism- stopped posture, shuffling gait, tremors at rest
• Akinesia-
• Akathisia-restless, trouble standing, paces the floor 
• Dystonia-upward eye movement, msucle spasms of the tingue, face, neck
• Oculogyric crisis

dyskinesia- tongue sticking out 
• Antiparkinsonian agents may
be prescribed 

AIMS

records the occurance of tardive dyskinesia in pateints receiving neuroleptic medications

detect eps

nonparmacological treatments of phsycosis

individual phsycotherapy

group therpay behavior therapy

social skills training- role play to teach client proper eye contact, posture, etc (mileu therapy)

faily therapy

What education should you provide for Benztropine?

switcjh psotions slowly

True or False: Benztropine decreased Extra-Pyramidal Symptoms (EPS) such as tremors or muscle stiffness indicates effectiveness.

true 

Benztropine is used to treat which condition?

drug induced EPS

True or False: Benztropine works by blocking cholinergic activity Central Nervous System

true 

What are common or serious side effects of Benztropine? (Select all that apply.)

sedation, dry mouth, urinary retention

What assessments should be performed before giving Haloperidol? (Select all that apply.)

mood/behvaior, cbc, halluxinations

What teaching is important for a client taking Haloperidol?

report fever 

True or False: Haloperidol increases agitation or hallucinations.

false 

Haloperidol is commonly used to treat which condition?

schizoaffective disorder

What should be assessed before giving Risperidone? (Select all that apply.)

Arrhythmias

 

Tardive Dyskinesia

 

Suicidal ideation

True or False: Risperidone reduces hallucinations, agitation, and delusions are signs of effectiveness.

true 

Risperidone is used to treat which condition?

schizophrenia 

True or False: Risperidone blocks norepinephrine receptors to reduce psychotic symptoms.

false

What are common or serious side effects of Risperidone? (Select all that apply.)

hyperglycemia, sedation,  Agranulocytosis 

True or False: Haloperidol alters the effects of dopamine in the central nervous system

true

Delusions of
grandeur

ones own beleif of superior importance

psychological vs physiological

• Physiological:

  Refers to the biological processes and functions of the body, including organs, systems, and physical health. 

• Psychological:

  Deals with the mental processes, thoughts, emotions, and behaviors that influence a person's mind and well-being

which disorder is best described by an uninterupyted period of illness during which there is a major depressive, manic, or mixed episode alogn with symptoms of schizophrenia 

schizoaffective disorder 

stupor

pateints remains unmoved for logn periods of time

which side affect of antiphsycotic medicsation is ireversable

tardive dyskinesia

erotomania

beleive someone usually famous is in love with them

somatic delusion

belif that the body is changing in dom way

neurocognitive impairments for individuals with schizophrenia include 

disorganized thinking

disorganized speech 

what does schizophernia do to the brain

lowers blood flow to the brain, lower brain volume,

positive symptoms of schizophernia are related to excess what in the mesolimbic area fo the brain

dopamine

autism

eaisly distractable and seems to be in their own world

labile 

affect of pateitn changes quickly from one to another 

When conducting a health history, the nurse identifies which environmental risk factors as possible predictors of a diagnosis of schizophrenia. (Select all that apply.)

Urban residence

Recent immigration

Sleep deprivation

Child abuse

Decreased hippocampus

urban resistance 

recent immigration

child abuse 

haloperidol

tindications: schizoaffective disorder, schizophrenia, manic states, drug induced psychoses

assessments:mood/behvaior, cbc, hallucinations/ positive and negative synmtims, intake/output, bp, liver function

patient teaching: report fever,

side effects: agranulocytosis, seizures, neuroleptic maligant syndrome, eps, dry mouth

clas: antiphsycotics, butyrophenones

action:alters the effects of dopamine in the cns, anticholergenic and alpha adrengic blocking acivitivy

effectiveness:dimished signs and symptoms of psychoses,

benztropine

assessments: eps symptoms, intake.output, behavior, bp

patient teaching: avoid changing positions quickly

action: decreased EPS sympotms such as tremors of muscle stiffness 

indicatioons: drug induced eps, reductions

action:blocking cholinergic activity Central Nervous System

side effects: dry mouth, urinary retention, sedation 

class: antiparkinsons agets, anticholinergics

risperidone

assessment:arrythmias, tardive dyskinesia, suicidal ideation, cbc

education: change position slowly, use susncreen,

effectiveness: Risperidone reduces hallucinations, agitation, and delusions are signs of effectiveness.

