Basics (week 1)
________________ is to psych nursing as the head-to-toe assessment is to med-surge nursing. This broad assessment covers appearance, speech, thoughts, perceptions and more.
Mental Status Exam or Mental State Exam (MSE)
Fixed false belief that is not explained by culture
delusion
An elevation in this neurotransmitter is associated with schizophrenia and mania
Dopamine
The nurse knows to monitor patients on typical (1st generation) antipsychotics for a cluster of serious side effects called ________________ ______________ and to monitor patients on atypical (newer) antipsychotics for ____________ side effects
extrapyramidal symptoms, metabolic
The behavioral expression of emotion; may be appropriate (congruent with the situation), inappropriate (incongruent with the situation), constricted or blunted (diminished range and intensity), or flat (absence of emotional expression).
affect
defense mechanism: Creating reasonable and acceptable explanations for unacceptable behavior
rationalization
True or False: Most patient with a diagnosis of bulimia nervosa have a normal or overweight BMI (18.5-30)
true
Patients with this status do not retain the right to refuse medication
incompetent
A disorganized speech pattern with use of words based on rhyme patterns rather than meaning
clang assosiations
This mood regulating neurotransmitter is decreased in depression, OCD, Alzheimers, and Anorexia Nervosa
Serotonin
This medication can be given as a prophylaxes for EPS and can also be used to treat acute presentation of EPS
Benztropine (Cogentin)
overly suspicious, baseless suspicions
paranoid
An adverse effect of long-time neuroleptic use that initial presents as lip smacking and repetitive tongue protrusion
tardive dyskinesia
This eating disorder has clinical manifestations including bruises on the hard and soft palate, and dental caries
Bulimia Nervosa
The client tells the nurse, "When I am discharged I am going to make my boss suffer, I'll make sure he can never ruin anyone else's life the way he ruined mine. The company will be better off without him anyway." What is the nurse's ethical obligation in this case.
Duty to warn
defense mechanism where one pretends truth is not reality to manage unpleasant, anxiety causing thoughts or feelings
denial
A patient with OCD is prescribed venlafaxine (Effexor) and Fluoxatine (Prozac) He presents to the ED with NVD, diaphoresis, and dilated pupils. Based on the patient's medications what is a likely cause of the symptons?
Serotonin Syndrome
Metabolic side effects such as weight gain, high cholesterol, and impaired glucose regulation may result from 2nd generation antipsychotic use. The cumulative effect of these issues may lead to this syndrome
metabolic syndrome (increasing risk for heart disease/MI/stroke/diabetes)
ideas that one's thoughts or behaviors have control over specific situations
magical thinking
This 2nd generation antipsychotic is associated with elevated prolactin levels which can cause gynecomastia (breast tissue growth in males) or galactorrhea (breast milk production in the absence of pregnancy/perinatal status)
Risperidone
The nurse would anticipate the provider to prescribe a drug from which class of medications to the patient with anorexia nervosa
SSRI
True or false: a patient who is voluntary and competent retains the right to refuse an ETO (emergency treatment order) of Haldol+Benadryl?
False (ETOs are given when patient poses imminent danger to self/others.)
Defense mechanism in which unacceptable ideas, thoughts, and emotions are unconsciously removed from awareness
repression
Panic Disorder and/or Anxiety is associated with an elevation in this fight or flight neurotransmitter (1) and a decrease in this relaxation neurotransmitter (2)
1._________
2._________
norepinephrine
GABA
The nurse is checking the labs for the patient on clozapine. What lab value must they monitor based on a serious adverse effect that is associated with this medication
WBC and/or ANC due to risk for agranulocytosis
abrupt ending of a thought process
expressed as a sudden interruption in speech
thought blocking
Besides benzodiazapines, name one drug used to treat NMS
Dantoline
Bromocriptine
A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, “I’m going to the bathroom and will be back in a few minutes.” Which nursing response is most appropriate?
1. “Thanks for checking in.”
2. “I will accompany you to the bathroom.”
3. “Let me know when you get back to the dayroom.”
4. “I’ll stand outside your door to give you privacy.”
2
ATI lists several therapeutic communication techniques inclding:
silence, active listening, questions (open-ended, projective...), Clarifying (restating, reflecting, exploring), Touch, and Summarizing
They also list several barriers to communication (nontherapeutic respnses) NAME 5 of them
False, fixed belief that there is something abnormal about one's body, for example "There is a mouse that lives in my gallbladder."
Somatic delusion
An acute increase in activity of this "rest and digest" neurotransmitter is implicated in akathisia, dystonia, and pseudo parkinsonism.
Acetylcholine
Signs and symptoms or Neurleptic Malignant Syndrome (F.E.V.E.R. MNEUMONIC)
fever
encephalopathy (ams)
vital signs unstable
elevated enzymes
rigidity
rapidly changing or disjointed thoughts
flight of ideas
Defense Mechanism: Responding to stress through the unconscious development of physical manifestations not caused by a physical illness
Conversion
What is the term for a clinical finding in Bulemia Nervosa of bruises or tissue/skin damage on the knuckles of the dominant hand
Russel's Sign