I'm not being defensive.
What defense mechanism involves escaping unpleasant, anxiety-causing thoughts and/or feelings by ignoring their existance?
Denial
What are some examples of benzodiazepines?
What are they used for?
lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin)
used for acute anxiety
What are positive symptoms of schizophrenia?
presence of symptoms that should not be there (e.g., hallucinations, delusions, paranoia, disorganized or bizarre thoughts, behaviors, speech
What behaviors might someone diagnosed with OCD exhibit?
What is a risk for all patients prescribed first-generation (typical) antipsychotics?
Extrapyramidal Symptoms (EPS)
What defense mechanism involves reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been exhibited previously?
Regression
What medication can be prescribed for Generalized Anxiety Disorder long-term?
BuSpar (buspirone)
What are some negative symptoms of schizophrenia?
The absence of qualities that should be present.
Negative symptoms include the inability to enjoy activities (anhedonia), asociality (social discomfort), avolition (lack of goal-directed behavior), affective blunting (reduced affect), apathy, and alogia (poverty of speech). This may result in decreased ADLs (e.g., hygiene/grooming).
In what stages of anxiety can learning no longer occur?
Severe anxiety and Panic
What is a risk for all patients prescribed second-generation antipsychotic medications?
risk for developing Metabolic Syndrome (weight gain, especially in abdomen, dyslipidemia, increased blood glucose, and insulin resistance)
What defense mechanism refers to the unconscious rejection of emotionally unacceptable features and attributing to others?
Projection
benztropine (Cogentin)
What assessment findings indicate the prodromal stage of schizophrenia?
withdrawal, diminished school performance, decreased cognitive ability, poor concentration, suspiciousness, disorganized thoughts/speech, preoccupation with religion
What are the priority nursing interventions for patients experiencing severe anxiety or panic?
provide safety of patient and others, meet physical needs (e.g., fluids, prevent exhaustion), move to quiet environment, use of benzodiazepine, use short & simple statements
These antipsychotics are used primarily to treat positive and negative symptoms of schizophrenia.
Second generation (Atypical) antipsychotics
What defense mechanism involves a disruption in consciousness, memory, identity, or perception of environment that results in compartmentalizing uncomfortable or unpleasant aspects of oneself?
Dissociation
What health teaching is important to provide clients prescribed benzodiazepines?
May cause drowsiness/slowed reactins so do not operate heavy machinery; do not mix with alcohol, increased fall risk, do not mix with opioids, can cause respiratory depression, only to be used for acute anxiety and short-term use is preferred, taper off slowly, avoid in older adults
What is concrete thinking?
impaired ability to think abstractly which results in interpreting and perceiving things in a literal manner. Concreteness reduces one’s ability to understand and respond to concepts requiring abstract reasoning, such as love or humor.
What cognitive behavioral therapy involves exposing a patient to stimuli that trigger their OCD symptoms then preventing patients from engaging in compulsive ritual(s) and will eventually lead patient to learn that the anxiety does subside even when the ritual is not completed?
Exposure and response prevention
What is the priority nursing assessment for a patient that has been taking Risperdal (risperidone) for ten years?
assess for EPS (extrapyramidal side effects) such as acute dystonia (sudden sustained muscle contraction), akathisia (motor restlessness), Pseudoparkinsonism (tremor, gait impairment, reduced facial expressions, bradykinesia (slowing of body movements), and tardive dyskinesia (lip smacking, pill rolling, involuntary movements)
What defense mechanism involves making excuses that sound logical to avoid emotional discomfort.
rationalization
What other class(es) of medications can be used for generalized anxiety disorder and OCD?
What are key patient teaching points for these meds?
GAD: SSRIs - paroxetine (Paxil), fluoxetine (Prozac), escitalopram (Lexapro), Zoloft and SNRIs - venlafaxine (Effexor), duloxetine (Cymbalta)
OCD: SSRIs - sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), etc. TCA - clomipramine (Anafranil), SNRI - venlafaxine (Effexor); fluoxetine (Prozac) ages 7-17, fluvoxamine (Luvox) 8-17, sertraline (Zoloft) 6-17, clomipramine (Anafranil) 10-17
Teaching: Take time to work, may experience increased anxiety initially, do not stop abruptly, monitor for suicidal thoughts, risk for serotonin syndrome, sexual dysfunction, monitor BP (SNRIs), etc.
A client in a catatonic state has not moved from the same position for several hours and does not respond when the nurses assess the client. What should the nurse do first?
Assess vital signs, hydration and nutrition status, and risk for complications (e.g., blood clots, rhabdomyolysis, cardiac arrhythmias, etc.)
Before providing client education with a pre-surgical client, what should the nurse do first before beginning education?
Establish rapport and reduce anxiety
Give an example of a "third generation" atypical antipsychotic that may reduce the risk of metabolic syndrome and has a lower side effect panel.
aripiprazole (Abilify), brexpiprazole (Rexulti), cariprazine (Vraylar)