indications: schizophrenia, decreas enegative synotoms 

action: antagonziing dopamine and serotonin in the cns 

side effects:hyperglycemia, sedation, agranulocytosis

class:antipsychotics, mood stabilizers, benzisoxazoles

what happens during fight or flight

when in a stressful situation the hypothalamus seceretes CSF this activates the sympathetic nervous system to release norepinephrine, epinephrine, and dopamine

this cuases an increased heart rate, blood pressure cardiac output, dilation of bronchial airways, pupil dilation, amd an increase in blood glucose levels

general adaptation syndrome

three stage reponse to stress including alarm, resistance, and exhaustion

different types of stressors

physical-illness or injury, infection, trauma, heat/cold, fatigue, pain

psychological/emotional-an event or situation which is interpreted as negative or threatening, death, job related, family issues, physical disabuilities, divorce/marriage

eisodic stress

fequent bouts of acute stress

what do rofessional do to help a clinet in a crisis

Lengthy psychiatric hospitalizations are not appropriate for crisis
intervention. The focus of the problem is here and now

During crisis, the health care team helps the individual get relief and calls
into action the personnel and other resources required. Guide the individual
through a problem-solving process by which he or she may move in the
direction of positive life change.

short term coping skills

distractions, self care, creative actvities, reflection(journaling), spirituality

long term coping skills

adherence, adaptation, resilienc, imroving health, lifestyles chnages

difference between anxiety and stress

Stress is external pressure (stressor) that is brought to bear on the individual. Anxiety is a
feeling of discomfort, apprehension, or dread related to the anticipation of danger, the
source of which is often nonspecific or unknown. Anxiety is considered a disorder.

difference between anxiety and fear

Anxiety is an emotional response, and fear is a cognitive response. Fear involves the
appraisal of threatening stimulus. Anxiety involves the emotional response to that
appraisal

predisposing factors of anxiety

gener, genetics, substance use, medicla conditions, history of stressful events

different conditions that involve anxiety

phobias-fear t objects or situations that might cause harm, but the persosn repsonse is very extra\

ptsd-high level of anxiety while remembering a triggering event

ocd-intense anxiety with guilt if taks is not erformed

mild, moderate, severe, and panic anxity

mild-sharpened senses, alert, sleepless irritable

moderate-cant connect thoughts, diaphoysis, muscle tension

sevre-cannot complete taks sor solve problems, vertigo

panic-connot process environemental stimuli, distrorted perceptions, cant communicate verbally

serotonin syndrome 

confusion, agitation, halluncinations, tachycardia, diaphorysisfever, incoordination

alternative treatments to anxiety nonpharmacological 

aromatherapy, biofeedback, psychopharmacology, acupuncture, stress and relaxtion technquies, animal therapy

buspirone

education: avid alcohol, avoid grapejuice

effects reduction in anxiety without sedation.

treats: generalized anxiety disorder

action: binds to serotonin and dopamine receptors in the brain, and increases norepinephrine metabolism

side effects:tachycardia, rash, tinnitus, nausea, myalgia, fatigue, shortness of breath

assessments: degree of anxiety, resistric amoutn available for those who had a substance use disorder

class: antianxiety agents

diazepames

assessment: renal function, cbc, mood, bp, respiratory rate, hr, hepatic and renal function

education: avoid alcohol, avid driving

effectiveness:Sedation and reduced anxiety symptoms

indictations: panic disorder, alcohol withdrawl, muscle spams, seizures

action:enhances GABA activity in the brain to produce a calming effect by suprressing the cns

side effects:sedation, tremor, nausea, , hypotension, respiratory depression

class:antianxiety agent, anticovulsant, sedative, muscle relaxant, benzodiazapines

escitalopram

assessment: mood changes, bipolar or mania, sucidal tendicnes, sexual function, serotonin syndrome

education: avoid alcohol, look for suicidal thoughts, sexual dysfunction

efefctiveness:improve mood, sleep, and reduce anxiety.

indictation: major depressive disorder, geenrlized anxiety

action:increases serotonin availability by inhibiting its reuptake.

side effects: bleeding, serotonin syndrome, sucicidal thoughts, neuroleptic ,maligant syndrome, toruble with sexual organs, insomnia, nausea

class:antidepressant, ssri

venlaflaxine

assessments: mood, suicidal tendinces, bp, weight, serotonin syndrome, sexual function, cbc, bun, serumcholesterol

education: look for suicide, caution driving, may cause rash, sexual dysfunction, , avoid alcohol

efefctiveness:Improved energy, mood, and reduced anxiety and panic attacks

indications: major depressive disorder, generalized anxiety disorder, social anxiety, panic disorder

action:blocks(inhibits) reuptake of both serotonin and norepinephrine.

