*Anhedonia (feeling of no pleasure) – ineffective coping skill - Anhedonia is prevalent

** ask open ended question

** manipulation
*help the client identify & change unrealistic thoughts
**fluphenazine -- prolixin (typical)
**body weight well behavior ideal???
**phenytoin (Dilantin): anti-seizure med, w/hold before ECT
**Autonomy - Independent (make own choices) their rights should be respected
* ataxia: loss of body movements
Complementary therapy: acupuncture &acupressure, diet &nutrition, chiropractic, therapeutic
touch, massage, yoga, pet therapy, herbal medicine
*Depersonalization: lost of identity/detached fr: oneself
*Loose associations: shift/flights of ideas fr: 1 unrelated topic to another
*Neologism – new words/made up
-Child abuse reporting – nurses are mandatory reporter*
* Gradiosity - (prez of US or God) better than everyone else

Behavior modification for phobias - **Systematic desensitization: intro lil by lil

Identify the nutritional status when someone is 88 lbs & says they’re fat
Lady 68, fell, broke hip, gets fixed, 2nd day of admission a to sx, hallucinating, disoriented, htn,
 DELIRIUM
pt stated can’t think right now – summarize their feelings, eye contact
Interviewing pt, w/ angry appearance  AFFECT

Delusional best response: RESTATE what they said

Mania & manipulative behavior  set limits, set boundaries, consequences
-manic behavior: short term goal paint 15 min (concentration)

Cognitive therapy – mood d/o

-Helps pt change/control thoughts & behaviors to solve current probs
-Kid runs away, mom blames herself, REPLACE W/ + REALISTIC THOUGHTS
Cognitive reframing: Assist pts identify - thoughts that produces anxiety & replace w/+
thoughts. Priority restructuring. Journal Keeping, Assertiveness training (teaches to prob-solve).
Monitor thoughts. Helps pt be aware of - thinking.
Cognitive behavior, specific type of mental tx –modeling?

Pedophile d/o – generic ?, choose best answer (doesn’t have to do w/children)

- Paraphilia- Repetitive/preferred sex fantasies/behaviors that involve: Preference for use of
nonhuman object, Sexual act w/humans involving real /simulated suffering/ humiliation,
Repetitive sexual act w/nonconsenting partners. - men
-Types: Exhibitionistic (exposing genitals to strangers), Fetishistic (fantasies about non living
objects), Pedophilic, Sexual masochism, Sexual sadism, Transvestic, Voyeuristic (peeping tom)

ECT – tx for manic episodes for bipolar, depression, suicide, mania - NPO night before
-they can still refuse tx even after they signed
-w/hold: phenytoin (Dilantin) –Anticonvulsant (2 wks before)
-succinylcholine is given to reduce muscle movements during therapy
-ati: cardiac monitor, 2 tx for 4-6wks, short term mem loss p procedure

Tertiary intervention – outside the hospital “counseling”

ati: refer fams to a grief counselor following suicide
-primary – work w/nurse to determine students @risk for suicide - promoting self–esteem
-secondary: estab telephone hotline for indiv experiencing a suicide crisis, review suicide
precautions w/nursing staff - admin meds to minimize long term effects of violence

Auditory and visual hallucinations what’s the lady doing when she looks over her
shoulder &talks to herself (+symptom) -validate feelings(must be scared) but not hallucinations
Test/Exam: check body for any medical reasons for their psych prob (ex: needs to be medically
cleared before going into psych facility)
Distorted and psychotic  you don’t invite them to any activities

Opioid/heroin(narcotic) : METHADONE (dolopine) – maintenance/prevent w/drawl

symptoms blocks pain receptors… safety &fluids (methadonedolo)
-Barrbitures & Opiods = watch for resp depression
-overdose: take - narcan (Naloxone) has short life (na-na-I-can take more =overdose)
other meds: naltrexone (revia), nalmefene (revex), buprenorphine,
-intox: slurred speech, impaired memory, constricted pupils, decreased resps & loc, low bp
-symp of w/drawal: Dysphoria, muscle aches/weakness, n/v, rhinorrhea, irritated, restless,
piloerection(gooseflesh), sweating, tremors, diarrhea, f & insomnia.
Dependency a physical thing. But may be able to fnc.
addiction it is affecting their daily life. DEPENDENCY CAN LEAD TO ADDICTION

Therapeutic Communication 2
--Effective comm: Silence, Active listening: SOLER, Open-ended ?s, clarifying techniques:
(restating, reflecting, &paraphrasing, exploring), offering general leads/broad opening
statements, showing acceptance & recognition, focusing, asking ?s, giving info, presenting
reality, summarizing, offering self, touch
- Barriers to Effective Comm: Asking irrelevant personal ?s, offering personal opinions, giving
advice, false reassurances, minimizing feelings, changing the topic, asking “why”, offering value
judgments, excessive questioning, responding approvingly/disapprovingly

culture is select all that applies

Anorexia nervosa 4 it’s the longest answer but also the obvious one
-they believe/see that they are fat, when they’re not
-feeling cold all the time bcuz doesn’t have enough fat
-ati: displays poor sense of self-identity, amenorrhea (abnormal period), relentless exercise,
restlessness
ati: restricting type decrease calorie intake , restrict caffeine
-increase fiber to prevent constipation, intake should be btwn 1200-2500, orthostatic
hypotenstion
-Morbid fear of obesity, Gross distortion of body image, preoccupations w/food, refusal to eat
&maintain body wt. Wt loss= extreme. Often in females
-Symptoms: hypothermia, bradycardia, “baby hair” called LANUGO on the face, back &arms .
often associated w/anxiety &depression. (feel more calm when they aren’t near food)
-ati: weight loss of over 30% in 6 mnths, hypothermia (<96.8), K < 3, HR <40
Bulimia Nervosa: maintain normal range of weight/higher -females
- Uncontrolled, compulsive, rapid ingestion of large amounts of food followed by v/laxative.
-ati: binge eating abdominal pain (excessive foods)
-types: purging (self-induced v, lax, diuretics &/or enemas to lose/maintain weight)
nonpurging (excessive exercise)
-Complications: low self-esteem, impulsivity, & difficulty w/interpersonal relationships.
Low BP, Orthostatic HTN, decrease pulse & body temp, irregular HR & Poor skin turgor
Enlargement of Parotid, dental erosion & caries, calluses on knuckles, russell’s signs
 using food to cope Helps temp & then feel guilty afterwards. More common>anorexia. acid
stomach leads to erosion of the esophagus.

