When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include: Show 1.preoccupation with minute details; perfectionist: Upgrade to remove ads Only ₩37,125/year
Terms in this set (167)Schizophrenia definition -inability to think/communicate accurately There is often a pre-psychotic phase prior to acute onset of schizophrenia...what will you see? -disturbed sleep
cycle What about amphetamines? How would this impact someone with schizophrenia? -they make symptoms worse because of the increase in dopamine levels Psychosis severe mental disorder in which a persons ability to think, reason, and respond, and behave appropriately toward reality is impaired grossly enough to not meet the ordinary demands of life Delusions -ideas Clanging meaningless rhyming Concrete thinking take everything literally Neologisms made up words Hallucinations the feelings Command hallucinations voices are telling the patient to do something, such as harm themselves Depersonalization the pt does not feel real
Derealization the environment does not feel real If a patient all of a sudden begins to act out and threatens to hurt themselves, what do you do? 1. "I am here to help you" aka orient them, and remove the weapon if there is one You believe that the young man you are admitting to your unit is suffering from command hallucinations. "what are
the voices telling you to do?" Illusions misperceptions or misinterpretations of a real experience waxy flexibility body parts are rigid but you can move them echopraxia copying movements echolalia repetition of words avolition loss of motivation anhedonia loss of pleasure anergia loss of energy Positive schizophrenic symptoms (primary symptoms) -hallucinations/delusions Negative schizophrenic symptoms -affect disturbances How long does one have to have schizophrenic symptoms to be diagnosed? 6 months water intoxication symptoms of schizophrenia Catatonic schizophrenia motor immobility or excitability Disorganized schizophrenia prominent negative symptoms Paranoid schizophrenia positive symptoms Loose associations in a person with schizophrenia indicate: D which assessment finding represents a negative symptom of schizophrenia? A What are the 1st gen antipsychotics? Thorazine What are some nursing implications for Thorazine (chlorpromazine)? photosensitivity, so wear sunblock and glasses Haldol (haloperidol); Prolixin (fluphenazine) -targets positive symptoms Side effects of conventional antipsychotics- 1st gen -all antipsychotics can have anticholinergic (ACH) and extrapyramidal side effects (EPS) Which antipsychotic is similar to haldol and prolixin? thiothixene Which antipsychotic is most likely to have ACH side effects? Thorazine Which antipsychotic is most likely to have EPS side effects? haldol and prolixin Define Extrapyramidal (EPS) effects -pseudoparkinsonism (parkinson-like symptoms) -may switch neuroleptics in order to treat When do EPS side effects occur? 5-30 days of med administration EPS symptoms parkinson symptoms Dangerous EPS complications -acute dystonic reactions When does tardive dyskinesias occur? a month after the med administration Define tardive dyskinesias tongue thrusting Define akathisia constant need to move Define acute dystonic reactions painful muscle contractures Define Neuroleptic malignant syndrome (NMS) acute adverse reaction caused by antipsychotics What are the NMS symptoms? high fever Neuroleptic malignant syndrome (NMS) interventions -stop the med What can 2nd gen antipsychotics used for? -treat both positive and negative symptoms What are the 2nd gen antipsychotics? Risperdal 2nd gen antipsychotics have ____________ EPS side effects or tardive dyskinesia. little to no 2nd gen antipsychotics can have major _____________ side effects. metabolic (weight gain, HTN, hyperglycemia, hyperlipidemia) What effects can risperdal have on males? breast development How can Invega be given? 1 month and 3 month dose How can zyprexa be given? dissolvable tongue strip Which 2nd gen antipsychotic is given mostly for bipolar? Zyprexa Which 2nd gen antipsychotic should NOT be given to a patient with cardiac issues? Geodon Which 2nd gen antipsychotic can help with insomnia? Seroquel Which are more expensive, 1st gen or 2nd gen antipsychotics? 1st gen What is an atypical antipsychotic? Clozaril (clozapine) Clozapine has a high risk of EPS side effects, true or false? false What are some nursing implications for clozapine? increase
