bh 5, 6

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bh 5, 6
2013-10-13 20:30:10

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  1. Trazodone
    helps pts sleep but not helpful for depression
  2. black box warning
    risk of suicide d/t lifting
  3. 3 major categories of antidepressants
    • TCA
    • MAOI
    • SSRI
  4. TCAs
    tricyclic antidepressants
  5. first developed tcas
    • imipramine
    • first antidepressant used
  6. TCAs do what
    stimulate appetite
  7. TCAs s/e
    • anticholinergic
    • no sense of euphoria
    • not addicting
  8. anticholinergic 6
    • dry mouth
    • visual disturbances
    • constipation
    • decr sweating
    • urinary retention
    • incr appetite
  9. TCAs use cautiously in
    • elderly
    • start low and go slow w dosing
  10. MAOIs
    Monoamine oxidase inhibitors
  11. MAOIs s/e 4
    • anticholinergic
    • cardiac 
    • risk of dependance
    • risk of hypertensive crisis
  12. cardiac probs with MAOIs 3
    • tachy
    • arrhythmias
    • cardiotoxicity
  13. foods to avoid w MAOIs
    • high tyramine foods
    • ages, fermented, pickled, smoked
    • beer, salami, cheese
  14. SSRIs
    Selective serotonin reuptake inhibitors
  15. SSRIs first developed
  16. SSRIs 
    3 advantages
    • less s/e than others
    • low potential for od
    • safe for elderly (still low and slow)
  17. SSRIs s/e 3
    • anticholinergic (not as severe)
    • decr sex drive
    • cardiovascular effects
  18. bipolar disorder 5
    • mania w or w/o depression
    • pts extremes of mood polarity;
    • may feel euporic or depressed;
    • may have rapid cycling at times
    • crying one moment, euphoric the next
  19. manic episode 5
    • elevated, expansive, irritable mood
    • begins suddenly
    • escalates rapid
    • last a wk to months
    • followed by extreme depression
  20. Bipolar I
    hx of manic episode
  21. manic episode
    watch for...
  22. objective s/s
    bipolar 3
    • disturbed speech
    • altered social, interpersonal relations
    • altered act and appearance
  23. subjective s/s
    bipolar 2
    • altered affect
    • altered perceptions
  24. antimanic/mood stabilizing medication
    drug of choice
    lithium carbonate
  25. lithium carbonate
    • bipolar
    • takes 7-10 days to begin
  26. lithium carbonate
    • sodium levels/diet
    • incr na = decr lith level
    • decr na  = incr lith
    • need balance 
    • maintain consistant na and h20 i&O
  27. antimanic/mood
    s/e 9
    nausea, dry mouth, diarrhea, thirst, drowsiness, tremors (lithy shakes), wt gain, polyuria, polydipsia
  28. monitor lithium levels closely 
    therapeutic level
    0.6 - 1.2 mEg/L
  29. monitor lithium levels 
    how and when
    draw bld early in the am before first dose and 8-12 h after last dose
  30. s/s lith tox 6
    n/v/d, drowsy, musc wkness, lack coordination/ataxia, tinnitus, blurred vision
  31. lithium cannot be used in
  32. nsg interventions for bipolar 6
    • use matter of fact tone
    • clear, concise directions & comments
    • limit setting
    • reinforce reality
    • respond to legitimate complaints
    • redirect pts to more healthy act
  33. guns
    • used more for suicide than homicide
    • incr use by teens
  34. suicide
    assess for
    • plan
    • intent
    • means
  35. suicide
    precautions 4
    • monitor for "sharps" (strings, cans)
    • remove all means from reach (pills, guns)
    • do not allow wkend passes
    • freq observations
  36. suicide 
    no harm agreement
    contract w pt that they agree if they feel like harming themselves they come and talk to you first
  37. benzodiazepines
    • enhance effects of inhibitory neurotransmitter GABA; 
    • depresses cns
    • GABA goes up and anx goes down
  38. benzodiazepines
    • Klonopin
    • ativan
    • valium
    • xanax
    • librium for detox
  39. desired actions of benzos
    • reduce anx
    • promote sleep
    • relax musc
    • prevent seizures
    • produce amnesia
  40. antidote for benzos
    flumazenil (Romazicon)
  41. benzos s/e 2
    • cns: drowsy, fat, decr coord
    • PNS: occ constipation, double vision, hypotension, incont, urin retention
  42. anx
    nonspecific, unpleasant, feeling of discomfort w phisiologic and pschy sx that generally result from perception of threat to safety and security (subconscious)
  43. fear
    • id cause easily
    • consciously recognize
  44. maturational anx
    • experiences that are expected as part of normal processes of g&d, for most ind in particular society
    • start school, develop relations, new job
  45. situational anx
    less predictable, specific actions are taken only when the threat is eminent or after it occurs
  46. situational anx
    ind recognize acute illnesses/accidents can occur - purchase health insurance but dont know exactly how or when it will happen 

    hurricanes and other natural disasters
  47. mild anx
    • +1
    • constructive motivator, discuss source of anx, prob solve, accept anx as natural, benefit from it
  48. psychomotor mild anx
    energetic, fidgeting, muscle tension, good eye contact
  49. emotional mild anx
    slight irritability, feeling challenged, confident
  50. cognitive mild anx
    alertness, aware of surrounding, concentration, attentiveness
  51. moderate anx
    • +2
