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Psych

Terms in this set (291)

conditions in which evidence supports a connection between abnormalities in the brain and altered .........................
psychobiologic disorders
-cognition
-perception
-emotion
-behavior
-socialization
the brain consists of ...................
-cerebrum
-brain stem
-cerebellum
cerebrum is the basis for .................
-sensory Perception
-voluntary movement
-personality
-intelligence
-language
-thoughts
-judgment
-emotions
-memory
-creativity
-motivation
a network in the brain that is involved in emotions and relate physiologic functions ................
limbic system
limbic system is made up of ...................
thalamus and hypothalamus
structures found on the surface of cells throughout the body and brain responsible for sensing and the pick up of chemical messengers that arrive in extracellular fluid ........................
receptors
-mimics a lock and key
once binding occurs with receptors ...................
-message is received
-cell begins to respond
neurotransmitters plat major role in regulating all .................
-physical
-emotional
-mental processes
neurotransmitters communication affects ..................
-thinking
-behavior
-bodily functions across the synaptic cleft between neurons
neurotransmitters have either .................... or .................... effect on neurons .
stimulating, inhibiting
due to neurotransmitters location in the endocrine and immune system, we can see ....................
-how mind and emotions can affect physical well-being
-how physical status can affect the mind.
we used to believed mental illness was a result from ..................
-character defects
-demonic possession
-punishment from God
neurotransmitters in the psychobiology of mental illness ..................
-dopamine
-norepinephrine
-epinephrine
-serotonin
-acetylcholine
-hibbard
limbic system is ................
center for emotions
observing effects of medications on behavior and symptoms ...................
psychopharmacology
forces that shape behavior and influence psychological equilibrium and may be tied to brain chemistry .......................
-intrapersonal development
-interpersonal interactions
-learning
.................. proposed that disordered behavior is the result of intrapersonal (within oneself) conflicts that arise during particular stages of development between infancy and adolescence .
Sigmund Freud
......................... proposed that mental health or illness is a consequence of social relationships and interpersonal interactions .
Erik Erikson and Harry Stack Sullivan
........................... proposed the theory that adaptive and maladaptive behaviors are learned and repeated because of rewarding reinforcement .
B.F. Skinner
-learning
assessment s/s .....................
-anxiety
-mood changes
-abnormal eating patterns
-chemical dependence
-thought disturbances
diagnosis ....................
-obtain personal and family medical history
-perform mental status examination
-perform psychological testing
-perform lab/diagnostic testing (ruling out something mimicking mental illness- brain tumor, hypoglycemia, etc.)
mental status examination ...................
-physical appearance
-orientation
-attention/ concentration
-short-term/long-term memory
-movement/ coordination
-speech patterns
-mood
-intellectual performance
-perception
-insight
-judgment
-thought content
psychological tests administered to detect ......................
-personality characteristics
-interpersonal conflicts
-self-concept
lab/diagnostic testing ..................
-definitive diagnosis is usually achieved by ruling out other diseases that manifest similar symptoms.
-EEG
-CT
-MRI
-PET Scans
-brain mapping- the technique that compares a clients' brain activity patterns with a computerized database of electrophysiological abnormalities.
management ....................
-treatment depends on the specific diagnosis.
-drug therapy- corrects the underlying biochemical abnormality.
-psychotherapy, cognitive therapy and behavior modifications- uncover repressed thoughts and emotions and identify healthier coping mechanisms
brain and psychosomatic function ........................
-emotions, which originate in brain structures and chemicals, can powerfully influence an individuals health and sense of well-being.
-stress- physiologic response to biologic stressors, psychological stressors or sociologic stressors.
just the right amount of stress ....................
eustress
excessive, ill-timed or unrelieved stress .....................
distress
nonspecific physiologic response to a stressor .....................
distress triggers general adaptation syndrome
ANS consists of ................
sympathetic and parasympathetic divisions
most common pathway for the stress response is through ...................
sympathetic division
unconscious tactics humans use to protect themselves from feeling inadequate or threatened ...................
coping mechanisms
.................... refers to the mind .
psyche
................ refers to the body .
soma
....................... means "pertaining to the mind-body relationship" .
psychosomatic
illnesses influenced by the mind .......................
psychosomatic illness
medical conditions associated with or aggravated by stress .........................
psychosomatic disorders AKA stress-related disorders
stress can affect the ........................ by lowering the number of ......................... and the ...........................
immune system, WBC, immune system's disease fighters
AKA cytokines: that function in the same way as neurotransmitters (they relay messages throughout the immune system & brain) ........................
immunopeptides
immune cells secrete small quantities of .........................
neurochemicals
many stress related diseases involve .....................
-allergic
-inflammatory
-altered immune responses
the brain-immune system connection suggests that changes in body chemistry during periods of stress ....................
triggers an autoimmune response or result in immunosuppression
research suggests that there may be a generic disease-prone personality with character traits that include .........................
-anger
-hostility
-depression
-anxiety
the type of disease that develops depends on ........................
-individual health habits
-environmental exposure
-family history
-anxiety
assessment of S/S.....................
-heart palpitations
-pounding headache
-breathlessness
-tightness in the chest/chest pain
-chronic pain
-irritability
-epigastric pain
-abdominal discomfort & bloating
-constipation alternating with diarrhea
diagnostics .............
-performed to determine the extent of the disease and all physical causes for the clients symptoms

-many conditions can mimic the signs and symptoms of stress-related disease

-it is important to conduct test before assuming the disorder is stress induced
nursing management .....................
-standard medical care pertinent to diagnosis
-control of physical symptoms
-implementation of methods effective in managing stress
-supporting the immune system
pharmacology ........................
-obtain complete current medication history

-anti-inflammatory drugs and corticosteroids often are the treatment for symptoms of psychosomatic diseases.
techniques that use the mind and body to alter disease .....................
psychobiologic intervention
an inert or inactive substance that by its very nature cannot alter physiology ....................
placebo
refers to the healing or improvement that takes place simply because the individual believes a treatment method will be effective ........................
placebo effect
placebo effect ......................
shows how a person's belief system can positively influence health and that a purely psychological basis for recovery exists
we can significantly affect wellness by ............................
-communicating caring
-optimism about treatment
-belief that the client has the ability to recover
a vague uneasy feeling, the cause of which is not readily identifiable & is evoked when a person anticipates nonspecific danger .....................
anxiety
a feeling of terror in response to someone or something specific that a person perceives as dangerous or threatening ....................
fear
anxiety facts ..................
-anxiety and fear are normal human responses