Major depression – 3 -adolescent, give away possession, no hx of manic behavior

-risk for suicide  1:1 (ati: short term goal: sign contract;; “there’s no point in living any longer”
“it’s easier to talk about my feelings now” “thanks for taking care of me”) 3rd leading cause of
death -“No matter what I do, everything turns out bad” -total despair
-do you have feel like hurting themselves, do they have a plan , are they taking their meds

Depression– give them a structured program. go w/them (don’t give choice) make time for pt
-relapse teaching: early identification of changes such as decreased social involvement =
important PROVIDE SPECIFIC DIRECTIONS
feeling useless – “not going to fam reunion bcuz no one asked”
Signs: flat affect, anhedonia, feeling hopeless
Increase risk for depression is a client who has COPD

Alcohol withdrawal 6 –very lethal -Occur w/in 24hrs (4-12hrs mainly)

-heavy use can cause CIRRHOSIS (end stage of liver disease)
-beginning important = rest & nutrition
benzo  chlordiazepoxide (libirium), lorazepam (Ativan) diazepam(valium – dry mouth) - alc
detox used for w/drawal
Other meds: Aprazolam (Xanax) – dry mouth, clonazepam (klonopin), anticonvulsants,
multivit therapy, thiamine, antianxiety meds
-beginning of w/drawal: tremors (start <24hrs of last drink), weakness, elevated temperature,
high bp, tachycardia, sweating, risk for seizure*
-SE: headache, insomnia, sedation, irritated, n/v, depression, anxious
-ati: intox: gather supplies for endotracheal intubation (ER)
-Priority intervention: date & time of last drink
-Support group purpose: provide assurance that others have similar prob. to maintain abstinence
- “I am powerless about my addiction to alc” basic concept of aa
-disulfiram (Antabuse): daily oral, for alc dependence –MAINTAIN ABSTINENCE, no alc -
vanilla extract , can cause acetaldehyde syndrome.
-other meds: naltrexone (revia), nalmefene (revex), ssris, acamprosate (campral)

CAGE questionnaire– alc abuse

-Cut down on your drinking? Annoyed you by criticizing your drinking? felt Guilty about
drinking? needed a drink 1st thing in the am(Eye-opener) to steady your nerves/to get rid of a
hangover?

Alcohol w/drawal delirium s/s most deadly -onset: 2-3days.

-severe w/drawal symptoms, disorientation, hallucination (auditory &tactile), elevated temp,
severe HTN, dysrhythmias, tachycardia, increased BP, sweating, can cause gran mal seizures

Cocaine & amphetamine abuse

-complication: cardiovascular collapse! (ruins blood vessels in the brain)
- intox: paranoia/hypervilagence. Dilated pupils, tachycardia, agitation, HTN, hallucinations,
seizures, chest pains, confusion, impaired judgment,
-w/drawal: 1hr to several days: depression, craving, dysphoria, fatigue, insomnia, nightmares,
agiation/ psychomotor retardation

Crisis intervention, Everyone experiences it

-Situational/external : unanticipated loss/changed experienced in everyday – illness/lost job. Loss
grandparent in motor crash
-Internal: marriage/children
-Maturation/developmental: (moving away to college/retirement) occurs in response to a
situation that triggers emotions related to unresolved conflicts in one’s life.
-Adventitious: Natural disasters, crime – hit by tornado
-Ask: pt’s feelings, related to event, identify current prob/loss, stressors, any mental/physical
health issues, pain/fatigue, age, support system, prior experience w/stress, suicidal?, pt’s
perception, religion, coping skills,

-diff btwn anger & aggression=intent (Aggression: behavior that’s intended to inflict harm)

Dementia s/s
-Care: Room close to station, low stimuli, well-lit enviro, id bracelet, admin PRN for
agitation/anxiety, lower bed/remove rugs, clocks/calendars, Consistent caregivers& daily routine.
- is progressive & irreversible –impaired judgment & cogn fnc of thinking, memory, reasoning
s/s: aphasia (can’t speak), apraxia (misuse of objects), agnosia (can’t recog fam objects)
neglected hygiene -remote memory: remember things from past that can be validated
-early stage: recall events of distant past
-expected manifestation: frequently misplaces object

-ati: alzheimer’s disease: mematine, admin (Aricept) donepezil @bedtime – prolongs time of
decreased cog fnc-ing during early stages (se: bradycardia); loses short term memory, acute
confusion & inattention, can give lorazepam (Ativan) : sedation & anxiety. Give haldol
-Risperidone (Risperdal)- helps them sleep if given at night (antipsychotic – agitation,
aggression, hallucinations, disturbances, wandering, polyuria
teach: may cause high blood sugar diabetes, menstrual irregularities, dizzy

Delirium: Acute, sudden onset of confusion Reversible. Delirium = common in older adults
&pts in ICU, -alter loc, rapid inappropriate speech, rapid mood swings, expression of feelings,
easily distracted. Disturbed lvl of awareness &change in cognition – give antianxiety med
-intervention: don’t give a lot of decisions, keep room well lit, permit pt daily rituals to reduce
anxiety