    • destructive, decr anx-ventilation, crying, exercise, relax techs, refocus attention, relate feelings and behaviors to anx, then use prob-solving techs, give oral meds prn
  52. modorate anx psychomotor
    incr bp, pulse and resp, slight perspiration, startle reflex
  53. emotional mod anx
    motivated to decr anx, incr irritability, decr confidence
  54. cognitive mod anx
    difficulty concentrating, tangentiality, loose assocaition
  55. severe anx
    • +3
    • decr anx, stimuli and pressure, use kind firm simple directions, use time out (seclusion), five im meds prn
  56. severe anx emotional
    extreme discomfort, feeling of dread, hypersensitivity
  57. severe anx pscyhomotor
    extreme musc tension, rapid pacing, reflex responses
  58. severe anx cognitive
    distorted perceptions, diff focusing, flight of ideas, disorientation
  59. panic anx
    • +4 
    • guide firmly, physically take control, give im meds, order restraints prn
  60. panic anx psychomotor
    actual flight or fight, suicide attempts, eyes fixed, incoherent
  61. panic anx emotional
    rage, depression, feeling totally drained
  62. panic anx cognitive
    word salad, clang associations, neologisms, disorganized perceptions
  63. loss/threats related to anx
    • health or ability to function
    • self-esteem/respect
    • self control
    • control or power over own life
    • status/prestige
    • resources (emotional, physical, etc)
    • loved ones
    • freedom and needs and goals
  64. descriptions of anx
    • subjective experience detected only by obj behaviors 
    • emotional pain, apprehension, fearful, sense of powerlessness. warning sign, triggers behaviors, alerts for self defense, contagious, part of a process
  65. freud id
    pleasure principle, all abt me; unconscious drvie for self-perservation, reproduction, and group association; id is w/o a sense of right and wrong, and ruthlessly insists on immediate satisfaction of impulses and desires; babies are bundles of id
  66. freud ego
    promotes the ind/s satisfactory adjustment in relation to the environment; main funt is to establish an acceptable compromise bw the crude, pleasure seeking id and the inhibitions of the superego; mediator bw id and superego; helps relieve anx
  67. freud superego
    blindly rigid, strictly moralistic and as unrelenting and ruthless; inhibits id
  68. conscience
    punishes the ind thru feelings of guilt and anx when behavior deviated from strict standards
  69. ego ideal
    rewards the ind thru feelings of euphoria and well being
  70. defense mechs
    protect ego and relieve anx
  71. selye general adaptation syndrome
    • alarm
    • resistance
    • exhaustion
  72. alarm
    any stressor that activates the prep for fight/flight; incr in alertness to mobilize resources; level of anx is mild +1, to moderate +2; learning and prob solving; when stressor cont and not resolved...moves to next stage
  73. resistance
    ind strives to adapt to stress; coping and def mechs use increased; prob solving/learning difficult; moderate +2 to severe +3;
  74. exhaustion
    stress that lasts too long; overwhelming; inability to cope; severe +3 to panic +4; defenses are exaggerated; personality disorganized; misperception; reduced orientation; violent, suicidal, immobilized; death w/o intervention
  75. physiological responses to anx
    sympathetic fight or flight
    • dilated pupils
    • incr resps, sweating, and hr
    • any sx of fight or flight
  76. coping w anx
    • adaptive
    • palliative
    • maladaptive
    • dysfunctiona;
  77. adaptive
    solves the prob that is causing anx, anx is decreased; pt is objective, rational, and productive; **most effective coping way
  78. palliative
    temp decr anx but does not solve prob; anx returns; temp relief allows pt to return to prob solving
  79. maladaptive
    unsuccessful attempts to decr anx w/o attempting to solve the prob; anx remains
  80. dysfunctional
    not successful in reducing anx or solving prob; functioning becomes difficult, new probs develop
  81. nsg interventions r/t anx
    • relieve anx**
    • calm, quiet environment
    • ask pts to id how they feel
    • encourage to express feelings
    • help pt id cause of feelings
    • listen for pt expressions of helplessness
    • plan and involve pts in act such as walks
  82. anx
    nonspecific unpleasant feeling of discomfort w physicologic and psychological sx that generally result from a perception of a threat to safety and security; anx is a sx
  83. anx d/o
    patterns of sxs and behaviors in which anx  is either the primary disturbance or a secondary prob that is recognized w the prim sx are removed; has to disrupt adls more days than not over 6 mo
  84. generalized anx d/o
    ind experiences the sx of anx cognitively and physically; most common anx d/o, seen w depression, anx or worry is chronic and excessive, can be bt nothing at all; difficulty in controlling anx, habitual worrying way of coping to prevent something bad
  85. phobic disorders
    intense, irrational fear responses to an external object, act, or situation
  86. social phobia
    fear of being humiliated, scrutinized, or embarrassed in public
  87. agoraphobia
    fear of being in public or open spaces, places, or situations in which escape might be diff or help might not be available; may not leave home alone