-anxiety disorders are not normal human responses

-anxiety disorders may be biological, learned, and/or unconscious emotional conflicts
medical and surgical clients feel ......................... and may experience different levels of ..........................
vulnerable, anxiety
it is the nurses job with anxiety to ..........................
recognize, understand, and intervene appropriately to the client's anxiety
types of anxiety ........................
-milk
-moderate
-severe
-panic
mild anxiety ................
-attention is heightened
-sensory perception is expanded
-focus is on stimuli
-reality is intact
-information processing is accurate
-person feels in control
-muscle tone increases
-heart rate, blood pressure, breathing slightly increase
-perspiration is noticeable
-positive affect
moderate anxiety ....................
-more easily distracted
-concentration is slightly impaired
-can redirect attention
-learning takes more effort
-perception narrows
-problem-solving becomes difficult
-person is irritable and feels inadequate
-muscles are tense
-slight leg or hand tremors may occur
-rate, pitch, & volume of speech change
-respiratory depth and vital signs increase
-sleep is disturbed
severe anxiety ......................
-attention span decreases
-cannot concentrate or remain focused
-perception is reduced
-ability to learn is impaired
-information processing is inaccurate or incomplete
-person is aware of extreme discomfort
effort is needed to control emotions
-person feels incompetent
-symptoms include hyperventilation, dizziness, tachycardia, palpitations, hypertension
-fine motor movement is impaired
-communication is limited
panic ........................
-exaggerates details
-perception is distorted
-learning is disabled
-thoughts are fragmented
-cannot control emotions and feels helpless
-speech is incoherent
-movements are haphazard, usually in an effort to escape
-symptoms include dyspnea, fainting, tremors, and diaphoresis
anxiety management ..............
-building trust
-restoring comfort
-modifying communication
-adjusting teaching
-helping problem-solve
-ensuring safety
building trust with anxiety ..................
-be available
-be attentive to the client's needs
-do not leave an anxious client alone
restoring comfort .................
-interventions are guided by what will bring relief to that person
-ask the client to suggest methods that may be comforting
-ask 1st
especially with touch
modifying communication with anxiety ......................
-avoid interrupting anxious clients
-allow the client to talk about their anxiety
-allow the client to explore methods for dealing with problems
-if the client does not want to discuss their anxiety and fears, the nurse needs to respect the client's right to privacy
-offer a referral to a health professional such as a psychiatrist or a medical social worker
adjust teaching with anxiety ...................
-directions and explanations must be simple, brief, and repeated frequently

-ask the person to paraphrase what he or she has been taught

-reduce sensory stimulation

-avoid expecting the client to show a great deal of self-reliance or independence until the client feels more relaxed and secure
helping problem solve with anxiety ..............................
-avoid influencing your clients decision making

-help the clients to:
(1) Identify problem
(2) Determine cause
(3) Explore possible solutions
(4) Examine the pros and cons of each option
(5) Select the choice that is most compatible with
personal values
ensuring safety with anxiety .......................
-may act impulsively and endanger their safety

-nurse needs to remain calm

-have only one nurse interact with the client

-responding to multiple sources of stimulation adds to the client's agitation

-avoid touching or getting physically close without permission

-intruding the client's personal space is likely to increase anxiety
a group of psychobiologic illnesses that result from activation of the autonomic nervous system ...................
anxiety disorders
anxiety disorders sometimes tend to be .......................
chronic and sometimes appear without any logical explanation
anxiety can lead to .....................
-depression
-substance abuse
-binge-eating
-compulsive overeating
types of anxiety disorders ...................
(1) Generalized anxiety disorder
(2) Panic disorder
(3) Phobic disorders
(4) Post-traumatic stress disorder
(5) Obsessive-compulsive disorder
generalized anxiety disorders ........................
-chronic worrying on a daily basis for 6 or more months
-usually more than one focus of worry
-worrying is out of proportion with reality
-other signs and symptoms of anxiety accompany the clients distress
conditions resembling anxiety ..................
-mitral valve prolapse
-hypoglycemia
-hyperthyroidism
-premenstrual syndrome
-menopause
-dementia
-abuse of psychostimulants (cocaine, caffeine, weight loss drugs)
-sedative (alcohol, opioids, barbiturates) withdrawal
most extreme manifestation of anxiety .................
panic disorder

-abrupt onset of physical symptoms and terror that include:
1. intense apprehension
2. tachycardia
3. palpitations
4. chest pain
5. smothering or choking sensations; hyperventilation; lightheadedness;
6. feeling of impending doom; and fear of fainting, dying, losing control or going insane
panic disorder can last ...............................
minutes to less than 1 hr and then spontaneously subside
panic disorder .........................
-first instinct is to escape to a safer place

-unexplained flight from work, school often strains relationships with others who observe the client's behavior as strange

-person is at a loss to identify its cause but associates the location or concurrent activity as the precipitating event

-most cope by avoiding situations or places where attacks have occurred
people often develop ..................... with panic disorders .
agoraphobia
a fear of experiencing a panic attack in a place where the person may be publicly humiliated by his or her behavior or help may be unavailable ......................
agoraphobia

-permanently confine themselves to their homes
phobic disorders .....................
-conditions in which a person manifests an exaggerated fear.

-when exposed to phobic stimuli they experience symptoms of anxiety that may reach severe or panic levels.

-includes social phobia "social anxiety" which is fear of situations in which they must perform in front of or may capture the attention of others.

-the greatest worry is that they will be embarrassed or criticized for failing to meet standards.
a condition that involves a delayed anxiety response 3 or more months after an emotionally traumatic experience ....................
post traumatic stress disorder (ptsd)
PTSD factors .........................
-witnessing a murder or violent crime
-escaping a fiery crash
-seeing military friends killed
-being raped or abused
-surviving a natural disaster
-being taken hostage
signs of PTSD ...................
-feel helpless

-feel guilty for surviving while others died

-initially avoids dealing with tragedy and detaches self; called psychic numbing

-months or years later, memories resurface in recurrent nightmares or flashbacks

-resembling situation may also bring back memories

-some abuse substances such as alcohol, or drugs to relieve symptoms of guilt, grief, anger, or sadness
manifested by the performance of an anxiety-relieving ritual to terminate a disturbing, persistent thought ..................
obsessive compulsive disorder (OCD)
performance of an anxiety-relieving ritual ..................
compulsion
disturbing, persistent thought ...........................
obsession
OCD compulsions ....................
-cleaning
-washing
-checking
-counting
-touching
-hoarding
-repeating
OCD rituals ..................
-rituals become excessive and time-consuming

-if person resists performing the compulsive act anxiety escalates

-interruptions also escalate anxiety

-may lead to problems in social relationships, failure in school, or loss of employment

-most OCD clients recognize that their thoughts and behaviors are ridiculous, but are helpless to stop
patho of OCD ....................
-studies suggest familial patterns

1) Inherited faulty physiology
2) Maladaptive learning
3) Acquisition of personality traits modeled by others
a ring of neural structures is buried within the cerebrum .....................
limbic system

1) made up of portions of the
thalamus, hypothalamus, &
other structures

2) is a physiologic network for
emotions, survival and
behavioral responses, motivation,
& learning
(hypothalamic-pituitary-adrenal axis) the psychological sense of danger triggers neuroendocrine changes throughout the ..................
-HIPPOCAMPUS
-HYPOTHAMLAMUS
-PITUITARY
-ADRENAL GLANDS


-dysregulation of the system can result in an unrelieved stress response and stress-related disorders.
patho of hypothalamic-pituitary-adrenal axis ....................
-symptoms are manifested because:

1) norepinephrine floods
the limbic system
2) dysregulation of GABA
3) depletion of serotonin
4) combination of these
s/s of anxiety disorders .................
-most clients seek treatment for physical signs & Symptoms
-behavioral
-cognitive
-emotional effects
anxiety in older adults may be manifested as ....................
1) confusion
2) behavior changes
3) withdrawal

-assess loss of significant others
-relocation
-fears about future
-self-care abilities
dx. findings of anxiety .................
1. Lab - normal
2. ECG - normal
3. PET - may show abnormal brain use of glucose
4. CT - essentially normal
5. MRI - may show atrophy in some brain areas

diagnosis is based of symptomatology and history
medical management of anxiety .............
1) does not eliminate causative factors

2) reduces or blocks levels of norepinephrine

3) normalizes levels of serotonin

psychotherapy

1) involves talking with a psychiatrist, psychologist, or
mental health counselor