Benzodiazipine – taper, don’t stop taking it abruptly (can develop abuseaddictive)

*Flumazenil (Romazicon) antidote for overdose -ati: common se: sedation, dizzy
-for: skeletal muscle injuries, status epilepticus, insomnia (NOT PAIN/HYPOTENSION)
-intoxi: decreased bp -admin slower &smaller dose in elderly, increase gradually
- Enhances inhibitory effects of GABA (gamma-amino butyric acid) in CNS
-w/drawal (1-10 days after d/c, duration 5 days-1 month): ↑ anxiety, concentration difficulties,
tremor, &sensory disturbances, paresthesias (abnormal sensation – prickling/tingling),
photophobia, hyperinsomnia, &metallic taste, diaphoresis (sweating), tachycardia,
SEDATION, toxicity, drowsiness, slurred speech, anterograde amnesia, hypotension, light
headedness, decreased cognitive fnc, ataxia– motor incoordination, confusion, lethargy, dry
mouth, n/v, blood dyscrasias,
 may cause paradoxical (instead of helping, makes it worse) response: insomnia,
excitation, euphoria, anxiety, &rage.
 May cause resp depression, especially w/IV admin. Take w/food or GI upset occurs
 Avoid other CNS depressants. Avoid grapefruit juice and fatty foods
 Cause hypotension increase risk for cardiac arrest

contradictions: glaucoma, coma/shock, neonates, prego, labor/delivery/lactation, caution w/hx of

drug abuse/addiction, & w/those who are depressed/suicidal
Precaution: older adults, renal/hepatic impairment, mental d/o, suicidal ideation, resp
d/o/depression, neuromuscular d/o, sleep apnea,

Dependent personality disorder – goal of therapy: help them to become independent

Antisocial personality – -chemical dependency unit MEAN
- exploitive & disregards the rights of others, unlawful actions, deceitful, lacks of empathy,
manipulative, lacks personal responsibility, aggressive (ex: of people in prisons) don’t care
(cluster B: dramatic, emotional/erratic traits)
-LIMIT & CONSISTENT (angry for being in the hosp, lil respon/concern for their current sit.)

Avoidant personality d/o: pt has trouble starting new rltnshps unless he feels accepted

Borderline personality disorder 2 -SPLITTING ** defense mechanism

-NOT: the safety, bible one, or the behavioral contract
-NOT: bargain, strict schedule, allow manipulation (answer: consequences for their behavior)
-Unstable identity & relationships, fear of abandonment, splitting, manipulation, impulsive
mutilations, &frequent suicidal tendencies -be your bf til they get what they want, their
way(cluster B) -LIMIT & CONSISTENT
-impulsive behaviors low tolerance for frustration
-priority goal: refrain from self-mutilation EMOTIONAL LABILITY
-DBT (dialectical behavior therapy)  sim to cog behavioral therapy But specific to personality
d/o, Helping them become compassionate.

-Paranoid: distrust & suspiciousness twrd others based on unfounded beliefs that others want
to harm, exploit/ deceive the person (cluster A: odd/eccentric traits)

-Narcissistic- Arrogance, grandiose view of self & self-importance, need to be admired, lacks
empathy, stained relationships, &sensitive to criticism. (cluster b)

-histrionic: emotional attn seeking behavior, center of attention, seductive & flirty
-personality d/o characteristics: inflexibility/maladaptive responses to stress, compulsiveness
&lack of social restraint, inability to emotionally connect in social & professional rltnships,
tendency to provoke interpersonal conflict, ability to merge personal boundaries w/others.

risk factors: less educated, unemployed, single/divorced, comorbid subs abuse

-care: pt may evoke intense emotions fr: nurse, aware of personal reactions to stress, therapeutic
comm & intervention, repeat self-assessment as a personal stress response to pt behavior.
-Milieu management, SAFETY=always a priority (risk for self-injury/violence). CLEAR
BOUNDARIES:LIMIT SETTING -get them to talk, don’t make decisions for them
-Therapeutic comm strategies: firm, yet supportive approach & consistent care, offer realistic
choices to enhance pt’s sense of control,

Schizophrenia – s/s, which type of meds, 7 - ANTIPSYCHOTICS / NEUROLEPTICS

-causes too much dopamine (increases psychosis) genetics found in more poverty
med compliance (#1 reason for admission) -not Haldol, not lithium, not valium
-ati: w/delusional thinking = projection,
POSITIVE symptoms: (things that aren’t normally there are present) easily treated
-Thought d/o:
-ideas of reference: believe others, who are discussing food, are talking about them
-persecution: being hunted by others -grandeur: powerful & important like a god
-somatic delusions: body changing in an unusual way (3rd arm)
-jealousy: husband cheating w/someone else
-being controlled: force outside his body is controlling them
-nihilistic: false idea that self/part of self/others/world is nonexistent
-though of broadcasting: their thoughts are heard by others
-thought insertion: other’s thoughts are being inserted into their mind
-thought w/drawal: their thoughts have been removed from their mind by an outside agency
Delusions: false personal beliefs.
 Religiosity: excessive demonstration of obsession with religious ideas & behavior.
 Paranoia: extreme suspiciousness of others.
 Magical thinking: one’s thoughts/behaviors have control over specific situations.
Form of thought: (alterations in speech)
Echolalia: repeats words spoken to them (echo)
Associative looseness (loose association), Neologisms, Concrete thinking: literal

 Clang associations, Word salad, Mutism: inability/refusal to speak.

