Behavioral Health HESI 2nd Semester

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1

Mental Illness

Distress to the Person

Impairment (carry out in society)

Inability to carry out day-to-day activities

2

Diathesis

Biological predisposition (susceptible to illness/environment)

3

Incidence

Number of new cases of mental disorders in population within given time

4

Prevalence

Total number of cases new and existing (Alzheimer's highest)

5

Cormorbididtes

More than one mental disorder at a time (or illness)

6

ID

Pleasure Principle

7

Ego

Problem solver, reality tester

8

Superego

Moral component; guilt; values and morals

9

Maslow's Hierarchy of Needs

  • Physiological Needs
  • Safety Needs
  • Love and Belonging Needs
  • Esteem
  • Self-Actualization
  • Self-Transcendence
10

Milieu Therapy

Total environment; people, setting, structure, and emotion climate

11

Sympathetic

Increased BP; vasoconstrictor

12

Parasympathetic

Decreased BP; vasodilator

13

Anti-anxiety and Hypnotic Drugs

-pam and -lam

Affect: motor function; attention; and judgement

14

Anti-Depressant

Tricyclic antidepressants

-tyline and -mine

Two to three weeks to take affect

15

Anit-Depressants

SSRIs

-ine and -ram

Side Effects: weight gain, insomnia, nausea, sexual difficulties

16

Olanzapine (Zyprexa)

Anti-Depressant/Antipsycotic

Side Effects: weight gain

17

Trazodone (Desyrel)

Anti-Depressant

Side Effects: Priapism (erection for extended time)

18

SNRIs

Venlafaxine (Effexor); Duloxetine (Cymbalta)

Side Effects: less weight gain; fewer sexual problems

19

SNDIs

Appetite stimulant/anti-emetic (N/V)

Mirtazapine (Remeron)

Side Effects: sedation; weight gain; improves sleep; less sexual sx

20

MAOIs

Atypical depression

Phenelzine (Nardil); Tranuylcypromine (Parnate); Selegiline (ENSAM)

**Strict low tyramine diet (avoid: organ meats; aged or fermented, alcohol, bananas, chocolate)

21

Lithium - Bipolar

0.5 - 1.5 theraputic range

*Give flat affect/even mood

*Polydipsia (increased thirst) - monitor fluid intake/low sodium

1.5 hold and tell doc next morning

1.8 call doctor immediately

22

Lithium 1.5-2.0

Blurred vision, ataxia, tenitis, N/V, severe diarrhea

23

Agranulocytosis

W/O WBC; watch for trending with blood test; CBC; increased risk for infection

24

NMS

Neuroleptic malignant syndrome

Muscle rigidity, increase fever, fluctuating BP, altered mental status

Decreased LOC, increased muscle tone, tachycardia

25

EPS - Extrapyramidal Side Effects

  • Acute dystonia (contracted muscles; head and neck stiff)
  • Akathisia (intense need to move)
  • Pseudoparkinsonism - tremors
26

Tardive dyskinesia

involuntary movement (head, pelvis) permanent

27

Metabolic Syndrome

Increase weight, glucose, and triglycerides

28

Risperidone (Risperdal)

Atypical Antipsychoitcs

Side Effects: gynecomastia (man boobs)

29

ADHD Meds

Timing of medication key for kids / don't take close to bedtime (4 hour half life)

Methylphenidate (Ritalin)

amphetamine salts (Adderall)

Side Effects: weight loss and insomnia

30

ADHD

Symptoms in two settings

Goals: managing disruptive behaviors

31

Alzheimer's (slow and insidious)

Meds:

Slow the process and preserve function; doesn't reverse or cure

32

Criteria for Admission for Psychiatric Care

Danger to self

Danger to others

Unable to care for self (nutrition; hygiene; rational decision making)

33

Divalproex (Depakote)

Bipolar Disorder - continuously cycling patients

Side Effects: dizziness, drowsiness, fatigue, nausea, tremor, rash, weight gain

34

Benzatropine (Cogentin)

Parkinson disease

Treating Parkinson disease in combination with other medicines. It is also used to control tremors and stiffness of the muscles due to certain antipsychotic medicines (eg, phenothiazines).

