Anxiety and OCD
List 5 symptoms of anxiety.
•Feeling apprehensive or nervous
•Restlessness
•Irritability
•Anticipating the worst result
•Watching for what causes anxiety
•Avoidance of cause of anxiety
Physiological manifestations
•Increased heart rate and respiratory rate
•Sweating
•Fatigue or exhaustion
•Difficulty concentrating
•GI disturbances
•Sleep disruptions
You are caring for a 50 year-old patient who consumes dishwasher detergent whenever they run the dishwasher. Which feeding disorder would they have?
You are admitting a patient to the unit for suicide ideation. You tell the patient that you will need to go through their bag of belongings, but they are confused why you are doing that. What should you do?
A) Respect their privacy
B) Inform them that for their safety you will need to search their belongings
C) Ignore them and continue to search their belongings
D) Say you are sorry but it's just protocol
B
What is the difference between mania and hypomania?
Mania is an abnormally elevated mood that typically requires hospitalization.
Hypomania is less severe abnormally elevated mood and patients typically do not need to be hospitalized.
A patient has been diagnosed with major depressive disorder. Which drug class is typically the first line of meds to be started on?
What is Selective Serotonin Reuptake Inhibitors (SSRI)
You are caring for Mr. Jackson, a 50 year-old male. He is consistently asking about how he looks and checks himself in the mirror regularly. He states, "I wish my nose wasn't so big. I should go talk to my plastic surgeon about this." Even though you try to reassure him, he is still dissatisfied with his appearance.
What specific Obsessive-Compulsive Disorder does Mr. Jackson have?
What is Body Dysmorphic Disorder
Sally is a teenager who is spends a lot of time reading food labels and counting calories. She enjoys making meals for her loved ones, but spends time cleaning the kitchen instead of enjoying the meal with them. She has very brittle hair and nails and lanugo is present. She has issues with constipation and has not had a menstrual cycle in over a year. You check her vitals in the clinic and she is hypotensive as well as bradycardic. Which eating disorder is she being treated for?
What is Anorexia Nervosa
List 5 assessment findings for a person with depression.
Anergia
Anhedonia
Feelings of worthlessness, hopelessness, guilt, anger, helplessness
Chronic pain
Sleep disturbance (too much or too little)
Decreased libido
Neglected personal hygiene
GI issues (constipation)
Poor concentration
A female patient comes into the ED dressed in very vibrant clothing and bright makeup. Her friend states "She has been up for two days and has not slept. She has been rearranging our apartment and the amazon packages have been piling up at the door. When I try to talk to her, it's like she doesn't understand what I'm saying."
Based on her symptoms, which episode is this patient in?
Manic Episode.
You are caring for an older adult patient. The family is requesting you to give their loved one an extra dose of xanax/alprazolam. What is your best response?
a. "Why do you want me to do that?"
b. "We need to be careful with this medication because of the sedative effects and I want your loved one to be safe."
c. "I'm way ahead of you and already gave a nurse dose."
d. "I think you are trying to chemically restrain them and I will report you as a concern for elder abuse."
B. Education is very beneficial to help the family member have more information about this med and the dangers it can have
We do not want to use "why" when asking questions. Giving a "nurse dose" is unsafe practice. D is accusing them of something without asking clarifying questions.
Tiffany is a nursing student who is preparing for her exam in Mental Health. She feels unease and tense as the testing day is coming up. She is becoming slightly more irritable and fidgets with her pen as she studies. She does admit to having a slight issue with focusing during her study time, but is able to eventually get back on track.
What level of anxiety is Tiffany experiencing?
What is mild.
Symptoms: unease, tense, slightly irritable, fidgeting, focus is not as good
Betty is coming to the clinic for a routine check up. Her weight is within normal limits for her height. You notice her face has a "chipmunk cheek" appearance. You also notice calluses on the knuckles of her hand. You begin to think she may have which eating disorder?
What is Bulimia Nervosa
True or False: we should never ask someone if they have thoughts of killing themselves unless they directly tell us.