side effects: bleeding, seizures, suicidal thoughts, serotonin sync=drome, neuleptic maligant sydrome

class:antidepressants, antianxiety agents, ssnri

stress and axiety/coping medications

Benzodiazepines, Non-benzodiazepine
anxiolytics, SSRIs, SNRIs, Benzodiazepine antidote

buspirone(non-benzodiazepine anxiolytics), diazepames(benzo), escitalopram(ssris) , venlaflaxine(SNRI), flumazenil(benzo antidote)

psychocsis mediction

typical antipsychotics, atypical antipsychotics, anti-
Parkinsons/anticholinergic

most appropriate therapy for generlaized anxiety disorder

cognitive behavioral therapy 

After performing a screening assessment on a patient, which finding should be documented as a physiological stressor?

dementia

A patient has begun smoking again and drinks six alcoholic beverages per day since experiencing the loss of their job. The nurse recognizes that the patient’s behaviors exhibit what condition?

maladaptive coping

neurotramsmitters that cuase anxiety

gaba, serotonin(monoamines), norepinephrine(monoamines)

typical antipsychotics

first gen antipsychotics, 

Benzodiazepines

for anxiety disorder and alcohol withdrawl

atypical antipsychotics

second gen antipsychoti

anti-
Parkinsons/anticholinergic

treats eps

ssri

major depressive disorder, may cause serotonin syndrome

snri

serotonin and norepinephrine reuptake inhibitor 

Benzodiazepine antidote

reversal of benxo affects 

2. During acute stress, which hormone is primarily released from the adrenal medulla?

spinephrine 

8. What neurotransmitter imbalance is most closely linked to anxiety disorders?

B. Low serotonin and GABA activity

what is reuqired to be diagnosed with generalized anxiety disorder

three constant symptoms over a long amoutn of time

Which medication class is now preferred over benzodiazepines for anxiety treatment?

• 
  

ssris 

Buspirone works by:

• 
  

• c) Binding serotonin and dopamine receptors

Which statement about SSRIs is correct?

• 
  

they take 3-5 weeks to reach full effect 

2. Which of the following medications is most commonly used as a first-line pharmacological treatment for generalized anxiety disorder (GAD)?

ssris

4. Benzodiazepines (e.g., diazepam, lorazepam) are effective for short-term anxiety relief because they:

Increase serotonin levels
B. Block beta-adrenergic receptors
C. Enhance the effect of the neurotransmitter GABA
D. Stimulate the sympathetic nervous system

C. Enhance the effect of the neurotransmitter GABA

7. SSRIs help reduce anxiety symptoms primarily by:

A. Inhibiting serotonin reuptake in the brain

10. Which of the following medications may be prescribed for performance anxiety (e.g., stage fright)?

B. Beta-blocker (propranolol)

propranolol

cna be used to help with alcohol qithdrawl or situational anxiety 

12. Which medication class is an alternative to SSRIs for patients who do not respond to them?

snri

Which factor best determines whether a defense mechanism is adaptive or maladaptive?

• 
  

degree of reality distortion

which type of anxiety may be associated with delusional thinking

panic

pain pharm classes

NSAIDS(ibuprofen), cox 2 inhibitors(celecoxib), opioid agonist(morphine), non opioid analgesic(acetaminophen), opioid antagonist(naloxone)

ibuprofen

class: nsaids

action: inhibits prostaglandin synthesis, reduces inflammation by blocking the COX-1 and COX-2 enzymes involved in prostaglandin production, acts mainly in the cns 

effectiveness: decreased pain and inflammation, reduction of fever, 

side effects:constipation, nausea, vomiting, gi bleeding, stroke, renal failure

assessments: gi bleeding, skin rash, pain, range of motion, fever, liver function, cbc, bun

teaching:take with full glass of water and remain uright, avoid driving, avoid alcohol

celecoxib

class: cox 2 inhibitors 

indications: acute pain and inflammation due to osteoarthritis 

actions: inhibits the COX-2 enzyme, reducing inflammation and pain with less gastrointestinal irritation than traditional NSAIDs.

effectiveness: reduction in joint swelling and and reported pain level

side effects: increased risk of stroke, hypertension, abdominal pain

assessments: range of motion, allergy to aspirin, potassium level 

teaching: increased risk of heart attack and stroke, report difficulty breathing

acetamenophen

class: nonopioid analgesics

indications: mild pain, fever

action: ibhibits synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the cns

effectiveness: releif of mild to moderate pain, reduction of fever

side effects: hepatotoxicity, renal failure, nausea, hypokalemia

assesssments: last dose, pain level, liver function test peridocially 

teaching: avoid alcohol, rash, dont take other medications with it to avoid overdose