35

Beneficence

The duty to promote good

36

Autonomy

Respecting the rights of others to make their own decisions

37

Justice

Distribute resources or care equally

38

Fidelity (nonmaleficence)

Maintaining loyalty and commitment; doing no wrong to a patient

39

Veracity

One's duty to always communicate truthfully

40

Mental status examination

Coping; appearance; perception; behavior

41

Transference

Patient displaces feelings and behaviors r/t significant figures in patients past

42

Countertransference

Nurse displaces feelings and behaviors r/t significant figures in nurse's past

43

Distress

Negative stress

44

Eustress

Good stress

45

General adaptation syndrome (GAS)

Alarm or acute stress state "flight or flight" (dry mouth)

Resistance or adaption stage "stressor is overcame"/accepted

Exhaustion stage "no resolution to stress"

46

Autism Spectrum Disorder

Social and Communication

Early intervention key

47

Safety for Patient

Good lighting, clutter free, watch exit, establish rapport, staffing (qualified)

48

Sertraline (Zoloft)

Don't take while breastfeeding

49

Dealing with Hostile Patient

  • non-threatening posture, flat tone
  • Matter-of-fact speech, small words
  • Avoid "I" and "you" when setting limits
  • CONSISTENCY
  • eye level; change environment; personal space; visible staff
50

Escalating Patient

  • pacing
  • increase volume of voice
  • flush
  • gritting teeth
  • physical (hitting)
51

Schizophrenia

Polydipsia (1-5)

Increase thirst; hyopnatremia; watch sodium intake; water intoxication; appropriate fluid balance

52

Schizophrenia

Positive Symptoms: presence of something not normally present

Delusions; clang associations; echolalia; word salad; flight of ideas; hallucinations (sensory/command); illusions (cord is snake)

*Easier to treat with drugs than negative symptoms*

53

Hallucinations

Sensory

Command:

Do you recognize the voices, do you believe they're real, are you planning to follow through with what the voice says?

54

Illusions

Misconception of something that is there (cord is snake)

55

Delusion

Thought (false belief)

56

Schizophrenia

Negative Symptoms: absence of something that should be there

Anergia (lack of energy); anhedonia (lack of pleasure); avolition (lack of motivation)

57

Schizophrenia Meds:

Chlorpromazine (Thorazin)

Haloperidol (Haldol)

Side Effects: EPS and tardive dyskinesia

58

Bipolar Disorder

Manic Phase: euphoria, agitation/irritation

Depression Phase: sadness, hopelessness, anhedonia (lack of joy)

Splitting (nice/angry)

59

Lorazepam (Ativan)

Antianiolytics

Bipolor

60

Depression

Assess suicide risk first always!

61

Anxiety Levels

Mild - heightened awareness; more efficient; normal

Moderate - perceptual field narrows; clouded thinking; physical sx

Severe - perceptual field narrower; not able to problem solve; physical sx

Panic - unable to function or process information; dramatic change in behavior; physical sx lead to exhaustion.

62

Refocus Group

Redirect/back to topic

63

Anxiety Sx

Agoraphobia, panic, social, generalized, trichotillomania (hair pulling), excoriation (skin picking)

64

Projection

Attributing feelings or impulses unacceptable to one's self to another

65

Regression

Retreating in response to stress to an earlier level of development and the comfort measures associated with that level of functioning. (drinking from a baby bottle when been drinking from big cup)

66

Repression

Involuntarily blocking unpleasant feelings and experiences from one's awareness (forgets accident)

67

PTSD

Avoid triggers; safety; suicide

68

Comorbidities

More complicated to treat

Have more crises

Respond more slowly to treatment

69

Detox

Headache, sweating

Focus On: safety, fluids, food depends, calm environment, comfort, support, TLC

Safety then treat symptoms

70

Hildegard Peplau

Mother of psychiatric nursing

71

Alcohol Withdrawl

Hyper-alert, easily startle, jerky movements, irritable

24-48 hrs. after last drink (ask when last drink was)

72

Disulfiram (Antabuse)

Treatment of Alcoholism: makes very sick if any alcohol is ingested

73

CAGE Assessment

Cut down on drinking?

Annoyed by other criticizing your use?

Guilty about your drinking?

Eye opener in the morning?

74

Marijuana

Abuse?