2) May be one on one or group sessions
drugs that relieve symptoms of anxiety ......................
anxiolytics

-BENZODIAZEPINES: Xanax, Ativan, Valium, Serax (Oxazepam)

-NONBENZODIAZEPINES: BuSpar, Paxil, Luvox
beta adrenergic blockers .....................
-Inderal, Ternormin, Lopressor

do not cause sedation, tolerance, or addiction- try these first

-lowers BP, helps take care of sympathetic symptoms. Take these with CHF, HTN
central acting sympatholytics .......................
-Catapres, Aldomet, Wytensin

-reduce HR and blood pressure (2nd choice)
pick .................. first then ..................
1. beta-adrenergic blockers
2. central acting sympatholytics
antidepressants ......................
-Luvox
-Zoloft
-Paxil
-Prozac
-Tricyclic Antidepressants
a type of psychotherapy in which the therapist helps clients alter their irrational thinking,
corrects their faulty belief systems, & replaces negative self-statements with positive ones ....................
cognitive therapy

1. is based on the theory that it is not events that provoke anxiety but rather the person's
interpretation of events

2. reshapes the persons viewpoint
attempts to extinguish undesirable responses by learning other adaptive techniques. desensitization may be used which involves providing emotional support while gradually
exposing a person to whatever it is that provokes anxiety ....................
behavioral therapy

-if anxiety escalates, the therapist uses distraction or relaxation or breathing exercises to
overcome symptoms
Nursing Rules with anxiety ..........................
-have the client rate his or her anxiety level using a scale from 0-10
-determine the level at which the client feels that anxiety is tolerable
-clients with anxiety should avoid caffeine
-reduce external stimuli
-maintain a calm manner
-take a position at least arm's length away from client
-avoid touching the client without first asking permission
-establish trust by being available to the client and keeping promises
-advise client to seek out nurse or another supportive person when feeling effects of anxiety
-stay with the client during periods of severe anxiety
-follow a consistent schedule for routine activities
-encourage client to ID what he or she perceives to be a threat
-use a soft voice, short sentences, & clear messages when exchanging information
-provide specific directions for tasks
how to help a client with moderate or severe anxiety ..................
-instruct client to count slowly backward from 100
-instruct client to have client breathe slowly and deeply in through nose and out through mouth
-offer a warm bath or back rub
-help client to progressively relax
instruct client to repeat positive statements such as "I am in control", "I am safe"
-instruct client to visualize a pleasant, relaxing place
-instruct client to listen to a relaxation tape or soothing music
-instruct client to engage in a large-muscle activity such as riding an exercise bike
-administer anti-anxiety meds
outcomes for anxiety ..................
-client deals with anxiety-provoking stimuli realistically.

-implements measures to decrease anxiety.

-have periods where anxiety is tolerable.

-participates in normal activities without becoming incapacitated by anxiety.
refers to a person's overall feeling state. is displayed in a person's affect .......................
mood
the verbal and nonverbal behavior that communicates feelings ......................
affect
people with normal moods ....................
euthymic
a feeling of unremitting sadness (less severe than major depression) ........................
dysthymia
alternating sad and elated moods (resembles bipolar) .......................
cyclothymia
the frenzied state of euphoria exhibited by persons during manic phase of bipolar disorder ..................
mania
extreme persistent mood or severe mood swings that interfere with social relationships ......................
mood disorders
list of mood disorders ....................
-unipolar depression (major depression)
-bipolar disorder
-psychotic depression
-seasonal affective disorder (SAD)
sensory phenomena such as hearing voices or seeing images that do not objectively exist ....................
halluctinations
fixed false belief that often are persecutory or guilt-ridden in nature .......................
delusions
characterized by depression that develops during winter and disappears in Spring ......................
seasonal affective disorder
normal depression, can be directly relation to an event- ex car wreck ........................
transient depression:
(AKA) reactive depression
depression that is self limiting, will resolve with time or support- therapy, takes longer than transient ........................
reactive depression
depression that is a sad mood with no obvious relationship
to situational events .......................
major depression
major depression ....................
-AKA unipolar

-14.9 million people suffer from major depression

-is usually a co-morbid condition among people with anxiety disorders & substance abuse
major depression patho .................
-mood depends on interplay of neurotransmitters

-likely generated by the limbic system (center of emotions)

-could be biological - genetics, dysregulation of neurotransmitters, & neuroendocrine imbalance

-Psychological - infantile rejection or neglect, learned feelings of helplessness, chronic exposure to discrimination or distorted or false perceptions

-research gives more support to biologic explanations

-even when raised separately, blood relatives may have mood disorders

-such as identical twins
neurotransmitter dysregulation: monoamine hypothesis .................
depression results from imbalances in one or more of the monoamine neurotransmitters (serotonin, norepinephrine and dopamine) could be disruption in 1 or all

based of the fact that:
1. Norepinephrine levels may be low or high among people affected by depression
2. Excess of dopamine is associated with distortion of thoughts
neuroendocrine imbalance .......................
-pituitary, adrenal cortex, thyroid gland & ovaries produce depression by alternating levels of hormones.

-stimulated and suppressed through the hypothalamus

-abnormal levels of cortisol and variations in thyroid hormones produce changes in mood & motor activity

-hypothalamus also influences pituitary glands stimulation of reproductive
hormones
s/s of major depression ..................
-Sad mood
-Appetite change
-Disturbed sleep
-Inability to concentrate
-Marked decrease in pleasure
-Apathy, including lack of interest in sex
-Guilty feelings
-Energy changes
-Suicidal thoughts
conditions mimicking depression .......................
-hypothyroidism
-brain tumor
-alcohol or sedative abuse
-stimulant withdrawal
-chronic hypoxia
-side effects of drug therapy: corticosteroids and antihypertensives
diagnostic of depression ...................
-Dexamethasone Suppression Test (DST): AKA Cortisol Suppression Test

-Blood Test

-Diagnostic if cortisol levels remain elevated despite taking an oral dose of dexamethasone the previous day

-CT or MRI Scans
-performed to eliminate diagnosis such as brain tumor or CVA which may be the cause for altered mood

-Pet Scan
-shows a change in activity in the prefrontal cortex suggestive of a mood disorder
treatment for depression ....................
-drug therapy
-psychotherapy
-electroconvulsive therapy
-vagus nerve stimulation
-deep brain stimulation
-transcranial magnetic stimulation
top 3 treatments .......................
1. drug
2. psychotherapy
3. electroconvulsive therapy
drug therapy for depression .................
-TCAs (tricyclic antidepressants)
-MAOIs (Monoamine oxidase inhibitors)
-SSRIs (Selective serotonin reuptake inhibitors)
-SNRIs (Serotonin norepinephrine reuptake inhibitors)
-SSNRIs (Selective serotonin norepinephrine reuptake inhibitors)
-Atypical antidepressants

PROBABLY TAKE A COMBINATION OF THESE, THEN TAKE SOMETHING ELSE FOR THE SIDE EFFECTS
antidepressants ...............
-most increase or potentiate levels of serotonin
potentially life-threatening condition from high levels of serotonin in the blood from drug therapy ....................
serotonin syndrome
s/s of serotonin syndrome .................
-fever
-sweating
-shivering
-intoxication feeling
-confusion
-restlessness
-anxiety
-disorientation
-ataxia
-tachycardia
-hypertension
-muscular spasms
-rigidity
causes of serotonin syndrome ......................
-antidepressants from different classes such as MAOIs and SSRIs are co-prescribed

