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84 terms

Mental Health Nursing Exam 3

Schizophrenia, Eating Disorders, Addictive Disorders, Cognitive Disorders, Disorders of Children and Adolescents, Psychosocial Needs of Older Adult, Serious Mental Illnesses
STUDY
PLAY
Schizophrenia DSM-IV Criteria
A. Characteristic Symptoms
Two or more in a month:
-Delusions
-Hallucinations
-Disorganized Speech
-Grossly Disorganized
-Negative Symptoms
B. Social/Occupational Dysfunction
C. Duration (At least 6 months with at least 1 month that meets criteria of A.)
Schizophrenia Epidemiology
Usually late teens-20s
More common in men
No racial/cultural difference
Schizophrenia Comorbidity
Polydipsia, Substance abuse (esp. nicotine), Anxiety, Depression, Suicide, Physical illness
Schizophrenia Genetics
Runs in families; Cluster A PD in family
Dopamine Theory
When dopamine is controlled, helps with positive symptoms of Schizophrenia
Positive Symptoms
-Alterations in Thinking
-Alterations in Speech
-Alterations in Perception
-Alterations in Behavior
Alterations in Thinking
-Delusions are false, fixed beliefs
-Concrete thinking (can't think abstractly)
-Ideas of reference (everything is related to them)
-Persecution
-Grandiosity
-Somatic Sensations
-Jealousy
-Though Broadcasting (TV, Radio)
-Thought Insertion/Withdrawal
-Delusions of being controlled
Alterations in Speech
-Neologisms (Made up words)
-Echolalia (Repeat what you say)
-Echopraxia (Repeat movements)
-Clang Associations
-Word Salad
Alterations in Perception
-Depersonalization
-Derealization (Outer environment doesn't feel right)
-Hallucinations
-Boundary Impairment
Alterations in Behavior
-Catatonia
-Motor Retardation/Agitation
-Stereotyped Behaviors
-Automatic Obedience
-Waxy Flexibility (Could have arm up in air for hrs)
-Negativism
-Impaired Impulse Control
Negative Symptoms
-Blunt, flat, bizarre affect
-Anergia (No energy)
-Anhedonia (No pleasure)
-Avolition (Reduced motivation)
-Poverty of speech/content
-Thought Blocking
Cognitive Symptoms
Difficulty with: Attention, memory, information processing, cognitive flexibility, executive functions
Affective Symptoms
Assess for depression is key!
Conventional Antipsychotics
First-Generation drug for Schizophrenia
-Treats pos. symptoms ONLY (dopamine receptors)
-Less expensive, more side effects
Disadvantages: Extrapyramidal side effects, Anticholinergic side effects, tardive dyskinesia, lower seizure threshold*
Atypical Antipsychotics
Second-Generation drug for Schizophrenia
-Treats both pos. and neg. symptoms
-Low extrapyramidal side effects or tardive dyskinesia
-Disadvantage: Wt. gain, metabolic syndrome/potential to develop diabetes (*Measure abdominal girth!)
Anticholinergic Symptoms
Seen in Atypical and Conventional Antipsychotics: -Dry Mouth
-Urinary Retention
-Constipation
-Blurred Vision
-Photosensitivity
-Dry Eyes
-Sexual Problems
Types of Atypical Antipsychotics
-Clozapine (Clozaril): Use declining (lowers WBCs)
-Risperidone (Risperdal)
-Olanzapine (Zyprexa)
-Quetiapine (Seroquel)*
-Ziprasidone (Geodon)
-Aripiprazole (Abilify)*
Extrapyramidal Side Effects
Seen in Conventional Antipsychotics:
-Acute Dystonia (head & neck muscles contract)
-Akathisia (Restless, pacing)
-Pseudoparkinsonism (give Benadryl or Cogentin)
-Tardive Dyskinesia (Abnormal involuntary movement scale- Persistant lip smacking)
Neuroleptic Malignant Syndrome
Response to antipsychotics
-Very high fever, muscle rigidity
-Treat Immediately!
Agranulocytosis
Low WBCs from antipsychotics
Residual Schizophrenia
Active-phase symptoms no longer present
Evidence of two or more residual symptoms:
-Reduced initiative, interests, or energy
-Social withdrawal
-Impaired role function
-Speech deficits
-Odd beliefs
Anorexia Nervosa
<85% Ideal Body Weight
-Terrified of wt. gain/Sees self as fat
-Amenorrhea (loss of menses)
-Preoccupied with food-related activities
-Uses vomiting/laxatives/diuretics
Medical Complications of Anorexia
-Bradycardia
-Changes in BP/HR
-Cardiac arrythmias
-Prolonged QT interval
-Leukopneia
-Lymphocytosis
-Elevated Carotene in blood
-Hypokalemic Alkalosis
-Elevated bicarbonate
-Electrolyte imbalances
-Osteoporosis
-Fatty degeneration of liver
-Elevated cholesterol
-Hematuria/Proteinuria
Bulimia Nervosa
-May not appear ill
-Often slightly above or below ideal body weight
-Purging and Non-purging types
-Binge eating
-Depression
-Relationship Problems
Medical Complications of Bulimia
-Sinus bradycardia
-Orthostatic changes
-Cardiac Murmur
-Abnormal Potassium, Sodium values
-Russell's Sign (Callused knuckles)
-Esophageal Tears
-Parotid Swelling
-Dental erosion
Binge Eating
-Frequently symptom of Affective Disorder/Mood Disorder
-2 days/wk for 6 months
-Lack of control over episode
Synergistic Effect
Drugs taken together to intensify/prolong effects
ex. alcohol & benaodiazepine/opiate
Antagonistic Effect
Drugs taken together to weaken/inhibit effects
ex. cocaine & heroine (speedball), caffiene & alcohol
Codependence
Family/friends enable addicts
Dual-Diagnosis
Addiction AND Mental Illness
Addiction Comorbidity
-Psychiatric: 6/10 have mental disorder (depression, anxiety, antisocial, paranoid, schizophrenic, histrionic)
-Medical: Alcohol medical problems are most common
Addiction Etiology
-Biological Factors: Substance abuse affects brain/neurotransmitters (Opoid, catecholamine, dopamine, GABA systems)