 Circumstantiality: delay in reaching point of comm bc of unnecessary & tedious dets
 Tangentiality: inability to get to the point of comm due to intro of many new topics.
  Perseveration: persistent rep of same word/idea in response to different ?s.

 Perception: interpretation of stimuli through the senses.

 Hallucinations: false sensory perceptions not assoc w/real external stimuli.
Auditory (hearing), Visual (seeing), Tactile (touch), Gustatory (taste), Olfactory (smell)
 Illusions: misperceptions of real external stimuli.
 Sense of Self: The uniqueness & individuality a person feels.
Echolalia: repeating words. Echopraxia: repeating mvmnts
 - bizarre behavior, walking backward constantly
 Identification and imitation: taking on the form of behavior one observes in another.
 Depersonalization & “derealization” : enviro has changed

NEGATIVE (the absence of things that are normally there)

catatonic is normally more assoc w/this. Disturbed perceptions &thought process. Risk for
Violence: Self-directed/Other-directed related, Impaired Verbal Comm, Self-Care Deficit,
Disabled Fam Coping, Ineffective Health Maintenance, Impaired Home-Maintenance,

Thought blocking
 Affect: the feeling state/emotional tone.
 Inappropriate affect: emotions are incongruent with the circumstances.
 Bland: weak emotional tone. Apathy: disinterest in the environment.
 Flat: appears to be void of emotional tone. (common) (facial never changes)
 Blunted: narrow range of normal expressions (usually)
avolition: lack of motivation in acts & hygiene, impairment in the ability to initiate goal-
directed acts
Emotional ambivalence: coexistence of opposite emotions twrd same object, person/sit.
 Impaired social interaction: clinging &intruding on the personal space of others,
exhibiting behaviors that aren’t culturally &socially acceptable.
 Social isolation: a focus inward on the self to the exclusion of the external enviro
 Psychomotor behavior: Extreme agitation, inclu: rocking and pacing
 Automatic obedience: Stupor: motionless for long periods of time, comalike
 Negativism: opposite of whats requested
 Waxy flexibility: passive yielding of all movable parts of the body to any effort
made at placing them in certain positions. Anergia: deficiency of energy.
 Posturing: voluntary assumption of inappropriate or bizarre postures.
 Associated features:
 Anhedonia Regression
Screening tools:
-Global assessment of fnc-ing (GAF) scale, Scale for assessment of – symptoms ,
Brief psychiatric rating scale (BPRS), Abnormal involuntary movement scale (AIMS)
Nursing interventions
  Decrease anxiety &establih trust (always 1st), Assist pt to define & test reality,
Encourage interaction w/others, safety of client & others, Meeting pt’s self-care needs,
Promoting adaptive fam coping. (they’re hopeless &suicidal)
TX
Psychological treatments: Indiv psychotherapy: long-term therapeutic approach; Group
therapy, Behavior therapy, Social skills training, case management, Recovery model, Milieu
therapy, Fam therapy: relaxation therapy, biofeedback; assertiveness training: patterns of
responding; cognitive therapy. Support groups

Antipsychotics-to decrease agitation & psychotic symptoms of schizo & other psychotic d/o.
-decrease dopamine * Schizo = chronic progressive d/o, & medications are managed for life.

 Typicals: dopaminergic blockers w/various affinity for cholinergic, α-adrenergic, &

histaminic receptors.
 Atypicals: weak dopamine antagonists; potent 5HT2A antagonists; also exhibit
antagonism for cholinergic, histaminic, & adrenergic receptors.

 Typical (conventional) Antipsychotics: Used to treat (+) symptoms, 1st line of tx

Chlorpromazine (Thorazine), haloperidol (Haldol – vitamin h) prochlorperazine
(Compazine – used for nausea), thioridazine (Mellaril), Fluphenazine (Prolixin)**

Chlorpromazine (Thorazine) – helps control symptoms of illness Se: - acute dystonia

-IM injection 3 to 4 weeks; fluphenazine (Prolixin) decanoate, haloperidol (Haldol)

-Haldol effects on what neurotransmitter

-decreases dopamine. (blocks the reuptake) (-dol/-dop) (hal stop=block=decreases)
Haloperidol (Haldol) teaching 3 IM injection 3-4wks - ati: for agitation & promote sleep
- stay out of the sun, sips fluids, chew sugarless gum
-report: shuffling gait, dry mouth & blurred vision -needs to get EKG, can cause cardiac probs
-Thioridazine (mellaril): low potency – antipsychotic (conventional) schizo
- SE: dry mouth, blurred vision, photophobia, urinary hesitancy/retention, constipation,
tachycardia, has tremors, drooling, & rigid extremities (pseudoparkinsons – shuffling gait)
-SE: n, (take w/food)GI upset, skin rash, sedation, orthostatic hypotension, photosensitivity,
decreased libido, retrograde ejaculation, ED, gynecomastia (men), amenorrhea (absence of
menstruation), agranulocytosis – hypersalivation, hyperglycemia & diabetes (common
w/atypical)cardiac dysrhythmias, dermatitis
-Stop the med & restart it later at a lower dose But a lot of times ppl have been on meds for
so long cant have it resolved

 Extrapyramidal syndrome (EPS)

Symptoms: muscle spasms – Pseudoparkinsonism (tremors, shuffling gait, rigidity)
-akathisia (restless movements), dystonia (facial grimacing and twisting of the neck into
unnatural positions – involuntary muscular movements). akinesia (muscular weakness),
oculogyric crisis (uncontrolled rolling back of the eyes/rapid fluttering)
 Tx (antipsychotic): Trihexyphenidyl (Artane) or benzotropine (Cogentin) are anti
parkinsonian meds &rx PRN for EPS symptoms lowering dopamine lvls **

 Neuroleptics – anti-psychotic med : tx both + & - symptoms of schizo & psychotic d/o
not depression, or alcohol?, or narcotics. FOR PSYCHOSIS

 Tardive dyskinesia (TD) (SE)

 irreversible, lip smacking , involuntary tongue movements
- Symptoms: rhythmic, involuntary mvmnts of the face, mouth, jaw &sometimes the
extremities. Tongue may protrude, chewing mvmnts, mouth puckering /facial grimacing.