-the time between weaning from one antidepressant drug to initiating another is inadequate

-other serotonergic agonists, drugs that stimulate serotonin receptors, are combined with antidepressant therapy

temporarily withhold antidepressant
severe cases of serotonin syndrome .....................
-anxiolytic drugs such as:
1. diazepam (Valium)
2. beta-adrenergic blockers: propranolol (Inderol) or skeletal muscle relaxants dantrolene (Dantrium)
tricyclic antidepressants ...................
-elavil and tofranil (1st group of drugs used)

-tricyclics: 3 chemical attachments in their organic molecular structure
-many other variations have been developed such as bicyclics and heterocyclics

-collectively called cyclic antidepressants
cyclic antidepressants job ..................
-block the reuptake of serotonin and norepinephrine

-take 10-28 days to notice change in mood

-highly lethal if taken in an overdose

-monitor liver toxicity and bone marrow depression

-taper dosage when discontinuing

-side effects: postural hypotension, tachycardia, cardiac dysrhythmias, blurred vision, dry mouth, urinary retention,
and constipation

sit up slow, sit on side of the bed. keep a log of BP and HR
monoamine oxidase inhibitors .....................
-block the enzyme that breaks down monoamines

-may take 3-6 weeks before therapeutic effect

-taper dosage when discontinuing

-side effects: headache, nausea, vomiting, sweating, palpitations, visual changes, neck stiffness, sensitivity to light, and tachycardia
selective serotonin reuptake inhibitors ......................
-block the reuptake of serotonin and lesser amounts of norepinephrine

-widely used because:
1. They have milder side effects
2. They are unlikely to cause death in causes of overdose
3. Dosages do not need much adjustment
4. Lag time is short
(3-10 days)
SSRI's side effects .......................
-side effects: weight loss, insomnia, tremor, nervousness, headache, decreased libido, erectile dysfunction

taper dosage when discontinuing
serotonin norepinephrine reuptake inhibitors ....................
-block reuptake of serotonin and norepinephrine & reduce sensitivity to glutamate

-side Effects: weight gain or loss, insomnia, decreased libido, erectile dysfunction, chest pain/heart palpitations

-taper dosage when discontinuing
atypical antidepressants ..................
-wellbutrin- blocks reuptake of dopamine and norepinephrine and have slight effect on serotonin. Affects all 3 neurotransmitters, so could start out taking it to see if it helps

-ludiomil- blocks reuptake of norepinephrine

-side effects: weight loss or gain, nervousness, anxiety, decreased libido
-taper dosage when discontinuing
talking with a psychiatrist, psychologist, or mental health counselor, promotes coping with emotional problems, gaining insight into behaviors, and learning techniques that can improve well being .................
psychotherapy

-types:
1. psychodynamic psychotherapy
2. interpersonal psychotherapy
3. supportive psychotherapy
4. cognitive therapy
5. behavioral therapy
this therapy - clients discuss their early life experiences to raise repressed feelings to a conscious level .......................
psychodynamic
this therapy - bond between therapist & client, this trust helps clients gain an understanding of their condition & the courage & support to overcome it ...................
interpersonal
this therapy - clients learn about their disorder & treatment techniques, improve social skills, obtain positive reinforcement for progress, & gain encouragement to persevere ......................
supportive
this therapy - helps clients replace negative & often illogical ways of thinking with more positive outlooks ....................
cognitive
this therapy - endeavors to change unhealthy ways or behaving, rewards are given verbally when clients alter their behavior positively ........................
behavioral
electroconvulsive therapy ......................
-uses the application of an electric stimulus to one or both temporal regions of the head to produce a brief, generalized seizure.

-believed to work by increasing circulating levels of monoamine neurotransmitters or by improving transmissions to receptor site

-after effects: HA, soreness of skeletal muscles, temporary confusion, short-term memory loss, brief learning disability

-administered on an ambulatory,
outpatient basis

WHEN ALL OTHER TREATMENTS HAVE FAILED
alternative therapies ................
-vagus nerve stimulation
-deep brain stimulation
-transcranial magnetic stimulation
an electrode is tunneled beneath the skin at the neck, one end is attached to the vagus nerve. other end is connected to a pulse generator implanted in the chest. pulse generator sends intermittent electrical impulses toward the brain via the vagus nerve ......................
vagus nerve stimulation

-clients may experience: hoarseness, cough, or some shortness of breath

-can take 9-12 months for relief of symptoms
believed that sending continuous electrical signals via DBS can alter brain circulation and relieve depression. implanting an electrode in the brain through a small opening in skull. distal end is passed under the skin of the head, neck, and shoulder and eventually connecting to a neurostimulator implanted under the skin near the clavicle, chest or abdomen ...................
deep brain stimulation
side effects of deep brain stimulation ................
-temporary tingling in the face or limbs
-speech or vision problems
-jolting or shocking sensations
-dizziness
-reduced coordination
-difficulty concentrating
stimulation of the brain occurs by delivering short pulses of energy through an electromagnetic coil placed against the scalp near the forehead .....................
transcranial magnetic stimulation

-aimed at brain cells within the limbic system

-3,000 pulses administered per minute for 20-40 minutes, up to 5x/week to everyday for several weeks
suicidality ...............
-clients that are depressed may also experience suicidal thoughts.

-the rate of suicide is extremely high in older adults.
suicide assessment .................
-always ask the client direct questions if you feel the client is suicidal: clues to Suicidal Intentions Box 69-5, page 1185

-to gather more information, use the mnemonic SLAP:
-Specificity
-Lethality
-Availability
-Proximity
nursing assessment of the depressed ..............
-assess the client physically
-monitor mood and affect
-assume that if a client is depressed they may be suicidal: Ask bluntly "Do you feel like killing yourself?"
-if they admit to being suicidal, determine if they have a plan: Is it feasible? Is it high or low lethality?
-determine the level at which the client can carry out activities of daily living
a primitive biologic response triggered by photoperiods (daytime hours that are short because of fewer hours of sunlight) ........................
seasonal affective disorder

-light rays follow a visual pathway to the hypothalamus

-hypothalamus relays the light-sensing data to the pineal gland

-melatonin affects regulation of serotonin, induces sleep during dark hours and is suppressed by daylight
assessment of SAD ..................
-commonly found to be sleepy, fatigued, and lethargic during the winter
-lack of energy causes feelings of irritability, unable to concentrate, worthless, guilty, depressed, and suicidal
-it is bimodal- means it cycles with the seasons (depressed during winter/high spirits in spring)
-no diagnostic test can confirm SAD
medical management of SAD ...................
-move to a sunnier location
-phototherapy- uses artificial light that simulates the intensity of sunlight
-treated as outpatient
bipolar disorder ....................
-bipolar 1 disorder
-bipolar 2 disorder

involves cycling among depressive, euthymic, and euphoric moods
severely dysfunctional moods lasting several months; depressive phases tend to be longer than manic phases ....................
-bipolar 1

may manifest psychotic symptoms such as delusions and hallucinations
severe depression alternating with hypomania between periods of euthymia. client never has psychotic symptoms .....................
-bipolar 2

-subtypes:
1. Cyclothymic Disorder
2. Mixed Bipolar Disorder
3. Rapid Cycling Bipolar Disorder
4. Ultra Rapid Cycling Bipolar Disorder
pathophysiology of bipolar disorder ............................
-extremes in levels of monoamines- excessive in mania and inadequate during depression

-in severe cases excess dopamine may cause distorted thinking and hallucinations

-insufficient gamma-aminobutyric acid (GABA)

-altered blood calcium levels because calcium is required for exciting neurons

-genetic predisposition
s/s of bipolar ...............
-depressive phase- same as those with major depression

-manic phase- hyperactive, exaggerated sense of their own importance, can quickly become angry and aggressive, they go without sleep for long periods

-extremely ill and will experience psychotic features such as hallucinations and delusions making them become homicidal or suicidal
diagnostic for bipolar ................
-diagnosis is based on clients history and by patterns of "highs" and "lows"
mood stabilizing medications .................
-lithium
-depakote
-trileptal
-zyprexa
-trilafon
-anticonvulsants (tegretol, depakote)
lithium .................
-alters sodium transport in nerve and muscle cells, increases intraneural stores, and inhibits release of norepinephrine and dopamine.

