Mental Health act
How many days is a patient certified for when they have 2 Form G's? and how many days does the second psychiatrist have to fill out the second Form G?
21 days
72 hours
This diagnosis presents as a combination of hallucinations, delusions, hypomania or major depression.
schizoaffective disorder
This medication class works by increasing/stimulating GABA resulting in decreased seizure activity and sedation
Gamma-aminobutyric acid (GABA)
Benzodiazepines
what is the actual medical terminology used for a blood pressure cuff
sphygmomanometer
17 year old female with anorexia nervosa is being released from the hospital. To facilitate at home recovery the nurse tells the family to
A) discourage sneaking food by restricting access to the kitchen
B) encourage her interest in menu planning, food magazines etc. by leaving information/materials around the house in order for her to continue her education on appropriate nutritional intake
C)permit her to eat meals privately so she does not feel embarrassed or self conscious while eating.
D)recommend she join in family meals and clears dishes even if she doesn't eat
D
Who has more power regarding health care decisions.
A Proxy or legal guardian
Proxy
a community mental health nurse meets with a patient, they tell the nurse that they recently quit their job to start a new business, they have been feeling really good about themselves since they got a new haircut and a tattoo of their childhood cat.
This pt has a long history of impulsive behavior, but they believe this is not the same as last time.
do you have any questions about this patient before you make a possible diagnosis?
Bipolar 1 disorder.
Lithium is a mood stabilizer that alters cation transport to nerves and muscles. It is metabolized in the kidneys. it requires regular blood work to ensure the patient doesn't have lithium toxicity.
What blood work should be ordered?
lithium levels
BUN, creatinine, sodium, potassium, calcium, eGFR
What experiment demonstrated that you can learn through observation not just conditioning?
Bobo the doll
A patient with Alzheimer’s disease is having trouble performing the movements needed to brush their teeth. The inability to perform this task can be described with which term below
A. Aphasia
B. Apraxia
C. Anomia
D. Agnosia
Apraxia
aphasia: impaired communication
anomia: difficulty finding the right words
agnosia: difficulty recognizing or understand everyday objects
What form do you give your patient when they want to appeal their certification?
Form N
A common nursing diagnosis for a person with antisocial personality disorder is?
A) chronic low self-esteem, related to poor self image and excessive fear of failure
B) disturbed thought process related to sensory perceptual alterations
C) impaired social interaction, related to manipulative behaviors
D) social isolation, related to anxiety in social situations.
C) impaired social interaction, related to manipulative behaviors
in some studies people with this disorder were shown evocative images like a child being hit or a woman with a knife at their throat and had no physiological response. Additionally people with this disorder or traits similar to this disorder show greatly reduced frontal lobe activity
what disorder am I describing
Antisocial personality disorder
What causes neuroleptic malignant syndrome? What are the symptoms?
antipsychotics are dopamine receptor agonists. The decrease in dopamine levels results in this syndrome. symptoms include. Fever, muscle rigidity, ALOC, hypermetabolism (weight loss, increased appetite, fatigue, excessive sweating), autonomic dysfunction (low dopamine reduces heart rate, BP, causes abd pain, bloating, vision changes)
A nurse is displaying inconsistently towards a patient, unreasonably concerned, overly kind or irrationally hostile. what is the nurse displaying?
A) countertransference
B) empathic resonance
C) splitting behavior
D) transference
A) Countertransference!
countertransference: unconscious redirection of a therapists feelings onto a patient
transference: redirection from a patient on to therapist, nurse, dr. etc.
Empathic resonance: deep shared emotional connection where you feel with someone, mirroring their feelings
splitting behavior: black and white thinking
What are the 3 requirements for a patient to be certified?
1 - suffering from a mental disorder that requires treatment that can only be provided inpatient
2 - due to the mental disorder, the pt cannot fully understand and make an informed decision regarding their treatment and supervision
3 - due to the mental disorder, the pt is likely to cause harm to themselves or others or to suffer substantial mental or physical deterioration if they do not receive treatment
The next day when you get on shift they are laying in bed, holding one arm straight up in the air, their eyebrows scrunched frowning and they ignore you when you try to engage. in the afternoon they revert back to being agitated and pace around the unit.
What are they displaying symptoms of?
Mixed catatonia
a male client is admitted to the brief and social detox unit with a blood alcohol level of 0.2. throughout the hospitalization the client complains of tingling and numbness in hands and feet. As the nurse you know that these symptoms are probably a result of.
