Jaws
What types of things should we consider before administering any medication that can cause sedation? (name 4)
Current use of other CNS depressants
Any other CNS depression (altered LOC, decreased oxygenation, comatose state)
Recent H/o head injury
H/o substance abuse (these medications can be addictive)
Respiratory compromise (sleep apnea, chronic resp illness)
Renal, liver or cardiac impairment
Age (should be used cautiously with older adults due to safety risks)
Pregnancy
True or False: SSRIs are used to increase serotonin levels to help treat depression
True! By inhibiting the reuptake of serotonin there is more available to be used by the brain.
True or false: peristalsis and digestion increase during the fight or flight response
False. This happens during the rest and digest stage (the opposite of the fight or flight)
Also recall that the sympathetic nervous system is responsible for the fight or flight response during stressful situations and the parasympathetic nervous system is responsible for calming the body after these stressors and entering the rest and digest stage
Which neurotransmitter is associated with the fight or flight response of the sympathetic nervous system?
Norepinephrine
Serotonin
Dopamine
Acetylcholine
Norepinephrine!
Serotonin: sleep/arousal, mood, libido
Dopamine: movement, emotions, judgement
Acetylcholine: Sleep/arousal, memory, movement & coordination
Match the timeframes of restraint Rx renewal to the appropriate age group
Ages:
≥ 18, 9-17, ≤ 8yo
Time:
1hr, 2hr, 4hr
≥ 18 = 4hrs
9-17 = 2hr
≤ 8yo = 1hr
Dry mouth, insomnia, weight gain and sexual dysfunction are the most likely S/E for which type of medication?
SSRI
TCA
MAOI
SSRI
TCA: Anticholinergic effects (dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia) sedation and orthostatic hypotension
MAOI: Hypertensive crisis (BP of 180/120+), sexual dysfunction, sedation, dizziness
Which are true of the monoamine neurotransmitter dopamine (SATA):
High levels are associated with mania and schizophrenia
It is responsible for the fight or flight response
It is involved with sleep regulation
It helps regulate emotions
Correct:
High levels are associated with mania and schizophrenia and it helps regulate emotions
Incorrect:
It is responsible for the fight or flight response: this is norepinephrine
It is involved with sleep regulation: this is histamine and norepinephrine
Which are true of cholinergic neurotransmitter acetylcholine (SATA):
It has an effect on the neuromuscular junction
High levels are seen in Alzheimer’s & Parkinson’s disease
It plays an important role in motor function and coordination
It is associated with memory
Correct:
It has an effect on the neuromuscular junction, it plays an important role in motor function and coordination, it is associated with memory
Incorrect:
High levels are seen in Alzheimer’s & Parkinson’s disease: LOW levels are seen in Alzheimer's and Parkinson's
_____ is muscle rigidity in the neck and jaw while _____ involves involuntary, rhythmic movements of the tongue and lips.
Dystonia and tardive dyskinesia
Recall that long term use of typical/1st gen antipsychotics comes with the risk of developing these extrapyramidal symptoms.
Patient: I'm really worried about getting discharged
RN: You're really worried about getting discharged?
Which therapeutic technique is the nurse using?
Exploring
Restating
Summarizing
Making observations
Restating - uses the pt's exact words to restate their concern
Samples of the others:
Exploring - Tell me more about what worries you about getting discharged.
Summarizing - Your impending discharge is something that is a subject of worry for you
Making observations - I noticed you pacing, you seem anxious
Review tables 7-2 (therapeutic) & 7-3 (nontherapeutic) on pg 131 of textbook and pg 17 of ATI book.
Your client taking an antidepressant calls you c/o dizziness, fatigue, irritability and nausea. What is likely occurring?
The pt likely abruptly stopped taking their medication. These are Sx of antidepressant withdrawal.
Buspirone is being prescribed for anxiety. What is a major difference with how this medication is taken compared to other anxiolytics?
Buspirone is taken and the same time each day to build up a therapeutic effect whereas other commonly prescribed anxiolytics are taken PRN
Which actions are part of the working phase of the nurse client relationship (SATA)?