 Neuroleptic malignant syndrome (NMS)- autonomic dysfunction - deadly

 Rare reaction, extrapyramidal effects, hyperthermia, & autonomic disturbance.
 SE: High Fever, VS instable, Dysrhythmias, Altered LOC, Muscle Rigidity &coma

TX:
 Atypical (conventional) Antipsychotics: tx ( + & - symptoms ) 2nd line
 w/fewer SE : decrease agitation, and psychotic symptoms. Decreases your dopamine!!!!
 risperidone (Rispedal) – se: polyuria polydipsia (thirst), lab: glucose diabetes
 Blocks both serotonin & dopamine receptors. Metabolic Syndrome
 constipation, sexual dysfnc, monitor vs, periodic ecgs, serum K lvls, neuroleptic
syndrom
Quetiapine/fumarate (Seroquel) : wt gain= less common, risk at abnormal glucose metabolism
diabetes, increase exercise &diet low in sugar and calories, don’t drive

Clozapine (Clozaril) – -bone marrow depression (agranulocytosis)

Wbc of 2500 = bad, get blood drawn weekly, monitor cbc and wbc
-w/hold if pt has sore throat -common w/hypersalivation

Monitor: Ziprasidone (Geodon)-low risk for EPS, Diabetes, wt gain, &hyperlipidemia

Hypercholesterolemia: Monitor triglycerides, fall risk
 s/e: agitation, dizzy, sedation, sleep disruption - insomnia, REPORT TO PCP,
extrapyramidal effects (often less than conventional antipsycho)

admin: mix w/juice, milk, water, coffee (not tea/soft drinks), admin every 2 wks
contradict: allergies, cns depression, ecg abnorm, dementia, risk for cerebrovascular accident
precaut: elders, parkinsons disease, liver/renal d/o, hypotension, seizure, fluid/electrolyte
disturb, diabetes
The client should:Not stop taking the drug abruptly. Be aware of possible risks during
pregnancy.
Wernicke’s encephalopathy 1
ati: short termy memory loss & disorientation, confusion, confabulation, stupor, diplopia,
paralysis of the ocular muscles. ataxia
Need to know B1 thiamine. Something is wrong with the brain, bleeding can happen if there is
thiamine deficiency in alcoholics, can lead to death
-2ndary dementia caused by thiaminie deficiency  korsakoff syndrome (help pt w/ambulation)

Stages of grief
-denial stage pick statement that matches (? – liver cancer and in denial)
-5 stages: denial, anger, bargaining, depression, &acceptance (Elisabeth Kubler ross)
- maladaptive grief responses: prolonged/chronic (unable to let go of personal
possessions), delayed/inhib (absence of evidence of grief), distorted (exaggerated)
-everyone reacts differently, there’s no time length, no order
-complicated grief: trouble carrying on normal acts after loss – “I feel so empty w/o my
wife, its hard to get up every morning”
-disenfranchised grief: unable to openly acknowledge & express grief
Bereavement: period of grief & mourning after a death

Clinical manifestation of somatic d/o

- physical symptoms that cant be explained medically &are associated w/psychological distress
- found in: Women, Less educated persons, Rural areas
-chronic, and anxiety, depression, and suicidal ideation are frequently manifested
-ati: conversion: physical manifestation/complaint w/o organic impairment
---------------------------------------------------------------------------------------------------------------------------
*Defense mechanism:
-altruism: dealing w/anxiety by reaching out to others
ex: nurse lost fam memb in a fire is a volunteer firefighter
-compensation, *denial, -regression, identification, *rationalization. -projection: (delusions
thinking), -splitting, somatization (repression), repression, suppression, undoing: (OCD)
-dissociation: temp blocking memories & perceptions fr: consciousness
ex: kid saw shooting, can’t remember the details of event
*displacement: transfers feelings from 1 target to a less threatening one/neutral (agoraphobia)
-reaction formation: ex: hates being a nurse, but tells nursing students it’s amazing
intellectualization: attempt to avoid expressing actual emotions assoc w/stressful situations by
using logic, reasoning & analysis
ex: his wife is transferring job location, hides anxiety by telling her parents the advantages of
moving
-introjection: ex: what children learn from parents – “don’t cheat, it’s wrong”
-isolation: sep thought/memory fr feeling tone/emotion assoc w/it
ex: w/out showing any emotion, women tells her rape story
sublimation: rechanneling of drives/impulses that are personally/socially unacceptable into
 activities that are constructive
ex: son killed by drunk driver, mom becomes president of mothers against drunk drivers
-Tort: violation of civil law -Unintentional tort: malpractice and negligence
.*Ethical & Legal Issues Principless
Ethics: What’s right and wrong. Bioethics: Ethics applied to medicine, nursing, & allied
health *Right: a valid, legally recognized claim or entitlement
-*Absolute right: when there is no restriction whatsoever on the indiv’s entitlement.
-*Legal right: a right on which the society has agreed and formalized into law.
-*Moral behavior: How to treat others Values: personal belief on what is important.
values clarification: a process of self-exploration by which ppl identify &rank their own values
(dirty rag to us is gross, but to them could be their valuable)
Autonomy: Independent (make own choices) their rights should be respected
Beneficence: doing good (charity Advocacy: Speaking on behalf of someone
Nonmaleficence: Do no harm Fidelity: Loyalty Justice: fair and equal tx Veracity: Being honest
-restraints (obtain a prn px &check q15mins, w/2 fingers space, 1:1)& seclusions (offer food
qhr, doc behavior q15-30mins, renew rx q4hrs)