  88. specific phobia
    fear of a specific object or situation that is not either 1 of the above; fear of animals, flying, or hts
  89. obsessive compulsive disorder
    disorder in which recurrent obsessions (thought) alternate w compulsions (behaviors). both are unwilled
  90. hypochondriacs
    worried abt having, or believe that they have, a serious dis based on the misinterpretation of bodily signs and sensations
  91. dissociative identity disorder
    existance of two or more identities or personalities that take control of the persons behavior; the host is unaware of the other personailities but the others might be aware of ea other to varying degrees
  92. dissociative fugue
    sudden, unexpected travel away from home or some other location w the assumption of a new identity or a confusion abt ones identity; travel and behavior appear norm; last from a few hrs to several days; rare and unusual follows severe psychosocial stress
  93. dissociative amnesia
    loss of mem or the inability to recall important personal info; usually occurs immediately after a traumatic event, one or more episodes of the inability to recall important personal info that is beyond ordinary forgetfulness
  94. posttraumatic stress do
    development of characteristics sxs (intense fear, helplessness, re-experiencing of events) following exposure to an extreme traumatic stressor; such as war, escaping fire, mva, that maybe a friend/fam member didnt escape
  95. defense mechs
    protect ego and relieve anx
  96. denial
    unconscious refusal to admit an unacceptable idea or behavior
  97. repression
    unconscious and invol forgetting of painful ideas
  98. suppression
    conscious exclusion from awareness anx-producing feelings, ideas, situations
  99. rationalization
    conscious or uncon attempts to make or prove that ones feelings or behaviors are justifiable
  100. intellectualization
    con or uncon, using only logical explanations w/o feelings or an affective component
  101. dissociation
    uncon seperation of painful feelings and emotions from an unacceptable idea, sit, or object
  102. identification
    con or uncon attempt to model one self after respected person
  103. introjection
    uncon incororating values and attitudes of others as if they were your own
  104. compensation
    con covering up for a wkness by overemphasizing or making up a desirable trait
  105. sublimination
    con or uncon channeling instinctual drives into acceptable activities
  106. reaction formation
    a con behavior that is exact opposite of an uncon feeling
  107. undoing
    con doing something to counteract or make up for a transgression of wrong doing
  108. displacement
    uncon d/c pent-up feelings to a less threatening object
  109. projection
    unco or con blaming someone else for ones difficulties or placing ones unethical desires on someone else
  110. conversion
    the uncon expression of intrapsychic conflict symbolically thru physical sx
  111. regression
    uncon return to a earlier and mroe comfy developmental level
  112. major depression
    anx accompanies depression
  113. sx of depression
    • affect change
    • anhedonia
    • irritability in kids and young adults
    • fatigue
    • apathy
    • sleep disturbances
    • wt changes
    • psychomotor changes
    • decr/lack of concentration
    • inability to make decisions
    • feelings of worthlessness/guilt
  114. incr risk of suicide in
    single white males <24 and >65
  115. neurochemical cause of depression
    decr levels of neurotransmitters, esp serotonin, norepinephrine, and in some cases dopamine
  116. dexamethasone suppression test
    give dexamethasone inj, if depression - urine and bld cortisol levels will not fall, 40% w severe dep fail to suppress any cortisol; not exclusive to the dx of dep
  117. anhedonia
    inability to experience pleasure
  118. apathy
    • no motivation/lack of feeling or interest
    • indifferent
  119. psychomotor changes
    retardation or agitation
  120. assessment tools for depression
    • used to assess a pt for dep; baseline and cont:
    • beck dep inventory
    • hamilton rating scale for dep
    • zung self rating dep scale
  121. zung self rating depression scale
    self rating assessment scale; pt w depress will score 50-69; highest possible 80
  122. thorough h and p done to
    rule out med or drug induced depre
  123. nsg interventions for a depressed pt
    • accept pt where they are and focus on strength
    • reinforce decision making by pts
    • respnd to anger therapeutically
    • spend time w withdrawn pts
    • make decisions for pts in acts for success
    • assess for suicide - intent, plan, and means
  124. antidepressant meds
    do not mix, risk for serotonin syndrome
  125. serotonin syndrome
    overstimulation of serotonin at synapse, major s/s include hyperthermia, change in loc and musc rigidity
  126. guide for dxing bipolar
    young mania rating scale
  127. milieu management
  128. antipsychotics
    may be used alone or in conj w other meds
  129. anticonvulsants
    used as alternate for those that dont respnd to lith; valproates, gabapentin
  130. sympathetic 
    fight or flight
    • sweating
    • incr bp - panic - shock = decr bld press
    • incr cardiac op