-Psychological Factors: Lack of tolerance for frustration/pain; Lack of success in life; Lack of affectionate and meaningful relationships; Low self-esteem; Risk-taking propensity

-Sociocultural factors: Socioeconomic stress, social/cultural norms

NO CLEAR genetic link, but highly likely
Red flag responses during assessment
-Rationalizations, automatic responses, slow/prolonged responses
Alcohol Poisoning
-Can result in death from choking on vomit or shutdown of body systems
Signs: inability to arouse pt, cool clammy skin, resp.<10/min, cyanosis under fingernails, emesis while semiconscious/unconscious, coma, shock, convulsions

Treatment: Induce vomiting, keep awake, give activated charcoal, check q 15 min
If in coma: Clear airway, insert endotracheal tube, give IV, pump stomach, check VS, initiate seizure precautions, administer flumazenil (romazicon) IV
Alcohol Withdrawal
Signs develop within few hrs of last drink, peaks at 24-48 hrs
-Let Dr. know if you see symptoms!

Symptoms: N&V, tachycardia, diaphoresis, anxiety, remors in hands/fingers/eyelids, marked insomnia, grand mal seizures, delerium, increase B/P
Alcohol Withdrawl Delirium
Seen after 5-15 yrs of heavy use
Medical emergency, can lead to death
-48-72 hrs after last drink, can last 2-3 days
Alcohol Intoxication
Slurred speech, incoordination, unsteady gait, drowsiness, decreased B/P, disinhibition of sexual or aggressive drives, impaired judgment, impaired social function, impaired attention/memory, irritability
CNS Stimulants
-Cocaine/Crack
-Caffeine
-Nicotine
-Amphetamines
CNS Stimulant Intoxication
Tachycardia, dilated pupils, elevated BP, N&V, insomnia, assaultiveness, grandiosity, impaired judgment, euphoria, increase energy
-Severe: State resembling paranoid schizophrenia, delusions, psychosis, hallucinations, panic levels of anxiety, violence
CNS Stimulant Overdose
Respiratory distress, ataxia, hyperpyrexia, convulsions, stroke, coma, myocardial infarction, death
Effects of CNS withdrawal
Fatigue, depression, agitation, apathy, anxiety, sleepiness, disorientation, lethargy, craving, sweating, chills, paranoia
Treatment: Antidepressants, dopamine agonist, bromocriptine
Cocaine and Crack
-Smoked: effect in 4-6 seconds, high for 5-7 min then deep depression
-Main effects on body: Anesthetic & Stimulant
-Produces imbalance in NTs
Opiates
-Morphine
-Heroin
-Codeine
-Fentanyl
-Methadone
-Meperidine
Opiate Intoxication
Constricted pupils, decreased respiration, drowsiness, decreased BP, slurred speech, psychomotor retardation, initial euphoria followed by dysphoria
Opiate Overdose
Possible dilation of pupils, respiratory depression/arrest, coma, shock, convulsions, death
Treatment: Narcotic antagonist
Effects of Opiate Withdrawal
Yawning, insomnia, irritability, runny nose, panic, N&V, cramps, muscle aches, chills, fever

-Less severe withdrawl
Marijuana
-Indian hemp plant
-THC is active ingredient
-Depressant and Hallucinogenic properties
Desired effects: euphoria, detachment, relaxation
Long-term effects: Lethargy, anhedonia, difficulty concentrating, loss of memory
Hallucinogens
-LSD/acid
-Mescaline
-Psilocybin (magic mushrooms)
-PCP
Hallucinogen Intoxication
Pupil dilation, tachycardia, diaphoresis, palpations, tremors, incoordination, elevated temp, pulse and respirations, hallucinations, bizzare behavior, paranoia, anxiety, depression, violent behaviors