Maslow Hierarchy of Needs: Physical needs 1st, Safety

-(top Self-Actualization: self-fulfillment & realization of his/her highest potential (goal)
self-esteem, esteem of others, love & belonging, saftey & security:
-(bottom)physiological needs: basic funds: food, h20, air, sleep, exercise, elimination, shelter, &
sexual expression
intervention//prevention:
1st: support groups, educational programs
2nd: relates to using early detection &intervention w/ppl experiencing mental illness symptoms.
3rd: reducing defects assoc w/severe &persistent mental illness/functional impairment”
(preventing complications of illness & promoting achievement of max lvl of fnc-ing

Managing autism (spectrum)

-ATI: teach parents: lang delay, no fear of abandonment
ASD (Autism) more often in boys, early childhood, chronic. can be very high/low fnc-ing.
aggressive, self-injury, temper tantrums, quickly changing moods. Impairment in social
interaction, communication &imaginative acts, restricts acts &interests
Nursing interventions  protect fr: self-harm. Improvement in social fnc-ing, verbal comm,
THE PRIMARY KEY IS EARLY IDENTIFICATION! Eye test on babies
ADHD inappropriate degrees of inattention, impulsiveness, &hyperactivity.
-a tolva test. It’s a computerized boring test game S/S lack attention and have hyperactivity.
can affect their everyday life. Comorbidity: Children w/ADHD are more prone to mental health
d/o, less likely to go to college, & more likely to struggle w/subs abuse.
-CNS stimulants: dextroamphetamine: Adderall & methylphenidate (Ritalin)
S/E insomnia, anorexia, wt loss, tachycardia &increase in BP, decrease in growth
&development. increase in SUDDEN DEATH. There’s a link btwn stimulants & cardiac arrest,
need ekg before giving meds  seeting them for adverse effects
methylphenidate (Ritalin): used for narcolepsy (sleepy), careful if they have anxiety
Adderall (dextroapheniamine): Check VS q4hrs check for htn, tachycardia
better attention span &can focus. It is a HIGHLY abused drug. stay up longer, take in more
info, &retain more memory. not only help w/energy &alert level, lose weight

ati: ignore attention-seeking behavior that aren’t dangerous, remove unnecessary stuff fr: child’s
surroundings (risk for injury), impulsive behavior, DON’T use + reinforcement, help them be as
independent as possible*
- First cardinal sign: not making eye contact/responding to their name. They also act out
behaviorally.
-Predisposing factors; embryonic development, birth problems (not enough O2)
-IDD MR (mental retardation). Two types of functioning we assess. IQ (<50, they are
most likely retarded). & adaptive functioning tests.
Mild-Capable of independent living, and development of social skills
Moderate-Can perform some activities independently; some speech limitation
Severe-Can be trained in basic hygiene skills, communicates by “acting out” behaviors.
Profound-No capacity
Conduct d/o:
-ATI: easily angered, lack of respect for rules & authorities, aggressive.
-Gender dysphoria occurs when there is incongruence btwn biological/assigned gender & one’s
experienced/expressed gender. Men wanting to be women =common (trans)
-Gender identity awareness of one’s masculinity or femininity.

Inhalants can be very lethal &readily available at home. Can have cardiac arrhythmias
&suffocation bc hemoglobin attaches to it & not O2. People can replace the O2 in their body
&poison themselves. -pts who have CNS depression have inhaled intox
Hallucinogen can lead to the development of psychosis, they have the abilities they think they
have but actually don’t.

-Lithium (antimanic- bipolar med) – acute mania

-Takes 7-14 days to become effective, monitor levels every 2-3 days until stable then 1-3
months BUN lvl (normal is 6-20) kidney
-need liver and blood test, stop taking it if they have hand tremors, take w/food
-Rapidly absorbed, take regularly Drink 6-8 glasses of h2o qday, Notify pcp if
v/diarrhea occur, serum lithium level checked every 1 to 2 months, don’t
drive/operate dangerous machinery, adequate sodium– monitor levels
 avoid: caffeine
 SE: tremors (prevents doing ADLs), N/V, thirst -dehydration – dry mouth, & polyuria,
Drowsiness, dizziness, headache, Hypotension; arrhythmias, pulse irregularities,
electrolyte imbalances, Wt gain, Potential for toxicity. ** Renal toxicity**: monitor
I&O, daily weight, baseline kidney function tests (BUN, Crt). Lithium may cause goiter
and hypothyroidism**: monitor T3, T4, and TSH levels prior to starting tx &then
annually, muscle weakness, confusion,

don’t stop abruptly, take at bedtime, increase fiber/fluid intake, Fiber = increase to prevent
constipation, -fasting can lead to lithium toxicity, NA lvl <135 = bad

Therapeutic range & toxicity – check regularly

1.8 = toxic level for lithium

 1.0 to 1.5 mEq/L (acute mania)

 0.4 to 1.0 mEq/L (maintenance) give meds (0.5-1.3)
 Levels > 1.5 mEq/L Toxic

-symptoms of toxicity inclu: Blurred vision, ataxia, tinnitus, persistent n/v, diarrhea. Confusion,
Tremors, Polyuria, Dehydration, v.drowsiness. Muscle weakness

Anticonvulsant Valproic acid (Depakote)- anti-seziure med

- pt teaching – valporic acid(Depakot)e: for bipolar manic episode, depression
-take w/food
-test for liver, pancreatisis, thrombocytopenia (monitor cbc) - normal for tremors,
insomnia, rash, GI issues
-works when decrease episodes of pressure speech, insomnia, grandiose thoughts &
hyperactivity