-side effects: hand tremors, nausea, vomiting, diarrhea, thirst, polyuria, sedation, thyroid dysfunction, wrist and ankle edema
depakote .....................
-may increase levels of GABA

-side effects: drowsiness, mild tremor, ataxia, nausea, vomiting, and diarrhea
trileptal ...................
-decreases rate of neuronal impulse transmission

-side effects: dizziness, drowsiness, unsteady gait, nausea, vomiting, skin rash, liver toxicity, hyponatremia, ankle swelling, birth defects
get liver labs checked frequently
prescription for birth control with Trileptal
zyprexa .................
-mechanism of action not fully understood; blocks dopamine receptors in the brain; and also serotonin

-side effects: somnolence, dizziness, nervousness, orthostatic hypotension, tardive dyskinesia
trilafon .................
-acts at all levels of the central nervous system, particularly the hypothalamus

-side effects: postural hypotension, dizziness, anxiety, headache, insomnia
anticonvulsants with bipolar ...................
-achieve their therapeutic effects by enhancing the action of GABA

-tegretol- decreases the incidence and frequency of mood swings among rapid cycles

-depakote- enhances GABA activity
nursing management of bipolar ........................
-perform initial assessment in brief increments.

-determine types of prescribed medications patient is taking and if they are compliant.

-ask about use of alcohol or other controlled substances.

-obtain information about sleep patterns, hydration, and dietary intake.

-pay attention to hygiene and manner of dress

-prepare for laboratory and diagnostic tests

-record baseline vital signs

-listen to the clients thought content during verbal interactions
discharge with bipolar .................
-make sure they understand the disease process

-how prescribed drugs help in symptom management

-drug effects and side effects

-signs of drug toxicity and actions to take

-frequency of blood tests

-advantage of wearing a medic alert bracelet

-times for outpatient therapy
NEED TO KNOW:
Lithium ....................
always wear a medical alert bracelet
normal lithium levels ................
0.6 to 1.2
occurs in response to hunger and ceases when satiety is obtained .....................
normal eating
involve eating that
-Is outside the range of normal
-Is accompanied by anxiety and guilt
-Results in physiologic imbalances or medical complications .................
eating disorders
prevalence of ED .................
-eating disorders affect from 10-24 million

-all ethnicities & socioeconomic levels

-more prevalent in young women between 12-25 years of age

-clients strive to keep their illness secret

-family and friends may become aware when emotional and behavioral symptoms become repeatedly noticeable or when serious health consequences develop.
types of eating disorders ..................
-anorexia nervosa

-bulimia nervosa

-binge eating

-compulsive overeating
is an eating disorder characterized by an obsession for thinness that is achieved through self-starvation. people only consume 600-900 calories/day .................
anorexia nervosa

-occurs more often in women

-they feel hunger but have a morbid fear of becoming fat
2 types of anorexia ...............
1) severe restriction of caloric intake
2) bulimarexia- characterized by periods of food restriction and periods of binging followed by purging or exercising
pathophysiology of anorexia nervosa .................
-exact cause is unknown

-we believe it can be a result from a combination of cultural, social, psychological, and physiologic factors

-thinness is linked to attractiveness and success, however this image is unhealthy and unrealistic

-self starvation or rigorous physical activity achieves this appearance

-physiological influences may play major roles in development of eating disorders

-neurotransmitters & neurohormones influence normal & abnormal eating patterns by binding with receptors in the appetite center of the hypothalamus.

-may have a dysregulation of serotonin & dopamine
patho continued ..............
-increased serotonin levels contribute to restricted eating, the brain is fooled into believing fullness has occurred

-dopamine in excess can interfere with the ability to recognize and respond appropriately to the potential health hazards from self-starvation

-people with bulimarexia may experience feelings of euphoria at the time of the binge

-recent research located receptors in the brain for melanin-concentrating hormone

-low levels cause weight loss/high levels promote obesity

-another consideration is leptin, it acts on receptors in the hypothalamus where high levels inhibit food intake
the psychological end notes that people with anorexia nervosa are .....................
1. perfectionists

2. have low self-esteem

3. possess intense desire to please others
a form of self-control used to cope with stressful life experiences or dysfunctional family relationships ......................
refusal to eat
complications of refusal to eat ..............
-inadequate nutrition deprives all body systems of nutritional elements required for homeostasis, growth, & cellular repair

-low levels of serum estrogen leads to osteopenia & premature osteoporosis

-starvation leads to vitamin deficiencies, fluid & electrolyte imbalances, & death from cardiac failure or arrhythmia
s/s of refusal to eat ..................
-appear skeleton like
-develop fine body hair called lanugo
-hypotensive
-low-irregular pulse rate
-constipated
-feels cold most of the time
-frequent infections
-cease menstruating
-starvation is concealed by hiding or disposing of food
-dressing in bulky clothing
-when confronted about their danger of dying, they deny the seriousness of others concerns
diagnosis of anorexia ..................
-body mass index- evaluates a persons size in relation to norms

-BMI is usually 16 or less

-anemia is present with electrolyte imbalances

-cardiac irregularities

-bone densitometry- looking to see if osteopenia is present
medical management of anorexia ............................
-nutritional therapy

-drug therapy

-psychotherapy

-family counseling
nutritional therapy .................
-provides nourishing meals, supplemental vitamins and minerals, IV fluids, electrolytes, tube feedings, or total parenteral nutrition

-goal is to establish normal eating behaviors and restore body weight

DON'T DRINK NON-NUTRITIOUS DRINKS. Will fill them up
behavioral therapy with anorexia ..................
-privileges used to reinforce desired behavior

-clients may earn privileges like having visitors and participating in social and physical activities for eating
drug therapy for anorexia .....................
-antidepressants such as SSRI's to manage depressive and obsessive symptoms

-atypical antipsychotics such as Zyprexa and Abilify block dopamine receptors

-supplemental vitamins and minerals

-stool softeners or laxatives
psychotherapy with anorexia .................
-used to help clients gain insight into their distorted perceptions of thinness and the motivations for weight loss behaviors.
family counseling with anorexia ..................
aimed at relieving the power struggle between the client and those who try to convince the client to eat
nursing process of anorexia .................
-perform a physical assessment

-monitor vital signs on a regular basis

-cardiac monitoring to detect dysrhythmias

-weight/calculate BMI

-obtain nutritional history

-ask if the client restricts food intake or combines it with purging

-ask female clients for date of last menstrual period

-observe mood and anxiety levels

-ask about family dynamics and other stressors
expected outcomes for anorexia nervosa ................
-client consumes nutritious food