-Can lead to permanent psychosis
Inhalants
-Spray paint, glue, lighter fluid, aerosols
-Alcohol-like symptoms, hallucinations, euphoria
-Toxic to heart, lungs, liver and kidneys
-May die from vagal stimulation, respiratory depression, profound systolic BP drop
Club Drugs
-Ecstasy, MDA, MDE
-Produce subjective effects resembling stimulants and hallucinogens (hyperactive, dilated pupils, tachycardia, central serotonin syndrome, severe sodium depletion, grinding teeth, increased BP and temp, tremors)
Date Rape Drugs
Flunitrazepam (Roofies), Gamma hydroxybutyric acid (GHB)
-Rapidly produce disinhibition, relaxation of voluntary muscles, anterograde amnesia
Naltrexone (ReVia)
Reduces/eliminates alcohol craving
Acamprosate (Campral)
Helps client abstain from alcohol
Topiramate (Topamax)
Works to decrease alcohol cravings
Disulfiram (Antabuse)
Alcohol-disulifram reaction causes unpleasant physical effects
-Must take daily!
Valium
Often used for alcohol withdrawal (decreases symptoms, stabilize V.S., prevent seizures)
Methadone (Dolophine)
Synthetic opiate blocks craving for and effects of heroin
LAAM
Alternative to methadone for heroin withdrawal
Naltrexone (ReVia)
Antagonist that blocks euphoric effects of opioids
Clonidine (Catapres)
Effective somatic treatment when combined with naltrexone
Buprenorphrine (Subutex)
Blocks signs and symptoms of opioid withdrawal
Assessment tool for pain in elderly
-Wong Baker FACES
-Present pain intensity rating
-Pain assessment in Advanced Dementia (PAINAD) scale (looks at 5 aspects)

Give morphine for pain (Safer in elderly)- regular dose, not PRN
Delirium
Change in cognition/consciousness, less clarity, sudden onset, fluctuating, common in hospitalized patients especially older adults (due to infection, high fever, pain, etc.)
-Low doses of Halidol can prevent
Cardinal Features of Delirium
-Acute onset and fluctuating course
-Inattention
-Disorganized thinking
-Disturbances of consciousness
Illusions
Misinterpresting something that is really there
Dementia
-Progressive, irreversible
-No change in consciousness
-Difficulty with memory, thinking, and comprehension
Alzheimer's Disease Etiology
-Cerebral Atrophy (especially in hippocampus)
-Neurofibrillary tangles
-Neuritic Plaques
-Ventricles enlarge
-Risk factors: Head injury, aging, down syndrome
Confabulation
Unconscious attempt to maintain self-esteem
Perseveration
Repetition of phrase or behaviors
Cardinal Symptoms of Alzheimer's Disease
-Amnesia/Memory impairment
-Aphasia
-Apraxia (loss of purposeful movement in absence of motor or sensory impairment)
-Agnosia (loss of sensory ability to recognize objects)
-Disturbances in executive functioning (can't make decisions)
Early AD
Plaques/tangles begin to form in areas of learning, memory, thinking and planning
-Forgetfulness
Mild AD
-Confusion
Moderate AD
-More plaques and tangles
-Problems with memory/thinking that is severe enough to affect work or social life
-Trouble identifying familiar objects or people
Severe AD
-Unable to identify familiar objects or people
-Most of cortex is seriously damaged
-Brain shrinks dramatically
Drugs for AD
-Tacrine (Cognex)
-Donepezil (Aricept) *Less liver toxicity
-Rivastigmine (Exelon)
-Galantamine (Razadyne)
-Memantine (Namenda)

-Anticonvulsants help with mood
-Benzodiapines help with anxiety
Tacrine (Cognex)
For mild-moderate symptoms of AD, improves functioning and slows progress of disease
-Side effects common: Nightmares, Elevated liver transaminase levels, GI effects, and liver toxicity
Aricept (Donepezil)
-BEST AD DRUG
-Most prescribed, slows deterioration w/o liver toxicity
-Improve/Maintain thinking
-Allow to perform ADLs
-Delay onset of negative behavioral symptoms
Side effects: Diarrhea, N&V
Nameda (Memantine)
-For moderate to severe stages of AD
-Low side effects and proven effective in helping treat symptoms of AD
-Improve/Maintain thinking
-Allow to perform ADLs
-Delay onset of negative behavioral symptoms
Pervasive Developmental Disorders
-Autistic Disorder: don't like touch/stimulus, pull away, poor eye contact, don't like to play with other kids, impairment in communication
-Asperger's Disorder: focus on one subject that they're very smart in, "high functioning autism"
-Rett's Disorder
ADHD
-Inattention
-Hyperactivity
-Impulsivity
Drugs: Ritalin (most prescribed, addictive, give before 4 PM); Strattera (less addictive)
Oppositional Defiant Disorder
Pattern of disobedience, but don't violate others
-More common in teens, boys
Conduct Disorder
-Worse that Oppositional; Hurt others, steal, etc.
-No remorse for actions
-Childhood & Adolescent onset
-History of ADHD common
Types of Conventional Antipsychotics
-Chlorpromazine (Throazine)
-Loxapine
-Molindone
-Perphenazine
-Trifluoperazine
-Thiothixene (Navane)
-Fluphenazine (Prolixin)
-Haloperidol (Haldol)** COMMON
-Pimozide (Orap)

-Give Cogentin if severe side effects!