Anticonvulsant Carbamazepine (Tegretol) – anti-seizure med

 SE: dry mouth &throat, N/V, indigestion- abdominal pain, constipation, diarrhea,
impaired urination, ↓ sense of taste, dizziness, drowsiness, unsteadiness, loss of
appetite. Risk for suicides, rash
 May cause agranulocytosis and liver dysfunction (monitor CBC & LFTs).

lamotrigine (lamictal): antiepileptic – mood stabilizer: bipolar d/o

-SE: double/blurred vision, dizzy, headache, nausea, vomiting  caution when performing
acts that require concentration/visual acuity
-rash inclu: Stevens-Johnson syndrome
SSRI Psychopharmacology (1st in line) (decrease depression)
tell pt what the meds do (not having enough serotonin, so it gives you little extra)
-Block reuptake Serotonin, which intensifies effects of serotonin. Improvement in mood. Lowest SE
-takes 4-6wks to start working ,, 1st in line
-fever – serotonin syndrome

 Meds: Citalopram (Celexa), escitalopram (Lexapro)lowest se, fluoxetine (Prozac)–onset

1-4wks, duration 2wk), paroxetine (Paxil) , sertraline (Zoloft)
 Serotonin regulates happiness, anxiety, & mood.
 SE: somnolence (sleepiness), dizziness, lightheadedness, faintness, headache, insomnia,
tremor, weakness. Agitation, nausea, sexual dysfnc , anxiety, rash, GI bleeding, bruxism,
hyponatremia, increase risk of suicide, serotonin syndrome, constipation, dry mouth,
nausea, pharyngitis, runny nose, impotence, abnormal ejaculation, ↓ libido, no
orgasm, weight gain; encourage regular exercise & healthy low cal diet.

Fluoxetine (Prozac) 2
-ssri – takes 4-6wks to start working, serotonin syndrome
-Se: somnolence(sleepy), dizzy, constipation, dry mouth, nausea, wt gain
-may have diff w/sexual fnc-ing, admin in am, take w/food
-if taking tegretol, don’t take Prozac bcuz of increase lvls of tca & lithium

admin in am to prevent sleep disruption, take w/food, oral only, takes 4-6wks for effectiveness

Serotonin syndrome begins 2-72 hours after starting treatment (typically 6hr):
SE: confusion, abd pain, diarrhea, fever, agitation, anxiety, hallucinations, headache, n, dizzy,
diaphoresis, diarrhea, fever- life threatening, restlessness, tremors; hyperreflexia, Seizures,
-notify the primary care provider and stop the medication.
 Supportive tx: Cardiac monitor & oxygen
-cautiously in pts w/DM, cardiac disease, impaired liver/kidney fnc, suicidal ideation/behavior.
Seizure d/o, ulcers, GI bleeding, allergy, hyponatremia,
Do not use within 2 weeks of stopping an MAOI antidepressant.
 Do not administer with St. John’s Wort. ->serotonin syndrome

taper off (causes dzzy, insomnia, irritation, agitation),monitor NA levels for pt’s taking diuretics

Atypical Antidepressant Psychopharmacology (2nd round)

Long term use, non addictive, takes time to become achieve therapeutic effect (3-6 weeks)
Bupropion (Wellbutrin) - depression, seasonal affective d/o, nicotine addiction, lower seizure
threshold

-Nonbenzodiazepines: buspirone (Buspar), doxepin (Sinequan)

-used for panic d/o, ocd & related d/o, social anxiety d/o trauma/ptsd
-inhib serotonin reuptake, agonistic actions on dopamine receptors
- SE: dizzy, nausea, headache, light headedness, agitation, restlessness, paradoxical effects:
insomnia, restlessness, anxiety DROWSY
-interventions: monitor: paradoxical effects, fall precautions (elders), rise slowly
- contraindications: prego risk, no breastfeeding, cautiously w/older pt who has liver/renal
dysfnc/insufficency, CONCURRENT w/ MAOIs – 14 days after MAOIs are d/c bcuz
hypertensive crisis may result
- interacts w/ st. john’s wort, NO grapefruit juice, erythromycin, ketoconazole
- take w/food to prevent GI upset, effects don’t occur immediately, can take up to 1wk (7-10
days), take regularly, full effect 2-4 weeks. Won’t cause w/drawal

Dopamine uptake, tx: depression, alternative SSRI unable to tolerate sex dysfnc se, aid to quit
smoking, prevention of seasonal pattern depression
SE: headache, dry mouth, GI distress, constipation, increased HR, insomnia, nausea,
restlessness, suppression of appetite = weight loss, seizures
 Caution: prego, seizure d/o, avoid MAOIs, anorexia, bulimia nervosa
 Take it in autumn (seasonal depression) and gradually taper off, d/c in spring

TCA Psychopharmacology (antidepressant, sleep &pain) (2nd)

-Reduces depression, relief severe pain, prevent panic attacks, insomnia, fibromyalgia
-Block reuptake serotonin, norepine and serotonin
-Amitriptyline (Elavil), imipramine (Tofranil), mirtazapine (Remeron), nortriptyline (Pamelor),

Imipramine (tofranil) tca s/e something about the eyes (answer) (i=eye)
se: mild tachycardia, urinary retention, increased appetite & wt gain, tinnitus
-sedation, drowsy, confusion, orthrostatic hypotension, dry mouth, constipation,
photosensitivity, tachycardia, sex dysfnc, sweaty

