NCLEX Review: Mental Health Disorders
Anxiety Disorders
Generalized Anxiety Disorder (GAD)
Excessive worry lasting 6 months or more
Symptoms:
Restlessness
Muscle tension
Fatigue
Poor concentration
Sleep disturbance
Panic Disorder
Sudden intense fear with:
Chest pain
Palpitations
Shortness of breath
Feeling of doom
Nursing:
Stay with client
Calm environment
Short/simple communication
Phobias
Irrational fear of object/situation
Treatment:
Exposure therapy
CBT
SSRIs sometimes used
OCD (Obsessive-Compulsive Disorder)
Obsessions = intrusive thoughts
Compulsions = repetitive behaviors to reduce anxiety
Nursing:
Do not suddenly stop rituals
Set limits gradually
Encourage coping skills
PTSD
Triggered after traumatic event
Symptoms:
Flashbacks
Hypervigilance
Nightmares
Avoidance
Priority:
Safety
Trauma-informed care
Depression Disorders
Major Depressive Disorder
Symptoms
SIGECAPS:
Sleep changes
Interest loss
Guilt
Energy low
Concentration poor
Appetite changes
Psychomotor changes
Suicidal thoughts
Nursing Priorities
Suicide assessment
Nutrition/hydration
Sleep/rest
Medication adherence
Medications
SSRIs
Examples:
Sertraline
Fluoxetine
Teachings:
Takes weeks to work
Do not stop abruptly
Watch for serotonin syndrome
Serotonin Syndrome
Symptoms:
Agitation
Fever
Tremor
Hyperreflexia
Diarrhea
Bipolar Disorder
Mania Symptoms
Mnemonic: DIG FAST
Distractibility
Indiscretion
Grandiosity
Flight of ideas
Activity increased
Sleep deficit
Talkative
Nursing Care
Reduce stimulation
Set firm limits
High-calorie finger foods
Encourage rest
Medications
Mood Stabilizers
Lithium
Anticonvulsants
Lithium Toxicity
Therapeutic level:
0.6–1.2 mEq/L
Toxic signs:
Tremor
Vomiting
Confusion
Ataxia
Severe diarrhea
Important:
Maintain sodium/fluid intake
Dehydration increases toxicity risk
Schizophrenia Spectrum Disorders
Positive Symptoms
Things added:
Hallucinations
Delusions
Paranoia
Disorganized speech
Negative Symptoms
Things lost:
Flat affect
Social withdrawal
Anhedonia
Lack of motivation
Hallucination Nursing Response
Present reality
“I do not hear the voices.”
Assess for command hallucinations
Delusions
Do NOT argue.
Respond:
“I understand this feels real to you.”
Antipsychotics
First Generation
Haloperidol
Risk:
EPS
Tardive dyskinesia
Neuroleptic malignant syndrome (NMS)
Second Generation
Olanzapine
Risperidone
Risk:
Weight gain
Diabetes
Metabolic syndrome
EPS Symptoms
Acute dystonia
Akathisia
Parkinsonism
Tardive dyskinesia
Treatment:
Benztropine
Diphenhydramine
Neuroleptic Malignant Syndrome
Medical emergency:
Fever
Rigidity
Confusion
Elevated CK
Personality Disorders
Cluster A
Odd/eccentric
Paranoid
Schizoid
Schizotypal
Cluster B
Dramatic/emotional
Antisocial
Borderline
Histrionic
Narcissistic
Borderline Personality Disorder
Fear of abandonment
Splitting staff
Self-harm risk
Nursing:
Consistent boundaries
Team communication
Cluster C
Anxious/fearful
Avoidant
Dependent
Obsessive-compulsive personality disorder
Eating Disorders
Anorexia Nervosa
Severe restriction
Distorted body image
Bradycardia
Electrolyte imbalance
Priority:
Monitor cardiac status
Daily weights
Observe after meals
Bulimia Nervosa
Binge/purge behavior
Normal weight often seen
Complications:
Hypokalemia
Dental erosion
Substance Use Disorders
Alcohol Withdrawal
Starts within hours after last drink
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