A. acetate accumulation
B. thiamine deficiency
C. Triglyceride buildup
D. below normal serum potassium level.
answer: B
tingling and numbness in hands and feet is a symptom of peripheral polyneuritis which is caused by inadequate intake of vitamin B1 secondary to alcohol intake.
Alcohol inhibits the transport of thiamine across the intestinal membrane and reduces thiamine absorption.
a male client is brought into the emergency department after being found unconscious on the side of the road. When the client gains consciousness in the ER and is able to converse with the staff he states the following: he drinks 1 qt of vodka a day. and his last drink was 6 hours ago. the medical staff are concerned that patient will soon start experiencing alcohol withdrawal. To prevent this, the Dr will most likely prescribed what class of medication
benzos
- the nervous system becomes dependent on alcohol to provide a sedating effect. when it is suddenly removed, the body is unable to regulate itself resulting in a hyperexcited nervous system. This can result in seizures, delirium tremens (hallucinations, high bp, tremors), strokes and heart attacks
benzos are administered as a replacement for alcohol to relax the nervous system and prevent hyperactivity
A 69 year old female client who lives alone tells the mental health nurse “I don’t need anyone to talk to, the TV is my best friend”. The nurse recognizes this as what defence mechanism?
A. Displacement
B. Projection
C. Sublimation
D. Denial
DENIAL
displacement: taking out feelings on objects or people that are less threatening.
Projection: taking our own unacceptable feelings or qualities and ascribing them to others
sublimation: acting out unacceptable impulses in a more acceptable form. (Rage room)
What is the difference between a long term detention order and a community treatment order?
LTDO: 1 year detained
CTO: 6 months of mandatory supervision and treatment in the community
describe cluster B personality disorders. What personalities are in this cluster?
B- dramatic, emotional and erratic: impulsive, emotional instability, attention seeking, relationship difficulties (antisocial, borderline, histrionic, narcissistic)
your client is started on an MAOI, you instruct your client to avoid tyramine rich foods (aged cheese, processed meet, alcohol, fermented foods etc.)
Why do you tell the client this?
MAOI stands for monoamine oxidase inhibitor
monoamine's are neurotransmitters and neuromodulators
monoamine oxidase is an enzyme that metabolizes monoamines such as neurotransmitters serotonin, norepinephrine and dopamine
Tyramine is a natural compound and a trace monoamine increases blood pressure.
so monoamine oxidase would metabolize tyramine as well. If this is inhibited and the client continues to ingest tyramine they can have a dangerous spike in their blood pressure.
List all Antidepressant medication classes and 1 medication from each class
1. SSRI - prozac, citalopram, sertraline, paroxetine,
2. SNRI - effexor, duoloxetine,
3. MAOI -isocarboxazid, phenelzine, tranylcypromine
4. TCA - amitriptyline, doxepin, nortriptyline
5. atypical - bupropion, mirtazapine
6. serotonin modulators - Trazodone,
you are a community mental health nurse. You are working with a patient with a diagnosis of treatment resistant schizophrenia. their last admission to dube was 2 years ago. You visit this patient once per month in their home. Your patient cancelled your appointment as well as their blood work appointment last week as they felt like they were coming down with something so you rescheduled for today (one week later) They tried to cancel again but you were insistent on seeing them this week and inform them you will wear a mask and the visit won't be long, they agree. when you arrive News papers are piled up on the steps dating back to last month. when you enter the house they are laying on the couch, used tissues are on the coffee table along with numerous dirty dishes. An empty bottle of NyQuil is on the floor next to them and half a bottle is on the couch at their feet. You complete your interview, they are doing well mentally, deny any auditory or visual hallucinations, they just look sick. You promptly leave to let them rest and avoid further exposure to the cold/flu.
1 week later their neighbor calls the police, requesting a wellness check on your patient as the neighbors haven't seen them in a while. The police find the patient dead.
What did you miss?
Newspapers: indicative of the patient not leaving their house in a prolonged time. says they started coming down with something the week before but there were newspapers piled up for a month.
They have treatment resistant schizophrenia and are stable on meds = clozapine.
They have flu like symptoms
Cancelled scheduled blood work.
They are drinking NyQuil
cough suppressants: increase side effects such as dizziness, confusion, sedation and cognitive impairments.
Benadryl/antihistamines: may slow down how the liver breaks down clozapine