75

Methadone Overdose

LOC

76

Meth Use

Risk for MI

77

Suicide Assessment

Plans, means, lethality

78

Depression/Grief

Electrocondutive Therapy (ECT)

79

Delirium

  • Acute; rapid onset
  • Always physiological cause
  • Fever, BG low, drugs, disease, UTI
  • Return to previous level of functioning
  • Treat symptoms and underlying cause
  • SAFETY
80

Dementia

  • Chronic; insidious onset
  • Irreversible
  • May or may not have physiological cause
  • Prevent injury
  • Meds slow progression
81

Alzheimer's Disease (dementia)

Amnesia - memory problems

Aphasia - difficulty with formulation of words

Apraxia - loss of purposeful movement (shaving, dress)

Agnosia - loss of knowledge (can't identify similar objects)

82

Nursing Home Criteria

Danger to self or others

Wondering

Incontinence

Interference with sleep or health of others

83

Suicide Risk

Hopelessness, helplessness, worthlessness

84

Anorexia Nervosa

  • emaciated (thin, weak); amenorrhea (no period); disheveled appearance; dehydration
  • below normal body weight; distorted body image; low BM
  • Nutritional, heart, mouth
  • Syncope; decreased BP
85

Anorexia Management

Milieu:

Structured meal time; Daily weight (same clothes, time); watch bathroom; look for hiding foods/meds

86

Bulimia Nervosa

  • Normal weight; secretive; binge after eating; hide food; mouth (bad teeth); electrolyte imbalance; cardiac problems
  • Milieu Therapy: meal option, social eating, bathroom monitoring, mediation monitoring, and daily weights
87

Bulimia Nervosa - Compensatory Behaviors 7

  1. Purging
  2. Laxatives
  3. Diuretics
  4. Enemas
  5. Emetics (induce vomiting)
  6. Fasting
  7. Excessive exercise (5+ hrs a day example)
88

Fluoxetine (Prozac)

Eating Disorders:

Must achieve weight gain goal before taking

Helps prevent relapse

89

Personality Disorders - Cluster A

*Weird, odd, eccentric

Paranoid

Schizoid

Schizotypal

90

Personality Disorders - Cluster B

*Wacky, dramatic, emotional

Antisocial

Borderline

Histrionic

Narcissistic

91

Personality Disorders - Cluster C

*Worried, anxious, fearful

Avoidant

Dependent

Obsessive-compulsive (most common)

92

Borderline Personality Disorder

Self-destructive behaviors; impulsive and antagonism; splitting; intense; lack of identity; unstable; superficial cutter for attention; suicide "attempt"

93

Conversion Disorder

Neurological symptoms in the absence of neurological disorder (blind all of the sudden before a test)

94

Obsessive-Compulsive Personality Disorder (OCD)

MONK

Rigidity, inflexible, meticulous, polite/formal, time-consuming, fear of making mistakes, repetitive

95

Anti-Social Personality Disorder

HANNIBAL LECTOR

Sociopaths, deceitful manipulative, guiltless behavior, irresponsible, want for gain of power or pleasure, callousness

96

What do you assess first no matter of the stage of crisis?

Suicide

97

Caplan's 4 Phases of Crisis

Phase 1: Conflict

Phase 2: Continued Threat

Phase 3: Panic Level

Phase 4: Problem still exist comping mechanisms ineffective

98

Anger

Emotional response

99

Aggression

Action or behavior

100

Violence

Act using intentional force

101

What neurotransmitter decreases when aggression increases?

Serotonin

102

History of Violence

Risk of negative coping skills; risk for being an aggressive person

103

Restraints

Least invasive measure first, last resort physical restraints (doc must see pt. within one hour)

104

How to help someone suffering from abuse:

  • remove obstacles that keep them from leaving
  • Charged cell phone, important papers for family, plans, RX drugs
105

Child Abuse

Different stages of healing; knowledgeable above years; story doesn't match injury

106

Criteria for Hospital Admissions of Patients with Eating Disorders

  1. Weight loss over 30% over 6 months
  2. Rapid decline in weight
  3. Inability to gain weight
  4. Severe hypothermia
  5. Heart rate less than 40 beats/min
  6. Systolic BP less than 70 mm Hg
  7. Hypokalemia (less than 3 mEq/L)
  8. ECG changes (arrhythmia's)