-gradual weight gain

-the client will attain and maintain a BMI of at least 16

-client no longer perceives themselves as fat
characterized by a minimum of 2 episodes of secret "food binges" per week followed by behaviors intended to prevent weight gain ......................
-bulimia nervosa

-must persist for at least 6 months

-clients are generally older at the onset

-are overweight or normal weight

-admit that their eating behavior is abnormal

-are ashamed of habitually binging/purging
2 manifestations of bulimia nervosa ....................
1) binging followed by purging
2) binging followed by fasting, using diet pills, or engaging in excessive exercise
pathophysiology of bulimia nervosa ..................
-research suggest that clients have a biochemically induced compulsion to eat as a result of increased sensitivity to norepinephrine within the hypothalamus and reduced levels of serotonin

-serotonin is synthesized from the essential amino acid tryptophan, binge eating is a mechanism to supply tryptophan to increase serotonin levels

-2 neurohormones: orexin A and orexin B levels contribute to binge eating and obesity in humans

-also Leptin is believed to suppress orexigenic chemicals, so in the absence of leptin or reduced receptors for leptin binge eating occurs

-whatever the cause once binge begins it is difficult to control

-clients usually consume 3,500-11,500 calories of food in 2 hours or less

-only stopping because of things such as: abdominal pain, interruption, or sleeping

-once they consume all of this food they then fast or exercise due to guilt
complications of bulimia nervosa .........................
-repetitive regurgitation of gastric acid damage teeth by eroding dental enamel and cause pharyngeal irritation

-abuse of laxatives contributes to constipation
se of diuretics can predispose to fluid, electrolyte, and cardiac problems

-some abuse drugs/alcohol

-shame/guilt may trigger suicidal thoughts or attempts
s/s of bulimia nervosa .................
-normal weight or slightly overweight
-fluctuate as much as 10lbs/week
-hoarseness
-inflammation of esophagus/oral pharynx
-calluses on back hand/fingers from stimulating gag reflex
-erosion of tooth enamel
-swollen parotid glands
diangosis of bulimia nervosa ..................
-based on clinical findings
-history of persistent binging/purging
-serum electrolyte imbalance
-radiograph of upper GI tract shows overstretched or stenotic esophagus
medical management of bulimia nervosa ....................
-drug therapy with antidepressants
-individual/group psychotherapy
-behavior modification techniques
-most managed on outpatient basis
nursing management of bulimia nervosa ....................
-need to resume normal eating behaviors & avoid restrictive practices
-accept a body weight higher than they would like
-identify and correct clients' fears and misconceptions about food & weight
-clients need to eat only in the presence of others and at a slow pace
nursing assessment of bulimia nervosa ..................
-obtain client's history/health information
-weight/calculate BMI
-inspect teeth
-examine conjunctiva for ruptured blood vessels
-write down all medications
-if client uses exercise to purge take not of type of activity/duration
-ask questions concerning: frequency of binging/purging, state of mind prior to binge, type & amounts of food during binge, nature of the purge
outcome of bulimia nervosa ................
-the client will delay the urge to binge/purge
-consume no more than 2,000-3,000 calories/day
-need to accept body weight & maintain stable weight
-tooth enamel will be restored or maintained
-will reduce or eliminate health risk practice of chronic vomiting
-implement effective coping mechanisms and report increased self-esteem
characterized as the inability to control overeating, accompanied by a guilty feeling ...................
binge eating disorder
characterized as eating in the absence of hunger or regardless of feeling full .....................
compulsive overeating
pathophysiology of binge and compulsive eating ....................
-can have both
-cause is still unknown
-it is thought that biochemical factors are involved because people with eating disorders suffer from:
-Anxiety
-Depression
-Compulsive Behavior

-likely to be an imbalance of neurotransmitters such as norepinephrine, serotonin, and dopamine or neurohormones such as orexin A & B or leptin

-also many overeaters state they cope with stress by eating
complications of binge and compulsive eating .....................
-many physical/emotional problems

-many develop hyperlipidemia, hypertension, type II diabetes, degenerative arthritis, and sleep apnea

-many feel unhappy, ashamed, and disgusted with themselves

-become socially isolated
s/s of binge and compulsive eating ......................
-overweight
-history of unsuccessful attempts at dieting
-eat in absence of hunger
-preference for high-sugar/high-fat foods
-overeat or binge during emotional changes
-history drug/alcohol abuse
-some have considered suicide or self-mutilation
diagnosis of overeating or binge eating .....................
-BMI= 30 or more

-Lab results show:
1. increased blood sugars
2. increased cholesterol
3. increased serum lipid levels
medical management of binge and overeating .................
-weight reduction- sensible weight loss regimen (Client and Family Teaching 70-2)

-psychotherapy

-self-help support groups

-drug therapy- antidepressants such as SSRI

-teach clients to recognize/differentiate between physiologic & psychological hunger

-surgery for severely obese clients (Bariatric Surgery)
assessment for binge and overeating ...................
-interview the client

-perform comprehensive physical assessment

-calculate BMI
outcome of binge and overeating ...................
-client complies with the food plan

-loses weight gradually

-takes part in group activities

-develops a network of friends
chemical dependance contributes to morbidity and mortality to .......................
-liver damage
-cardiopulmonary disease
-infectious disease
use of a drug for a purpose that is different from its intended use ........................
substance abuse

-common abused drugs:
1. Alcohol
2. Cocaine
3. Heroin
4. Hallucinogens
5. Amphetamines
6. Marijuana
7. Barbiturates
8. Volatile hydrocarbons (glue/nicotine)
.................... and ................. are considered the most harmful substances because they contribute most to morbidity and mortality . tobacco contributes annually to .......................... deaths .
alcohol, nicotine, 443,000
refers to the physical symptoms & craving for a drug that occurs when a person abruptly stops using an abused substance ....................
withdrawal
means that a person must take a drug to avoid withdrawal symptoms ........................
chemical dependence
refers to the drug seeking behaviors that interfere with work, relationships, and normal activities .....................
addiction (dependence)
the reduction in a drug's effect that follows persistent use ......................
tolerance
pathophysiology of chemical dependence ..................
-involves many psychobiologic factors

-often begins with curious experimentation that progresses to habituation, psychological and physical dependence, and finally addiction

-some substances have a pleasurable effect on the limbic system in the brain

-Pychosocial Dynamics- observing family members, peers, and role models use these agents ultimately influence teenagers and young adults
central nervous system stimulants (CNS) .........................
agents that temporarily accelerate physical and mental functions, they affect levels of:

-norepinephrine
-dopamine
-acetylcholine

ex: caffeine, nicotine, cocaine, & amphetamines
central nervous system depressants .........................
chemical agents that slow brain and physiologic activity, they cause effects similar to those of GABA, they either mimic the neurotransmitters by attaching to their receptor sites or block their reuptake

ex: alcohol, heroin, opiates, & barbiturates
treatment for chemical dependence ...................
-clients usually deny their addiction, rationalize substance use, or blame life situations for their drug and drinking habits

-they most often have to "hit bottom" before they will seek help

-some may quit unassisted but most benefit from:
-Chemical Detoxification- a treatment plan that involves abstinence, counseling, and support of peers through a 12-step program
a treatment plan that involves abstinence, counseling, and support of peers through a 12-step program .......................
chemical detoxification
a chronic, progressive, multi-system disease characterized by an inability to control the consumption of alcohol ......................
alcoholism

