Let's get to the basics
What is the most important priority in managing a milieu?
Safety
lamotrigine, carbamazepine, valproate, and gabapentin are all what drug class:?
Anticonvulsant (also used for mood disorders)
What are the key assessment findings of depression?
depressed mood and anhedonia
“Cinema row. Row, row, row, your boat. I’m going to cut your throat. I have a castle with a Moat, boat, coat. So I wrote.” Is an example of what speech pattern often exhibited in patients diagnosed with bipolar disorder?
Clang Associations
What is the primary issue with personality disorders?
Interpersonal relationships & functioning
What is considered the safe physical and social environment in which an individual receives treatment?
Milieu
What labs are important to collect before administering lithium?
lithium level, electrolytes (especially sodium and potassium), BUN, Cr, CBC, Thyroid
What amine cannot be present in food when taking a MAOI?
tyramine
What are the priority nursing interventions for patients diagnosed with bipolar disorder or mania admitted to in-patient behavioral health units?
Safety, Sleep, Nutrition, Set limits
This personality disorder is often referred to what we know as sociopaths because individuals may display antagonistic behaviors such as being deceitful & manipulative for personal gain, are selfish, irresponsible, and have a profound lack of empathy (callousness).
Antisocial Personality Disorder
n-patient hospitalization for individuals with mental health disorders is generally reserved for clients who demonstrate what characteristic?
Danger to self or others
What are the typical side effects for tricyclic antidepressants (TCAs)?
Anticholinergic (dry mouth, difficulty voiding, dilated pupils, blurred vision, decreased GI motility, constipation); may also have orthostatic hypotension = rise slowly
What are some tyramine-containing foods that a patient taking a MAOI would need to avoid?
avocados, bananas, beef/chicken liver, cheese (especially aged), eggplant, figs, meat extracts/tenderizers, papaya, pickled herring, raisins, red wine, beer, sauerkraut, sausage, bologna, pepperoni, salami, sour cream, soy sauce, yogurt, etc)
What is therapeutic range for lithium? When are you considered toxic?
0.8-1.2; greater than 1.5 would be considered toxic
This personality disorder often struggles with patterns of marked instability in emotional control or regulation, impulsivity, identity, or self-image distortions, unstable mood, unstable interpersonal relationships, emotional lability, and may engage in self-harming activities
Borderline Personality Disorder
Ligature risks are what?
items or architectural features in an environment that can be used to attach a material for hanging or strangulation
Give 3 drugs that are classified as tricyclic antidepressants (TCAs):
amitriptyline, clomipramine, doxepin, imipramine, nortriptyline
What are the vegetative symptoms of depression?
Physical changes in bodily systems: changes in sleep pattern, appetite changes, fatigue, low energy, psychomotor retardation, decreased libido
A client with bipolar disorder displays a highly inflated self-regard by saying “I am the Messiah. I own the planet Jupiter.” This is an example of what?
Grandiose Delusion/Grandiosity
What is splitting?
A defense mechanism or coping style where individual has the inability to view both positive and negative aspects of others as a whole; common with borderline personality disorder
Provide three examples of clients' rights for clients admitted to a behavioral health unit.
Right to confidentiality, Right to visitors, Right to report inadequate care, Right to be treated with dignity, Right to be involved in treatment decisions, Right to vote, Right to legal council, Right to least restrictive means of treatment, Right to participate in religious worship, etc.
The nurse reviews the new prescription, phenelzine (Nardil), for a client with depression on the behavioral health unit. Which information is most important for the nurse to assess?
consumption of any alcohol and tyramine-rich food
Name 3 drugs that are classified as SSRIs:
citalopram, escitalopram, fluoxetine, paroxetine, sertraline, fluvoxamine
What are the symptoms of moderate or advanced lithium toxicity (levels 2.0-2.5 mEq/L)?
ataxia, giddiness, EEG changes, blurred vision, clonic movements, large amounts of dilute urine, seizures, nausea, vomiting, slurred speech, severe diarrhea, irregular tremor
A client presents with strange, unusual, magical thinking, odd beliefs, strange speech patterns, inappropriate affect (blunted) and shows some paranoia and social anxiety. What is the personality disorder?
Schizotypal Personality Disorder