False. We should always ask our patients. Just because we ask does not mean we are planting that idea in their minds.
You are caring for a patient with Bipolar Disorder who is being discharged on Lithium. What education should you give this patient regarding this new medication?
1. take the medication as directed to prevent relapse
2. follow up labs are needed frequently for lithium levels and thyroid levels should be monitored
3. drink plenty of fluids
4. be consistent with sodium intake as it effects the therapeutic effect
5. talk to your provider before taking any over the counter medications
6. Symptoms of lithium toxicity
What are 4 things to teach someone taking a Selective Serotonin Reuptake Inhibitor (SSRI)
1. Can cause drowsiness (do not operate heavy machinery until you know the effects)
2. Do not consume alcohol
3. Do not stop this medication abruptly
4. Serotonin Syndrome (fever, hypertension, tachycardia, irregular heart rhythm)
5. Headache
6. Decreased libido
What is an obsession?
What is a compulsion?
Obsession: persistent and recurrent thoughts or urges that are unwanted and become intrusive
Compulsion: repetitive behaviors to lessen/prevent anxiety brought on by obsessions
What are three interventions a nurse can implement when caring for a patient with an eating disorder?
1. Monitor Meals
2. Medications (vitamins, antidepressants, anxiolytics, mood stabilizers)
3. Monitor Bathroom Breaks
4. Therapy
5. Nutritional Re-engineering (dietitian, daily intake 1800 calories, monitoring for refeeding syndrome)
A nurse is caring for a patient who states, "My family would be better off without me. I am too much of a burden to them." What question should the nurse ask the patient?
Are you thinking of harming yourself?
What are 3 things we can teach the patient with Bipolar Disorder in the maintenance phase?
1. how to prevent relapse
2. medication adherence
3. regular sleep and exercise (have a schedule)
4. healthy nutrition
5. support system (family/friends/groups)
6. outpatient facilities/community resources available for help
7. therapy
What are three things to teach your client about taking Tricyclic Antidepressants (TCAs)?
1. Anticholinergic affects (drink plenty of water, use sugar free gum and candy)
2. Best to take at night (risk of hypotension)
3. Rise slowly (orthostatic hypotension)
4. Monitor for signs of suicide (important to have family/friends are aware too)
5. Takes time for med to fully work
6. Take as prescribed
You are caring for a patient with anxiety. They ask you what they can do to help get rid of their anxiety. You state that they can't get rid of it, but it can be managed by...(list 3 strategies to manage anxiety).
1. meds
2. when to seek provider (anxiety interfering with life, difficult to control, thoughts of self-harm)
3. breathing techniques
4. Therapy/Support Groups
5. Mindfulness/meditation
6. Determining the cause/triggers
7. Exercise
A patient is being admitted to the unit with a new diagnosis of anorexia nervosa. Which questions should the nurse include in her assessment? (Select all that apply)
A) "What is your relationship like with your family?"
B) "Why do you want to lose weight?"
C) "Tell me about your current eating habits?"
D) "At what weight do you believe you will look better?"
E) "Let's discuss your feelings about your appearance."
A, C, E
It's important to know the relationships of our patient and assess their support systems. It's important to know current eating habits. It's important to know the patient's perception of the issue.
We should never ask why questions. D is very insensitive to the issue and can make the patient feel that their appearance is not acceptable.
List 2 ways to properly communicate with someone who has depression.
1. give time for the patient to respond (don't rush them)
2. Make observations
3 Use simple, concrete sentences
How do we communicate with a patient who is in the hospital being treated for Bipolar Disorder?
1. Provide structure by using a firm and calm approach
2. Use short, concise explanations
3. Set boundaries and identify expectations
4. Use active listening to hear the patient
5. Redirect energy (distraction)
List three foods that someone taking an MAOI cannot consume.
Foods high in tyramine (see small list below)
Chocolate
Meat that is aged, smoked, or fermented
Fish-dried, cured, smoked, fermented, aged
avocado
Cheese