-women usually experience health problems earlier than men

Can be fatal:
-Hypertension
-Esophageal Varices
- Cirrhosis of the liver
pathophysiology of alcohol dependence ..................
-genetic factors are linked to alcoholism

-evidence suggest that a genetically determined component alters metabolism of alcohol in those with the disease thus producing a substance called tetrahydroisoquinoline (THIQ)

-THIQ creates an intense craving for alcohol and remains in the brain of rats during experiments even during abstinence

-research is also looking at variant genes for dopamine/dopamine receptors & deficiencies in serotonin/serotonin receptors
s/s of alcohol dependence ..............
-history of increasing alcohol consumption, may hide containers of alcohol and drink privately, many develop a tolerance for alcohol and a cross-tolerance (reduced effect) for sedative-hypnotic drugs,

-experience blackouts

-history of marital, financial, and occupational problems

-many have been arrested for driving under the influence of alcohol
withdrawals s/s .......................
-tremors
-sweating
-hypertension
-tachycardia
-heart palpitations
-craving for alcohol
-seizures
-hallucinations
complications of alcohol dependence ....................
-esophagitis
-gastritis
-enlarged liver
-esophageal & rectal bleeding
-pancreatitis
-memory impairment
-babies born to women who consumed alcohol during pregnancy sometimes have fetal alcohol syndrome
diagnostics for alcohol dependence ......................
-blood alcohol level

-increased levels of GGTP, AST & ALT (liver)

-increased levels of amylase & lipase (pancreas)
medical management of alcohol dependence .................
-detoxification

-nutritional therapy

-psychotherapy

-drug therapy
involves stabilizing the client with a sedative drug while the alcohol is metabolized from the client's system .............................
detoxification

-drugs used: ativan, valium, librium

-usually a beta-adrenergic blocker such as Inderal is given to help reduce increased heart rate and blood pressures
nutritional therapy for alcohol dependence .................
-alcoholism leads to undernourished clients that have deficiencies of B vitamins

-thiamine injections for 3 days followed by oral administration and folic acid supplements
psychotherapy for alcohol dependence ...................
-individual or group

-helps clients to gain greater insight into the emotional problems that have led to or resulted from alcohol dependence
drug therapy for alcohol withdrawal .......................
-antabuse is a drug given to people recovering from alcoholism who cannot control the compulsion to drink

-it's a type of aversion therapy because it causes unpleasant physical reactions when alcohol is consumed or absorbed through the skin

-campral- new drug that acts on the neurotransmitter glutamate to alleviate the physiological and psychological distress following withdrawal from alcohol

-naltrexone- used when a person relapses, it reduces the pleasure associated with drinking alcohol
new drug that acts on the neurotransmitter glutamate to alleviate the physiological and psychological distress following withdrawal from alcohol .................
campral
used when a person relapses, it reduces the pleasure associated with drinking alcohol .....................
naltrexone
support groups ..........................
-alcoholics anonymous- run by recovering alcoholics to help people who are dependent on alcohol to get and stay sober
assessment for alcohol dependence .................
-head to toe assessment
-question client about use of alcohol
-determine the type of alcohol used, how much, and when last drink was consumed
-determine history of seizures or symptoms of previous attempts at withdrawal
-monitor for signs or symptoms of withdrawal
-administer breath-alcohol concentration test or blood alcohol level
outcome of alcohol dependence .....................
-vital signs are stable
-symptoms of withdrawal are controlled
-client eats a well-balanced diet
-sleeps an adequate # of hours per night
-demonstrates a willingness to cope with losses associated with overcoming dependence on alcohol
-moves forward with measures to remain sober
nicotine dependence .................
-the stimulant drug in tobacco

-most heavily used addictive, mood-altering substance in the U.S.

-absorbed by:
1. inhaling tobacco in cigarettes, cigars, or pipes
2. absorbed through the mucous membranes of the mouth from loose tobacco
pathophysiology of nicotine withdrawal ......................
-addictive quality of tobacco occurs because of nicotine

-nicotine mimics the neurotransmitter acetylcholine which intensifies the release of dopamine in the brain, promoting an experience of pleasure and reward

-dependence develops as a result of experiencing a combination of:
1. pleasure
2. reward
3. tolerance
................ of adults use tobacco. estimated medical cost is .................... annually .
19%, $96 billion
consequences of smoking .......................
-smoking is responsible for 90% of deaths from lung cancer and chronic obstructive lung disease

-cancers of the mouth, larynx, esophagus, and bladder

-rate of coronary heart disease in smokers is 4-6 times that of a non-smoker

-they are 10 times more likely to develop peripheral vascular disease and strokes

-risk for premature delivery and low-birth weight infants

-breathing secondhand smoke causes headaches and eye, nose, & throat irritation, also increases ones risk for heart disease, lung, and other types of cancers

-mothers that smoke during pregnancy and after delivery have infants that are at more risk for SIDS

-asthma kids have more severe attacks and increased frequency when exposed to secondhand smoke
medical management of smoking ..................
-all smokers and tobacco users are advised to quit

-counseling

-enrollment in behavior-modification programs

-pharmacologic therapy:
1. Non-Nicotine Meds: Zyban, Chantix
2. Nicotine Substitutes: Gum, Patch, Inhaler
nursing management ........................
-counseling them to quit

-providing information on smoking-cessation products and programs

-inform them of the dangers of secondhand smoke to others
cocaine and methamphetamine dependence .........................
-they are CNS stimulants

-similar because of the rapid and excessive release of norepinephrine, dopamine, & serotonin
cocaine is obtained from .....................
leaves of the coca plant

-powder form is snorted or dissolved and injected intravenously

-may be freebased

-metabolism is rapid and is usually followed by an intense craving to use the drug again
a purified form of cocaine with a crystalline or rock like appearance. Smoked in a pipe or sprinkled into or mixed with tobacco or marijuana ......................
crack
made by combining over-the-counter medications containing ephedrine and pseudoephedrine with other chemicals such as ammonia, acetone, & lye ..................
methamphetamine

-usually smoked or injected intravenously

-user experiences extreme pleasure, euphoria, & CNS stimulation similar to that associated with cocaine use
s/s of cocaine and meth use .....................
-cocaine: chronic cough & pulmonary congestion

-meth: acne, covered in multiple scratched lesions and poor tooth enamel and oral tissue decay "meth mouth"

-clients addicted to cocaine and methamphetamines often have a problem with poly-drug abuse

may take sedative drugs like:
-Alcohol
-Minor Tranquilizers
-Barbiturates
-Marijuana
These usually help to offset the clients agitation and irritability
complications of cocaine and meth use .....................
-anorexia
-weight Loss
-memory Impairment
-hallucinations
-cardiac dysrhythmias
-cerebral hemorrhage
-respiratory arrest
-personality & behavioral changes
-paranoia
-psychosis
-hypertension
-seizures
-MI
-newborns can also experience withdrawals if mom used during pregnancy
diagnostic for meth and cocaine use .................
drug test of blood and urine
cocaine medical management and rehab ......................
-cocaine anonymous-provides a source of ongoing support for those addicted

-participation in individual & group psychotherapy

-medications such as Parlodel & Symmetrel- they increase or mimic the effects of dopamine- the neurotransmitter that is most likely responsible for the rewarding & reinforcing effects of addicting substances

-antidepressants
medical management and rehab for meth .....................
-recovery from abuse is more difficult

-may take years of antidepressant drug therapy

-behavior modification techniques
nursing management for cocaine and meth .....................
-assess the clients history of drug use and current physical condition

