Inpatient Mental Health

Mood D/O

100

List two commonly seen mood disorders

Major Depression

Bipolar Disorder

200

What is the difference between Bipolar 1 & Bipolar 2

bipolar I disorder involves episodes of severe mania and often depression. Bipolar II disorder involves a less severe form of mania called hypomania.

300

Often we encourage and implement new coping strategies related to safety and MDD. 

List 5 coping strategies and their purpose/function

1. Behavioral Activation

2. Journaling

3. Challenging Negative Thought Process

4. Distraction

5. Deep Breathing

400

Sydney is a 29 y/o female (she/her) admitted with MDD following an intentional OD. Sydney recently lost her job two months ago and has since lost 15 lbs and stopped attending her book club. Upon assessment Sydney tells you she has been sleeping upwards of 14hrs on and off through the day and utilizing cannabis to help manage racing thoughts at night

List three priority nursing diagnosis related to MDD (include r/t as evidenced by)

●Risk for self-directed violence 

●Impaired thought processes 

●Altered sleep pattern 

●Nutrition, less than body requirements 

●Social isolation 

●Hopelessness 

●Ineffective coping

500

Laura has just been walked to the unit from the emergency department. She has been given an admitting diagnosis of manic episode. Laura has not slept in 4 days, she has spent upwards of $5000 in online shopping and has just informed you that Harry Styles has ended things with Olivia Wilde and is on his way to marry her. You have tried to perform your admission assessment but Laura cannot sit still and has been running laps around the unit because she tells you she is in training for the Boston Marathon

What are your priority nursing interventions?

Psychotic D/O

100

Often considered the most common type of the psychotic disorders, this illness is characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. 

Schizophrenia

200

List 5 common types of hallucinations

 

1. Auditory - hear

2. Visual - see

3. Tactile - feel

4. Olfactory - smell 

5. Gustatory - taste

300

List 5 types of delusions

1. Persecutory - someone or something is mistreating, spying on or attempting to harm them 

2. Grandiose - people with this type of delusional disorder have an overinflated sense of self-worth, power, knowledge or identity. 

3. Erotomanic  -  People with this type of delusional disorder believe that another person, often someone important or famous, is in love with them. 

4. Somatic : People with this type of delusional disorder believe that they have a physical issue or medical problem, 

5. Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.

400

Often presenting first in an organic occurrence of psychotic illness, negative symptoms involve the absence of something common to most people. List 5 negative symptoms

1. Anhedonia - reduced experience of pleasure

2. Alogia - reduced quantity of words spoken

3. Avolition - loss in goal directed activity

4. Asociality - loss in social activity 

5. Blunted Affect - loss of emotive ability

500

There is no known cause of psychotic disorders. Some factors are thought to be involved such as _______ and biochemistry. 

1. Fill in the blank

2. Which neurotransmitter is suggested to be linked to positive sx such as hallucinations, delusions, and agitation

1. Genetics: 60 - 80% 

2. Excessive dopamine levels

MSE/Suicide Risk

100

What is the difference between objective and subjective assessment

Obj: Not influenced by emotions, opinions, or personal feelings - based in facts

Sub: Open to greater interpretation and involves emotions, opinions, feelings

200

7 Components of an MSE

1. General Appearance & Attitude

2. LOC & Orientation

3. Speech & Language

4. Mood & Affect

5. Thought Process & Content

6. Memory & Cognition

7. Judgement & Insight

300

5 Components of a Suicide Risk Assessment

Step 1: Identify Risk Factors Note those that can be modified to reduce risk 

Step 2: Identify Protective Factors Note those that can be enhanced 

Step 3: Conduct Suicide Inquiry Suicide thoughts, plans, behaviours, and intent 

Step 4: Determine Risk Level/Intervention Determine risk. Choose appropriate intervention to address and reduce risk 

Step 5: Document Assessment of risk, rationale, intervention, and follow-up

400

Thought process in the MSE refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. 

List 5 examples of thought process descriptors besides logical and linear

1. Circumstantial: Over-inclusion of trivial or irrelevant details that impede the sense of getting to the point. Patients will often get back to the original point or question you asked, may wander and be over-inclusive.

2. Tangential: The patient provides an answer to a question that veers off from the target of the question, but the connection may still be appreciated or inferred by the clinician.