 SE: anticholinergic effects (sedation, dry mouth, visual disturbances, urinary

retention), constipation, photosensitivity, orthostatic hypotension, confusion
(especially in elderly), and increased/irregular heart rate (tachycardia)- ecg should be
monitored, DROWSINESS IS COMMON, Sexual dysfnc, weight gain, sedation, toxicity,
sweating, decreased seizure threshold
 Contraindications/Precautions: Previous hypersensitivity, Not given within 14 days of
the MAOI antidepressants (hypertensive crisis), to clients with recent MI,seizures,
 antihistamins, cardiac disease (may cause dysryhtmias)**, to children, lactating
mothers, prego
 *Used cautiously: Cardiac, hepatic, or renal disease, hyperthyroid disease, history of
seizures, narrow angle glaucoma, urinary retention, and risk of suicidal ideation or
behavior (very lethal in overdose). Coronary artery disease, diabetes, and resp d/o,
benign prostatic hypertrophy & hyperthyroidism. No MAOIs
 TCA: increases serotonin &norepinphrine. high dose can increase dopamine. increase
dopamine is assoc w/confusion, esp with older adults
 Don’t give to suicide (overdose) - Once takes effect and mood begins to lift, indiv has
increased energy w/with implement a suicide plan, suicide potential increases as
depression decreases)
 admin at bedtime due to sedation & risk for orthostatic hypotension.

Nortriptyline (pamelor/aventyl?)–
-don’t give til after 14 days of dc MAOIs, cautiously for cardiac, seizure, admin bed time due to
sedation & risk for orthostatic hypotension

MAOI Psychopharmacology (last)

Reduces depression, controls anxiety, bulimia nervosa
Block mao, increase Norepine, dopamine, serotonin, tranylcypromine (Parnate)
 Phenelzine(nardil) caution/concurrent w/ pseudoephedrine (sudafed) (interacts
w/MAOIs) hypertensive crisis: Headache, Stiff Neck, Tachycardia, n/v, ↑ BP,
sweating, fever, chest pain, dilated pupils
● No SSRI (Can cause serotonin syndrome), TCA, No suicide risk, No foods w/tyramine

SE: Sedation, sex dysfnc, ortho hypotension, dizziness, vertigo, headache, blurred vision, rash,
anxiety, agitation, hypomania, mania, constipation, dry mouth, nausea, diarrhea, impotence.

Avoid foods and medications high in tyramine when taking MAOIs.  hypertensive crisis
-Aged cheese Caviar Wine; beer Raisins Chocolate; colas Pickled herring
Coffee; tea Yeast products Sour cream; yogurt Broad beans Soy sauce
Smoked & processed meats (salami) Beef/chicken liver Cold remedies Canned figs
Diet pills
Can give roasted chicken*
Contradictions: no prego, heart failure, cardiovascular & cerebral vascular disease, renal
insufficiency, diabetes, seizure d/o, taking TCAs (hypertensive crisis), may increase blood levels,

selegiline (emsam): transdermal patch: MAOI: depression & bulimia nervosa

- contradictions: pt taking carbamazepine (tegretol) / oxcarbazepine (trileptal) may increase
blood lvls of MAOIs

anxiety: anxiety leads to OCD

*Peplau’s 4 Lvl’s of Anxiety:
-mild: Sharpens senses, increases motivation for productivity. (increased ability to perceive
reality). able to fnc at optimal lvl. Adaptive - restless, irritated, nail biting, fidgeting,
- teach relaxing techniques at this time
-moderate: perceptual field diminishes. Less alert to events, attention span & ability to
concentrate decreases, benefit fr: direction of others -tensions, palpitation,
increase hr, sweating, -important to foresee anxiety-provoking circumstances –plan of care
-severe: can only think of one thing. (repressed anxiety can result somatoform d/o)
-trouble sleeping, light head, nausea, tremors, sense of impending doom
- stay w/client and take to quiet room
-panic: most intense state. Unable to focus, loss of contact of reality,
(hallucinations/delusions). Fnc & communication are ineffective, extreme w/drawal
Panic-level anxiety – stay with them, be calm, simple words
ATI: “I’m going to die, this is it, heart attack”

STD: infections that are contracted primarily through sexual activities/intimate contact.
 nurse’s 1st responsibility in STD control is to educate pts who have/may develop a STI
 Prevention of STDs is the ideal goal, but early detection &appropriate tx cont to be
considered as realistic objectives.

BIPOLAR d/o: mood swings from profound depression to extreme euphoria (mania),
More common in single, higher socioeconomic classes.
-maintenance: increase ability to fnc -give high-calorie finger foods for manic phase

Bipolar I Disorder **
 experiencing/ has experienced, a full syndrome of manic or mixed symptoms
and/or experienced episodes of depression, Hx of hospitalization
 agitated, might even be suicidal. They can become psychotic. WAY WORSE!!

Bipolar II Disorder **
major depression w/episodic occurrence of hypomania (lowly manic). 1 or + episodes, Has
never met criteria for full manic episode. Lots of energy, higher fnc-ing, major depression, hx of
hypomania
____________________________________________________________________________
-Ocd: modeling, adheres to rigid set of rules, demonstrates a dedication to his job that excludes
time for leisure acts, risk for suicide, compulsion to relieve anxiety
-Ptsd: promote sleep, s/s: nightmares, difficulty concentrating, exaggerated startled response,
isolated
-1st action = estab rapport
-initial phase: presenting prob
-confabulation: filling in gaps in memory by fabrication, make up responses that are inaccurate
but sound apporiate (done to avoide embarrassment of memory loss)
-hypochondriasis: exaggerate preoccupation w/physical health
-reminiscence therapy  increase self-esteem by reflecting on past experiences
-alcohol cardiomyopathy  high CPK creatine phosphokinase
-tca and benzo and opiods = resp dep
- Leave client if they become verbally abusive
-signs of abuse in elderly: fam memb using alc