Postpartum Psychosis
These are symptoms that characterize postpartum psychosis
What are hallucinations, delusions, disorganized thinking, and a loss of reality within days to weeks after birth
Rationale:
Postpartum psychosis is a psychiatric emergency. It presents rapidly and severely, often within the first 2 weeks postpartum. It is distinct from postpartum depression and requires immediate intervention to protect mother and infant.
This type of symptom includes hallucinations, delusions, and disorganized speech.
What are positive symptoms of schizophrenia?
Rationale:
Positive symptoms reflect added behaviors not normally present. They are often the most visible and respond well to antipsychotic medications.
This term describes a global disturbance in brain function caused by metabolic, toxic, or structural factors
What is encephalopathy?
Rationale:
Encephalopathy is a broad syndrome involving altered mental status due to causes like liver failure, hypertension, infection, toxins, or hypoxia. It is not a disease itself but a manifestation of underlying dysfunction.
This standardized scale is used to assess a patient’s level of consciousness after a TBI
What is the Glasgow Coma Scale?
Rationale:
The GCS evaluates eye opening, verbal response, and motor response. It is essential for trending neurological status and identifying deterioration early.
This antipsychotic medication requires monitoring for agranulocytosis and weekly CBCs.
What is clozapine?
Rationale:
Clozapine is highly effective for schizophrenia but carries a risk of life‑threatening neutropenia. RN exams love this:
Monitor WBC/ANC
Report fever or sore throat immediately
Never stop abruptly
This is the nurse’s first priority when a postpartum patient expresses delusions involving her baby
What is ensuring the safety of the infant and mother?
Rationale:
Safety is always the priority. Delusions involving the infant can lead to infanticide or self‑harm. The nurse must remove the infant, stay with the mother, and initiate emergency psychiatric evaluation.
This is the most common type of hallucination experienced by people with schizophrenia
What are auditory hallucinations?
Rationale:
Hearing voices is the hallmark of schizophrenia. Voices may comment, command, or converse. Command hallucinations require immediate safety assessment.
These are the earliest signs of worsening encephalopathy and often appear before changes in vital signs.
What are confusion, irritability, and restlessness?
Rationale:
Early LOC changes are subtle. Confusion → lethargy → stupor → coma. Recognizing early cognitive changes prevents progression to seizures, aspiration, or coma.
A patient with a right temporal lobe injury is most likely to have difficulty with this cognitive function
What is visual memory or facial recognition?
Rationale:
The right temporal lobe controls visual memory, facial recognition, and interpretation of nonverbal cues. Left temporal injuries affect language instead.
This medication treats hepatic encephalopathy by reducing intestinal ammonia production and absorption
What is rifaximin?
Rationale:
Rifaximin is a non‑absorbable antibiotic that decreases ammonia‑producing gut bacteria. Often used with lactulose for severe or recurrent hepatic encephalopathy.
During a home visit, the nurse notes insomnia, agitation, and the mother saying she hears ‘God telling her to protect the baby from evil.’ These findings indicate this diagnosis
What is postpartum psychosis?
Rationale:
Auditory hallucinations + religious delusions + severe insomnia = classic presentation. Early recognition prevents harm. This is not postpartum depression or anxiety — hallucinations always indicate psychosis.
When a patient says, ‘The FBI implanted a chip in my brain,’ this is the therapeutic response
What is acknowledging the patient’s feelings without agreeing with the delusion?
Rationale:
The nurse should say something like: “I don’t hear or see that, but I can tell this feels frightening.” Never argue, never validate the delusion, and always focus on emotions and safety.
This medication is used to reduce ammonia levels by increasing excretion through the GI tract.
What is lactulose?
Rationale:
Lactulose traps ammonia in the stool. The expected outcome is 2–3 soft stools/day. Too many stools → dehydration; too few → ammonia buildup. Patients should call the provider for diarrhea or no bowel movements.
This communication technique helps nurses interact effectively with TBI patients who have slowed processing
What is using simple language and allowing extra time for responses?
Rationale:
TBI patients often have impaired attention, processing speed, and executive function. Short sentences, repetition, and visual cues improve comprehension.
This anticoagulant replaces heparin when HIT is diagnosed because it directly inhibits thrombin.
What is argatroban?
Rationale:
Argatroban prevents clot formation without activating HIT antibodies. Key exam point:
Stop heparin immediately
Start argatroban
Never give platelets unless life‑threatening bleeding
This is the priority nursing intervention for a postpartum patient with psychosis who becomes catatonic
What is initiating emergency psychiatric care and ensuring airway/safety?
Rationale:
Catatonia places the patient at risk for dehydration, aspiration, immobility complications, and inability to care for the infant. Immediate hospitalization is required. This is a medical and psychiatric emergency.
These three behaviors are early indicators of relapse in schizophrenia
What are social withdrawal, sleep disturbance, and increased irritability?
Rationale:
Relapse often begins subtly. Recognizing early signs allows for medication adjustment and prevents hospitalization.
This flapping tremor, tested by having the patient extend their arms and dorsiflex their wrists, is a hallmark sign of encephalopathy.
What is asterixis?
Rationale:
Asterixis indicates metabolic encephalopathy, especially hepatic. It results from impaired motor control due to toxin buildup affecting the brain.
This cognitive recovery scale helps determine when a TBI patient is ready to begin rehabilitation
What is the Rancho Los Amigos Scale?
Rationale:
Rehab typically begins at Level III–IV, when the patient shows localized responses or confused but purposeful behavior. This scale is heavily tested on neuro exams.
This medication is given to patients with HELLP syndrome to prevent seizures.
What is magnesium sulfate?
Rationale:
Magnesium sulfate is the first‑line seizure prophylaxis for HELLP and severe preeclampsia. Monitor for:
Hyporeflexia
Respiratory depression
Toxicity (treat with calcium gluconate)
These three factors significantly increase a woman’s risk of developing postpartum psychosis
What are bipolar disorder, previous postpartum psychosis, and abrupt sleep deprivation?
Rationale:
Bipolar disorder is the strongest predictor. A history of postpartum psychosis increases recurrence risk to 30–50%. Severe sleep loss can precipitate mania or psychosis in vulnerable patients.
This dangerous antipsychotic side effect presents with fever, muscle rigidity, and altered mental status
What is neuroleptic malignant syndrome (NMS)?
Rationale:
NMS is a life‑threatening emergency caused by dopamine blockade. Priority actions: stop the antipsychotic, notify provider, manage airway, give fluids, and monitor for rhabdomyolysis.
These two diagnostic tests are most commonly used to evaluate encephalopathy caused by liver dysfunction
What are ammonia levels and liver function tests (LFTs)?
Rationale:
Elevated ammonia is a key driver of hepatic encephalopathy. LFTs (AST, ALT, bilirubin) help determine severity. Imaging (CT/MRI) may be used to rule out structural causes, but labs guide treatment.
This type of aphasia results in a patient understanding speech but struggling to express words.
What is Broca’s aphasia?
Rationale:
Broca’s = expressive aphasia (broken speech). Wernicke’s = receptive aphasia (fluent but nonsensical). Knowing the difference is a classic neuro exam question.
This blood product is given in DIC to replace clotting factors and improve PT/INR
What is fresh frozen plasma (FFP)?
Rationale:
FFP contains all clotting factors and is used when DIC causes prolonged PT/INR or active bleeding. It does not replace platelets — that requires platelet transfusion.