3. FOIs: Rapid jumping (“flight”) from topic to topic without completing each train of thought 

4. LA: A breakdown in both the logical connection between ideas/words and the overall sense of goal-directedness. The words make sentences, but the sentences do not make sense!

5. Thought Blocking: Loss of the goal of a communication and not being able to return to the topic

500

You are sitting with a patient who has been admitted following an interrupted suicide attempt. They have just been moved from the high risk area to a low risk room due to a new admission needing the space. The patient remains on 15 minutes checks, and when you introduce yourself to start your MSE, they are vague in their answers. They are stressed by all the activity on the unit and ask to use their knitting needles as a distraction. Because they have just been moved from high risk, this will be their first time using them. 

1. What are your assessments and interventions?

Medications/Labs

100

This class of medications while effective in their treatment of psychotic sx, comes with a number of side effects. 

1. What is this class called and list one that you have seen in your clinical rotation

1. Typical

Haldol

200

This class of medications is most commonly used to treat major depression and anxiety disorders

1. List the Class

2. List three types within this class

3. What would you teach a patient about medication compliance related to anti-depressants

1. Anti-depressants

2. SSRI, SNRI, SARI, Tricyclics, Anti-Anx

3. Six weeks do not stop abruptly 

300

This class of medications _________ are often used as off label mood stabilizers. 

1. Name the class

2. Two examples

Anti-epileptic/convulsant

1. Valproic Acid

2. Gabapentin/Pregabalin

3. 

400

Benzodiazepines are an effective anti-anxiety relief agent. However require nursing judgement and patient teaching. 

1. What are the positives of benzodiazepine use?

2. What are the concerns with benzodiazepine use?

3. What patient teaching would you provide?

1. Fast acting, sleep, muscle relaxation

2. Addictive property, short half life, addictive property, builds resistance

3. Addictive nature, in tandem with coping strategies

500

Lithium is one of the most widely used medications in its tx of Bipolar Disorder. However, requires a number of patient teachings and monitoring. 

1. List three patient teachings related to Lithium

2. What is the appropriate monitoring for Lithium

3. What specific instructions are related to Lithium and BW

1. Lithium is a salt/proper hydration 2.5L/day

b) bloodwork (0.8-1.2)

c) Take as prescribed

2.  VS & BW Li level, Cr-, Lytes

3. Timed study 12hrs

Side Effects

100

Your patient has just been prescribed Citalopram, a SSRI for major depression and anxiety. What would you teach your patient about side effects? 

• feeling agitated, shaky or anxious.
• feeling and being sick.
• indigestion and stomach aches.
• diarrhoea or constipation.
• loss of appetite.
• dizziness.
• not sleeping well (insomnia), or feeling very sleepy.
• headaches.

200

This grouping of side effects most often occurs with the administration of antipsychotic medication.

What are they and describe them?

EPSE

1. Dystonia/Dystonic reactions: muscle spasms

2. Akasthisia: restlessness 

3. Parkinsonism

4. Tardive Dyskinesia

300

What are the signs of Lithium toxicity & what are your interventions

3. Nausea/vomitting/diarrhea, confusion, dizziness, LOC . VSS, Doctor report, Labs, Fluids, Stop medication

400

While atypical antipsychotic medication often reduces the risk for EPSE. Anticholinergic side effects remain a risk. 

1. What is an anticholinergic crisis?

2. What does it look like?

One particular pharmacologic action of conventional antipsychotics is the ability to block the muscarinic cholinergic receptors in the brain. Atypical antipsychotics have varying degrees of anticholinergic effects, but are generally associated with a lower incidence of EPS and tardive dyskinesia than conventional agents 

2. dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating

500

Serotonin Syndrome and Neuroleptic Malignant Syndrome are rare but serious life threatening issues. 

What do you know about both, how do you differentiate between the two. 

What are your nursing actions?

1. Serotonin syndrome can occur when you increase the dose of certain medications or start taking a new drug. Neuroleptic malignant syndrome (NMS) is a severe disorder caused by an adverse reaction to medications with dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications. 

3. Vitals, IV fluids, Medications (Benzos for SS/bromocriptine mesylate-dopamine agonist  NMS)