-look for signs of toxicity/withdrawal

-implement medical treatment

-explain effects of drug abuse and risks for continuing

-monitor for suicidal ideation

-administer medications that provide support during withdrawal
opiate dependence ......................
-an addiction to narcotics, CNS- depressant drugs that are either derived from or chemically similar to opium

-includes: heroin, morphine, codeine, demerol, methadone, dilaudid, oxycodone, and opium

-produce sedation after initial euphoria

-rate of tolerance and chemical dependence is related to the:
1. Drug
2. Dose
3. Frequency of use
assessment findings of opiate dependence ....................
-pupils are pinpoint
-constipation
-anorexia
-weight loss
-malnutrition
-needle mark/scarring
-respiratory depression can lead to death
-needle sharing can lead to AIDS, hepatitis, septicemia
-abscesses
-neonates in withdrawal have high-pitched cry, tremors, insomnia, increased respirations, vomiting, diarrhea, dehydration, and convulsions

diagnostics: urine drug screen
drug therapy for opiate dependence ..................
-rapid recovery (2-5 minutes) from lethargy, hypotension, & respiratory depression after IV administration of narcotic antagonist such as Narcan
medical management of opiate dependence ......................
-withdrawal symptoms are treated with alpha-adrenergic blocker (Catapres) to inhibit the release of norepinephrine

-methadone may be used to eliminate or control withdrawal symptoms

-methadone maintenance therapy- involves substituting one addicting drug for another, Advantage is that the drug is prepared by a pharmaceutical company so the drug is untainted and the dose is reliable

-naltrexone- an opiate antagonist, works by blocking endorphin receptors, if the client returns to opiate abuse while taking this they do not experience the previous level of opiate effects

-psychotherapy- involves treating the complex web of social problems that accompanies the addiction

-Narcotics Anonymous
involves substituting one addicting drug for another, Advantage is that the drug is prepared by a pharmaceutical company so the drug is untainted and the dose is reliable .....................
methadone
an opiate antagonist, works by blocking endorphin receptors, if the client returns to opiate abuse while taking this they do not experience the previous level of opiate effects ...........................
naltrexone
nursing management of opiate dependence ........................
-basically the same as other chemical dependence

-advise client who takes methadone to tell healthcare provider and wear a medic alert tag
thought impairments can occur ................
at any age
a sudden, transient state of confusion ................
delirium

-may have trouble processing information

-may be disoriented to the date, time of day, & location

-judgment may be impaired
delirium can result from things like ...................
-high fever
-head trauma
-brain tumor
-drug intoxication/withdrawal
-metabolic disorders
-inflammatory disorders of the CNS

Treat the medical condition and mental functions improve
condition in which decline in memory, thinking, and reasoning are severe enough to affect the daily life of an alert person .....................
dementia

manifested by a gradual, irreversible loss of intellectual abilities
a progressive, deteriorating brain disorder ....................
alzheimer's

2 types:
1. early onset (bt 30 and 60)
2. late onset (after 60)

-an estimated 5.4 million Americans live with AD today
-by 2030, the incidence of AD is estimated to reach 7.7 million
-by 2050, 11-16 million may be affected
pathophysiology of early onset alzheimers ..............................
-the strongest Alzheimer's markers are mutations that occur on various genes within specific chromosomes (1, 14, and 21)

-the mutated genes cause a disruption in the processing of a substance known as amyloid precursor protein (APP)
pathophysiology of late onset Alzheimer's ......................
-Early-onset- mutated genes are implicated as the etiology

-Late-onset- etiology not as clear, may be a combination of genetic, environmental, and lifestyle factors.
s/s of alzheimer's ................
7 Distinct Stages:
1)Normal mentation
2)Forgetfulness
3)Early confusion
4)Late confusion
5)Early dementia
6)Middle dementia
7)Late dementia

continued:
-Memory loss is the classic symptom

-Memory loss is confined at first to recent information

-Then is progresses to long-term memory and the ability to make appropriate judgments and problem-solve impairment

-Clients may wander and become lost

-Problems with speaking, reading, writing, & calculating develop

-Inability to recognize objects and sounds, difficulty walking, & tremors occur

-Final stage inability to accomplish ADL's
diagnostics of alzheimer's ...................
-CT shows shrinking of the cerebral cortex

-PET & MRI provide structural & metabolic information about the brain

-ECG shows slower-than-normal brain waves

-Nymox AD7C detects beta amyloid protein in CSF or urine

-Diagnosis of AD currently relies on validating mental decline
assessment of alzheimer's ...............
-Interview both client & family

-Assess the caregiver's strength's, limitations, & ability to manage care-giving activities

-Perform complete head-to-toe assessment

-Determine the client's mental status
medical management of alzheimer's ................
-no cure exists
-treatment is supportive
-drug therapy for the treatment of dementia of the Alzheimer's include cholinesterase inhibitors:
-Cognex
-Aricept
-Exelon
-Razadyne
-the newest drug is Namenda.
-antidepressants or tranquilizers may help agitated or depressed clients
alzheimer's medications ...............
-cognex
-aricept
-exelon
-razadyne
-namenda
nursing management of alzheimer's .................
-help the client & caregiver maintain the highest possible quality of life by supporting mental & physical functions & ensuring safety

-provide emotional support & intervene if family caregivers become overburdened

-evaluate nutritional needs

-help the family cope during the client's deterioration
a thought disorder characterized by deterioration in mental functioning, disturbances in sensory perception, & changes in affect (emotion) ....................
schizophrenia

-improves with drug therapy but never fully recover
pathophysiology of schizophrenia ..................
-is categorized as a psychobiologic disease because of recent findings in brain & neurotransmitter chemistry

-many neurotransmitter imbalances are involved

-dopamine excess is the major cause, with imbalances of norepinephrine, serotonin, & GABA also identified

-the neurochemical imbalance produces a variety of manifestations characterized by delusions

-hallucinations that are usually auditory or visual may be experienced
assessment findings of schizophrenia .................
-symptoms usually begin during late adolescence to early adulthood

-positive symptoms- delusions, hallucinations, & fluent but disorganized speech

-negative symptoms- impoverished speech & inability to enjoy relationships or express emotions
diagnosis of schizophrenia .................
-made primarily on symptomatology by ruling out other possible causes

-CT, PET scans, MRI's, & brain mapping may show decreased brain size & activity
medical management of schizophrenia .................
-referred to the care of psychiatrists

-anti-psychotic drugs are the best treatment

-they block receptors for dopamine

examples include:
-Haldol
-Prolixin
-Risperdal
-Clozaril
-Zyprexa

-sometimes these drugs are combined with anticonvulsant drugs such as Klonopin & Tegretol
leading cause of the return of disease symptoms & need for hospitalization with Schizophrenia .................
non compliance

to prevent this: depot injections may be given- IM injections of antipsychotic drugs in an oil suspension that are gradually absorbed
assessment of schizophrenia ..................
-perform a mini-mental status examination
-assess the client for positive & negative symptoms of Schizophrenia including:
1. Delusions
2. Bizarre-speech patterns
3. Hallucinations
4. Agitation
5. Stupor
6. Social withdrawal
-assess physical status including hygiene & nutritional condition
outcomes of schizophrenia .....................
-the client thinks rationally & realistically

-reports fewer delusions & hallucinations

-communication is coherent & understandable

-manages self-care, takes responsibility for ADL's

-socializes

-interacts in group activities
Sets with similar terms