Exam 2 Mental Health Galen.docx

Lithium - correct answer Mood stabilizer, used for treatment of bipolar disorder Narrow therapeutic window Lithium Levels - correct answer 0.4-1.0 therapeutic 1.5 mild toxicity 1.5-2.0 advanced toxicity 2.0- 2.5 severe toxicity > 2.5 death Signs & Symptoms of Lithium Toxicity - correct answer Thirst, Tremors, Vomiting, Diarrhea, Muscle Weakness Bipolar II Disorder - correct answer Episodes of hypomania (elation, high energy, but less than bipolar I) Does not experience psychosis Bipolar I Disorder - correct answer Episodes of mania (super elation, super energy, doesn't eat/drink/sleep, takes risks, spends excessive, hypersexual) May have hallucinations What is a priority when a Manic Bipolar I patient arrives at the ED? - correct answer 1. Medically evaluate 2. IVF 2. Benzodiazepines Nursing Interventions for Bipolar I Disorder - correct answer Limit Stimuli, Safety, Encourage Sleep, Set Limits Benztropine (Cogentin) - correct answer Used for treatment of EPS, pseudo-parkinson symptoms Signs & Symptoms of Neuroleptic Malignant Syndrome - correct answer Muscle rigidity, board-like, High temperature, diaphoretic, tachycardic Generation Three Antipsychotics - correct answer Aripiprazole (Abilify) Better side effect profile than generation one or two Treats positive and negative symptoms of schizophrenia Generation Two Antipsychotics (Atypical) - correct answer First line treatment, less chance of EPS Treats positive and negative symptoms of schizophrenia Clozapine, Olanzapine, Quetiapine, Risperadone, Ziprasidone Metabolic Syndrom - correct answer Occurs with generation two antipsychotics (atypical) Weight gain, hyperglycemia, hyperlipidemia Generation One Antipsychotics - correct answer Treats positive symptoms of schizophrenia Extrapyramidal Side Effects Chlorpromazine, Haloperidol, Fluphenazine Catonia - correct answer Moves very little or not at all Evaluate for hazards of immobility (edema, cyanosis, injury, skin impairment) Nursing Interventions for Delusions - correct answer Do not say you believe the delusion, don't try to talk the patient out of the delusion Explore delusion and how they feel about it If afraid of poisoning, let them eat prepackaged or wrapped food to establish trust Paranoid Schizophrenics - correct answer Most Dangerous If they feel that someone will harm them, they may assault them You do not know whom they feel is harmful Nursing Interventions for Hallucinations - correct answer Non-harmful: divert from hallucination and focus of feelings Command Hallucinations: Explore the hallucination and assess for safety ("What are the voices saying? Do you recognize them?") Delusions - correct answer A thought that is not based upon reality Ex.) You feel that people are trying to hurt you Illusions - correct answer You see/ hear something, but perceive it wrong You see an IV pole and believe its a large snake. Hallucinations - correct answer Things that are not present, but are perceived through one of the five senses You see spiders on the walls Negative Symptoms of Schizophrenia - correct answer Flat affect, anergia, avolition, poverty of speech, no ADLs, anhedonia Positive Symptoms of Schizophrenia - correct answer Hallucinations, delusions, illusions, word salad, clang association Causes of Schizophrenia - correct answer Increased Levels of Dopamine Genetics/Biologics Environmental Issues Catharsis - correct answer Expressing of feelings or emotions Universality - correct answer I am not alone, others share my problems Pre-orientation - correct answer Planning Orientation - correct answer Group normals, HIPAA, boundries, trust, rapport, start termination Working - correct answer Set goals, develop coping skills, problem solve Termination - correct answer Review positive accomplishments, goodbye/good luck, cut all ties Critical Incident Stress Debriefing - correct answer A series of sessions offered to personnel that were directly involved in crisis Nursing Interventions for Crisis & Disaster - correct answer Goals are short term and direct You can be more direct with patients Patient's are more receptive to learning If too upset to talk, just sit with them Establish Safety Decrease Anxiety