Encourage pts to express feelings and concerns
Gather information on the patient
Assist the client in finding stress management techniques
Establish clear boundaries between then nurse and the client
Encourage pts to express feelings and concerns and assist the client in finding stress management techniques
Gather information on the patient: this would be during the preinteraction phase
Establish clear boundaries between then nurse and the client: this would be during the orientation/introductory phase.
What topics would be discussed at the termination phase of the nurse/patient relationship? (name 2)
Discussion of the progress the pt has made
Offer referrals and other supportive services (PRN)
Review any unresolved issues
Discuss feelings surrounding the termination of the relationship (more specifically, how they feel about DC, not about no longer having you as their nurse)
Group therapy is scheduled for this afternoon. Which patient would be the best candidate for group therapy?
A patient who has been medicated for 6mo for schizophrenia
A patient admitted 12 hours ago for acute mania
A client who is going through ETOH detox
A patient who has been medicated for 6mo for schizophrenia
Of the options given, this patient is the most stable. The new admit likely needs time to acclimate to the environment and if they're manic, they may be disruptive in group. The ETOH detox needs careful medical monitoring and shouldn't be in group in case there is a medical emergency (like new onset hallucinations)
Which neurotransmitter is most likely to be considered with relation to depression?
Histamine
GABA
Opioid peptides
Histamine
As a monoamine, recall that low levels of all those that we discussed are associated with depression.
A patient tells you they cannot sleep because they believe they were poisoned during dinner. What would be a therapeutic response?
That sounds very frightening for you
What is happening that makes you think you were poisoned?
Tell me more about you being poisoned during dinner
Give an example of offering a "general lead"
(hint: this is a form of therapeutic communication)
General leads offer the patient encouragement to continue with minimal input from the nurse. Exs:
Go on
And after that?
I see that
Tell me more (without giving a specific topic)
Then what happened?
Define milieu therapy
Using the pt’s environment to promote a therapeutic environment
The scientific structuring of the environment in order to affect behavioral change
The goal of milieu therapy is to manipulate the environment so that all aspects of the patient’s hospital experience are considered therapeutic
Which would be the priority action for a patient experiencing a panic attack?
Encourage them to take deep breaths and focus on slow breathing
Ask the client to describe what led to the panic attack
Collaborate with the provider to get a social work consult
Leave the client alone in a quiet room to regain composure
Encourage them to take deep breaths and focus on slow breathing
The other options do not address the immediate need which is to help the patient calm down.
Billy calls the psych unit asking to talk to his sister Sally Mae. You patch the call through to her only to later learn that Billy wasn't on her approved call list. What regulation was just violated?
HIPAA
If the caller wasn't on the approved call list we shouldn't have confirmed that the patient is in our care and putting them on the phone certainly confirms they're in our care.
Which of the following would indicate a patient is suffering from mental illness?
Reports feeling sad but continues to care for their children
Is occasionally forgetful and experiences mild changes in mood
Is unable to concentrate on tasks due to constant worrying
Feels stressed at work but manages to get tasks done on time
Is unable to concentrate on tasks due to constant worrying
This option shows that their mental state is having an effect on their personal, social an/or occupational life. The other options, while they warrant attention, show that the patient is currently able to cope with how they're feeling.
Taking methylphenidate with an MAOI can cause what significant medical emergency?
ADHD meds + MAOI = potential for hypertensive crisis.
This is a BP of 180/120+. Other Sx include headache, nausea, tachycardia, chest pain and SOB
One of your patients calls you no less than five derogatory terms, then later makes you a gift during their craft hour. Which defense mechanism is this patient exhibiting?
Denial
Suppression
Undoing
Regression
Undoing: Performing an act to make up for prior behavior (commonly seen in children)
See ATI pgs 19-20 and table 2-2 on pg 19 of textbook for other definitions
Which of the following actions would be considered an appropriate boundary in the nurse-patient relationship?
Accepting an invitation from a patient to attend their family gathering
A nurse discussing personal experiences with a patient to establish a deeper emotional connection
Ensuring all communication occurs through the facility's approved methods
Ensuring all communication occurs through the facility's approved methods
Opt 1 is clearly a no-go and opt 2 is inappropriate because the therapeutic use of self should be done with caution and in moderation to establish trust and rapport, not a deep emotional connection.