NURS 222 Mental Health Final Exam Review 2023.

NURS 222 Mental Health Final Exam Review 2023. 50/50 new items 1. Main concept: legal aspects o Hold status o Riese petition. (Medication Capacity Hearing)  If constant refusal of Meds, can be given against will); also under conservatorship emergency o Probably cause hearings  Temporary Conservatorship – (GD): 30 days  LPS Conservatorship – (GD): 1 year temp conservatorship 2. What are some of the criteria for a hold? o Dangerous to self (DTS) o Danger to others (DTO) o Gravely Disabled (GD) 3. Seclusion and restraints (last resort) o After you have tried all other therapeutic techniques. o After all other interventions o Especially for someone that’s elderly – avoid using seclusion and restraints as much as possible o Four hour order (hard) o 24 hours (med/soft) o Can always be released earlier 4. Mood disorders (treatment for depression –MAOI’s) o Tyramine know foods that interact  If taken with tyramine – hypertensive crisis. (intracranial bleed) o PaNaMa. (Parnate, Nardil, Marplan, Emsam –patch). o Dietary restrictions. o CHECK handout 5. Clozaril: what are some of concerns. o Agranulocytosis: what is it?  S/S: sore throat, fever, malaise, mouth sores.  FLU-like symptoms.  CHECK fever. o Risk for fatal agranulocytosis  Baseline and weekly monitor WBC  Notify provider of indications of infection ( fever, sore throat, mouth lesions) o Other:  Sedation  Orthostatic hypotension  Anticholinergic effect (dry mouth/ urinary retention) 6. What are your results for white blood cells and neutrophils  Make sure to know counts.  WBC: 5,000-10,000  Neutrophils (ANC): 50-70% of the total WBCcount ( cells/mm)  n = 3-6% (0-700 cells/mm) 7. Lithium: o Therapeutic level 0.8 – 1.4 mEq/L o Maintenance: 0.6-1.2 mEq/L o Regular salt intake o Adequate fluid intake o Side effects  Fine hand tremor, polyuria, and mild thirst, mild nausea, general discomfort, weight gain o Early signs of toxicity  N/V/D, thrist, polyuria, lethargy, slurred speech, muscle weakness and fine hand tremor o Advanced signs of Toxicity  Coarse hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritability, electroencephalographi changes, incoordination, sedation o Severe Toxicity  Ataxia, giddiness, serious electroencephalographic changes, blurred vision, clonic movements, large output of dilute urine, seizures, stupor, severe hypotension coma. Death is usually secondary to pulmonary complications – Convulsions, oliguria and death can occur. Final review 8. Schizophrenia - Know positive and negative symptoms. o Comorbidity:  Substance abuse disorder  Anxiety, depression and suicide  Physical health issues (some due to meds)  Polydipsia (risk of water intoxication) o Etiology:  Biological – genetics  Neurobiological – dopamine and other neurochecmical theories  Brain structure abnormalities  Ventricle enlargement and or asymmetry  Reduces cortical, frontal lobe, hippocampal and or cereberllar volumes.  Increase size of sulci  Reduces cortical thickness  Reduced connectivity in various brain regions  Lowered rate of blood flow and glucose metabolism in the frontal lobes.  Psychological and environmental factors:  Prenatal stressors  Psychological stressors  Environmental stressors. o Assess for suicidal ideation every sift. o Positive symptoms:  Manifestation of things that are not normally present  Hallucinations, delusions, alteration in speech, bizarre behavior (walking backward) o Negative symptoms:  Absence of things that are normally pre  Affect – flat, blunted, inappropriate, bizarre, avolition (lack of emotion)  Lack of symptoms: ADL’s, Hygiene, etc. 9. Communication: o How do you respond to patient who is depressed, who tries to get you out of the room “leave me alone” been there for a week. o Someone who is suicidal. o Someone who just had a loss (grieving)  Hallucination Therapeutic Response o “Frightening for you” o “I don’t see” o My name is…, I am your nurse 10. Counter transference and transference (know difference) 11. What is methadone used for? o Opiates o Used for opioid maintenance as with heroin withdrawal o Synthetic opiate blocks craving for and effects of heroin 12. Haldol used for? o Psychosis. o TYPICAL (older meds) o Problems:  EPSTD, Akathisia (restlessness, tapping food, rocking, shifting.)  AIMSfor TD (protruding and rolling tongue, blowing, lip smacking, licking, spastic facial distortion. 13. What is dystonia? o Acute sustained contraction of muscles, usually of the head and neck including tongue, face, neck and back (usually tongue and jaw first o Rigid neck. o 4 dystonic reactions  Torticollis: twisted neck (head is tipped to one side, chin is turned to other)  “jaw is pulling”  Opisthotonos (arching of back) Final review  Titanic heightening of entire body  Head and belly up.  Oculogyric crisis: eyes locked upward.  Laryngeal dystonia: could threaten airway.  Squeaky voice. o Caused by EPS- of first generation antipsychotics (Thorazine, Mellaril, Serentil, Orap, Haldol, Prolixin, Navane, Stelazine, Trilafon, Loxitance).