dose slowly What are some Clozaril (clozapine) side effects? orthostatic hypotension What are the 3rd gen antipsychotics? -aripiprazole (abilify) Ability has little to no risk of __________________. EPS side effects Can ability be used with other meds? YES What occurs during Phase 1 (acute)? pt safety and med stabilization What occurs during Phase 2 (stabilization)? adhere to treatment What occurs during Phase 3 (maintenance)? maintain achievement Treatment modalities -social
skills group Define schizophreniform disorder given to patient with symptoms for 6 months Define schizoaffective disorder looks like schizophrenia with a mood disorder A patient with schizophrenia says, "There are worms under my skin eating the hair follicles." How would you classify this assessment finding? A. positive symptom A How does a patient receive a diagnosis of MDD? they have one or more major depressive episodes Define Disruptive Mood Dysregulation Disorder children that are depressed, appear tired constantly Who does MDD affect the most? children/adolescents and elderly Who is most at risk for being successful at committing suicide? -elderly white males MDD S/S -anhedonia How long do symptoms occur for MDD? at least 2 weeks Which question would be a priority when assessing for symptoms of major depression? A. "Tell me about any special powers you believe you have." B. "You look really sad. Have you ever thought of harming yourself?" C. "Your family says you never stop. How much sleep do you get?" D. "Do you ever find that you don't remember where you've been or what you've done?" B Can a person who is depressed experience delusions or hallucinations? yes Is guilt common with people that are depressed? yes Can a depressed patient have another Axis I disorder? yes What is the reason it is important for a nurse to perform a self-assessment of his/her feelings? -if the nurse has experienced depression, they should reflect on their own experience because it will likely differ from the pt's MDD interventions -mileau How is depression different than normal grief? -worthlessness How long do ECT usually last? 6-12 treatments over 2-3 weeks When is ECT used for MDD? only used after trial of antidepressant medication has failed or the depression is non responsive You are
worried about a close friend who recently broke up with a boyfriend. She is taking the breakup very hard and seems depressed. "are you thinking of harming yourself?" What is the primary level of suicide prevention? activities that provide support, information, and education to prevent suicide What is the second level of suicide prevention? treatment of the actual suicidal crisis What is the tertiary level of suicide prevention? interventions with the family and friends of a person who has committed suicide to reduce the traumatic aftereffects What is done for the patient threatening suicide? -1:1 monitoring OR q15 checks A patient is hospitalized with major depression and suicidal ideation. For the first 2 days of hospitalization the patient stays in his room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider? A. The patient is showing improvement and may be ready for discharge. B. The patient may have decided to commit suicide; the nurse should reassess suicidality. C. The patient is feeling rested, supported by the therapeutic milieu, and less depressed. D. The patient is benefiting from the antidepressant he has been taking for 4 days. B, b/c the meds take 4-8 weeks to work an suicide risk is highest in first weeks b/c they are still depressed but now have the energy to follow through with plans of suicide! Dysthymia (persistent depressive disorder) -occurs over 2 year period (1 year for adolescents and children) Which assessment finding in a patient with major depression represents a vegetative sign? B A person with which psychiatric problem is most likely to complete suicide? B Which method of suicide has the highest lethality? C A patient was just admitted to your unit with bipolar disorder I and is in the manic state. What symptoms might you expect to see? -labile mood (happy then sad very suddenly) Define Bipolar disorder 1 at least one manic episode and depressed episode Define Bipolar disorder 2 no manic history, have at least one episode of hypomania and depression Define Cyclothymia hypomanic symptoms and depressive symptoms fall short of MDD for 2 years in Adults, 1 year children Bipolar 1 is more common is ______________. males Rapid cycling is most common in ___________ with bipolar disorder. children Outcomes identification for bipolar -acute phase: prevent
injury Planning: bipolar -acute phase: med stabilization, maintaining safety, self care needs Define Rapid cycling 4+ episodes of bipolar disorder disorder a year (manic to depressed) Bipolar disorder: nutrition -provide finger foods!! Cyclothymia -occurs over a 2 year period SSRIs block _____________ uptake serotonin What is the 1st line of therapy for mood disorders? SSRIs What are the SSRIs used for mood disorders? Prozac (fluoxetine) What SSRI is used for OCD? Luvox SSRIs side effects anxiety Define Central serotonin syndrome too high dose or reactions with other drugs What makes CSS worse? MAOIs What are the S/S of CSS? abdominal pain How long do antidepressants take to have therapeutic effect? 4-8 weeks How should a patient stop SSRIs? taper them slowly!! TCA side effects -anticholinergic MAOIs Nardil (phenalzine), What should patients not eat with MAOIs? tyramine foods! MAOI side effects weight gain MAOIs+Tyramine= hypertensive crisis -severe HA
Serotonin-Norepinephrine Reuptake Inhibators (SNRIs) -effexor, cymbalta, remeron -remeron can help with sleep SNRIs side effects -nausea What would be an advantage of a SNRI like Cymbalta or Effexor? not habit forming so can be used for pain! Cymbalta and the elderly -diabetic neuropathy Wellbutrin is the recommended med for _________________. rapid cycling bipolar -will not cause a manic episode Wellbutrin has an increased risk of ___________________. seizures Trazadone -can be used for sedation Your patient was just diagnosed with a major depressive disorder. -SSRIs What is Lithium used as? -mood stabilizer for pure manic episodes How long does it take for lithium to reach therapeutic levels? 7-14 days What is a nursing implication for lithium? patient should not change salt or fluid intake What are long term risks of lithium? Kidney function Lithium: expected side effects polyuria Lithium: unexpected side effects TOXICITY N/V Lithium toxicity advanced signs hand tremor Anticonvulsants Tegretol Nueortontin JUST SAY NO! Benefits of anticonvulsants -better for continuous rapid cycling pts Tegretol -give with meals Tegretol side effects drowsy Tegretol adverse effects STATUS EPILEPTICCUS if abrupt withdrawal! Tegretol: pt teaching -monitor therapeutic levels Tegretol signs of toxicity fever Depakene/Depakote pt teaching -similar to tegretol Depakene/Depakote side effects tremors Which anticonvulsant medication might be prescribed for a
patient with bipolar disorder? A Anxiety disorders -panic disorder Panic disorder S/S -panic attacks Generalized Anxiety Disorder (GAD) S/S -difficulty making decisions GAD interventions and meds -SSRIs Phobias -intense fear of a specific object/activity/situation Phobias interventions -anxiolytics, antidepressants OCD obsessions: compulsions: OCD interventions -luvox (SSRI), anafranil (TCA), prozac PTSD S/S -event threatened life PTSD interventions -SSRIs, atypical antipsychotics, mood stabilizers Defenses in anxiety disorders -phobias= displacement Benzodiazepines are _____________________. anziolytics Benzodiazepines xanax Benzodiazepines pt teaching -habituating, gradual tapering BuSpar is NOT an _________________, it is similar to a _________________. anxiolytic BuSpar is NOT ____________________. habit forming BuSpar benefits less sedating Students also viewedChapter 21,18 terms seifercPLUS Cardiac Nursing88 terms kkmommy11125PLUS Cardiovascular108 terms wdurst21PLUS RN 3 Test 2; PART 217 terms ck7qsf8sghPLUS Other sets by this creatorCognitive Disorders18 terms ajstalets Eating disorders11 terms ajstalets Childhood mental illness44 terms ajstalets Adult Health 1 Test 2221 terms ajstalets Recommended textbook solutions Pharmacology and the Nursing Process7th EditionJulie S Snyder, Linda Lilley, Shelly Collins 388 solutions Pathophysiology6th EditionJacquelyn Banasik 362 solutions Medical Assisting: Administrative Procedures7th EditionKathryn A Booth, Leesa Whicker, Terri D Wyman 319 solutions
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